CBT – involves teaching client’s a range of strategies and techniques to identify and address

unhelpful behaviours and ways of thinking. Notion that how a person thinks and acts can change the
way they feel.

Thoughts and beliefs can be negative or positive, realistic or unrealistic, helpful or unhelpful – NOT
‘good’ or ‘bad’.

Three ‘levels’ of thought:

Automatic thoughts (e.g. self-talk, imagery) – a running commentary in our head that we sometimes
attend to

Intermediate beliefs – rules (‘shoulds’, ‘musts’), attitudes (value-laden judgements), assumptions (if,
then statements)

Core beliefs – global, rigid, overgeneralised, pervasive beliefs about self, others and/or future

All sessions:
* Important to ‘bridge’ sessions (“last week we did/covered X”, “did you have any thoughts about
our last session?”). Later: encourage client to be more active – to summarise themselves (“what do
you remember covering in last week’s session?”)
* Review homework – this emphasises its important and rewards client’s efforts between sessions
* Summarise session at end and obtain feedback.
* Work collaboratively to design and assign homework
* Connect session agenda with overall therapy goals

Early sessions:
* Start of first session: “What brings you to therapy?”
* End of first session: “What do you expect to get out of therapy”
* FACT: most client’s notice an improvement after 4-5 sessions, benefit most from 10 sessions
* Orient to CBT framework (relationship between thoughts, feelings, behaviours), show clients how
to identify and monitor thoughts
* Teach the notion that thoughts are HYPOTHESES or hunches, NOT FACTS
* Thoughts are subject to ‘cognitive errors’ in thinking, which are taught to help clients evaluate
their negative thoughts (work with client to come up with personal examples of each error type)
* Evaluate ‘hottest’ (most salient) negative thought and come up with an alternative

Teach client to IDENTIFY (find situations when you are really bothered/find really difficult),
EVALUATE (how realistic/accurate? – evidence for and against, explore worst, best and most realistic
scenarios assuming negative thought is true, can test via behavioural experiments; how
helpful/useful? – explore consequences of thinking/behaving negatively, advantages and
disadvantages analysis) and MODIFY (cognitive restructuring, changing the meaning given to them)
unhelpful or inaccurate thoughts and behaviours.