The Central Role of Evaluation and FollowUp in Relapse Prevention Prerequisites to Learning and to Providing CCT

A therapist with a firm foundation in cognitive theory and diagnostic and behavioral assessment has the background to learn to provide C-CT to promote remission and recovery, and to reduce relapse. Cognitive theory guides therapists in identifying patients' emotional vulnerabilities, and learning theory guides them in teaching patients new behaviors to cope with the inherent vulnerabilities of suffering from a recurrent, often chronic illness, to cope with coming to painful conclusions about the self, world, and future. Behavioral assessment aids the therapist in knowing when to modify the therapy content, homework, or schedule.

Specific prerequisite skills that therapists need to produce preventive effects with C-CT include (1) mastery of CT (as described by Beck, Rush, Shaw, & Emery, 1979), defined as scores above 39 on the Cognitive Therapy Scale (Young & Beck, 1980); and (2) competence in diagnosing psychiatric syndromes and symptoms both at initial presentation and longitudinally. Therapists who are competent in C-CT know how (1) to use collaborative empiricism (Beck et al., 1979) and case conceptualization (J. S. Beck, 1995; Persons, 1989; see Whisman & Weinstock, Chapter 2, this volume) to develop a multifactorial model for an at-risk patient; (2) to identify and to teach the patient "key" skills to promote recovery and reduce risk; and (3) to structure and monitor the patient's acquisition and generalization of key skills.

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