Please click on individual components for a description:
A. Assessment (1-2 sessions)
At the outset of treatment, clients have a 45 or 90-minute consultation with a psychologist. Depending on the age of the individual
presenting for treatment as well as the presenting problem, this consultation may involve parents, spouses, or other caregivers.
The purpose of this initial meeting is to assess the client's presenting problem, the history of the client's difficulties, current
and prior treatments, and family history of psychological disorders. In addition, the therapist gathers information about other
aspects of the client's life, including relationships, medical history, academic and work history, as well as recent and long-term
stressors that may be affecting the client's life and mood. Finally, the psychologist works with the client to set goals to lessen
symptoms of distress, resolve problems, and improve functioning. The psychologist also assesses the client's expectations for therapy.
At the conclusion of the consultation, the therapist provides the client(s) with his or her initial impressions, as well as recommendations
for treatment. At this point, the therapist and client(s) determine whether the current provider and the proposed treatment plan is a
good fit for the client's needs and goals. If the client and therapist collaboratively agree to start treatment, a treatment contract
is developed outlining goals and timeframes for treatment. Should the therapist and/or client determine that another provider would
be more effective in addressing the client's needs, a referral would be made at this time.
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B. Psychoeducation (1-2 sessions)
Prior to starting treatment, the therapist provides the client with psychoeducation regarding his or her presenting problem,
diagnosis, and treatment. The therapist may provide the client with recommendations for articles, books, and other readings
that will provide additional information regarding symptoms, prognosis, and treatment options. This is a period of both orienting
the client to the components of the treatment plan, and using strategies to build commitment for the treatment plan. Given the
collaborative nature of cognitive behavioral treatment, the therapist emphasizes the need for the client's participation and
feedback, as well as the completion of homework assignments between sessions to assist with skills generalization. Depending
on the client's presenting problem, the therapist may be orienting the client to one or more therapeutic modalities, including
individual therapy, family therapy, couples counseling, group therapy, and parent training.
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C. Treatment (varied length)
Depending on the specific presenting problem, therapists choose from a menu of cognitive behavioral techniques to help the
client to address his or her difficulties and improve his or her quality of life:
- Cognitive Strategies: Clients learn to notice thoughts, be present in the moment, understand the impact of thoughts on the
way they feel and behave, accept thoughts even when they are painful, and change thoughts that are inaccurate, unhelpful or are
causing emotional pain.
- Behavioral Strategies: Clients learn strategies to solve problems, make effective decisions, manage time effectively, complete
tasks and overcome procrastination, confront situations that are feared or avoided, learn new skills, such as social skills,
negotiating skills and assertiveness training, and identify and work toward valued life goals.
- Physical Strategies: Clients learn to counteract unpleasant physical symptoms associated with different feelings by tensing
and relax various muscle groups, performing breathing exercises, and learning other meditative techniques to reduce tension
and improve well-being.
The skills described above are applied within a range of therapeutic modalities, including individual, group, family, couples,
and parent training. For children and adolescents, parent training and family therapy are included as an essential component of
the treatment plan. By adopting this type of comprehensive treatment approach, therapists help clients to generalize skills
learned in treatment, address systemic factors that may be contributing to or maintaining problem behaviors, and conduct
interventions in the environment to increase reinforcement of skillful behaviors.
a. Individual therapy
Individual CBT therapists will help the client to: 1) identify goals designed to reduce symptoms or problem behaviors, increase
skillful behaviors, and improve quality of life; 2) learn a variety of cognitive and behavioral strategies to achieve identified
goals; 3) maintain motivation to participate in treatment and generalize skills outside of session; and 4) monitor treatment progress
to determine when treatment is complete and/or treatment goals need to be revised.
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b. Group therapy
Cognitive behavioral group therapy is a form of treatment in which a carefully selected group of individuals meets regularly
with a therapist. CBT groups range from 2 – 6 months and assist members with improving their ability to cope with various emotions
and to solve problems. For example, individuals who struggle with social skills learn strategies for managing feelings of anxiety
and other emotions that interfere with relationships, techniques for communicating more effectively, and ways to maintain and strengthen
social connections. Group therapy has been shown to be effective for a wide range of presenting problems, including but not limited
to depression, social anxiety, performance anxiety, anger management, stress, and eating disorders.
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c. Family therapy
Family therapy brings about change and development by examining the role of interactions between family members in psychological
health. In family therapy, there is a focus on involving families in solutions, regardless of whether the original problem was
viewed as an "individual" or "family" issue. The involvement of families is usually accomplished by their direct participation in
the therapy session. Depending on the presenting problem and goals of therapy, family therapy may be the primary treatment modality
or may be employed as needed in addition to individual therapy.
d. Parent training
Parent training focuses on helping caregivers with implementing behavioral plans that support the treatment goals of child and
adolescent clients. Therapists work with parents on such goals as creating behavioral contracts aimed to increase the frequency
of skills use and decrease the frequency of problem behaviors. Such training may also include in-session coaching, as well as modeling
of reinforcement, effective commands, and strategies for resolving problems.
e. Couples therapy
Couples therapy helps partners understand and resolve conflicts with the goal of improving the relationship. The purpose of
this treatment is to assist clients with communicating, resolving differences, and solving problems in a more effective way.
In couples therapy, the therapist works with couples to identify problematic behavioral patterns and address factors, such as
high levels of emotional arousal and inaccurate thoughts, which may be contributing to and maintaining problems in the relationship.
Given that relationship problems can create feelings of misery, effective couples therapy can help to improve the mood and well
being of each member of the couple.
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Maintenance/Relapse Prevention Phase (as needed)
Once the active treatment is completed, mutually agreed upon goals have been met, and the client has demonstrated that he or she
can adequately apply strategies to daily life, the maintenance/relapse prevention phase is initiated. During this phase,
sessions are gradually tapered, as needed from weekly to biweekly, to monthly, and so on. The therapist reviews the client's
progress in treatment, skills learned, and tools the client will continue to utilize to maintain treatment gains. The therapist
and client collaboratively work on relapse prevention by discussing potential symptom recurrence, identifying stressors that
trigger symptoms, and developing plans for coping with these stressors. During this phase, the therapist and client will also
discuss conditions under which the client may consider 'booster sessions' to review and reinforce skills.
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