Mini Workshop 19 - Recovery-oriented Cognitive Therapy for Inpatients and Outpatients

Recovery-Oriented Cognitive Therapy (CT-R) was developed by Aaron Beck and colleagues to treat individuals diagnosed with serious mental health conditions, such as schizophrenia and bipolar disorder. The principles of CT-R can also be adapted to make CBT more effective for individuals with acute or chronic or complex conditions. This mini-workshop will describe both sets of clients, from those who have been hospitalized for decades to those whose conditions, such as depression and anxiety, are relatively mild. CT-R requires both a strength-based and a traditional problem-based conceptualization; the cognitive conceptualization diagrams (J. Beck, 2020) are used for outpatients while inpatients are conceptualized according to a Recovery Map (A. Beck et al, 2020). Therapists de-emphasize clients’ psychopathology. Instead, they encourage clients to engage in highly meaningful experiences that lead to a sense of purpose, hope, control, well-being, connection, and empowerment. In session, therapists aim to move clients from the maladaptive mode in which negative cognitions, expectations, and emotions dominate to an adaptive mode. Both groups of clients identify their key values and aspirations. Inpatient therapists provide positive experiences in session, linked to the individual’s interests and values, in alignment with their aspirations, and help clients draw positive conclusions about these experiences, which increases the strength of their positive beliefs, expectations, and emotions. Outpatients are asked to describe and then draw positive conclusions about the positive experiences they had in the previous week. When clients are ready (this usually starts in the first session for those with fewer challenges), clients identify goals for the session or for the coming week and steps they want to take toward these goals. Then standard CBT interventions focus on identifying and resolving obstacles through standard CBT techniques or techniques from any evidence-based treatment. To build resilience, therapists help clients recognize how they overcome obstacles.