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What does Cognitive Behavioral Therapy look like?

Cognitive Behavioral Therapy (CBT) typically lasts 12 to 16 sessions. Of course every client is different and therapy is always specialized to target your specific needs and goals. I have had some clients complete treatment in 6 to 8 sessions and others who needed 16-20 sessions. However on average, CBT typically lasts 3-4 months (12-16 sessions) of once a week sessions.

The following is a general guideline of what to expect over the course of CBT:

INITIAL PHASE Sessions 1-3

1. Intake

During the intake the therapist gathers information about your current concerns, your symptoms, and the things you are currently struggling with. This is when the therapist gets to know you and what brought you into therapy. The therapist also gathers information about your past, especially as it might relate to what you are currently dealing with. You might be asked about what your family was like while growing up, how you did school and made friends, your pattern of romantic relationships, any history of substance use, and your previous experiences with mental health treatment.

2. Treatment Goals

It is important that you and your therapist clearly lay out goals for treatment. We use these goals to check in periodically to see if therapy is actually helping! This helps us stay on track and make sure that what we are focusing in therapy is helping you make progress towards your goals. Your therapist will help guide you as you think through what your goals are and what changes you would like to see in your life. A question I like to ask is: “If you went to bed tonight and your mental health issues were magically cured overnight how would you know when you wake up the next day? What would you be doing differently? What would others notice was different about you?” It is important that you have short term goals that can be achieved during the few months of therapy (e.g., starting to go out and get to know people) that will then help you work towards your long term goals (e.g., gain new friends).

3. Motivation and Readiness for Treatment

We all want to feel better and make healthy changes in our lives. That is why most of us set New Year’s resolutions. However, sticking it out is another story and many of us drop our New Year’s resolution before the month of January ends. A similar thing can happen in therapy! In order to try to prevent this it is my goal to help you identify your motivation for therapy so you clearly know the reasons why you want to change. This will help you stay on track when things get difficult. Therapy can be tough at times. You are talking to someone about the exact things you usually try not to think about! You are also being prompted to step out of your comfort zone to make changes. One helpful way to think about therapy is to liken it to going to physical therapy. A physical therapist will have you do stretches and exercises that push you to your limit. She then has you practice these exercises at home to increase your strength, and she knows when you haven’t been practicing! Over time, your strength and flexibility builds and you are able to do things you could not do at the beginning. Eventually you do not need physical therapy anymore. Therapy is similar. Your therapist will guide you as you talk about difficult things. You will have practice assignments to work on during the week to help you really learn and practice the skills you were taught in session. Eventually you will start to learn how to become your own therapist as you apply these skills outside of therapy in your day to day life.

MIDDLE PHASE Sessions 4-9

1. Behavioral Strategies aka Learning ways to Change What you DO.

I usually like to start therapy by examining your behaviors: the things you are doing or not doing. I have found that this helps many people get a jump start on making changes. In addition, as we explore the things you do (or don’t do) we can begin to identify how your thoughts might be keeping you stuck. Some of the behavioral strategies we might use include:

  • Taking notes in therapy
  • Monitoring you mood and thoughts during the week
  • Learning Problem Solving Skills
  • Increasing Pleasant Events and Self-Care
  • Learning Coping Skills
  • Learning Relaxation Skills

2. Cognitive Strategies aka Learning ways to Change How you THINK.

We don’t usually walk around thinking about how we think. Our thoughts are usually automatic and when we are depressed or anxious they tend to run through our minds a million miles an hour. Cognitive strategies will help you learn to identify those automatic thoughts, slowdown that spiral of escalating thoughts, look for patterns, challenge those thoughts, and create new, healthier thoughts. Some of the cognitive strategies we might use include:

  • Writing in a journal
  • Learning to connect an event — with a thought — with an emotion (we call this completing a Thought Record)
  • Learning to challenge our automatic assumptions (gain new perspectives, discover new meanings)
  • Learning to recognize unhelpful patterns of thinking (such as jumping to conclusions)
  • Writing Coping Cards to help remind us of other ways to look at the situation

LATER PHASE Sessions 10-16

1. Refining Skills and Applying them in new situations

Once you’ve built up a tool box of a variety of skills the challenge in therapy shifts to learning how to refine those skills and adapt them to newer, sometimes more challenging, situations. It is kind of like learning how to drive a car. At first you were running through the checklist of things to do, consciously reminding yourself to check your mirrors and position. However, with time and practice you became better at it, it doesn’t take as much effort, and it feels more automatic. Until of course you get a rental car, in this new situation you may notice that you need to go back to basics and put a little more effort into being aware of things as you drive in a different car.

2. Relapse Prevention and Maintenance Planning

This phase focuses on outlining your typical patterns and triggers, anticipating situations when you may feel more stressed, and creating a plan of action. Life is naturally full of ups and downs, and plateaus. The goal is to help you know where to turn to and what to do when facing new challenges. Whether that is contacting a mental health professional for particularly challenging situations, or remembering to go back to the basics of your coping skills, my hope is that you feel empowered and in control of your mental well-being.