How can termination of the therapy be initiated? - Chapter 21

This chapter will discuss the termination of the treatment and how to prevent relapse.

Research indacte that focussing on relapse prevention help delay the onset of relapse and recurrence among depressed clients. Therefore, it is important to pay attention to relapse prevention. 

What are some techniques that help facilitate relapse prevention?

The goal in CBT is to facilitate remission of clients’ disorders and teach them skills they can use throughout their lifetime. A therapist cannot solve all the problems a client has, but can teach the client to be his/her own therapist. The therapist will tell the client already in the first session that the goal is for them to become their own therapist. The course of recovery with its ups and down is discussed. Clients will also have some downs after therapy, but by then they will have the tools to help themselves

There are quite a few techniques designed to prevent relape, some of them are:

• Attributing progress to the client: The therapist should reinforce clients for their progress. They should emphasize the fact that clients experienced mood improvements and why. It should be clear to the client that the client is responsible for the positive changes, not only to the therapist, medication or circumstance (self efficacy).

• Teaching and using tools learned in therapy. The client should understand that the techniques used in therapy could be used in many other situations. The therapist should help clients understand how they can use these tools in other situations. For example: doing relaxation exercises or using thought records.

• Preparing for setbacks during therapy. As soon as clients begin to feel better, therapists will prepare clients for a potential setback by asking them to imagine what will go through their mind if they start to feel worse. The therapist and client both discuss how the client could respond to these negative thoughts in the future by using coping cards and look at a process of therapy graph (with ups and downs).

How is termination initiated?

Several weeks before therapy ends the frequency of therapy sessions will decrease to get used to the idea. Some clients might get anxious at the idea of termination. For these clients it can be helpful to write down advantages and disadvantages of leaving therapy. The disadvantages need to be reframed into disadvantages that can be coped with. Tapering can be viewed as an experiment. At each succeeding session, the therapist and the client agree either to continue spacing sessions or to return to more frequent sessions. It is important that clients read and organize their therapy notes so they can easily refer to them in the future. The therapist will encourage the client to use a self-therapy plan. In this way they are continuing therapy, but at their own convenience and without charge. It could be useful to start the self-therapy already during therapy so that the clients will see which difficulties with self-therapy they might encounter. These difficulties then can be discussed with the therapist.

After therapy a booster session can be planned after a couple of weeks or months. A booster session is to check on the client’s well being and plan for continue maintenance or progress. If during a booster session in occurs that the client is not feeling well, additional session can be planned again.