What to Expect from CBT Sessions
You may be wondering what to expect from CBT sessions. CBT therapy is an opportunity to learn more about yourself and your interactions with others. During your CBT sessions, we will look at how you came to develop your current problems. But, more importantly, we will unravel the factors that are keeping your current problems going.
Preliminary Phone Call
The first step is for us to have a preliminary phone call (15 minutes) so that I can find out a bit more about you, explain how I work, discuss my fees, etc.
We will discuss whether the problems you have lend themselves to a CBT approach or whether a different therapy might be more helpful to you. I will also let you know whether I specialise in the areas you are struggling in. Provided I feel able to help you, I will invite you in for an assessment.
Our First Meeting: CBT Assessment
In our first appointment you will have an opportunity to tell me about your difficulties. I will ask you about your current problems, as well as other areas of your life, i.e., family history, work history, relationship history, health issues, etc. We will develop an in-depth understanding of your difficulties. We will specifically look at your thoughts and beliefs and how they affect your day-to-day functioning (behaviours and feelings). We will clarify your goals and what you hope to achieve from therapy.
The assessment session is a structured session; although you will do most of the talking, the session is therapist-lead, and follows a format, to ensure we cover all of the important areas. This session lasts 90 minutes.
The assessment phase can take 2-3 sessions; there is a lot of information to gather, and it takes time to develop a full understanding of how your problems developed and what is keeping them going. You can understand how your thoughts and beliefs relate to your behaviours, feelings and day-to-day functioning. We can clarify your goals and what you hope to achieve from therapy, giving our work a clear focus and helping us determine whether CBT is the best approach to help tackle your problems
By the end of the assessment, you will also have a better idea about my style and how I work so you will be able to make a more considered decision about whether you’d like to continue working with me. If we both agree that we would like to work together, we will schedule a second appointment.
The Therapist/Client Relationship
As a CBT therapist, I foster a collaborative environment where we can work together to make sense of what changes need to occur and how best to make these changes. I may be the expert in Cognitive Behavioural Therapy, but you are the expert on you.
Are we a good fit?
The assessment session is an opportunity for us to see whether we would like to work together. This is a two-way relationship and it is important that we feel comfortable with each other. If I feel that I am not the best person to help you, I will let you know; if I have someone in mind who I feel would be able to help you I will let you know. .
I am very aware that I may be the first person you are opening up to about your problems, and I appreciate how difficult that may be. First and foremost, my aim is to help you feel comfortable enough to open up to me, and my second aim is to help you feel understood.
It is normal to feel anxious before your first appointment; either because you may not know what to expect or because you find it difficult to open up. I promise to do my best to make you feel at ease.
What to Expect from a Typical Treatment Session
Once we decide that we would like to continue working together, we will use our understanding of your main problems, how they are related, and what keeps them going to develop realistic goals and strategies to help you achieve your goals. We will look at what is working for you—and what isn’t—and we will make sense of it all together.
You will learn how to identify the negative predictions and catastrophic thoughts, i.e., “what if I can’t do this”; “what if my boss tells me this is awful”; “I won’t be able to cope with negative feedback”; “what if I panic during the meeting”, as well as avoidance or safety behaviours (avoiding meetings, making excuses to get out of presenting; over-preparing; taking beta-blockers, etc.) that keep anxiety or depression going. Behavioural strategies like over-preparing or making excuses to get out of presenting keep anxiety going by reinforcing the fear. By avoiding a meeting or procrastinating on a piece of work, you prevent yourself from learning it may have gone better than predicted.
Treatment sessions can feel challenging as we get at the heart of your thoughts and feelings. It isn’t easy to allow yourself to open up, but as you get to know me and feel comfortable with me, the benefits of having someone to talk to in confidence can be huge.
“Marla’s attention to detail is phenomenal (she really gets to the core of what’s going on), and the level of preparation put into each session is always evident. Marla’s manner is very warm and engaging, her sense of humour also brings much needed-levity to proceedings. This is not therapy by rote. Marla gets results”. FW in E14
Structure of CBT Treatment Sessions
A typical CBT session involves:
- Review of the week: a succinct summary of your week, including a mood update, i.e., my mood was better/worse/ than last week, along with a bit of context as to what might have contributed to your improved/worsened mood. We will look at what went well in the week, as well as what didn’t go so well.
- Homework review: The week’s review will lead nicely into “homework” review, where we discuss tasks you have completed between sessions and decide what the main focus for today should be.
- Agenda-setting:Selecting 2-3 main topics to discuss in a particular session gives us a focus and structure, and prevents the session from losing direction
- Skill acquisition: I teach skills and techniques you can practise during the week.
- Building on acquired skills: How can you put into practice what you are learning, in the real world?
Fifty minute sessions go by quickly so it helps to come prepared, having done any agreed upon homework exercises and thought about what you would like to achieve in session.
Most people find it helpful to stay focused and “on topic.” Otherwise, sessions become unfocused and this can lead us to feel like we’re not moving forward.
Making the Most of CBT Sessions
There is a lot of information to take in and process during a therapy session, and you will not be expected to remember everything we discuss. You may find it helpful to bring a notepad to your appointment, so that you can note down the main discussion points and the “homework” or self-help exercises you will carry out for the next session. This will allow you to reflect on our sessions after you’ve left, and it will allow you to move forward with some of the key points discussed.
