5 ways to make the most of your CBT therapy sessions

Now that you have taken the brave step of reaching out for help and since you are investing time and effort in coming to sessions, I’d like to offer you some tips on making the most of your CBT therapy sessions. Here's how best to navigate the process and  work towards the life you want.

First task. Let's clear up any misconceptions about therapy. Of course CBT is a talking therapy, but it might be more truthful if we called it a talking and doing therapy. Emotional change only comes from thinking and doing things differently. It will never be as effective to only talk about your problems. Talking may help you to understand why you feel the way you feel or think the way you think; of course, this can be helpful. But, if you think of therapy as like playing a musical instrument, such as the guitar, you will never succeed at playing by just talking, thinking or reading about guitars. Progress comes from practice, perseverance and commitment. Making changes are the way to experience the progress you are looking for, and CBT is most effective when approached as an active therapy.

The more you can do between sessions influences the amount of time you may spend in therapy. If at one far end of the scale, you only turn up to sessions to talk with your therapist, then it goes without saying progress will be slower.

Here are 5 tips to make the most of your therapy sessions.

1 Get yourself a therapy notebook
Even though we all carry phones around, and these can be helpful for on-the-fly notes, slowing down and putting pen to paper really does help to clarify the kinds of thoughts we are having, and can even help us to see our thoughts for what they are. We can better identify patterns of thinking which may be contributing to our problems.

To get the most out of therapy it is beneficial to make notes before, during and after sessions.

Before sessions Make a note of anything which would be helpful for you to discuss in your therapy session. However, since CBT is a goal-oriented therapy, if it is on a different topic entirely, you may have to weigh up whether this is something you would like to spend time discussing. 

Perhaps something might occur to you during the week which you wish you had told your therapist and which you think may be relevant to your treatment. If so, make a note, so you don’t forget.

During sessions Keep your pen handy during sessions and be ready to write down anything you find helpful or that you will want to remember. You never know when you might have a lightbulb moment. And it’s a good discipline to get into so that you remember any tasks you might have planned for between sessions… Therapists don’t like to nag, they really don’t.

After sessions Reflecting on a session is a good way to make the most of your latest session. Find some time, ideally while the session is still relatively fresh in your mind, and ask yourself a couple of simple questions. What stood out for you in the session today? How are you feeling now? What did you find helpful today? Did you (even in any small way) experience different feelings or think differently about yourself, others or the world in general? What friendly, compassionate and kind thing could you say to yourself now, which would support you to go about the rest of your day?

2 Learn to journal
During CBT we will cover different ways of journaling your thoughts, feelings, behaviours and physical sensations / symptoms. Practising noticing your own particular patterns is going to be important, because if we would like to change how we think and act, then we first need to notice our own tendencies which may be unhelpful and maintaining any difficulties we might be experiencing.

I’ll often supply different thought records and templates so you can practise noticing, then working towards reframing or managing your thinking in a new and helpful way.

3 Be clear about your goals
Even if your initial therapy goal is quite general, such as learning to manage your anxiety, or to cope better with life’s challenges, as therapy continues, it will be helpful to spend time reflecting on what specifically you want to be doing differently. As the weeks go by, it will help you enormously to have a picture of what you would like to aim for, the more specific the better. As with all goals, it’s important for your goals to be specific, measurable, achievable and to have an idea of when you would like to do this by. Goals help therapy to remain on track, although it is fine to step off the pathway from time to time. Life is like that and we can accept that sometimes life throws curveballs during your time in therapy and these may be more pressing to talk about at times.

4 Be honest
This is important on different levels. I really encourage my clients to understand that they are the expert on themselves and to be as honest as they can about how they think and feel. This will help your therapist to devise the best plan for you. If ever you don’t understand a concept or the rationale for an exercise, point it out, so your therapist can be more helpful. If you have struggled with an exercise, let your therapist know. 

5 Do your homework
Homework, or as some might call it, an action plan, consists of between sessions tasks. You might be working towards managing your thinking in a different way, practising mindfulness or relaxation techniques, or journaling. You might be changing what you do and approaching rather than avoiding difficult situations, places, conversations or people. You might be learning to relate to yourself in a kinder, more compassionate way.

In CBT we focus on using evidence based techniques, but it is only in the practice of these where you will learn what works best for you. Even if you think it might not work for you, can you be willing just to see that as an unhelpful thought which may be standing between you and feeling better.

Many tasks in CBT need to be repeated in order to experience a benefit, so be prepared to practice and repeat a task for at least a week or two to see what benefits you experience. Once you know what works for you, you’ll feel encouraged to keep doing it.

