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Starting cognitive behavioral therapy
Usually you 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 private home. Therapy also can take place in a hospital, if you've been admitted for treatment. You usually meet with your therapist once a week for a session that lasts about 45 to 60 minutes. Cognitive behavioral therapy also can be done for your whole family or in group sessions for people with similar issues.
Your first cognitive behavioral therapy session is usually a time for the therapist to gather information about your situation. The therapist may ask you to fill out forms about your current and past physical and emotional health. All this information helps the therapist gain a deeper understanding of your situation and whether you might benefit from other or additional treatment, such as medications. It might take a few sessions for a full evaluation of your situation and issues.
Exploring your therapist's approach
At any time during cognitive behavioral therapy, especially in the beginning, feel free to ask your therapist questions about:
- His or her general approach
- The goals of your treatment
- How long therapy may last
- When and how to contact your therapist during a crisis
- Any other details about your therapeutic relationship
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. Talk to your therapist about any worries you might have about confidentiality.
During psychotherapy
For cognitive behavioral therapy, as with most types of psychotherapy, you and your therapist generally sit facing each other during sessions. Your therapist encourages you to talk about your thoughts and feelings and what's troubling you. You may 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 and goals affecting you now. 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 may ask that you schedule time for activities you enjoy or once enjoyed.
Because psychotherapy sometimes involves intense emotional discussions, you may cry, get upset or have an angry outburst during a session. You may also feel physically exhausted after a session. Your therapist helps you cope with these feelings and emotions.
Five typical steps in cognitive behavioral therapy
Although there are different ways to conduct cognitive behavioral therapy, it typically includes five steps:
- Identify troubling situations or conditions in your life. These may include such issues as a medical condition, divorce, grief, anger and specific mental illnesses, such as panic disorder or bipolar disorder. 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 encourages you to share your thoughts about them. This may include 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 and self-talk. Your thoughts and beliefs may be positive, negative or neutral. They may be rational (based on reason, logic or facts) or they may be irrational. As you continue with cognitive behavioral therapy, you explore negative or inaccurate thought patterns and work to replace them with more positive, accurate thinking.
- Identify negative or inaccurate thinking. Your thoughts about a situation or condition can affect the way you react to it. Inaccurate or negative thoughts and beliefs about something or someone can lead you to react in undesirable ways. To help you determine whether distorted thinking may be contributing to your problem, your therapist may ask you to pay attention to your physical, emotional and behavioral responses to a troubling event.
- Challenge negative or inaccurate thinking. As you continue to examine your thinking patterns, your therapist may encourage you to test the validity of your thoughts and beliefs. This may include asking yourself whether your view of an event fits the facts and logic, and whether there might be other explanations for a situation. 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 to you. You may not easily recognize inaccuracies in your thinking.
- Change your thoughts and beliefs. The final step in the cognitive behavioral therapy process is to replace negative or inaccurate thinking with positive and accurate thoughts and beliefs. By changing your view of a situation and your view of yourself, you may be able to find more constructive ways to cope — your behavior will become less harmful or self-defeating. Changing your thought patterns also can be difficult. Thoughts often occur spontaneously or automatically, without any effort on your part. It can be hard to control or turn off your thoughts. Thoughts can be very powerful, and they aren't always based on logic. It takes time and effort to learn how to replace distressing thoughts with rational, positive ones. Your therapist can help you recognize and challenge distorted thinking with more realistic thinking. Your therapist also may help you identify behaviors you wish to change and give you the chance to practice new ways to deal with situations that trigger negative, distorted thoughts.
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
- 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
