Chapter 11: Completion of treatment and prevention of relapse

Question 1

remission

Answer 1

either full or partial improvement of symptoms, to the degree that diagnostic criteria are no longer met

Question 2

recovery

Answer 2

remission that lasts more than a respecified period of time

Question 3

lapse or “slip”

Answer 3

a short-term, temporary, or minor recurrence of symptoms or problem behaviour

Question 4

relapse

Answer 4

recurrence of symptoms or problem behaviour following remission, to the degree that diagnostic criteria are remet

Question 5

recurrence

Answer 5

occurrence of symptoms or problem behaviour following recovery, including the presence of a new episode of a diagnosable problem

Question 6

problems with dependence

Answer 6

• client may not attribute change to their own efforts, and

- they may have a difficult time generalising change principles to situations beyond therapy sessions

Question 7

ways to identify and manage dependence in CBT

Answer 7

1. encourage clients to take responsibility for their treatment
2. many clients make external attributions for change during treatment, giving credit to therapist, medications or changes in their environment
3. be aware of some clients tendency to seek reassurance from the therapist
4. in general, the more dependent clients tend to be, the more important it is to have them be in charge of the treatment
5. utilise resources in addition to CBT
6. gradually wean clients from therapy, reducing the frequency of sessions
7. agree to take a temporary break from treatment, with a scheduled follow-up session
8. agree to disagree. if you think that it is a good idea to end treatment and your client does not agree, say so

Question 8

family practice

Answer 8

• refers to a clinical setting in which clients can access treatment without referral and are likely to see the same practitioner across different problems or times in their lives

Question 9

speciality clinic models

Answer 9

• typically focuses on a single disorder or group of related disorders, or on a particular treatment modality, and is more likely to be located in a hospital, outpatient clinic, or research or university setting
• make maintenance therapy, booster sessions or easy return to treatment somewhat problematic

Question 10

clinical realities: reasons why treatments end

Answer 10

• clients may not have the resources
• limitations to coverage
• financial or logistical reasons

Question 11

making the best use of limited resources

Answer 11

1. plan carefully
2. set appropriate goals that are likely to be met with the resources available
3. if problems are mild, consider less resource-intensive interventions, such as bibliography, web-based interventions, psychoeducation groups
4. schedule less frequent or shorter sessions
5. investigate other options and look for community resources
6. use CBT groups

Question 12

Decision to end treatment

Answer 12

1. end therapy when the crisis or problem that brought the client in to see you has resolved
2. end therapy when the symptoms of a diagnosed disorder decrease or are eliminated
3. end therapy when the therapy goals are achieved, regardless of symptom change
4. end therapy when symptom change and goals are both achieved
5. end therapy when hypothesised underlying causative factors have changed
6. drop-out or premature ending
7. if therapy does not seem to be effective
8. after therapeutic rapture

Question 13

relapse prevention

Answer 13

• determine with clients what the early warning signs of relapse look like, and what they can do if these signs occur
• be honest about areas of lack of change bc these areas may reflect dimensions on which the client is more sensitive to relapse
• discuss how client can continue to address problems on his own, e.g. self-help groups
• teach clients how they can do their self-assessments
• normale and validate the clients fears about lapses and relapse, but be realistic in your discussions regarding risk
• help client determine the difference between normal negative emotions and symptoms of a disorder