A typical cognitive behavioural therapy session
Almost all CBT sessions are highly structured and follow a specific format. This has been developed so that the therapy treatment is focused on the issue that you find most problematic. The session often starts out with a small check in where you are asked about how your mood has been since the last session. Some CBT therapists use psychological questionnaires that they ask their patents to fill in before each session as a means to measure progress within therapy. It also helps the CBT therapist to adapt treatment as necessary.
Review of homework
Within CBT homework, or work in-between sessions, are seen as paramount to your progress. Homework means exercises that are specifically designed to move you forward. They are set by you together with your therapist in order for the therapy to move forward at a faster pace than if you were to attend therapy just one day a week. They are designed in relation to your needs and wants in the here and now. It can be something as simple as checking in on how you are feeling twice a day. Or monitoring your thoughts. For some it may be breathing exercises and for others it may be an exercise in looking others in the eye. For a few it can be practicing self-compassion. You get the gist - it is individualised and based on needs. Together with your CBT therapist you go over whether the exercise has helped and troubleshoot if it hasn't.
It may sound clinical, dull and office like but bare with me. It is a highly effective way of keeping the therapy structured around what you find most important. It is a way for the CBT therapist to avoid guess work and leading you down paths which you may not feel are as pertinent to your well-being and mental health. This is the time when you pick a focus of the session - it can be very specific or more general.
This may sound more appropriate for a lab with people wearing white coats, but it is the exact phase of the therapy that most clients report most useful. This is where you, in a safe and protected environment try out stuff you find yourself fearful of. For example; take someone who has a fear of spiders, the session experiment may start with:
- Talking about spiders
- Imagining a spider
- Seeing a video of a spider
- Looking at a live spider in a cage
For others the in session experiment may involve treatment for a fear of rejection, or public speaking, or an exercise in mindfulness. For some it could simply be sitting in silence and learning to just be. It's totally individual and tailored to your needs which is key.
Out-of-session experiment / homework setting
The next phase of the therapy hour involves homework setting. This is when you together with your CBT therapist can start looking at things you can take from the therapy and put into practice in every-day life. How can what you learned in the therapy session be applied outside of it? What could you take forward? What would have been helpful to focus on at home? Collaboratively with your CBT therapist you plan and devise an appropriate exercise using your knowledge and understanding of your problems and the CBT therapist's expertise in psychology and effective treatment methods.
The last part of the therapy is the ending. You will be asked what you found useful in the session as well as what you found less useful. If there is anything you like to spend more time on in the next session or if there is anything you wish the CBT therapist to prepare. This is also the time when you look over practicalities such as booking next session etc.