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What Happens In A Therapy Session?


In some of my conversations with clients, they discuss barriers to treatment. These are obstacles that prevent them from reaching out for help. Some clients cite providers lacking consistent availability while others express a need for telehealth (or in-person) services. But, I frequently hear clients mention their concerns about the therapy session itself.


"What will I talk about? What if I can’t figure out what to discuss? How long will the sessions last?" These questions are common and have very specific answers.


While a therapy session is largely open-ended, its structure typically falls within a consistent format. Most cognitive behavioral therapists will begin a session by checking in on your emotional state and asking about updates from the prior week(s); you’ll then move on to structured agenda setting. Agenda setting is beneficial as it is positively associated with reliable improvement within treatment. Oftentimes, your therapist will bring up a few issues that you may have mentioned in the intake session (core themes that initially brought you to therapy); you may also have a few topics that you want to address (more recent events). Collaboratively, you’ll decide what’s on the docket for the next hour (53 minutes, to be specific).


Next, the session transitions into the skills which you will be learning in therapy. For many clients, earlier sessions will consist of linking thoughts with emotions and behaviors. This skill is imperative in becoming proficient with CBT. In later sessions, the discussion will involve cognitive challenging and restructuring (i.e., replacing inaccurate, dysfunctional statements with more accurate and functional interpretations). As these skills become more crystallized in subsequent sessions, the client takes more of a leading role and guides the session where it needs to go. This ensures you have the necessary skills to implement CBT skills in your day-to-day (i.e., during non-therapy hours of the week and after you ultimately discontinue treatment).


Eventually, most clients tend to address the most pertinent matters in therapy and find that they are struggling to find issues/topics to discuss. At this point, we move into discharge planning and process the work that has led to improvement (in order to maintain those gains). It warrants mentioning that therapy sessions do not have to fit within this specific structure and can be framed in the manner that you find most helpful. Ultimately, you are the expert on yourself and know the routes to your own success. If you’re interested in better understanding what therapy might look like for you, reach out to Roswell Psychology today for a complimentary consultation.

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