So these were the five things I’d like you to know. If that all sounds like a lot of hard work, you probably already knew that nobody ever said therapy was easy. It isn't, but it can be the most rewarding and valuable experience. It can be emotional and it can (clients say) even be fascinating. I wish you well in your therapy and much courage to try new and helpful ways of thinking and acting.

Ali Binns is a CBT therapist based in Bath, UK. To find out more click on the links at the top of the page.

Gratitude journal: how to make the most of gratitude journaling

Want to start a gratitude journal? Here's some help to get you started. I've put together a list of tips for getting the most out of keeping a gratitude journal. At the heart of any gratitude journal lies the conscious intention to boost happiness and find a way to gently nudge your brain to seek out the positives in life. In my work as a CBT therapist in Bath, I often discuss this with clients, because it is a good way of becoming aware of the moments which bring us joy. This kind of habit can help to lift us up when we're feeling down. There's an old African proverb which states, "Give thanks for a little, and you will find a lot." All you've got to do is start, and discover what gratitude will bring to you.

What to write?

To begin, it's the simplest thing. You don't need anything more than a pencil and a simple notebook which you can keep for the purpose. Next, take a little time to reflect and find something which you are grateful for over the past few days. Let your mind take time to seek out meaningful moments, however fleeting, with whatever, wherever, whomever that may be for you. The practice of gratitude becomes even more valuable if we can note not only what, but also how and why our object of gratitude is meaningful to us. If you can take time to remember how you savoured that experience, you can recapture some of those positive feelings as you write.

At times, we may have to seek hard to find even small things, while other days may offer more. And, we can come to notice that often the unexpected moments are what make a real difference. An experience you are grateful for can be as straightforward a pleasure as watching or listening to a bird in the garden, watching the passing clouds in the sky, feeling a touch from a friend, listening to a favourite piece of music, or a tasting a favourite flavour... any moment which feels precious to you. A simple example might be: "I was grateful today for seeing the sunlight on the river. It was calm and peaceful reminded me of summer days and enjoying a picnic outdoors."

When to write?

Choose any time when you can sit quietly and reflect. Sometimes things will come quickly to you, other times not and that's okay - just allow yourself these moments and don't rush. Many people find it rewarding to write their gratitude journal in the evening, as it can be a comforting way to close the day before going to bed.

How often?

While you might like to write in a gratitude journal every day, research has shown that this isn't necessary. In fact, some evidence points to occasional journaling (a couple of times per week) bringing greater benefits than a daily list. I say: experiment, and find what works for you. Certainly, if you turn this into a 'must-do' rather than a 'like to' this becomes another task on the to do list, which of course is no way to begin! So, take heart that once or twice a week is enough.

Creative gratitude: gratitude jar, scrapbooking and photo journaling

The simplest journal is nothing more than a basic notepad which you keep for the purpose. But if you're more of a tactile or visual person, you could consider a gratitude jar which you can put on display. Not only will this serve as a visual reminder to remember to do your gratitude practice, but you can also dip into it at random at a later date, and read through some happy memories.

To make a gratitude jar, get a screw top jar, decorate it in any way you like (paint it, add a ribbon or a label – make it special) and write down things you are grateful for on slips of paper, fold and place in the jar. It can be fun to see how they mount up over time. Some of my clients with young families have had children who want to get in on the act, so it can even be a fun joint activity, particularly with little ones who might like their own jar to decorate.

Alternatively you could try out a gratitude scrapbook. You don't have to write words, you could stick in photos, tickets, restaurant receipts, anything which reminds you of a good experience. Over time you're keeping a record of what gives you pleasure and builds meaning and positivity to your life.

Gratitude on the go

Another way to keep track of 'gratitude on the go' is to put your phone to positive use. Snap photos of your gratitude moments and create a visual reference to look back at. You could create a collage or moodboard over time to display in real life.

If the idea of high-tech gratitude appeals, there are even apps to keep track of your moments of pleasure. 

Active gratitude

Once you're in the habit of keeping a gratitude journal, you might like to take your gratitude to the next level. Active gratitude involves finding real ways to express your gratitude to others, which means taking gratitude from our private world out into the real world. This involves finding ways to let others know what they mean to us through deliberate action to express our positive thoughts and gratitude. Options include sending a handwritten note, a bunch of flowers, a hug. It doesn't matter how, but expressing thanks, love and kindness in the way that feels right for us brings big benefits. Expressing gratitude builds up our relationships with others. And, not only do we feel good when appreciating another person, but the other person feels happy and valued too - win-win!

Best of luck with your efforts and I hope you can find some creative ways to give a little thanks for the everyday things.