My Relapse Prevention Plan – An Efficacy Client Story

When people start therapy they can experience difficulties that affect all areas of their life. Towards the end of cognitive behavioural therapy we place importance on building a relapse prevention plan. Effectively this is a plan for not just staying well but building on the gains that have been made in therapy.

One of our clients has kindly agreed to share her Relapse Prevention Plan. ‘Alexandra’ was in a very dark place when she started therapy and she hopes that by sharing her story, this might offer some hope to others.

Every relapse prevention plan is unique. It is a tailored document designed to minimise the risk of relapsing but also there for the future as a reminder to help in times of a wobble. Alexandra’s therapist sent her key questions to respond to, and this is what she wrote in reply:

What did you need help with?

Advice on how to take action to instigate change and overcome my fear in social situations.
• To have a conversation without writing the script in advance. Also - not to edit my response. The choice of words are to be appropriate to the situation and respectful but at times need to be assertive.
• How to react to bullying in the office without escalating the issues.
• To learn skills on how to counteract lack of sleep and eating during the night.
• To make home a social environment not an isolation unit where I could block out any normal life circumstances.
• To address challenging situations e.g. the most important one was reaching a conclusion to the relationship with Byron.

What did you learn?

The most effective skill was to react to the bullying by lowering the volume of my voice, speaking slowly and using the minimum amount of words as practical.
• Frequent social interaction will help me. Sharing stories, views, offering and receiving advice is uplifting. You have to be a friend to have friends.
• To re-evaluate relationships within my family as they are in 2015. The past is not to be dismissed but cannot be carried on our shoulders - it is too heavy to carry.
• Skills to help me sleep and enable the mind association of Bed = Sleep. No eating or looking at my mobile. If it is necessary to get up during the night to go to the bathroom it is best not to look at the clock. Establishing a regular routine will help resolve many of the issues. More sleep is required to function properly and helps with my epilepsy.
• At times action has to be taken although I will feel afraid (i.e. it is a matter of Feel the Fear and do it anyway). Thoughts will result in emotional and physical reactions but action is required.
• To plan my time for watching television and not be lost in hours of being comforted by human voices.
• To plan one pleasure activity each day.

What did you do that helped?

With sincere thanks to my therapist's time and advice. There have been some major changes and I need to draw strength from the progress made to date. In summary the following changes have taken place since starting therapy and have resulted in action:

I moved to a new flat.
• The boxes that had not been opened for six years were tackled and the declutter process started. Many sentimental items from when I lived abroad have been taken to charity shops or given to my family. Many old papers have been shredded and home admin has been placed in separate lever arch files.
• The relationship with Byron has ended.
• The realisation/awakening that the abuse in my childhood drives me to attempt to try to stop people shouting in the hope it will change the unpleasant events in the past. No amount of effort will change these experiences as a child.
• In relation to the Magdalene Laundries/ Convents: the hatred has to be buried with those who inflicted the pain. The officials in costumes were not representatives of Christianity but of a manmade religion that served only their self-interest.
• My resignation letter has been handed to my employer.
• Progress has been made. There are options to keep the train moving along the track and I hope wisdom will prevail to see the alarm signals in time to prevent a further crash.
• In addition I did plan more social events no matter how uncomfortable this felt initially. When socialising I tried to focus on what was being said and not planning what to say.
• I regularly cleaned my flat to mentally prepare for visitors as well as getting help with some DIY work in January which provided more space.
What are the future potential obstacles?
• Interviewing for a permanent contract.
• Being consistently stable.
• Adapting to a new relationship with a companion.
• Setting boundaries in existing and future relationships of any kind e.g. work, friends etc.
• Health matters. e.g. the impact of epilepsy seems to be changing and the issue with memory is a concern. There have been periods of time throughout 2014 where I had no interest in getting out of bed or leaving the flat. Not out of self-pity, I just felt lost. The tiredness (more exhaustion) factor at times resulted in not being able to write greeting cards (as one example) and is a challenge when I would like to get involved in some activities.

What can you do about it?

Prepare for each interview and adapt my CV to each role.
• A longer term employment contract may help provide stability.
• Meet new men - initially for tea/coffee to get used to interacting with men other than at work. Attend social events and be more proactive with internet dating sites with a certain amount of realistic caution.
• It is as equally important to say no as yes. Setting boundaries helps both parties in a relationship and potentially leads to a balanced interaction.
• Seek help from medical professionals sooner rather than later. Not to get too hungry or too tired. Exercise regularly and think about the quality of the food rather than the quantity.

What help do you have?

Faith. It provides conviction not condemnation e.g. the spark to ask questions when demands were made to process false expense claims. The Christian faith was the root of the questions that my line manager had never been asked before. If it resulted in losing my job it was a matter of learning to trust in God. To clarify, I am not perfect and slip up regularly. This example provided the opportunity to take time and think.
• The professional medical support and advice of the best Neurology hospital. The members of staff have been incredible amidst the pressure building on them.
• The local GP if the onset of the dark clouds start forming. Trying to catch it at an earlier stage is key.
• Interaction of biological and Christian family. Support was provided during the move. There will be different work colleagues offering support on a social level.
• The team at the ABF-Soldiers' Charity who provide wonderful opportunities for social events whilst volunteering e.g. Carol services at the Royal Hospital Chelsea, Beating the Retreat in Horseguards Parade etc.
• The members of staff at one of the global banks that contacted me to offer employment.



Feb 2015

Problems presented: Relapsing, social anxiety, relationships