Manage endings When working briefly, practitioners can find it challenging to raise the issue of discharge, particularly if the patient is socially isolated or lonely as a result of their difficulties. Patients may wrongly assume that treatment will go on for longer than the short-term nature of Low Intensity CBT. A clear discussion at the start of treatment about the structure and short term nature of the approach can stop this from feeling abrupt when it arises. Practitioners may also find it helpful to remind patients at each subsequent contact about the number of sessions before a review will take place (usually at session 4 of treatment for exposure and habituation). In an active CBT based intervention, if a patient is not engaging in exposure and habituation exercises, despite solid rationales and motivational support, this should be taken to case management supervision and an honest discussion with the patient take place about the focus and structure of the approach. If the patient continues to not engage with the change method, but is attending sessions looking for a more informal discussion or supportive approach, this needs to be flagged to supervisors and a decision made to either step the patient up if this will likely increase engagement with CBT or, discharge them with signposting advice or services who may be better able to meet their needs. If a patient is discharged for this reason, a discussion about the right time for engaging in treatment and being able to refer themselves back when they are ready should take place.
© Marie Chellingsworth (2020). The CBT Resource.
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