Clinical Issues and Summary
Kelly’s case illustrates that CBT for negative symptoms is built upon traditional
cognitive behavioral therapy principles but also relies critically on the therapist’s
creativity and openness to use the session as a laboratory in which entrenched
dysfunctional beliefs are examined and debunked.
Kelly’s case illustrates a common etiological pathway in which neurocognitive impairment contributes to setbacks and failures that, in turn, result in dysfunctional beliefs that freeze clients into a shell of
avoidance and withdrawal that shields them from further disappointment.
The goal of CBT for negative symptoms is not necessarily to restore clients to their premorbid
level of functioning, but rather to help them break out of this shell by mobilizing
their personal and situational resources and fostering emotionally meaningful reengagement
with the world around them. Despite his significant progress and the
relatively long duration of treatment, Kelly still has much to accomplish.
Negative symptoms can persist long after other symptoms of schizophrenia have resolved.
Realistically, CBT for negative symptoms may entail openness to longer term
treatment that includes interval booster sessions after the completion of an initial
course of therapy, much like we have begun to conceptualize, extended and episodic
treatments in general medicine for chronic illness to ensure sustained effects, a
reduction in the rate of demoralizing relapses, and maintenance of positive functional
outcomes.
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