Understanding the Maintenance Stage of Therapy
The maintenance stage of therapy occurs when a patient has met or made significant progress toward their treatment goals, and their symptoms and functioning are stable. At this point, the patient may not need the same intensity or frequency of therapy sessions but could still benefit from support to maintain progress, reinforce skills, and prevent relapse.
In this phase, therapy sessions often become less frequent, reflecting the goal of fostering patient autonomy and supporting the internalization of treatment gains.
Clinical Considerations
Patients should only be transitioned to maintenance care if they are presenting no current risk factors and are stabilized in their symptoms. To align with clinical best practice and ensure that medical necessity is met for services, the maintenance phase at Rula should not exceed 3 months. During this time, you will track the patient’s ability to maintain progress and navigate challenges using the strategies they have built.
Consider transitioning a patient to maintenance when:
- They have met their primary treatment goals or are close to doing so
- Symptoms are stable or well-managed
- They are independently applying tools learned in therapy
How to Speak with Patients About Maintenance Sessions
- Affirm the patient’s progress and strengths: “I’ve noticed how much progress you have made recently. You are using your coping skills consistently, and I see your PHQ-9 scores have remained low the last month.”
- Frame the shift as an experience of empowerment and success: “Because you’re doing so well, I think it might be time to shift to biweekly sessions so you can have a chance to focus more on implementing what you’ve learned outside of session. We will still be working together, but less frequently to make sure you are able to maintain the momentum from therapy.”
- Collaborate and answer questions: “How do you feel about this? Do you have concerns about meeting less frequently? What do you imagine it will be like to come to therapy less often?”
- Assure that maintenance is not the same as discharge but can be a step towards finishing care: “This is a chance to review what you’ve learned and troubleshoot anything that arises in your life. If after a few weeks you are doing great, we can shift to meeting less often or end our work together.”
Common Themes of Maintenance Sessions
These sessions may look and feel slightly different than previous sessions, because they focus more on how the patient is navigating current challenges and less on an exploration of deeper feelings or past experiences. Some common aims of a maintenance session are:
- Review progress: Guide the patient to identify what they have learned, including any new or strengthened skills, coping strategies, or adaptive behaviors.
- Assess ongoing risk: Evaluate whether the client is at risk for regression or recurrence of symptoms without continued therapy. This can also include identifying potential triggers or stressors that could lead to setbacks.
- Develop a plan for discharge, including how and when to return to therapy if needed.
What Happens After Maintenance Goals Are Achieved
When maintenance goals are met, it means the patient has sustained stability, effectively uses coping strategies, and demonstrates ongoing functional wellness. At this point, discharge is the next step. Clinicians should:
- Review progress and reinforce relapse prevention skills
- Provide community or self-help resources
- Clarify that the patient can return to therapy if symptoms recur
This transition supports patient autonomy and recognizes therapy completion as a sign of success.
If Maintenance Goals Are Not Achieved
If, after the 3-month maintenance period, the patient has not met their maintenance goals or symptoms begin to worsen, you and the patient should collaboratively re-evaluate the treatment plan. In Rula’s system, this will prompt the creation of a new non-maintenance goal and objective to address the current clinical needs.
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