What to Expect from Cognitive Behavioural Therapy (CBT)

Therapy often continues to be depicted as a space where clients lie on a sofa or curl up in a big chair and talk through their dreams or childhood memories in great detail but this is not what you will get from CBT! CBT is a pro-active form of therapy that involves a limited number of sessions, a focus on achieving clearly defined goals and regularly completing independent practice (homework!) in order to provide you with the tools you need in order to make sustainable changes without long-term dependency on a therapist.


In CBT, we recognise that aspects of our past influence our patterns of thinking and behaving related to the difficulties we are currently experiencing. These experiences are acknowledged in understanding these patterns but the focus is on making change in the present and into the future rather than unpicking the past.


This guide walks you through some of the main components of CBT.


What is CBT?


Cognitive Behavioural Therapy (CBT) is a highly evidence-based and effective form of therapy that focuses on understanding and changing the way we think and behave in order to improve how we feel emotionally. CBT is recommended by the National Institute for Health and Care Excellence (NICE) for a number of mental health disorders including but not limited to depression, generalised anxiety, social anxiety, post-traumatic stress disorder, eating disorders and obsessive-compulsive disorder.


The Cognitive-Behavioural model highlights multiple links between the way we think, the way we feel physically, the way we feel emotionally and the way we behave. Making a change in one area, has an impact on the others.


First Steps of CBT: Assessment


The first appointment is an initial consultation which is essentially an assessment of your difficulties and needs which informs your treatment plan. Your therapist will provide space for you to talk through how you've been feeling, your understanding of what may have triggered your current difficulties how this is impacting you. They will support you to identify therapy goals so that you can both be clear on what it is that you want to gain from treatment. You can read our Guide to Preparing for Your Mental Health Consultation for further information about this appointment.


The Process


In the first sessions of CBT, there is a focus on formulation and education in order to build an understanding of the problem, how is it maintained and provide a clear rationale and strategy for making change. Sessions then move into more active treatment focused on exercises and interventions to support change.


There is sometimes an expectation that simply attending therapy is enough to help the problem or that it is the therapist’s role to make everything better. However, this is not the case. CBT is an active and collaborative process between therapist and client where the therapist holds the expertise in understanding and treating mental health difficulties and the client holds the expertise in themselves.


The therapist doesn’t give quick solutions or advice but instead, skilfully poses questions that guide the client to come to new ways of thinking and understanding and then homework tasks are agreed that help to test out or reinforce ways of thinking and behaving. The majority of real learning and progress takes place outside of the sessions because this is where real life happens and where there are opportunities to apply learning and practice new skills.


Session Structure


In CBT, to support focus and progress, an agenda is set at the start of the session. Home practice is absolutely key to progress and will be reviewed as a standard agenda item within every session. In fact, it is such an important part of the process that it is quite common for therapy sessions to be used for home practice if the agreed task has not been completed. This is to ensure you have understood the exercises and feel confident using them independently. You are then more likely to be able to use them once therapy has ended and continue making progress.


The homework review generally feeds into the next task or exercise that the therapist introduces. Not completing the home practice therefore slows things down. This may result in the need for additional sessions or if the completion of home practice is really problematic and impacting progress, it may be necessary to stop therapy until this aspect of the process is more achievable.


Goal Setting


The first home practice task in CBT is usually around goal-setting. The goals guide the treatment plan and ensure that focus is maintained on working towards achieving them. Often, people will express wanting to feel ‘normal’ or ‘gain coping strategies’ or ‘not feel depressed.’ These are great starting points but it’s quite difficult to measure progress with such broad goals. The first treatment session often focuses on understanding these goals and breaking them into smaller steps. Goals are then reviewed throughout treatment as a way to check progress and maintain focus.


Number and Frequency of Sessions


As part of the assessment process, a number of sessions is usually established and agreed before commencing treatment. This varies depending on the nature of the problem but is usually between 6 and 25 sessions. Sessions are usually 50-60 minutes in length and take place weekly in the beginning and often move to fortnightly towards the end of therapy. This is to allow longer periods of time for home practice, to test out new skills and strategies and to get used to managing independently, without a therapist.


For some conditions, therapy can be more frequent. For example, with certain eating disorders, it is recommended that appointments occur twice a week initially. For social anxiety and post-traumatic stress disorder, for part of the treatment, 90-minute sessions are recommended. The number of recommended sessions as well as their duration and frequency should all be discussed and agreed at the start of therapy.


Hurdles and Challenges


CBT has a strong evidence-base, has been found to be effective in treating many mental health disorders and is therefore recommended by NICE (National Institute of Health and Care Excellence) as a treatment for common mental health disorders. However, it is a process and with all things that require effort and change, it comes with challenges. Knowing what these are ahead of treatment can help you prepare for them. It is common practice for CBT therapist to support with identifying and ‘troubleshooting’ anticipated difficulties to support their clients in managing them.


Feedback


A CBT therapist will usually end each session enquiring about how you have found the session and inviting feedback from you. This is a great opportunity for you to share your honest views about not only what has been helpful but also anything you might be struggling with, don’t understand or are finding unhelpful. However, it is not necessary to wait until the end of the session to give feedback.


Ending Therapy


The end of therapy should be planned and referred to as it gets closer so the final session should never come as a surprise and you should feel well prepared to end. The final session is usually a summary session in which you review everything that you have covered and learnt and create a plan that you can take away and refer to as needed. Some therapy services allow you to return to them should you feel the need for further support in the future and private therapists will often offer this option.


It is important to know that in CBT, the process doesn’t end when the therapy ends. The idea is that you to continue practicing the skills you have learnt to keep maintaining positive change and progress.


Booking with Brighter Minds


To arrange an Initial Consultation and start your CBT journey with us, you can book this online now.


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