How are patients evaluated?

When you begin cognitive-behavioral therapy, you will begin with an intake evaluation which may take two or more sessions. Your therapist will ask you to fill out a variety of self-report forms that assess a range of symptoms and problems. These forms evaluate depression, anxiety, anger, fears, physical complaints, personality, and relationships. Your therapist will also review with you the various situations and relationships that may be troublesome for you. Specifically, we will want to learn the kinds of thoughts and assumptions you may have, what behaviors you engage in that are rewarding or unpleasant to your and others, and your style of communicating and listening. The purpose of this evaluation is to gather sufficient information on you so that you and your therapist can know quickly the kinds of problems you do (or do not) have and the degree of your problem. For additional information on cognitive assessmentclick here.

For a list of problems addressedclick here.

How are treatment plans developed?

You and your therapist will work together to develop a plan of therapy. This might include how often you need to come, the relevance of medication, your diagnosis, your goals, skill acquistion, needed changes in the way you think, behave, and communicate, and other factors. As part of your treatment plan, your therapist will develop a conceptualization of the nature of your problem. This will include a review of your past experience with similar or different problems, the habitual and problematic style of thinking and behaving that characterizes your problem, and a strategy to develop new ways of thinking, behaving and interacting to help you solve your current problems and prevent them from re-occurring.

What are therapy sessions like?

Cognitive therapy tries to work efficiently in the 45 minute session. Unlike other forms of therapy which are unstructured, you and your therapist will set an agenda for each meeting. The agenda might include a review of your experience in the previous session, your homework, one or two current problems, a review of what you’ve accomplished in this session, and homework for the next session. The goal is to solve problems, not just complain about them.

Is there homework between sessions?

If you went to a personal trainer at a health club, you would expect to get guidance on how to exercise when the trainer is not there. The same thing is true in cognitive-behavioral therapy. What you learn in therapy is what you practice outside of therapy. Research demonstrates that patients who carry out homework assignments get better faster and stay better longer. Your self-help homework might include keeping track of your moods, thoughts and behaviors, scheduling activitues, developing goals, challenging your negative thoughts, collecting information, changing the way you communicate with others, and other assignments.

Although homework and self-help are part of therapy, you may find that you have the same difficulties doing the self-help homework that you have in your “real life”. This is to be expected. For example, if you procrastinate in your life, you may procrastinate in doing your homework. The advantage of these self-help homework assignments is that you and your therapist can troubleshoot together to identify your thoughts and patterns of behavior in doing homework–and then apply these to other areas of your life. For example, you might procrastinate on homework because you assume it will not help—or that you need to have an immediate improvement in order to do something to help yourself. Your therapist can help you cope with these problems during your therapy sessions and set up practical ways of coping with procrastination outside of sessions.

What if I don’t like my therapist?

Differences between patient and therapist may arise as they do in any meaningful human relationship. We encourage you to give your therapist both negative and positive feedback as an ongoing part of your treatment. Perhaps your therapist needs to readjust the approach to fit your specific needs and sensitivities. Perhaps your therapist is not doing as good a job as he or she can in understanding the meaning of your problems to you. In addition, your automatic thoughts and assumptions may be activated in the relationship and may prove useful in understanding other problems that you may have. However, if you have tried to discuss this and work on it with your therapist and still do not feel comfortable with him or her, you may wish to transfer to another therapist at the Institute. Many patients find that the transfer helps them move on more rapidly in solving problems.

What if I need medication?

If you are on medication, you may wish to continue to be supervised on your medication with your physician. If you would like to have us recommend a psychiatrist for medication, we will be happy to do so. In addition, we also can provide you with referrals for internists, gynecologists, and other physicians.

What about group therapy?

In addition to individual and couples therapy, we also offer group therapy and specialized workshops. The intake coordinator can inform you of the scheduling of these groups and workshops. We currently have group therapy for mindfulness training and dialectical behavior therapy. Mindfulness training is a cognitive-behavioral approach that helps you become less overwhelmed by your thoughts and feelings and assists you in improving relaxation, awareness, appreciation, and the ability to take a detached perspective. Based on meditative practices that have proven to be highly effective in the treatment of depression, mindfulness training can enhance your ability to cope with everyday stress. Dialectical behavior therapy is a widely used cognitive-behavioral approach to learning how to handle impulses, resolve interpersonal conflicts, improve your everyday life, and regulate emotions in everyday life. You can learn more about these groups by contacting our Intake Coordinator at 212 308 2440.

Cognitive Therapy
Substance Abuse Miniseries by
Dr. Graham Reynolds