Patients frequently experience a period of relapse, even if it is only short. Discussion around this possibility is a crucial part of therapy. It should be done before therapy sessions are concluded, as the patient still needs to feel that they have some support. This may be triggered by a new health scare of some kind or some other external pressure, such as stress at work. It can be opportune if this occurs within the period of therapy so that further work can be undertaken to cope with potential problems in the future. Sometimes the last therapy session can be set at a more distant time in the future to allow for this.

Breaking down the problem into sets of potential triggers, followed by early warning signs of these, can help your patient to start to put in place the new skills that they have learnt in therapy straight away, and they can learn from the experience. It is also important for them to realise when and how they can ask for help. If the problem seems overpowering they need to be able to contact you, their therapist, or perhaps their GP, who should be aware of the problem early on. But they can also take the step of contacting you to explain they are having difficulties, outlining what they are doing to cope, so at least they know you are aware of the problem. Remember to recognise that they are trying to work through it on their own, and encourage them to contact you when they have got through it so you can congratulate them on how they have done. It is helpful to emphasise that a relapse is not going to be as bad, or last as long, as the initial illness and that they are in a better place now with new skills and beliefs.

Identifying potential triggers for relapse

Although the details of these are highly specific to your patient, there are some general pointers for all patients. Any major life event, such as a promotion at work, loss of a job, financial pressures, relationship difficulties, illness in family or friends, or the increased responsibility of having a child can trigger a relapse (see Case example 8.1).