What actually happens in a CBT appointment?

Sarah22nd February 20219 min

What actually happens in CBT appointments? This is something I asked myself before I attended therapy. I’d read they gave you homework and was worried this could be time consuming or feel childish. I think one of my main fears was that therapy in general would be patronising. I’m intelligent, have studied psychology and I know I’m being silly and my thoughts are irrational so what more can CBT teach me? CBT wasn’t always about learning something new, I think I greatly benefited from having space and time to really think about my anxiety and address it head on with a therapist.

My CBT was to address Social Anxiety Disorder. At the start of every appointment, I was asked to fill in an anxiety/depression questionnaire. It was beneficial to see my scores improving as the weeks went on - a visual representation that the sessions were working for me and a reminder of how far I’d come in a short amount of time. It also took my mind off things whilst waiting for my appointment to start.

My first appointment was a general ‘assessment’ appointment to see if CBT was suitable for me. Myself and the therapist discussed a general overview of my symptoms and what I wanted to get out of therapy appointments. I cried for the majority of the appointment and I HATE ugly crying in front of people (you know when the tears are flowing and so is your nose). The therapist didn’t mind, she would offer me tissues, sit quietly and let me stop crying or compose myself and finish what I was saying. We agreed on an appointment schedule (I think it was 45 minutes to an hour session, once every week or two). I was allowed to bring a friend in my appointments if I wanted, but it felt like a personal thing I needed to do by myself.

Is it worth mentioning there was no lying down on a couch like in all the american movies?? We both sat on chairs opposite each other and near a box of tissues should you need them and the therapist would make notes throughout the session. During my appointments, we would talk about specific events/ situations I’d found challenging and why I thought that way. My therapist helped me challenge my thoughts and think about the situation in another way. For example, we discussed how I thought everyone would think of me as incompetant when I was shopping alone if I stayed in an aisle too long looking for something. She would ask why I thought that, had anyone ever said that to me? Was I just assuming? Does it really matter what a stranger thinks? Wouldn’t they be too busy concentrating on their own shopping list? 

We also discussed some of the science and psychological models behind my thoughts/behaviour. This work was done by a combination of talking out loud and writing things down on paper. For example, whenever I was walking alone I would always call someone. We discussed how this was a ‘safety behaviour’, something someone with social anxiety does to feel better, but in the long run it just maintains there’s something to be anxious/scared about. 

My therapist did also set me homework. This was never anything that took loads of time, it wasn’t every week and wasn’t a burden. There also wasn’t a set homework sheet to fill out (I don’t know why but that’s what I’d imagined). One task set was keeping a note of every time I went to do something that made me feel anxious, how did I cope/ feel afterwards etc. Another was asking me to do something out of my comfort zone that I would never usually do, then speaking about it in my next appointment. My therapist helped me come up with a plan for this - I was to get the bus by myself into town and sit in a coffee shop alone with a drink or cake. Spoiler alert - didn’t do it, felt like too much too soon, but I went for a walk by myself without calling anyone and reported back to my therapist about that instead. She didn’t mind as it was still progress.

My final couple of sessions looked at relapse prevention and giving me the skills I would need when my anxiety inevitably returned. My therapist explained some coping techniques I could use when feeling anxious and practiced these with me in the sessions. The main one I remember was the 5-4-3-2-1 grounding technique (5 things you can see, 4 things you can feel, 3 things you can hear, 2 things you can smell, 1 thing you can taste). 

If you have any questions or concerns about therapy, these can be discussed with your therapist either in your initial assessment or at any stage during your appointments. If you don’t click with your therapist, it’s perfectly fine to ask for a new one. Remember your therapist has probably seen and heard it all and they just want the best for you, they’re not there to judge. CBT also might not work for you, but you won’t know until you try.

“Mental health is not a destination, but a process. It’s about how you drive, not where you’re going” – Noam Shpancer, PhD

Sarah x

Related posts