We don't lay on the couch and talk about the past. We work on the present to give you actual tools.
Several of my clients expect #CBT to be more like traditional talk therapy where we discuss the past and how it impacts your issues. In CBT, we do get a thorough history to understand you better. After getting a really good understanding of you as a person, your strengths, your weaknesses, your life in general, and the diagnostic picture, we move forward with a more structured approach. It is essential that the therapist gets to know you and where you come from so we can tailor the treatment interventions accordingly. I’ll say more on that when I post about doing thorough intake assessments.
A typical session is about 50 minutes. Together we set an agenda for the session. We discuss homework from the previous week. Yes, I did say “homework”. I’m not being a bore, just socializing you to the world of CBT. We can use euphemisms like assignments or tasks if you like. We may work on trouble shooting if there were issues the previous week. Often, you will be given specific questionnaires and worksheets pertaining to the issues you’re working on. Depending on what your diagnostic picture looks like and what you’ve identified as your goals for therapy, we may work on a number of interventions in session. For example, making a hierarchy of situations you’re anxious about and avoid, challenging your way of thinking (aka cognitive restructuring), doing exposures (facing thoughts, images, situations that make you anxious and that you avoid), assessing your level of anxiety during the exposures and learning to “sit with your anxiety”. I can imagine it sounds crazy when I say that you can learn to sit with your anxiety as opposed to trying to get rid of it. But it’s doable and it’s what we focus on quite a bit in therapy. More on how to cope with anxiety in a future post. Finally, towards the end of the session we will discuss homework for the following week. Homework is critical in CBT. It is a bridge between your 50 minutes a week in therapy and the rest of your life. I’ll say more on the importance of homework in therapy in a future post. CBT is a collaborative process. In my next post, I’ll talk about how and why it’s a collaborative process and how to make the most of your sessions.
Now, you may think that the treatment is so structured that there’s no room for what’s going on in your life. That’s not true at all. We do stick to the general structure. However, it is your therapy session. If you want to discuss something else that’s pressing, we can address it in as much depth as needed/wanted. There is flexibility within structure. For the most part, we build on every session to accomplish your goals.
This post represents the structure of a typical CBT session. However, depending on your specific diagnosis and the therapist you’re seeing, it may vary somewhat.
Common pitfalls
Clients who aren’t socialized to CBT at the outset may feel that CBT is not for them or the therapist is too rigid. The therapist doesn’t get what you’re going through and the therapist had you spend time answering specific questions or completing questionnaires. That’s not the case at all. The structure is part of the therapeutic process and as long as you’re aware of it, you will anticipate it. This will help in building better rapport between you and your therapist. Like it is with everything in life, give it a chance for a few sessions and see if it works for you!