Sessions in therapy changes depending on the specific patient and their presenting problem, goals for therapy, and case formulation (hypotheses about what might be the cause of a person’s psychological distress).
Fortunately, a benefit of CBT is that it is very structured. There is a guiding roadmap so that the therapist never loses themselves in the forest of therapy.
This article provides useful elements that are always helpful to touch on in each therapy session even if much of rest can depend on the specific patient’s needs.
1. Setting an agenda
Setting an agenda helps with forming structure during therapy. Of course, many things can come up in therapy and it’s completely okay to deviate at times; however, an agenda helps to get patients back on track if too much time is spent simply talking about a problem (rather than the work needed to get them on track!).
You should also check in with the patient to see how the agenda fits for them and if there is anything specific that they would like to add. This supports a sense of collaboration and creates a feeling of being valued from the patient’s side.
An example of an agenda:
- Check in on the previous week
- Complete mood questionnaires to evaluate progress
- Homework review and troubleshooting
- Introduce behavioural activation
- Assign home practice based on planned activities that bring pleasure and mastery
- Obtain feedback from patient
2. Summarize last session’s main points
Memory is a fickle creature and both the clinician and the patient are liable to forgetting important talking points in the past session.
Therefore, I typically like to briefly mention some of the main takeaways and home practice that was assigned from the previous session. This helps to refresh and consolidate learning, as well as facilitates a smoother transition into the current session.
For example, you might say something like:
“Last week, we had discussed the role those anxious predictions have on your behaviours, such as deciding to stay home and avoid situations. These behaviours relieve anxiety in the short-term but they maintain your problems in the long-term. We had talked about how these behaviours affect areas of your life that are important to you, such as making friends and travelling. To support our goals, we had assigned a home practice to engage in a behavioural experiment to see whether our anxious predictions are actually true”.
3. Obtain a brief update on the past week
It’s also helpful to get a sense of how the patient has been since the last time you spoke to them. This information help guide therapy by understanding how the patient responded to different challenges, emotions, thoughts, and what has been working for them/not working for them.
However, you should be cautious about spending too much time in this area as some patients tend to be more talkative and may get off-track. In this case, a gentle redirection to the agenda would be the proper action.
4. Check in on home practice
Checking in on home practice is necessary to emphasize to the patient the importance of between session homework. Without proper practice of skills, patients will have difficulty seeing improvements and becoming their own therapist.
Therefore, regular check-ins help to set an expectation to patients and gives the clinician a chance to troubleshoot challenges that come up or reinforce successes that they patient might have had.
5. Collaborate on home practice for the following session
Based on goals and topics discussed in the session, there is of course the need to assign specific home practice for the week.
When assigning home practice, ensure that it is collaborative, and the patient understands why they are putting in the hard work for this plan. It’s also good practice to check-in about how they feel about the assigned work and if they are confident that they would be able to properly try it out.
If there are reservations, troubleshoot by asking questions such as “what makes this practice more challenging?” and “how might we make this practice feel for right you?”. The use of SMART Goals setting can be a great way to support the development of achievable and relevant goals.
6. Get patient to summarize main points of the session
To consolidate learning and ensure that the patient has a good sense of the plan for the week, it is often helpful to get the patient to briefly summarize what was discussed during the session.
This is also a good way to check for comprehension and clarify anything that was confusing to them.
7. Elicit feedback from the patient
Although it can feel somewhat vulnerable to ask the patient for feedback, this can be an extremely helpful practice because it really shows to your patients that you care about their well-being.
Moreover, this feedback can be instrumental in making sure that the treatment is going well for the patient and allow for honest conversations about whether changes in therapy are needed. If you’re still a little worried, remember that most feedback will be positive and you’ll typically be seen even more positive light for asking!