How Cognitive Behavior Therapy Works
Cognitive behavior therapy is a collaborative process. You and your therapist will work together to identify problems and develop solutions. Although your therapist may be an expert in human behavior and psychological technique, you are an expert on your individual psychology. We recognize that “one size does not fit all,” and that what works for one, may be ineffective for another. Your therapist will encourage you to give feedback about sessions and your progress, to ensure you are getting the most out of your psychotherapy.
Initially, you and your therapist will discuss the history of your symptoms or concerns: what moods and behaviors are bothersome, when you first noticed the problem, whether any event may have triggered the problem and what strategies you have tried in order to address the problem. Your therapist will ask questions about sleep, appetite, concentration, energy and motivation, mood states, social network, activities and your daily life. Medical, psychological, family and legal history will be covered. The goal of the first session is to ensure that you and your therapist develop a mutual understanding of your difficulties.
Next, you and your therapist will develop goals for therapy. Goal setting is an important part of the therapeutic process for a number of reasons. First, goals ensure you and your therapist stay focused on what you want to change. Second, goals guide plans for change and the specific techniques and strategies to be utilized. Third, goals provide guideposts for tracking progress and ensuring you are headed in the direction you want to go. Finally, goals help to define when therapy is completed.
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Psychoeducation is an important part of CBT. You can expect to learn how the interaction between your thoughts, moods, behavior, physical reactions and environment impacts your problems and symptoms. You will learn to identify the perceptions and assumptions that underlie your negative moods, and the triggers that lead to problematic behaviors. You will learn to develop action plans to solve problems. These and other skills will be useful throughout your life.
At the beginning of each session, you and your therapist will set an agenda. Agendas keep sessions focused, and lessen the likelihood of wandering from topic to topic. Agendas relate to your therapy goals, and may include review of homework, one or two current problems, introduction and practice of new coping techniques and session summaries.
Self-help homework is an important component of CBT. Homework encourages you to practice the new concepts and techniques learned in session, and to make active changes to solve your problems and address your concerns. Homework is like practicing in between music lessons: you refine and gain expertise in newly learned skills. 
Homework might include keeping track of moods, thoughts and behaviors, scheduling activities, challenging negative thoughts, experimenting with behavior change or other assignments.
When you take an active role in therapy, you determine the pace of treatment, and ensure a satisfactory outcome. Your feedback helps to guide your therapist, and you should always feel free to express your thoughts, concerns and ideas. CBT is not a passive, “fix me doc” process. Instead, collaboration is the key to effective results.