CCFP priority topic 19 of 105
Counselling on the CCFP exam
2 key features, the mistakes that cost marks, and a practice question.
Checked by a Canadian family physician, MD, CCFP. Updated October 20, 2026.
What the exam tests
Key features
The CFPC’s 2 key features for Counselling. Each one below has how the exam asks it, the common mistakes and the approach.
Practice question
Try one before you read
A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.
Key feature 1 of 2
Counselling well
Counsel toward shared goals, with time to spare, inside your limits, watching your own views.
CFPC skill Clinical reasoning, patient-centred approach, professionalism, communicationPhase Treatment, follow-upSources Choosing Wisely Canada
On the exam
A tearful mother at her baby's 4-month visit, with a full waiting room. Expect a short menu (pick several from a list).
Pick what to do today, and what to wait on.
Common mistakes
Handing her a fix (sleep tips, a feeding plan, an antidepressant) before you know her goals. Unpacking it all today, with a full waiting room, is wrong too.
Approach
- Ask about safety first: thoughts of self-harm or of harming the baby, and safety at home. Tears with no risk are not a crisis, so urgent psychiatry is not the first step.
- Do the baby's planned care today, vaccines included. If she is safe, book a longer visit soon for her concerns.
- At that visit, ask what she wants to change. Agree on one or two goals together, and come back to them each time.
- Offer options and let her choose. Your fix for sleep, feeding or her partner, given before her goals are known, often misses.
- Keep your views out of her choices. If she has decided to stop breastfeeding, support that decision instead of pushing your plan.
- Assess before you treat. For mild low mood, start with support, psychotherapy and lifestyle steps. An antidepressant is not routine first-line care.
- Know your limits. Strong feelings either way (transference is hers toward you; countertransference is yours toward her) are a cue to step back and seek advice.
| Check | Warning sign | What to do |
|---|---|---|
| Time | A full waiting room, tears, a rushed talk | Confirm safety, then book a longer visit |
| Skill | Abuse, trauma, or couples work you are not trained for | Refer to someone trained for it |
| Boundaries | Extra visits, sharing your own story, wanting to rescue | Name it, keep your role, talk to a colleague |
| Bias | Your view on feeding or family shapes the plan | Lay out options; she chooses |
Key feature 2 of 2
Referral for therapy
When a patient wants therapy, clear up their worries and explain honestly how it works.
CFPC skill Clinical reasoning, patient-centred approachPhase Treatment, referralSources Choosing Wisely Canada
On the exam
A mother asks to “see someone”. She has no benefits and quit therapy after one session. Expect a short menu (pick several from a list).
Pick what to explain before you refer.
Common mistakes
A phone number with no talk of cost, or a promise of quick change. Without benefits, a private psychologist means a bill she did not expect.
Approach
- Ask what she hopes therapy will change, and what went wrong last time.
- Talk about cost early. Provincial plans usually do not pay for a psychologist in private practice. Ask about work benefits, and look for publicly funded or sliding-scale options.
- Explain the format: regular sessions over weeks or months, with practice at home between them. One session rarely settles it.
- Therapy is a joint effort toward her goals. The therapist will not make her decisions for her.
- Fit matters. If it is not working after a few sessions, she can say so or change therapists. Quitting quietly is not her only choice.
- Video sessions are an option when they suit her, for example when travel or childcare is hard.
- Ask about safety at home before any couples referral. With signs of control, couples therapy can put her at risk. Offer her own support first.
| What she describes | Fits | Not first |
|---|---|---|
| Low mood and loneliness, no risk found | Individual therapy, such as cognitive behavioural or interpersonal therapy | An antidepressant before any assessment |
| A partner who controls money or contact | A safety check, then her own support and a violence service | Couples therapy, an anger program, a budget class |
| Conflict, and both partners feel safe | Couples therapy with a trained therapist | Joint sessions you run without training |
Flashcards
Answer it first, then check.
KF 1A tearful mother at her baby's vaccine visit, and a full waiting room. Unpack it now?
No. Check that she and the baby are safe, give the vaccines, and book a longer visit.
KF 1She has decided to stop breastfeeding. Do you talk her out of it?
No. Ask what she decided and why, then support her choice and plan feeding with her.
KF 1Mild low mood, and no assessment yet. Do you start an antidepressant?
Not routinely. Assess first. For mild symptoms, therapy, support and lifestyle steps come first. Source: Choosing Wisely Canada
KF 1You feel a strong pull to rescue her. What is that, and what next?
Countertransference: your own feelings toward a patient. Name it, keep your role, and talk it through with a colleague.
KF 2She wants to see a psychologist. Will her provincial plan pay?
Usually not in private practice. Ask about work benefits, and find publicly funded or sliding-scale options.
KF 2She quit therapy after one session last time. What do you tell her now?
Change takes several sessions. If the fit feels wrong, she can say so or switch therapists.
KF 2Her partner controls the money. She asks for couples therapy. What comes first?
Ask about her safety, alone. With signs of control, couples therapy can put her at risk.
FAQ
Is counselling by a family doctor the same as psychotherapy?
No. Most counselling in family practice is brief and focused: shared goals, support and options. Longer, structured therapy, or a problem beyond your training, goes to a trained therapist.
Does the exam want a named model, like motivational interviewing?
It marks what you do, not the name. Set goals with the patient, make time, offer options, check your limits and views, and look after the relationship between you.
When is crying in the office a crisis?
When there is risk: thoughts of suicide or of harming someone, signs of psychosis, or a patient who cannot care for self or a child. Then act today. Tears alone are not a crisis.
What if the patient wants advice, not options?
Ask what they have thought of first. Then lay out the choices, with the good and bad of each. You can say what you would weigh, but the decision stays theirs.
Sources
Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.
Last reviewed October 20, 2026For exam study. Not advice for a patient in front of you.
- Assessment Objectives for Certification in Family Medicine, 2nd editionCollege of Family Physicians of Canada · 2020
- Choosing Wisely recommendationsChoosing Wisely Canada