The Initial Assessment and Orientation to Cognitive Behavioral Therapy

Abstract

Cognitive behavioral therapy is a highly structured and time-cognizant approach to therapy. It is generally performed according to an established set of events that take place in therapy, many of which are unique to this approach to practice. This chapter will cover nine steps that make up the beginning of cognitive behavioral therapy. These steps comprise what is generally known as the process of assessment and orientation to therapy. Ordinarily these nine steps are completed in the first therapy session. Alex, for example, was able to complete the nine steps in a single session. He was alert, focused, motivated, positive about receiving psychological help, and able to engage in the necessary cognitive tasks to complete the process. Because he did not have a complicated psychosocial history, he was able to identify a specific focal problem and corresponding goals for therapy relatively quickly. However, for a variety of reasons, some persons with chronic conditions may require two or more sessions to complete these steps. One example is Nina. She required several sessions to complete the first nine steps for two main reasons. First, Nina had difficulty concentrating and found it hard to follow along with the more cognitively oriented tasks. Second, she was distrustful of health care providers in general after having a long series of encounters that were disappointing to her and that failed to lead to any improvement in her fatigue. As a consequence , her therapist decided to proceed more slowly. Proceeding more slowly allowed the therapist to build a stronger therapeutic relationship with Nina and it also allowed her to avoid over-functioning in therapy by overtaking Nina's share of responsibilities in the therapy process. The Initial Sessions of Therapy In this section, the structure and contents of the initial sessions of cognitive behavioral therapy are described in detail. In addition, common difficulties that therapists may encounter in structuring therapy sessions are introduced and suggestions for managing these difficulties are discussed. There are nine steps that should comprise the initial sessions of cognitive behavioral therapy for 35