Session Structure

Updating and Agenda Setting

To maximize efficiency, CBT sessions follow a defined structure. The first part involves a brief review of mood (using subjective scales or inventories such as the BDI) and an update of the week.

Here the patient mentions significant events or recent crises. Immediately thereafter, the agenda is set collaboratively.

The therapist asks, "What specific problems would you like to work on today?"

If the patient mentions three issues (an argument with a partner, sleep problems, and a financial concern), one or two are prioritized to ensure that they are addressed in the necessary depth, avoiding superficially jumping from one issue to another without resolving any.

Homework Review and Core Work

A critical element that connects the sessions is the review of the previous week's homework (or action plan).

If the therapist forgets to review the homework, it sends the implicit message that the out-of-office work is not important.

Analyze what worked, what obstacles arose, and what the patient learned. Then proceed to the core work of the scheduled topics.

This is where techniques (cognitive restructuring, role-playing, problem solving) are applied.

For example, if the issue is the argument with the partner, the automatic thoughts that arose during the conflict are broken down, the evidence is eva luated and more functional alternative responses are sought.

Re-tasking and Feedback

Closing the session includes two vital steps. First, the design of new tasks for the week that follow logically from what was worked on in the session (e.g. "This week, when you notice that you get angry, try to write down the exact thought before reacting"). Finally, feedback is requested.

The therapist asks: "What did you take away from this session, was there anything that bothered you or that was not well understood?

This makes it possible to correct misunderstandings on the spot, adjust the approach if the patient felt he or she was not heard, and strengthen the therapeutic alliance by demonstrating that the patient's opinion is vital to the process.

Summary

Sessions follow a defined structure to maximize efficiency and order. They begin with a brief mood update and collaborative agenda setting to prioritize urgent issues to be addressed.

A critical element is the review of previous tasks to validate the out-of-office effort. Subsequently, core work proceeds by applying specific techniques, such as cognitive restructuring, on previously agendized issues.

Closure includes the logical design of new tasks derived from the session for the following week. Finally, feedback is solicited from the patient to correct misunderstandings, adjust the focus if necessary and strengthen the therapeutic alliance.