Relapse Prevention Therapy (RPT)- Understanding The clinical Process

By Terence T. Gorski (March, 20001)

<Mr. Gorski Is Available To Speak or Consult on the Trends in Addiction & Mental Health> 

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Relapse Prevention Therapy (RPT) is an in-depth clinical psychotherapy process that is designed to four outcomes - The development of a core issue list, a relapse warning sign list, warning sign management strategies, and a recovery plan.

1.  Core Issue List:

Each person completing RPT develops a list of the core personality and lifestyle problems that create pain and dysfunction while attempting to maintain long-term sobriety and responsibility.  These core personality and lifestyle problems lead a person back into patterns of addictive and irresponsible thinking and behavior during times of high stress and problems.  Since these patterns are automatic and unconscious and are activated by situational triggers, the individual can feel confused and powerless as they successfully avoid or cope with high risk situations only to find themselves acting out in other self-defeating ways for apparently no reason.  As a result, the failure to identify and address these issues increases the risk of relapse after initial stabilization and return to normal functioning has been achieved.

The Core Issue List identifies the core or central system of irrational or mistaken beliefs about self, others, and the world that leads to feelings of deprivation and hopelessness when practicing habits of sober and responsible living.  These Core issues are based upon the general mistaken belief that “I can’t have the good life, and be sober and responsible at the same time.”  The “good life” is subjectively defined by primary childhood experiences that cause the individual to perceive, think about and respond to the world using an automatic cycle of deeply habituated self-defeating behavior.

The core issue list is developed from a careful and systematic analysis of information gathered from three sources:  (1) the client’s original presenting problems,  (2) the client’s life and addiction history, and (3) the client’s recovery and relapse history.  The goal of completing these three assessments is to guide the client in answering two basic questions: (1)  “What did you come to believe that alcohol, drugs, and irresponsibility could do for you that you could not do for yourself while being sober and responsible?”  (2) “What problems did you come to believe that alcohol, drugs, and irresponsibility could help you to cope with or escape from that you believed you couldn’t deal with while being sober and responsible?”

The client is taught to recognize the basic core issues that increase the risk of relapse and to write clear statements that describe the general mistaken beliefs and the automatic and unconscious patterns of thinking, managing feelings and acting that is used when that core issue is activated.  The goal is to teach the client to understand and describe the problems that lead to relapse on three levels in clear, simple, and concrete terms.  These three levels are:  (1) the mistaken beliefs or assumptions about self, others, and the world that limit choices in life planning and problem solving;  (2) the automatic and habitual self-defeating thoughts, painful unmanageable emotions, self-defeating behaviors that are activated by the structure of mistaken beliefs; and (3) the dysfunctional professional and personal relationships that result from the habitual use of those self defeating behaviors.  This allows the client to unmask the big lie of addiction - the mistaken belief that alcohol, drugs and irresponsibility is good for me, can magically fix me and my problems, and can give me a better life.

Applications:   The core issue list is designed to both prevent relapse and improve overall  effectiveness by teaching the following skills:  (1) the ability to reflect upon past experiences, accurately assign meaning to those experiences, and avoid the thinking errors and self-defeating behaviors that are the logical consequences of mistaken beliefs; (2) mapping out the habitual patterns of thinking, feeling, and acting that are related to those mistaken beliefs; and (3) understanding how problems with professional and personal relationships are the logical extension of those core beliefs.

2.  Relapse Warning Sign List

Each person completing RPT learns how to develop a Relapse Warning Sign List that describes the specific sequence of events and the related irrational thoughts, unmanageable feelings, self-destructive urges, and self defeating behaviors that are acted out when the core mistaken beliefs are activated.  This warning sign list allows the client to describe in concrete and specific terms the subtle changes in thinking, feeling, motivation, and behavior that set the stage for addictive thinking.  It also allows significant others to recognize and assign meaning to the subtle changes in communication and behavior and to intervene appropriately before addictive thinking patterns become rigidly reestablished.

Applications: The relapse warning sign list is designed to prevent relapse and improve overall  effectiveness by teaching the following skills:  (1) developing a list of progressive personal problems and behaviors that lead back into a pattern of addictive and irresponsible thinking and behaviors;  (2)  isolating the warning signs that will interfere with performance  by writing a Warning Sign List.

3.    Warning Sign Management Strategies

Each person completing RPT learns how to identify key or critical warning signs and how to use specific skills or tools to manage those warning signs in a way that stops the progressive pattern of self-defeating thinking and behavior.  The coping strategies related to RPT go beyond the situational management strategies learned at the RPC level.  They involve recognizing and intervening upon the more subtle patterns of thinking, emotional management and acting out that set the stage for gradually more destructive behaviors. 

Applications: The relapse warning sign management strategies are designed to prevent relapse and improve overall  effectiveness by teaching the following skills:  

(1)   Clearly identifying intervention points in the progressive pattern of irrational thinking and self-destructive behaviors that can impair performance and increase the risk of mismanaging critical situations in a way that could lead to relapse;  

(2)   Learning specific skills for identifying and challenging irrational and addictive thinking patterns;  

(3)   Learning specific skills for responsibly managing unpleasant feelings and emotions;  

(4)   Learning specific tools and skills for recognizing and changing subtle patterns of self-defeating behaviors that can lead to serious long-term problems and eventual relapse; and 

(5)   Learning how to proactively invite others to support patterns of sobriety and responsibility and to point out self-defeating behaviors or problems that clients may be unaware of.

4.   Recovery Plan

Each person completing RPT develops a recovery plan consisting of regularly scheduled activities that clearly support the ability to challenge the mistaken beliefs that perpetuate a self-defeating style of living and working. 

<Mr. Gorski Is Available To Speak or Consult on the Trends in Addiction & Mental Health> 

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