A course of therapy consists of a (variable) number of sessions and will generally follow the outline below. However, everyone is unique (as are their problems!), so this is only a guide. You (and I) are free to change things as necessary.
1. The Assessment Session (free)
This is a relaxed chat where you tell me the difficulties you’ve been experiencing and what you’d like to achieve from therapy, and I will ask some questions and outline the CBT model for you. There’s no pressure and you’re welcome to go away and have a think about it all – I understand that undergoing any pyschological therapy is a daunting business!
This session will also allow me to assess the appropriateness of CBT for your particular difficulties. Whilst many CBT books (and practitioners) say that good results are obtained in virtually the entire spectrum of psychological problems, I believe that some difficulties such as psychotic disorders and substance abuse are best dealt with in a multi-disciplinary setting such as is provided by the specialist NHS services. These can be accessed by GP referral.
2. The Early Sessions
I discuss the CBT model in more detail and together we will begin to apply it to your particular difficulties. We will look for the ways in which your thinking is causing your problems, the starting point of which is to look for the “Negative Automatic Thoughts” (or NATs) that usually accompany unpleasant emotions. I will ask you to monitor for NATs between sessions, bringing back the results for discussion.
3. The Middle Sessions
You will now be more aware of your thinking processes, and be on the look-out for those NATs! And now we begin to challenge these problem thoughts, exposing them as the irrational, unhelpful (and often plain daft!) things that they are, and learn to recognise more adaptive and helpful ways of thinking. Challanging NATs reduces their impact on your emotions and you will (hopefully!) begin to feel better.
4. The Later Sessions
You’ll have experience with recognising and dealing with NATs, and you should be feeling the results. But we won’t stop there because you’ll probably want to know why you have NATs – some people don’t have them at all – and where they came from.
Your NATs are related to your Unhelpful Core Beliefs (UCBs). UCBs are the deep underlying cause of your emotional and psychological difficulties. They are commonly formed through adverse childhood and adolescencent experiences – even seemingly minor events can do it – and we tend to carry them throughout our lives.
UCBs distort the way you view yourself, others, and the world around you. Ultimately, they cause your NATs and hence your emotional problems. We can therefore trace back through your emotional problems and NATs to find these UCBs and – you guessed it – expose them to our vigorous scrutiny, wherein they will crumble to dust… or something like it.
Challenging your UCBs and finding adaptive and helpful alternatives is the surest way to a comprehensive and long lasting triumph over your emotional and psychological difficulties.
5. The Final Sessions
By now you will be fully “au fait” with CBT and your own thinking processes. You can recognise your NATs from twenty feet and can shoot them down with ease. Your UCBs cringe under your rational gaze. You feel better and all is well with the world…
Except that nothing’s easy, is it? UCBs are very resistant to change – they’ve probably a fundamental part of “you” for many years – and so you will remain at risk of distorted thinking, NATs, and hence emotional difficulties, for a long time.
In these final sessions we will discuss ways of preventing any resurgence of problems in the future, and also ways of dealing with them should they in fact recur.