Therapy is hard: Improving patient engagement and working through avoidance

This chapter seeks to supplement the cognitive processing therapy manual by expanding on topics around patient engagement and related avoidance most frequently queried during consultation. These topics include clinical hints around navigating pretreatment issues such as patient trepidation about beginning trauma-focused therapy and the value (and difficulty) of continuous assessment. We begin to discuss the multitude of ways patients might avoid engaging in the process of therapy and ways to successfully navigate such obstacles. We also offer suggestions on overarching therapist concerns that can occur throughout the protocol such as time management and patient compliance and engagement.