Navigating rough waters: Managing common challenges across the four cornerstones of CPT

This chapter supplements the cognitive processing therapy (CPT) manual by expanding on topics most frequently queried during consultation, including clinical hints around navigating pretreatment issues such as patient trepidation about beginning trauma-focused therapy and the value of continuous assessment. We offer suggestions on therapist concerns that can occur throughout the protocol such as time management and patient compliance and engagement. Finally, we also offer broad clinical strategies and hints for perfecting therapist skills across the four cornerstones of CPT: (1) emphasis on practice work, (2) promotion of the expression of natural emotions, (3) prioritization of challenging assimilated stuck points before over-accommodated stuck points, and (4) the use of Socratic questions. In summary, our goal in this chapter is to provide further guidance in honing therapist’s skills in the administration of the CPT manual. Later chapters offer more in-depth suggestions on applying those skills across various patient populations, clinical presentations, and clinical care settings.