How to Prepare for Your First CBT Session | DC CBT Therapy Guide

Each therapist will have their own way of conducting therapy sessions. We have identified some common elements of the CBT therapy process to help you prepare for your first session. This includes what you can expect at DC CBT, located near Dupont Circle in Washington, DC.

After setting up your first appointment with your provider, there are some things you can likely expect. Keep in mind that each therapist will have their own way of conducting first sessions. We describe a general outline that may be helpful when connecting with a CBT therapist.

Initial Paperwork

Often, your provider will request that you complete some upfront paperwork prior to the first appointment.

This paperwork might include things like

    • Basic contact information
    • Notice of privacy practices
    • Consent for services forms
    • Assessment questionnaire(s)
    • Additional forms related to services that are provided

These forms might be accessed through the provider’s website, through a portal system, or as paper copies. When completing paper copies at the office, you may want to consider arriving anywhere from 10 to 20 minutes early. Hopefully, this will give you enough time to read and complete the paperwork, even if you’re feeling a bit nervous.

At DC CBT, you can complete these forms online through our portal system. For those who prefer not to register for the portal or cannot do so, we will have paper copies. If you prefer, we can also send PDF copies for you to review ahead of time. Please be sure to arrive 10 to 15 minutes early to fill out paperwork.

The First Session

At the first session, therapists commonly go over the policies and procedures at their practice.

Some things that might be covered include

    • Confidentiality and its limits
    • Basic information about sessions and policies such as
      • session duration
      • cost per session
      • whether health insurance is accepted or not
      • typical frequency of sessions
      • cancellation policies
    • How to reach the therapist including emergency contact information
    • What to do in the event of an urgent matter or life-threatening emergency

Policies and Procedures Discussion

This information may already be familiar to someone who has read through and completed paperwork. However, therapists typically go over this information verbally to prevent misunderstandings, so that important information won't be missed, and to provide clarification. While you can ask questions at any time during therapy, this might be a particularly good time if you have questions or concerns related to the therapist's practice. The therapist may also provide you with more information on what you might be able to expect from this first session.

Sharing Your Story and Concerns

Two people sitting at a table consulting about CBT

You will likely spend the remainder of the session discussing what brings you to therapy. The therapist might provide you with a general prompt and give you time and space to explain your story. The therapist may interject to ask questions and obtain clarification to get a better picture of your concerns. They might also ask you to recall specific instances that illustrate your struggles. For instance, let’s say you are describing instances of periodically feeling depressed.

The therapist might ask when you most recently felt depressed, along with what you were thinking (i.e., cognitions) and doing (i.e., behaviors).

It’s okay if you cannot answer all of these questions, and it’s perfectly acceptable to say you’re not sure or that you do not know. The main thing to keep in mind is that during this first session, not only are you talking about your own concerns, which may feel cathartic in its own way, but the therapist is getting to know how you experience challenging situations. A CBT therapist may often inquire about experiences in relation to thoughts, feelings/physical sensations, and behaviors. As such, it can be a plus if you’re able to talk about these matters. But don’t worry if nothing comes to mind or you are not aware.

Treatment Goals and Expectations

In addition to asking about challenges you might be experiencing, a CBT therapist might inquire whether you have treatment goals. Some people come to therapy with specific goals, while others come to the first session without any goals in mind.

It can be helpful for a CBT therapist to hear what you would like to accomplish. Let’s return to the example of someone who is feeling depressed. That person might be inclined to say “I want to feel better” or “I want to not feel depressed.” It’s quite understandable to have such thoughts and there’s nothing wrong about making such desires known.

In addition to making such statements, the therapist might benefit from some specifics. For instance, “I want to learn skills to change how I think when I’m feeling depressed.” This statement gives the therapist more information. Specifically, that you might benefit from some cognitive work to challenge unhelpful thoughts when feeling down.

Finally, during your first CBT session, your therapist might inquire about matters that may or may not apply to you. What does that mean? Therapists are often trained to not just focus on the specific area of concern but also to gain a better sense of what else might be affecting a person’s day-to-day functioning. For instance, while you might be seeking out therapy for depression, your therapist might also inquire about other concerns such as feelings of anxiety, past trauma, challenges you might be experiencing at work, home, school, or in relationships, among other things such as current or past thoughts of suicide, self-injury, etc.

Rock balancing representing mental health stability through CBT

It may be helpful to keep in mind that therapists ask these questions to put your concerns into context. A CBT therapist will often develop and discuss an initial treatment plan after they get to know you and your concerns. However, as they are getting to know you, what if they notice something that might interfere with treatment? For example, while someone might want therapy to focus on their depressed mood, what if they rely on substances frequently and not sober most of the time? This might interfere with depression treatment, and the therapist might recommend treating the substance use first. This way, the individual can attend sessions sober and make effective use of the therapy time.

CBT therapists often discuss their initial impressions of your concerns, whether any contraindications exist with regard to addressing your concerns, and outline available treatment options for you. So, if you encounter a therapist who asks seemingly irrelevant questions, keep in mind this possibility. Perhaps it’s to help them understand your circumstances as much as possible.

Treatment Planning and Homework

Toward the end of session, a CBT therapist may discuss their impressions of the session along with potential recommendations. Recommendations may be as simple as suggesting that you schedule another session to continue this conversation, or they might focus on what to do for the second appointment (i.e. things to do before your next appointment).

One of the things that makes CBT a bit different from other therapies is the emphasis on out-of-session work or homework. Your therapist may ask you to complete some questionnaires, give you handout(s), or monitor and make note of certain experiences. Whatever it might be, there is a good chance a CBT therapist will have you do something between sessions. Research shows that individuals who complete therapy homework respond better to treatment.1, 2

Final Thoughts

Reaching out for help can be a challenge, and we hope that this post gives you a better idea of what you might be able to expect from your first CBT session. Each therapist will have their own style and way of conducting their first appointment. While we hope that what we described above are things you can likely expect from a CBT therapist, it's possible that the person you meet with might have a noticeably different way of conducting their session. There are many ways in which first therapy sessions are conducted.

What you have read in this post is what you might be able to reasonably expect at DC CBT, but there may be differences if you pursue services elsewhere. If you want to get a better idea before you schedule an appointment, it would be perfectly acceptable to inquire with your potential provider and ask them what you can expect during your first CBT session

We recognize the unique demands placed on individuals living in Washington, DC. At DC CBT, we strive to create a welcoming, affirming space where you can talk about your concerns with privacy, safety, and comfort. We are committed to providing quality, evidence-based care to address your concerns and to help you reach your treatment goals. We will gladly provide consultations to answer questions, provide you with more information about our services, or to get you set up for your first appointment.

References

  1. Kazantzis, N., Deane, F. P., & Ronan, K. R. (2000). Homework assignments in cognitive and behavioral therapy: A meta-analysis. Clinical Psychology: Science and Practice, 7(2), 189–202. https://psycnet.apa.org/doi/10.1093/clipsy.7.2.189
  1. LeBeau, R. T., Davies, C. D., Culver, N. C., & Craske, M. G. (2013). Homework compliance counts in cognitive-behavioral therapy. Cognitive Behaviour Therapy, 42(3), 171-179. https://doi.org/10.1080/16506073.2013.763286