Starting and ending my sessions on time is very important to help you and my other clients get the most out of each session. If I run over with you, my next client will be taken late and they will get short-changed. If I run over with the person before you, I will have to take you late, and you will get short-changed.
I normally like to start wrapping the session up at 40-45 minutes, to allow us 5-10 minutes to set some goals/homework for the coming week.
There are times when I may run over, especially if I have a longer gap between you and my next client. It’s therefore important that you tell me if you have to leave on time.
Self-Help Exercises or Mental Fitness Exercises
In order to gain the most from your therapy experience, you will need to spend some time each week reflecting on topics discussed and putting into practice the new behaviours and thinking styles that we discuss in session. An important part of cognitive behavioural therapy involves carrying out self-help exercises or mental fitness exercises.
Getting yourself in good physical shape requires self discipline. The same principle applies for mental fitness. If you want to feel better mentally and emotionally, you will need to practise what you learn in therapy on a daily basis.
Self-Help Exercises can involve any of the following:
- reading an article or a chapter in a CBT book
- keeping a daily record of your negative thoughts and feelings
- keeping a daily record of your activities (to learn more about how your activity level affects your mood)
- recording the frequency of particular behaviours
- practising new behaviours: for example, if you believe that people will not like you if you say “no”, a useful exercise would be to set up an experiment where you can test that out
- recording examples of recent “trigger” situations (situations that typically lead you to feel anxious, low or stressed).
A Mental Workout
Just like going to the gym, you may feel tired or drained after some therapy sessions. In the same way that your physical muscles might need a hot shower or bath after a work-out, your “mental” muscles may need a short rest after a therapy session. It’s a good idea to give yourself at least 15 to 30 minutes after a session to process and prepare yourself if you have to return to work.
When you decide to attend for CBT, it is important that you have realistic expectations.
Your progress in CBT depends on a few factors:
• How long-standing are your problems?
• How complex are they?
• How much time are you able to invest in your therapy between sessions?
• Do you have an accurate understanding of the cognitive (thinking) processes and behaviours that are keeping problems going? We will review this on a regular basis.
Therapy is a process, and there is no “quick fix”—not even in CBT. Any real changes in your emotional health will take time.
Are you committed to the process?
When you attend CBT sessions, you are committing to playing an active part in your treatment. This will involve completing exercises between sessions. Your progress is largely dependent on how much time you commit to the therapy process between sessions. If you attend two or more CBT sessions without completed the agreed tasks, I might suggest that we put treatment on hold until you are able and ready to commit to the process.
Your progress is largely dependent on how much time you commit to the therapy process between sessions.
Do you still have questions about what to expect from CBT?
When will I start to feel better?
Many of my clients have said that just picking up the phone to book their appointment felt good because they recognised they had taken the most important step of all—asking for help! For a lot of people, therapy is the first time they are really opening up completely and honestly about how they have been feeling, and it can be therapeutic simply to talk without fear of judgment. Typically, it can take a few sessions before you feel that you are making steady progress.
How will I feel after a session?
The goal of therapy is to help you to make positive changes in your life, so that you can achieve what is important to you, and ultimately feel better. However, the road to get there may not always be smooth. In our CBT sessions we will talk about some of the painful and difficult issues you are facing, and sometimes sessions may feel difficult or challenging or draining. This isn’t a bad thing, because it means that we’re talking about things that matter to you.
Can I expect to leave an assessment with some tools and techniques?
Our initial assessment session is intended to gather information about your current problems, how they developed and how other areas of your life, such as family, school, work and relationship history. This process can take time, and you won’t leave your first session with any concrete solutions. It may be helpful to think of a physical health analogy; if you broke your leg, you wouldn’t expect your orthopaedic surgeon to fix your broken leg at the initial appointment; instead, your doctor would take an X-ray and possibly scans to investigate the nature of the broken bones. A CBT assessment is also an investigation-of your emotional experiences. Once we have an understanding of these experiences, we can discuss effective treatment strategies.
What if I decide to stop therapy?
There are many reasons a person may want to stop attending therapy. You may not find it helpful, you may find it too much a financial burden, you may be changing jobs and/or relocating, etc. Whatever your reason for stopping, I always encourage the ending to be planned. If you let me know that you need to stop, we can plan one final closing session to review any progress, as well as areas you feel still need work. You can always come back to pick up where you left off, and your feedback is valuable to me even if you don’t find the sessions helpful.
What happens if I need to put therapy on hold or take a short break from it?
That shouldn’t be a problem. I understand that when work is particularly busy, you have less time available to you. And of course, there may be other reasons you need to put our sessions on hold. I have had individuals put sessions on hold from two to six weeks.
If, however, you need to put sessions on hold for any longer than that, it might be worth considering whether this is the right time to start CBT, because the continuity between sessions is important. We can discuss this if and when the need arises. There are no hard and fast rules and I try to be as flexible as possible.
What do CBT sessions cost?
If you’d like to know more about what CBT sessions cost, please visit my Fees page.
Do you have more general questions about CBT?
If you have more questions about CBT, please visit my FAQ page.