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. It 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-orientated 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. Practice 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 practice 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, would you be willing to see that an unhelpful thought might 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.
