General issues when conducting BA

General Issues When Conducting BA

One difficulty is that treatment is often not a main priority for many clients. This causes two main problems: (1) clients begin treatment in a heightened crisis because prior to this point they did not see a need for treatment, and (2) once clients begin to feel better they terminate treatment. It is very difficult to address clients beginning treatment in a heightened crisis, but preventative care can be taken to address clients terminating treatment early:

• Session 1: discuss the treatment course, emphasizing the importance of continuing even after feeling better. The goal is to teach clients the skill of responding with activation to difficult life events.
• Session 2: stress the importance of attending, treating it as an activation assignment. Discuss potential avoidance patterns and obstacles, and use techniques like reminders to ensure attendance.
• Ongoing treatment: gradually reduce session frequency (bi-weekly, then bi-monthly) as the client's depression stabilizes, to monitor the generalization of skills outside therapy.

This approach helps manage medication-related terminations, unreliable attendance, and unexpected situations.

Doing BA on the Fly

During treatment development, therapists often had to implement “BA on the fly,” typically over the phone, ensuring consistency with the BA model.

Reflect on what you would do in these 3 situations:

• Client cancels appointment: when clients cancel due to feeling unwell, therapists use this as an opportunity to discuss avoidance patterns and encourage attending the session to take an active step towards feeling better.
• Client discusses termination over the phone: if a client calls to terminate treatment, therapists assess whether termination is due to avoidance. They try to schedule an additional session or review termination materials during the session.
• Client calls about a crisis: for clients in crisis (not actively suicidal), therapists use BA techniques to identify avoidance patterns and plan action steps. This interaction is then discussed in the next session.