CBT: Structures and Styles

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When people learn I'm a psychologist they sometimes become wary. For instance, I'm sometimes asked if I "read minds" and, more often, if I'm always analyzing everything a person says and does. Both are misconceptions — although I admit the mind-reading part could come in handy sometimes — and many people hold similar misconceptions about therapy. In this post I want to explain something about the structure and styles of one of the most commonly used approaches: cognitive behavioral therapy.

The CBT approach

Cognitive Behavioral Therapy (CBT) is one of the most practical forms of therapy you are likely to encounter. The patient usually sits at a table with a therapist, sometimes over a cup of coffee. The therapist will provide an outline of what's involved and will ask about your problem(s) and what it is you want from therapy. It is then the job of the therapist to structure what happens next.

Your therapy won't be about saying whatever comes to mind. It will be a highly focused and structured affair. We've learned that structure is one of the most helpful aspects of therapy. By structure, I mean the number of sessions and what happens within these sessions. Your therapy, in other words, will have a clear beginning, middle and end.

Structure within sessions

Your first couple of sessions will probably focus on detailed information gathering, working up some goals, and settling on ways to record progress. The plan isn’t set in concrete, so if something important crops up, it will be attended to regardless of what you may have planned. Flexibility within a structure is perfectly acceptable.

Every session starts with making a plan for that session. Progress from the previous session is checked. The middle part of the session involves discussing the problem, maybe revising what needs to happen, and settling on how to move forwards. Sometimes the therapist will undertake "behavioral experiments" with you in order to demonstrate a point. The last part of the session involves setting homework tasks.

Styles of therapy

No two people are alike and the same applies to therapists and clients. "Style" in this sense can be thought of as the approach used by the therapist. Even though you've agreed on your goals, you are undertaking activities that will feel uncomfortable. Your therapist will be sensitive to your feelings, but may also need to be firm with you. This firm-but-fair style is common and you should expect it.

Self-criticism is not helpful. Compassion for yourself, but determination to try, is far more beneficial. The style of therapy will vary somewhat according to the task(s) ahead of you.

Time limits

A session of therapy usually lasts for an hour, or slightly less. Depending on your needs, therapy could last anywhere from five or six sessions to upward of 20 or more. A central aim of therapy is to equip you with all the tools you'll need for life. In this context, the time spent in therapy represents a short-term cost for a lifetime of benefits.

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Dr. Jerry Kennard is a Chartered Psychologist and Associate Fellow of the British Psychological Society. Jerry's clinical background is in mental health and, most recently, higher education. He is the author of various self-help books and is co-founder of positivityguides.net.