Long-term therapy

“Sustainable therapy” is not a term found in a diagnostic manual. It does not appear in the ICD-10 or the DSM-5, nor is it used in that way in clinical guidelines. Parents usually mean something specific by this: that what their child has learned in therapy continues to have an impact even after the last session. The appropriate technical term is relapse prevention (prevention of a recurrence of the illness).

Experts distinguish between two things here. Acute treatment is intended to alleviate symptoms. Maintenance therapy and relapse prevention are intended to sustain the achieved state over months or years. In this sense, sustainability means that the success stands the test of time, even if stressors reappear.

Relapses are not uncommon in mental illness. Expert information from the field of child and adolescent psychiatry indicates that children and adolescents who have experienced depression may experience a relapse later on. That is why effective treatment plans take the end of therapy into account from the very beginning.

The National Care Guideline for Depression states that ending treatment too early increases the risk of an early relapse within the first six months, even if symptoms have completely disappeared. If there have been multiple episodes within a few years, long-term prevention lasting at least two years is recommended. A meta-analysis showed that maintenance medication significantly reduced the risk of relapse compared to a placebo.

This is an important point for parents to understand. A setback does not mean that the treatment has failed. It occurs with many illnesses and can be mitigated with proper preparation.

The key to relapse prevention lies in practice. The website gesundheitsinformation.de and professional associations emphasize that the skills learned in therapy must be practiced regularly in order to be effective. These include mindfulness, relaxation techniques, emotion regulation, and engaging in enjoyable activities.

It is important to integrate these skills into daily life. What works in the therapy room must also be applied at school, at home, and during leisure time. Concrete agreements can help here: set times for practice, a plan for difficult situations, and small reminders.

Some treatments do not end abruptly. Refresher sessions (booster sessions) are individual appointments following the actual conclusion of treatment that help reinforce what has been learned. In Germany, following long-term psychotherapy, additional hours can also be used for relapse prevention. Good aftercare and the targeted activation of resources strengthen the child’s self-efficacy.

Family support is one of the key factors in treatment planning. Child and adolescent psychiatry identifies three key components for the post-treatment period: education about early warning signs (psychoeducation), family involvement, and a so-called “emergency kit” containing strategies for high-risk situations.

For parents, this means in practice:

• Recognizing early warning signs—such as withdrawal, sleep problems, or extreme irritability—and addressing them calmly.
• Work together to prepare a crisis plan and an “emergency kit” while the child is doing well.
• Clarify your own role. Psychoeducation for parents helps distinguish between observation and control.

The tone makes a big difference. Children sense whether their parents trust them to cope with a difficult day. It can be unsettling when a child suddenly seems uncertain after showing visible progress; this ambivalence regarding improvement is well-known and usually passes.

“A cure for life” is a promise that professionals rarely make. Psychotherapy reduces the risk of relapse and alleviates symptoms, but it affects everyone differently. For some, just a few sessions are enough; others need longer-term support. In this context, “sustainability” refers more to stable improvement, along with tools for emergencies.

Rückenwind “Eltern begleitet Familien” offers coaching. Janike is a social worker and parent coach currently training to become a child and adolescent psychotherapist; she is not licensed to practice medicine and does not make diagnoses. Whether treatment should be continued, resumed, or adjusted is determined exclusively by a medical or psychotherapeutic professional, such as a child and adolescent psychiatrist (KJP). In the event of an acute crisis, contact these services or the emergency medical service immediately.