Cognitive behavioural therapy (CBT) sessions typically take place on a weekly basis. CBT is a relatively short-term therapy; generally, about 10 to 20 sessions are involved. Sessions tend to become less frequent as the course of therapy progresses, when clients have made significant progress. At the end of therapy, occasional top-up or booster sessions – for example, three, six and 12 months later – are recommended.
Sessions last a minimum of 50 minutes. The initial sessions involve an assessment period where we will discuss your presenting problems and your expectations of therapy. We will discuss your background information, draw up a wish-list and potential obstacles, and explore how the CBT model pertains to your difficulties. Based on this shared assessment, treatment will begin and future sessions will aim to help you better understand your problems and learn new ways of tackling them.
These sessions are typically quite structured in nature, with a clear beginning, middle and end. Sessions begin with a brief mood check and a review as to how you have been feeling over the past week. We will discuss the previous session to see if you found any aspects particularly helpful or unhelpful and to see if we need to follow up on any issues discussed; I will ask you to name the most important problem you encountered during the week (or expect to encounter during the coming week); mention any recent positive and negative experiences you feel I should know about; and explore the treatment tasks you did during the week. This will help us to agree an agenda for the current session, prioritising the most important aspects (please note that if something more important arises during session, we may agree to deviate from our planned agenda).
Towards the end of the session, appropriate and manageable self-help assignments for the coming week are agreed. We will end with a review of the session and I will ask you for feedback. How did you feel the session went? Did anything about it bother you or was there a point that you think I may have misunderstood? Would you like to change anything for future weeks? My job is to help you, so honest feedback is both welcome and encouraged.
Confidentiality is very important in therapy. In general, what is said in sessions remains confidential.
If I need to discuss your case with a GP or another health professional, I will first ask for your permission.
It is recommended that all therapists meet with an experienced peer who provides clinical supervision. This is for the benefit of clients, to ensure my work is carried out in an ethical, professional fashion. During supervision, I discuss my work with clients, making sure to use first names only. Supervisors are also bound by confidentiality.
In exceptional cases, it may be necessary to break confidentiality. Examples would include if I had serious concerns regarding the safety of the client or for the safety of another person; mandatory requirements to report suspected child abuse; if the law had been broken; or if disclosure of client information was mandated through the legal system.