A collaborative process
Cognitive-behavior therapy is, to the greatest degree possible, a collaborative process. Patient and psychologist will work together to set collaborative agreements about what topics will be taken up in the therapy sessions, and what strategies will be used in treatment.

Setting treatment goals
Early on in treatment your psychologist will work with you to set goals for the therapy. Cognitive-behavior therapy is typically focused on helping patients achieve concrete goals like reducing unpleasant symptoms (e.g., reducing symptoms of depression or anxiety, stopping panic attacks, or reducing or stopping using substances) and/or increasing functioning (e.g., increasing ability to function at work, reducing fights with spouse, or increasing work satisfaction). After setting the goals, you and your psychologist will monitor progress to track whether the goals are being achieved. Many of our patients set goals of reducing symptoms of depression and anxiety. The psychologist will often ask those patients to complete a weekly scale assessing those symptoms in the waiting room (scales are kept in a box in the waiting room) and bring it to your therapy session for review and for tracking progress. If progress is slower than expected or the therapy stalls, it will be important for you and your psychologist to discuss the situation to evaluate what might be impeding progress, and what change in the treatment or treatment plan is needed to solve the problem. Your psychologist might recommend a trial of medication, more frequent therapy sessions, or perhaps a medical exam to be sure that no medical problem is interfering with your progress.

A typical therapy session
Most patients meet with their psychologist on a weekly basis. Patient and psychologist work together to decide how to spend the time. The psychologist will often begin by asking you to provide a review of how things have gone for you since the last session and then work with you to set an agenda for the therapy session. Typically the therapy session focuses on current concrete and specific problems with which you would like some help. The psychologist takes an active role in assessing the situation and making recommendations about how to proceed. Often this involves evaluating what thoughts, beliefs, and behaviors are contributing to the problem, and helping you change them. The psychologist's interventions in the therapy session might help you identify and shift some problematic beliefs that are causing distress, evaluate pros and cons to help you make a decision, identify what obstacles are impeding you from doing things that you know are in your best interest, or role-play a new way of handling a troublesome situation.

Homework
You and your psychologist will work together to create between session assignments focused on skills and strategies to help you towards your treatment goals. Between session assignments often involve reading something pertinent to your treatment, conducting a behavioral experiment, and monitoring thoughts, behaviors, and feelings. Your therapist will work collaboratively with you to tailor between-session assignments to your specific treatment.

The therapeutic relationship
A productive therapy depends on a collaborative, trusting patient-therapist relationship. If at any point you feel uncomfortable with your psychologist or experience a problem in the working relationship, please discuss this with your psychologist. If, in the initial consultation, you feel that you cannot work well with the consulting psychologist, be sure to raise the issue so the psychologist can help you assess the problem, evaluate whether it might be fixable, and if necessary find a therapist with whom you feel more comfortable.

Treatment duration
Treatment duration is variable and difficult to predict. However, after meeting with you to assess your situation, the psychologist will offer, if you would like, an estimate of the number of sessions of treatment that will be needed to accomplish your treatment goals. For most patients, treatment duration ranges between 5 and 50 sessions. The psychologist's estimate of the duration of treatment is only an estimate, and no guarantees can be made as to the length of treatment required.

Some patients want or need a time-limited therapy. If this is your situation, discuss this issue with your psychologist, who will work with you to determine whether it is possible to set a target number of sessions required to reach your treatment goals.