Rationale for relapse prevention
Identification of high-risk situations from self-monitoring
Preparation for high-risk situations
Regulate the consequences of thoughts and behaviours
Identify support people and additional means of maintaining skills
Using the relapse prevention plan
Rationale for relapse preventionOnce clients have learned the skills and behaviours to help them quit/cut down on the use of speed, they are ready to begin preparing for life after therapy where they must manage on their own. The rest of this session is concerned with anticipating future situations that pose relapse risks to the client. This session can be a way of increasing the client's selfefficacy about how they will cope in these high-risk situations, perhaps circumventing a relapse in the process (Wilson, 1992).
At this stage, both you and the client have the benefit of hindsight to assist you in collaboratively preparing for future high-risk situations. That is, you know how the client has responded to the different skills/techniques taught in previous sessions, as well as how they relate to events, thoughts and behaviours. In addition, the client has hopefully incorporated some of the skills/techniques into their repertoire of coping strategies, and will have a greater understanding of their problem (Wilson, 1992).
Identification of high-risk situations from self-monitoringIt is inevitable that certain events will occur in the client's life that will pose threats to maintaining abstinence or reduced use. Indeed Wilson (1992) reports that the average person will experience at least one adverse event in a 12 month period.
A vital first step in preventing relapse is to identify those high-risk situations in advance and allow the client time to prepare for them when they occur. Take time in the session to revisit the self-monitoring record the client has been completing for homework as a guide to the types of situations that have posed problems for them in the past. In addition, probe for additional life events the client anticipates will probably pose difficulties for them. These might include loss events (social, financial, failure to complete tasks, loss of status etc.) or even happy events that can also increase risk of relapse (celebrations, completion of projects etc). Top of page
Exercise 2: Identify/anticipate high-risk situations (Wilson, 1992)
- Ask the client to brainstorm high-risk situations or changes that they can anticipate in the future (e.g. adjustment to new situations, financial changes, and social separation).
- Use the following questions to assist the client to generate the list: "What kinds of people/places/things will make it difficult for you to stay on top of things/feel good about yourself? What situations do you consider to be high-risk for relapsing? How will you know when a slip occurs?" Alternatively, use the client's self-monitoring forms completed in previous sessions as a prompt.
- Write these situations down in the space provided on the "Relapse prevention plan" handout.
Preparation for high-risk situationsIn preparing for the high-risk situations that will inevitably occur, it is useful for the client to take stock of everything he or she has learned during the entire four-session intervention. This will also help the client to generalise the lessons learned during the sessions to real life situations.
Documenting which strategies are most useful in dealing with specific high-risk situations can also be useful, and can serve as a reference for the client at a later stage.
Exercise 3: Preparing for high-risk situations (Wilson, 1992)
- Look at the list made in the previous activity that will detail the client's anticipated high-risk situations.
- Ask the client to think back about all the different skills they have learned during the therapy sessions, and nominate which ones are appropriate to use in each of the high-risk situations. Examples may include: speed refusal, coping with cravings, challenging unhelpful thoughts, relaxation etc.
- Write these coping behaviours down on the space provided on the "Relapse prevention plan" handout.
- Explain to the client that not all situations can be anticipated in advance. Therefore it is useful to think about some generic coping strategies that the client can employ regardless of the situation. Write these down in the space provided on the handout ("General coping strategies for any situation").
- Also ask the client whether there are any additional skills they think they may need to assist them in future situations. Record these on the form ("Additional skills required") and discuss options for referral with the client to ensure he/she receives the necessary treatment.
Regulate the consequences of thoughts and behavioursFinally, discuss with the client how they intend to reward themselves for remaining abstinent. It is important for the client to create their own rewards as reinforcement for their behaviour, as this may not always come from other sources (e.g. family, friends).
Ask the client what it is that they enjoy doing. By planning time/criteria for participation in these activities the client can learn to regulate the consequences of their behaviour/thoughts for themselves. Top of page
Exercise 4: Regulate consequences (Wilson, 1992).
- Refer back to the "Relapse prevention plan" handout.
- Ask the client the following questions: "How will you know that you are successfully maintaining your behaviours? How can you reward yourself for a job well done?"
- Write these 'rewards' down on the "Relapse prevention plan" handout.
Identify support people and additional means of maintaining skillsAn important step in preventing relapse is identifying key people in the person's life who can help encourage them to keep to their goals, and support them through the challenges they will face. Thus, at this point it is also important to ask the client:
"Who can help you to maintain these skills you have learned?"
Record a list of support people in the space provided on the "Relapse prevention plan" handout. It can be very useful to record contact phone numbers on this sheet to enable clients to contact support people (including agencies) quickly if a high-risk situation is encountered and support is required rapidly. Some clients find it useful to carry a purse or wallet-sized card with support people/agencies and contact telephone numbers.
If the client chooses to list relatives/friends on their support list, remind them it is a good idea to talk to these people about their plans sometime over this next week, and explain to their relatives/friends what type of support they are hoping to receive from them (e.g. distraction, general chat etc.).
Using the relapse prevention planNow that you have collaboratively worked out a relapse prevention plan for high-risk situations with the client, you need to ensure the client uses his/ her plan effectively (Graham, 2000). To do this, Graham (2000) suggests you talk with the client about the following things:
- when to use his/her plan;
- how to regularly monitor their early warning signs of relapse; and
- refining and updating the plan as necessary (ie. coping strategies, forms of treatment and supports) and as circumstances change.