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By Mayo Clinic staffIt's likely that you'll go to a therapist's office for cognitive behavioral therapy sessions. A therapist may have an office in a medical clinic, an office building or a home office. Therapy can also take place in a hospital if you've been admitted for treatment. You'll probably meet weekly with your therapist for one-on-one sessions that last 45 to 60 minutes. Cognitive behavioral therapy may also be done in groups — either with family members or with people who have similar issues.
Your first therapy session
Your first session is usually a time for the therapist to gather information about you and to determine what concerns you'd like to work on. The therapist may ask you to fill out forms about your current and past physical and emotional health. This information helps the therapist gain a deeper understanding of your situation. Your therapist will also want to know whether you might benefit from other or additional treatment, such as medications. It might take a few sessions for your therapist to fully understand your situation and concerns, and to determine the best approach or course of action.
The first session is also an opportunity for you to interview your therapist to see if his or her approach and personality are going to work for you. Make sure you understand:
- His or her approach
- What type of therapy is appropriate for you
- The goals of your treatment
- The length of each session
- How many therapy sessions you may need
If you don't feel comfortable with the first psychotherapist you see, try someone else. Having a good "fit" with your therapist can help you get the most benefit from cognitive behavioral therapy.
In general, conversations with your therapist are confidential. However, in certain situations a therapist may be required by law to report serious concerns to authorities — such as threatening to commit suicide, threatening to harm another person or admitting to abusing a child. Talk to your therapist about any worries you might have regarding confidentiality.
During therapy
For cognitive behavioral therapy, you and your therapist will most likely sit facing each other during sessions. Your therapist will encourage you to talk about your thoughts and feelings and what's troubling you. Don't worry if you find it hard to open up about your feelings. Your therapist can help you gain more confidence and comfort.
Cognitive behavioral therapy is generally focused on specific problems, using a goal-oriented approach. Each session may have a specific agenda to guide discussion. As you go through the cognitive behavioral therapy process, your therapist may ask you to do "homework" — activities, reading or practices that build on what you learn during your regular therapy sessions. Along with homework, your therapist will likely encourage you to apply what you're learning in your daily life.
Steps in cognitive behavioral therapy
Although there are different ways to do cognitive behavioral therapy, it typically includes these steps:
- Identify troubling situations or conditions in your life. These may include such issues as a medical condition, divorce, grief, anger or symptoms of a specific mental illness. You and your therapist may have to spend some time deciding what problems and goals you want to focus on.
- Become aware of your thoughts, emotions and beliefs about these situations or conditions. Once you've identified the problems you want to work on, your therapist will encourage you to share your thoughts about them. This may include observing what you tell yourself about an experience (your "self-talk"), your interpretation of the meaning of a situation, and your beliefs about yourself, other people and events. Your therapist may suggest that you keep a journal of your thoughts.
- Identify negative or inaccurate thinking. To help you recognize patterns of thinking and behavior that may be contributing to your problem, your therapist may ask you to pay attention to your physical, emotional and behavioral responses in different situations.
- Challenge negative or inaccurate thinking. As you continue to examine your thought patterns, your therapist may encourage you to test the validity of your thoughts and beliefs. This may include asking yourself whether your view of a situation is based on fact or based on an inaccurate perception of what's going on. This step can be difficult. You may have long-standing ways of thinking about your life and yourself. Many thought patterns are first developed in childhood. Thoughts and beliefs that you've held for a long time feel normal and correct, so it can be a challenge to recognize inaccuracies or negative tendencies in your thinking. With practice, helpful thinking and behavior patterns will become a habit, and won't take as much effort.
Your therapist's approach will depend on your particular situation and preferences. Your therapist may combine cognitive behavioral therapy with another therapeutic approach — for example, interpersonal therapy, which focuses on your relationships with other people.
Length of psychotherapy
Cognitive behavioral therapy is generally considered short-term therapy — about 10 to 20 sessions. You and your therapist can discuss how many sessions may be right for you. Factors to consider include:
- The type of disorder or situation
- The severity of your symptoms
- How long you have had your symptoms or have been dealing with your situation
- How quickly you make progress
- How much stress you're experiencing
- How much support you receive from family members and other people
- Gafford J, et al. Psychological treatment of psychiatric disorders. http://www.uptodate.com/home/index.html. Accessed July 15, 2010.
- Epp A, et al. Applications of individual cognitive-behavioral therapy to specific disorders: Efficacy and indications. In: Gabbard GO. Textbook of Psychotherapeutic Treatments. Arlington, Va.: American Psychiatric Publishing; 2009. http://www.psychiatryonline.com/content.aspx?aID=369318&searchStr=cognitive-behavioral#searchTerm. Accessed July 15, 2010.
- Cognitive-behavioral therapy. National Association of Cognitive-Behavioral Therapists. http://www.nacbt.org/whatiscbt.htm. Accessed July 15, 2010.
- Cognitive behavioral therapy, National Alliance on Mental Illness. http://www.nami.org/Template.cfm?Section=About_Treatments_and_Supports&template=/ContentManagement/ContentDisplay.cfm&ContentID=7952. Accessed July 15, 2010.
- Barbara Woodward Lips Patient Education Center. Understanding psychotherapy for adults. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2010.
- Let's talk facts about psychotherapy. Healthyminds.org. http://www.healthyminds.org/Document-Library/Brochure-Library/Lets-Talk-Facts-Psychotherapy.aspx. Accessed July 16, 2010.
- Practice guideline for the treatment of patients with major depressive disorder. 2nd. ed. Arlington, Va.: American Psychiatric Association. http://www.psychiatryonline.com/popup.aspx?aID=49371&print=yes. Accessed July 15, 2010.
- Barbara Woodward Lips Patient Education Center. Cognitive behavioral therapy. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2009.
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