Table of Contents

I. CT-R Model of Transformation and Empowerment
1. Introduction to Recovery-Oriented Cognitive Therapy
2. Mapping Recovery: Developing a Plan for Transformative Action
3. Accessing and Energizing the Adaptive Mode
4. Developing the Adaptive Mode: Aspirations
5. Actualizing the Adaptive Mode: Positive Action
6. Strengthening the Adaptive Mode
II. Empowerment for Common Challenges
7. Empowering When Negative Symptoms Are the Challenge
8. Empowering When Delusions Are the Challenge
9. Empowering When Hallucinations Are the Challenge
10. Empowering When Communication Is the Challenge
11. Empowering When Trauma, Self-Injury, Aggressive Behavior, or Substance Use Is the Challenge
III.CT-R Contexts
12. Individual CT-R for the Sole Provider
13. The CT-R Inpatient Service
14. CT-R Group Therapy
15. Families as Facilitators of Empowerment
Appendices
- A. CT-R Terminology
- B. Blank Recovery Map
- C. Recovery Map How-To Guide
- D. Suggestions for Activities to Access the Adaptive Mode
- E. Blank Activity Schedule
- F. Blank Chart for Breaking Aspirations into Steps
- G. Interventions for Individuals Experiencing Negative Symptoms
- H. CT-R Benchmarks

About the Author

Aaron T. Beck, MD, until his death in 2021, was Professor Emeritus of Psychiatry at the University of Pennsylvania and President Emeritus of the Beck Institute for Cognitive Behavior Therapy. Internationally recognized as the founder of cognitive therapy, Dr. Beck has been credited with shaping the face of American psychiatry and was cited by American Psychologist as “one of the five most influential psychotherapists of all time.” Dr. Beck was the recipient of awards including the Lasker–DeBakey Clinical Medical Research Award, the Lifetime Achievement Award from the American Psychological Association, the Distinguished Service Award from the American Psychiatric Association, the James McKeen Cattell Fellow Award in Applied Psychology from the Association for Psychological Science, and the Sarnat International Prize in Mental Health and Gustav O. Lienhard Award from the Institute of Medicine. He authored or edited numerous books for professionals and the general public.

Paul Grant, PhD, is Director of Research, Innovation, and Practice at the Beck Institute Center for Recovery-Oriented Cognitive Therapy (CT-R). With Aaron T. Beck, he originated CT-R and conducted foundational research to validate it. He is a recipient of awards from the National Alliance on Mental Illness, the University of Medicine and Dentistry of New Jersey, and the Association for Behavioral and Cognitive Therapies. Dr. Grant developed group, family, and milieu CT-R approaches, and directs large projects implementing CT-R nationally and internationally. He has developed innovative implementation tools and is involved in researching positive beliefs and teamwide culture change as mediators of successful CT-R outcomes.

Ellen Inverso, PsyD, is Director of Clinical Training and Implementation at the Beck Institute Center for Recovery-Oriented Cognitive Therapy (CT-R). A codeveloper of CT-R, she has created transformative CT-R programming for psychiatric inpatient units, programmatic residences, schools, and community teams, with a special focus on adolescents and young adults, individuals engaging in extreme forms of self-injury, individuals considering transitions into the community following extended periods of institutionalization, and families. Dr. Inverso supervises early career professionals in CT-R, guides her seasoned colleagues to add the approach to their armamentaria, and has coauthored curricula for training peer specialists and expert trainers in CT-R.

Aaron P. Brinen, PsyD, is Assistant Professor of Clinical Psychiatry and Behavioral Sciences at Vanderbilt University Medical Center, where he provides training in recovery-oriented cognitive therapy (CT-R), serves individuals with psychosis, and collaborates on research. Previously, he directed Drexel University's center for the dissemination, development, study, and practice of CT-R. A codeveloper of CT-R, Dr. Brinen worked to formalize the treatment and adapt it for individual and group therapy settings, as well as in team-based psychiatric care and during inpatient treatment. He trains psychiatry residents in CT-R and has been active in training community therapists from around the world. Dr. Brinen also has a small clinical psychology practice specializing in cognitive-behavioral therapy for individuals with schizophrenia, posttraumatic stress disorder, and other disorders.

