What happens in a CBT session?

The initial appointment will be one hour, and will focus on taking an in depth history and defining the problems that an individual would like to work on. All subsequent appointments are 45 minutes long and are structured and problem oriented. CBT is shorter term treatment and significant results for a given problem can be anticipated in 12-20 sessions.

Each session, the therapist and client collaborate to set an agenda. For example, a client may choose to focus on an event (interpersonal problem, difficulty reaching a goal), an affective state (feeling sad, anxious, angry), a behavior (overeating, procrastinating), or cognitions (negative thoughts) . The agenda assists at keeping the session focused on the individual’s most immediate concerns and their longstanding cognitive patterns.

Once an agenda is set, the therapist reaches for thoughts, feelings, and behaviors. The therapist will intervene with thoughts and beliefs that lead to emotional disturbances by challenging clients dysfunctional thinking, and working towards a more adaptive belief. Behavioral interventions are used both to practice more adaptive behaviors and to challenge dysfunctional thoughts. Clients will be taught skills to regulate their mood as needed (including deep breathing, grounding and visualization).

Clients are asked to do homework assignments outside of each session incorporating the skills learned in therapy into their daily life. Homework may be cognitive, behavioral, or a combination. As clients practice these assignments, they begin to have greater ease at recognizing their thoughts, feelings, behaviors and their transactions. A big part of CBT is psycho-education and skill building. The therapist continuously teaches the model to the client. The clients learn to monitor their own thoughts, feelings and behaviors, intervene where necessary. In essence, the goal is for the client to become his or her own therapist.

As a client’s symptoms are alleviated, and their mood improves sessions will decrease frequency of therapy appointments from weekly, to bi-weekly, to monthly, to an as needed basis. I have an open door policy, and anyone who has “graduated” from therapy is welcome to return if a new problem presents itself or they feel the need for a “booster” session.