This includes exploring your problem (or problems) to see if CBT will be helpful for you. I will also ask you some more general questions about your family, upbringing, schooling, work and relationships. I will talk to you about what it is that you are hoping to get out of your CBT and by the end of the session I should be able to give you a good idea of how CBT may be used help the problems that you have described, including the number of sessions that you are likely to need. It is also likely that you will have questions to ask and these can be answered towards the end of the assessment. As part of the assessment I will ask you to complete some simple questionnaires.
Assessment sessions can be quite emotional, particularly if you have been trying to deal with things for quite a long time on your own or quite simply, because you will be talking about the things that are upsetting for you. Ensure that you allow yourself time to have a break after the appointment, particularly if you are returning to work or have something important to do afterwards.
Early CBT treatment sessions
It is useful to agree with people about the goals that they would like to set for themselves in the first treatment session. This ensures that the treatment has focus and direction from the outset. Early on in treatment and preferably in the first treatment session, it should also be possible to work with you to develop an individualised “formulation” or simple CBT diagram that explains more precisely, how any difficulties are being maintained. This formulation is important as it is the “road map” for treatment. The formulation may be changed as treatment progresses so that it continues to be an accurate representation of the maintenance factors in the problems that you are experiencing, and a good guide for treatment.
If it is possible we will agree out-of-session work for you to complete after the first CBT treatment session. This work is always negotiated with you and something that you are prepared to undertake. In order for people to build their confidence the process of doing out-of-session work is gradually directed by the person having the CBT. This means that once treatment is complete people are able to continue to use the treatment techniques independently and with confidence and have not become overly-reliant upon the therapist.
Later CBT treatment sessions
Each CBT session begins by setting an “agenda” or a list of things to be covered in the meeting. This ensures that the session time is used effectively and you will be encouraged to bring your own agenda items to each treatment session. As treatment progresses, the main body of each session will be taken up with reviewing out-of-session work, examining the issues and learning points that have arisen for you, thinking about how you can build on the CBT work that you have just done, and setting the next out-of-session assignment.
You will be encouraged to record your treatment sessions during therapy, so please bring along an MP3 player or something similar . It is very helpful if you can listen to each treatment session before the next one takes place. Each CBT session is likely to involve discussing a considerable amount of important material including some ideas that may be new and unfamiliar to you. Many people report that when they routinely listen to their sessions they get more from their treatment . Listening to your sessions also ensures that anything that you have not understood can be addressed at the next appointment if necessary. Listening to your most recent recording is also likely to form part of your out-of-session work.
As the CBT draws to a close we will look together again at the factors that were responsible for the onset and development of your problems, those that contributed to the persistence of the difficulties, and then, most importantly, the techniques and strategies that you used to overcome your problems. I will help you to make a therapy “blueprint” and relapse prevention plan detailing the work that you have done in therapy to continue to use and to keep you well. We will talk about any challenging situations you may be facing after discharge and make a plan detailing how you can use your new knowledge and skills from therapy to cope. If you recorded your CBT sessions you will find it useful to listen back to this body of work from time-to-time and it will form an important part of your relapse prevention plan once active treatment has finished. I will also ask you to complete some questionnaires again.