Dimitri Perivoliotis, PhD, is a psychologist at the VA San Diego Healthcare System and Associate Clinical Professor in the Department of Psychiatry at the University of California, San Diego (UCSD). At the VA, he is the coordinator of the Center of Recovery Education. He is also the Training Director of the VA San Diego/UCSD Interprofessional Fellowship in Psychosocial Rehabilitation and Recovery Oriented Services. In these settings, Dr. Perivoliotis conducts individual and group cognitive-behavioral therapy for people with psychosis and co-occurring conditions, such as posttraumatic stress disorder, and provides supervision, training, and consultation to psychology, psychiatry, and social work trainees. He is a codeveloper of recovery-oriented cognitive therapy.

Reviews

"Aaron Beck is one of the few heroic figures in the history of psychiatry; his CBT has helped more people than any other of the many psychotherapies developed in the past two centuries. Together with his highly talented team, Beck has set and met a most difficult new challenge--developing a special version of CBT for those who suffer from the most severe psychiatric disorders. This volume presents CT-R, a brilliant hybrid of standard CBT with techniques derived from the recovery movement. Beck is a great clinician who fills every page with profound wisdom, vast experience, technical savvy, practical common sense, and the empathic realization that we are all more simply human than otherwise. This is the go-to book for all who are dedicated to serving the people who most need our help, and CT-R will surely soon become part of the standard of their care."--Allen Frances, MD, Professor Emeritus and former Chair, Department of Psychiatry and Behavioral Sciences, Duke University

"Optimism is one of the hallmarks of cognitive therapy, yet when it comes to schizophrenia and other psychotic disorders, pessimism has persisted in many treatment settings. One of the first rays of sunlight came when Beck et al. published their previous book on schizophrenia. Now Beck and his colleagues move us further to positive change in both our treatment approaches and our conceptualization of what is possible for our patients. It is clear that the authors have spent many years listening to people with serious mental illness and learning from them about optimal ways to enable their path to recovery. For professionals who work with those suffering from serious mental illness, this book is invaluable. I expect it will become a standard text in graduate courses and residency curriculums dealing with therapeutic interventions. It will certainly be a primary resource for all of us involved in clinical research on psychotic disorders."--Elaine F. Walker, PhD, Charles Howard Candler Professor of Psychology and Neuroscience, Emory University

"This groundbreaking work offers the hope of recovery for individuals with serious mental health challenges. Through a decade-long collaboration with Dr. Beck and his team, as the commissioner of a large behavioral health system, I have seen firsthand the power and positive impact of CT-R, including for individuals who were living on the streets or experiencing very long stays in inpatient settings. This book provides a roadmap for service providers, program administrators, researchers, and policymakers who strive to ensure that each person has the opportunity to embark upon the road to recovery. Readers will understand and appreciate the gratitude shared by many of us for this highly innovative therapeutic approach."--Arthur C. Evans, Jr., PhD, former Commissioner, Philadelphia Department of Behavioral Health and Intellectual disAbility Services

"Beck and his team have done the heavy lifting to refine a treatment that targets the challenges that so often interfere with a person’s ability to recover and stay well, including negative as well as positive symptoms. CT-R offers a way to guide patients not only to re-engage with their treatment, but also to re-engage with life in general. With the approach described in this book, Beck et al. demonstrate the importance of compassion and optimism in drawing out patients’ strengths and prioritizing their values and dreams."--Dilip V. Jeste, MD, Distinguished Professor of Psychiatry and Neurosciences, University of California, San Diego

"This is the first book to re-envision the core work of psychotherapy from the perspective of the recovery movement. Beck and his team not only shift from a traditional cognitive therapy focus on symptoms to a focus on aspirations and adaptation, but also provide practical tools for assisting people to identify and pursue their life goals. CT-R is a strength-based, life-affirming approach that draws on people's inner stores of resilience to deal effectively with life’s challenges. This concrete guide, illustrated with case examples, will be of value to both experienced practitioners and trainees. Psychotherapists who have yearned for ways to embrace recovery-oriented care in practice finally have a trusted, highly experienced, and wise guide."--Larry Davidson, PhD, Professor of Psychiatry and Director, Program for Recovery and Community Health, Yale University-