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Structuring Your CBT Sessions


After identifying your problems, taking a history, understanding the CBT model, and setting goals, you are now ready to start addressing problems. In this blog, we'll be focusing on how to structure your therapy sessions.


Setting the Agenda


There are 6 items to keep in mind when setting up the agenda. These items include:


Agenda Item #1: Organize your therapy sessions.

Agenda Item #2: Start with a check-in.

Agenda Item #3: Collaboratively set an agenda.

Agenda Item #4: Work the agenda.

Agenda Item #5: Develop helpful homework for the next session.

Agenda Item #6: Review the session and ask for feedback.


Working on the Agenda


During sessions, a key part to having a meaningful one is setting up structure, sticking to it, and giving homework. Many therapists find structuring their sessions to be one of the most useful skills to learn; which will be a great tool for you as well.


 

Agenda Item #1: Organize Your Therapy Sessions


A structured therapy session entails bringing order and organization to the therapeutic process. Let's break down the five fundamental components:


  1. Check-in: This involves a brief update on recent developments since the last session, including a connection to previous discussions.

  2. Agenda Setting: Collaboratively determining which issues to address during the current session, with the option to review previous homework.

  3. Agenda Execution: Addressing the identified problems outlined on the agenda.

  4. Homework Assignment: Collaboratively devising homework tasks for the next session.

  5. Session Review: A concluding overview of what was covered, along with soliciting feedback from the client.


Initially, integrating all these components might seem daunting. Yet, with practice, it becomes second nature, akin to mastering driving. Just like learning to navigate a car, with time, employing a structured approach will become instinctual, leading to more seamless sessions and client engagement.


In this article, we'll be focusing on the first 2 agenda items: The structure, and the check-in.


Your Attitude Towards a Session


Some therapists embrace the idea of a structured session immediately, while others may have reservations, fearing it might feel too rigid or disrupt the natural flow of therapy. However, after experiencing structured sessions with clients, many therapists find that it enhances focus and allows clients to express their priorities. Take a moment to reflect on your own thoughts regarding using a structured approach.


Explaining the Session Structure to your Client


Introducing the structure of a therapy session can help your client feel more at ease, as they'll know what to expect. Think of therapy as navigating a foreign country – without knowing the customs, it can feel uncomfortable. Explaining the session structure is akin to guiding someone through unfamiliar territory, easing their discomfort.


With a new client, you might say something like: "We've discussed your concerns and set goals for therapy. Now, let's talk about how our therapy sessions will be structured. Each week, we'll start with a quick check-in to catch up on any developments since our last session. Then, we'll create an agenda together to ensure we focus on what's most important to you. We'll also review any homework from the previous session. Finally, we'll summarize our discussion and plan any homework for the next session. How does that sound to you?"


For a current client, you could say: "I've been considering our sessions, and I'd like to introduce a new approach today. We'll begin with a brief check-in to update me on recent events in your life. Then, we'll create an agenda together to prioritize what we'll discuss. This structured approach can help us stay focused on your needs. We'll wrap up by summarizing our session and discussing your thoughts on this new format. Does that sound okay to you?"

These explanations provide clarity and reassurance, helping clients navigate the therapy process with confidence.


 

Agenda Item #2: Start with a Check-In


The check-in serves as an initial opportunity to gauge your client's overall well-being, catch up on any recent developments, and address lingering issues from previous sessions. By incorporating this into your session structure, you can efficiently address pertinent topics and maintain continuity in therapy. Below, we'll delve into the key components typically covered during a check-in, although the order may vary depending on the session's flow.


Client Update: Begin by inquiring about any significant changes or updates since the last session. Understanding your client's current state sets the stage for the session ahead.


Mood Rating: Encourage your client to rate their overall mood since the previous session using a scale of 1 to 10. This simple exercise fosters self-reflection and provides insight into their emotional well-being.


Bridge to Previous Session: Establish continuity by revisiting any unresolved issues or concerns from previous sessions. Addressing these ensures that important topics aren't overlooked.


Homework Review: Take a moment to review any homework assigned in the previous session. This demonstrates the importance of completing tasks and allows for feedback and clarification.


Agenda Setting: Identify potential agenda items based on the check-in discussion. This helps prioritize topics for the current session, ensuring that client concerns are addressed effectively.


Check-In Components in Detail


Client Update: Start by exploring any changes or updates in your client's life since the last session. Understanding their current circumstances provides valuable context for the session.


Mood Rating: Invite your client to rate their mood using a 1 to 10 scale, with 10 being the worst they've ever felt and 1 indicating happiness. This rating offers a quick snapshot of their emotional state and facilitates self-awareness.


Bridge to Previous Session: Seamlessly transition by revisiting key topics or concerns discussed in the last session. This ensures continuity and allows for follow-up on unresolved issues.


Homework Review: Dedicate time to review any homework assigned in the previous session. Acknowledge completion and provide positive reinforcement, while also exploring any challenges or insights gained.


Agenda Setting: Based on the check-in discussion, collaboratively identify agenda items for the current session. This ensures that client priorities are addressed and sets a clear direction for the session.


Maintaining Focus During the Check-In


While the check-in serves as an essential component, it's crucial to keep it concise and focused. Avoid delving too deeply into specific issues before setting the agenda. Redirect the conversation if necessary to ensure alignment with session objectives.


Incorporating phrases like:


"Before we explore further, let's ensure we cover all bases."

"I want to ensure we address all relevant topics today. Is there anything else you'd like to discuss?"

"Let's prioritize our discussion points to make the most of our time together."

By maintaining focus and clarity during the check-in, you can efficiently address client needs and lay the groundwork for a productive session.



 

In conclusion, the structured approach and regular check-ins in therapy play a pivotal role in fostering a productive and supportive therapeutic environment. By implementing a structured session format, therapists can provide clarity and direction for both themselves and their clients. This framework allows for efficient utilization of session time, ensuring that important topics are addressed and progress towards therapeutic goals is made.

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