What is Cognitive Behavioral Therapy?

       Cognitive Behavioral Therapy ("CBT" or sometimes known as "CT") is a form of psychotherapy that teaches people specific cognitive and behavioral skills to help them manage depression, mood swings, anxiety, stress and other problems. Typically, CBT involves a very structured systematic approach in which clients are taught specific techniques to address problematic thoughts, feelings and behaviors that are interfering with their lives.
 

Examples of How Cognitive Behavioral Therapy Works

        For example, many people with depression have an overly negative, self-critical view of themselves and feel hopeless about the future. Cognitive therapy works to help clients identify certain types of thinking “errors” in which people tend to minimize accomplishments and dwell on problems in ways that are unhelpful and may generate ways of reacting or behaving that are unhelpful and cause additional problems. The therapist also helps individuals recognize and address environmental stressors (major life changes, relationship problems, conflict situations, etc) that may exacerbate their depression, anxiety, mood swings or other problems. Such changes in habitual ways of thinking and behaving may require a great deal of practice, individualized attention and encouragement. However, once individuals learn that they can manage depression, mood swings, anxiety, stress and other problems more effectively, their sense of self-efficacy and self-esteem typically improves, and they are much more likely to apply their newly learned skills in the future.

       Most of us use many of these skills on a daily basis in our attempts to cope with the stresses and strains of daily living, but we apply them so naturally and easily that we simply have little awareness that we have done so. In our experience, these mood and anxiety management skills or techniques can be taught effectively even to clients who have had very serious histories of hospitalization and long-term illness.
 

 Collaboration in Psychotherapy

      Cognitive behavioral therapy uses a collaborative approach in which the therapist and client work together to develop specific goals for treatment identify specific problems and develop solutions. From the initial session, I will emphasize that therapy is a working partnership and that successful treatment depends on active participation in therapy and a willingness to engage in new behaviors and to test out new ways of thinking. The most effective approach to exploring problems and developing solutions is not giving advice or direction but helping clients discover helpful solutions that they may have tried in the past using open-ended questioning and exploration sometimes called “Socratic Questioning”.

 An Active and Structured Therapy

      Cognitive behavioral therapy tends to be an active, directive, structured type of therapy in which each session has a specific “agenda” or set of problems to be worked on that is mutually identified by the client and the therapist. The client is expected to be an active partner in therapy including identifying problems, setting the agenda for sessions, trying out new thoughts and behaviors, setting up experiments to test out and develop solutions, and doing activities between sessions (called “homework”). The client is also expected to give periodic weekly feedback to the therapist about how things are going in the therapy and to identify any concerns or issues about treatment.
 

 What to Expect in Our First Appointment

     In the first appointment with me I will ask you a number of questions about the problems you are experiencing, your personal and family history, your goals for psychotherapy, your expectations and your hopes for the future. By the end of the first or second appointment I will also discuss possible treatment options that might be helpful for you and make specific recommendations. If cognitive behavioral therapy is recommended, I will explain what to expect and how the therapy works.
 

What Does a Typical Cognitive Therapy Session Look Like?

    Most appointments in cognitive behavioral therapy are more structured than in other therapies and typically have many of the following components:

1. A “check-in” which often involves the use of a mood graph to look at mood shifts over the past week

2. Setting the agenda- developing a plan for the session in terms of the most important topics

3. Review of the homework- reviewing any homework assigned in the past session with a special emphasis on problem-solving if there were any problems completing homework or barriers

4. Working through problems on the agenda

5. Summarizing the session and assigning homework. Not all sessions are this structured and sessions may vary a good deal in content. The goal is to make efficient use of therapy time by carefully structuring the therapy session in order to be most productive.

The Use of “Homework” in Cognitive Therapy

    The use of homework is an important part of cognitive therapy in that it extends the effectiveness of therapy into the client’s life and encourages practicing new skills and behaviors outside the therapy session.