What you can expect

By Mayo Clinic Staff

Cognitive behavioral therapy may be done one-on-one, or in groups with family members or with people who have similar issues.

Your first therapy session

At your first session, your therapist will typically gather information about you and determine what concerns you'd like to work on. The therapist will likely ask you about your current and past physical and emotional health to gain a deeper understanding of your situation. Your therapist will also want to know whether you might benefit from other 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 course of action.

The first session is also an opportunity for you to interview your therapist to see if he or she will be a good match 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 therapist you see, try someone else. Having a good "fit" with your therapist can help you get the most benefit from cognitive behavioral therapy.

Confidentiality

Except in very specific circumstances, conversations with your therapist are confidential. However, a therapist may break confidentiality if there is an immediate threat to safety or when required by state or federal law to report concerns to authorities. These situations include:

  • Threatening to immediately or soon (imminently) harm yourself or commit suicide
  • Threatening to immediately or soon (imminently) harm or take the life of another person
  • Abusing a child or a vulnerable adult (someone older than age 18 who is hospitalized or made vulnerable by a disability)
  • Being unable to safely care for yourself

During cognitive behavioral therapy

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 generally focuses on specific problems, using a goal-oriented approach. As you go through the 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 — and encourage you to apply what you're learning in your daily life.

Steps in cognitive behavioral therapy

Cognitive behavioral therapy 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 mental illness. You and your therapist may 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. Your therapist will likely encourage you to ask yourself whether your view of a situation is based on fact or 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. 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
Feb. 21, 2013