Cognitive behavior therapy is based on the cognitive model: the way we perceive situations influences how we feel emotionally.
For example, one person reading this website might think, “Wow! This sounds good, it’s just what I’ve always been looking for!” and feels happy. Another person reading this information might think, “Well, this sounds good but I don’t think I can do it.” This person feels sad and discouraged.
So it is not a situation that directly affects how people feel emotionally, but rather, their thoughts in that situation. When people are in distress, their perspective is often inaccurate and their thoughts may be unrealistic.
Cognitive behavior therapy helps people identify their distressing thoughts and evaluate how realistic the thoughts are. Then they learn to change their distorted thinking. When they think more realistically, they feel better. The emphasis is also consistently on solving problems and initiating behavioral changes.
It’s important to remember that cognitive behavior therapists use a different formulation for each psychiatric disorder. We use this formulation in conceptualizing the individual patient, which is an essential component to developing a sound therapeutic relationship, setting goals, planning treatment, and selecting interventions. Building trust and rapport with patients from the very first contact, demonstrating accurate empathy, sharing the conceptualization with the patient (and making sure it “rings true” for the patient), and collaborating are also essential. Another important part of every therapy session is helping patients respond to inaccurate or unhelpful ideas. The basic question to ask when a patient is reporting a distressing situation, emotion, or dysfunctional behavior is: “What is going through your mind right now?” Once we help patients identify their dysfunctional thinking, we help them gain more adaptive and accurate perspectives, especially by helping them examine the validity and usefulness of their thoughts. We also help them design behavioral experiments to test the accuracy of their predictions.
If you are undecided about therapy, think about the following:
You don’t need to make a commitment to a minimum number of sessions:
Some patients find even a few therapy sessions useful and then choose to continue working on their own.
View therapy as an experiment:
There is no way of your knowing in advance that cognitive therapy will definitely help, but it has helped countless people with difficulties. Think of giving cognitive therapy a try; there’s probably no hard evidence that it won’t help.
Realize that there is no big risk:
If it’s not helpful enough, you can stop, but the potential benefit might be great. It would be a shame if you decided not to try something that could really make a difference in your life.
It’s normal to have concerns:
You may worry whether therapy can help or you may feel hopeless about it. If you’re predicting that nothing will make you feel better, you may be wrong.
Finances are often a problem:
Many insurance plans pay for part of the cost of evaluation and treatment. Our goal is to teach you to be your own therapist and to keep therapy short, so cognitive therapy may be the best investment you could make.
If you’d like to know more, please call our intake coordinator, Molly Finkel, at 610-664-3020. There are also many excellent self-help books that can give you a good idea of what cognitive therapy is all about. We also have a recent blog post about this as well.
Cognitive therapists, being both practical and collaborative, can discuss the advantages and disadvantages of medication with you. Many patients are treated without medication at all. Some disorders, however, respond better to a combination of medication and cognitive therapy. If you are on medication, or would like to be on medication, you might want to discuss with your therapist whether you should have a psychiatric consultation with a specialist (a psychopharmacologist) to ensure that you are on the right kind and dosage of medication. If you are not on medication and do not want to be on medication, you and your therapist might assess, after four to six weeks, how much you’ve progressed and determine whether you might want a psychiatric consultation at that time to obtain more information about medication.
One way is to ask your therapist how you might be able to supplement your psychotherapy with cognitive therapy readings, workbooks, client pamphlets, etc. A second way is to prepare for each session, thinking about what you learned in the previous session and jotting down what you want to discuss in the next session.
A third way to maximize therapy is to make sure that you try to bring the therapy session into your everyday life. Therapists should make sure you take home notes or a recording of anything you want to remember, both changes in your thinking and an action plan to follow during the week.
Many patients notice a decrease in their symptoms within a few weeks of therapy, or even sooner, if they have been faithfully attending sessions and doing the suggested assignments between sessions on a daily basis.
At each therapy session, cognitive behavior therapists help clients specify the problems they have encountered during the week or that they expect to encounter in the current week. They then collect data to identify the ideas and behaviors that have interfered with patients’ ability to solve problems themselves. Cognitive behavior therapists get clients actively engaged in deciding where to start working. Together, they develop an “action plan” or homework for patients (to do during the week) to implement solutions to problems or to make changes in their thinking and actions. This process gets clients actively involved in their own treatment; they begin to recognize that the way to get better is to make small changes in how they think and what they do every day. When treatment ends, clients are able to use the skills and tools they have learned in therapy in their day-to-day lives.