40 Session Overview
CBT SESSION 10 OVERVIEW
Relapse Prevention & Treatment Consolidation
Mood & Presentation: Maggie arrived on time presenting as calm, confident, and emotionally grounded. Affect was bright and appropriate, with visible pride and bittersweet sadness related to termination. Body posture relaxed; demeanor self-assured. Emotional expression demonstrated full range and regulation. She presented as a client who now experiences anxiety as manageable rather than overwhelming.
CBT Skills
- Check in / Therapeutic Alliance
- Strong alliance maintained through termination.
- Maggie expressed appreciation and sadness appropriately, indicating secure attachment and healthy closure.
- Behavioral Activation
- Continued consistent use of:
- Scheduled worry time
- Relaxation practice
- Exposure strategies
- Skills now internalized as lifestyle habits.
- Continued consistent use of:
- Exposure Integration
- Maggie reports ongoing spontaneous use of worry exposure to interrupt rumination and promote hopeful thinking.
- Cognitive Restructuring
- Demonstrates autonomous ability to challenge negative thoughts and deploy adaptive responses without therapist prompting.
- Relapse Prevention Psychoeducation
- Introduced recovery model:
- Anxiety will recur
- Skills prevent escalation
- Monitoring prevents relapse
- Introduced recovery model:
- Warning Sign Identification
- Client identified early relapse indicators:
- Panic symptoms
- Feedback from trusted supports
- Rising STAI scores
- Client identified early relapse indicators:
- Support System Activation
- Established accountability plan with peer support (Sarah).
- Discussed option for future “therapy tune-ups.”
- Measurement & Outcome Tracking
- Final STAI scores:
- S-Anxiety: 24 (10th percentile)
- T-Anxiety: 29 (25th percentile)
- Final STAI scores:
- No longer meets criteria for GAD.
Fill in the Blank
Session Agenda
- Check-in and termination processing
- Review progress across treatment
- Final STAI scoring
- Relapse prevention psychoeducation
- Warning sign identification
- Support and accountability planning
- Program satisfaction review
- Closure
Symptoms Observed/Reported
- Cognitive: Improved flexibility, reduced catastrophizing, adaptive thinking.
- Physiological: Baseline anxiety within normal range.
- Emotional: Pride, sadness, hopefulness, confidence.
- Behavioral: Independent skill deployment; self-monitoring.
Homework Review:
- Worry record average low: 2
- Peak anxiety: 8 (termination-related anxiety)
- Consistent thought records
- Journal review completed
- Satisfaction questionnaire completed
Key Clinical Moments
- Client pride in transformation
- Recognition of identity shift
- Acceptance of ongoing vulnerability
- Commitment to maintenance skills
- Confidence in future autonomy
Identified Barriers
- Termination anxiety
- Fear of backsliding
- Anticipatory stress regarding Theo’s future placement
Cognitive-Behavioral Formulation:
- Core Beliefs (Revised):
- “I can manage anxiety.”
- “I am capable.”
- “I am not responsible for everything.”
- Automatic Thoughts:
- Adaptive self-correction present
- Emotions: Pride, sadness, resilience
- Behaviors: Self-monitoring, skill maintenance
- Maintaining Factors: Active coping and exposure
- Protective Factors: Insight, social support, skill mastery
Resources & Strengths:
- High resilience
- Strong insight
- Skill internalization
- Support network
- Self-efficacy
- Motivation for maintenance
Progress / Clinical Impressions:
- Maggie demonstrates full remission of GAD symptoms and strong consolidation of CBT skills. She has transitioned from crisis-driven coping to proactive self-regulation.
- Emotional range expanded; avoidance reduced; autonomy increased. Client is appropriate for discharge with relapse prevention plan in place.
Multiple Choice
