How to prepare for CBT

If you’ve recently visited the doctors about your mental health, particularly if it’s for anxiety-based issues, you may have been referred for CBT. CBT stands for cognitive behavioural therapy, and helps you to work on, well, your ‘cognition’. How you think and how your mind responds to certain situations, feelings or even memories. It can help with social anxieties, negative thought associations and much more.

I started CBT in September, and I go to help me manage Post Traumatic Stress Disorder (PTSD). Everyone has individual reasons for using CBT that may or may not be similar to other people’s reasons. For me, CBNT helps me to identify what triggers panic attacks, flashbacks and dissociative episodes, and manage those triggers effectively. So far, it’s been really helpful. After about the third session, I could already feel the techniques I’d learned for preventing flashbacks making a difference.

Since talking about going to CBT, I’ve had a lot of messages and in-person questions about what’s like and what to expect. A lot of people seem to assume it’s quite a daunting experience, but for the most part it’s not. For me, my CBT sessions have been very relaxed and in a casual setting. My time with my therapist feels like I go for a coffee with someone each Monday morning and I get to talk to someone, in return for some helpful methods for adjusting my thought and behaviour patterns.

I understand why doing CBT may be nerve wracking for some people. A few days before my first session I was feeling anxious about therapy because it had made my diagnosis/disorder feel more gut-punching and real, and I was scared I’d somehow do it wrong (just so you know, you really can’t do therapy incorrectly). So, I’ve wrote a few pointers on what you can do to make CBT seem less intimidating, and how to prepare for your first couple of sessions.

Disclaimer: please note that I am not a medical professional and I can’t speak on behalf of other people’s experiences. The advice given in this post is solely based off my own experience with mental health, public services, and CBT.

Before your first session

There’s really nothing to worry about with cognitive behavioural therapy. In my experience and in many other people’s too, it tends to be a very chilled out session where you just discuss your thoughts and goals for your mental health. My first session was fifty minutes and myself and my therapist talked about how I’d been felling, why I’m reaching out for support, what kinds of things I liked to do in my spare time, and what I wanted to get out of CBT. I wrote down some key areas I wanted to work on and things I was particularly concerned about, and how I’d like to see them change by the end of the sessions.

Before your first session, have a think about why you’re going to CBT in the first place, and what you’re hoping it can offer you. Think about what you’d like to achieve by the end of the sessions.

Oh, and make sure you do your homework! You’ll probably have a little bit of easy work to do after each session, but before my first appointment I was emailed some questionnaires to fil out and I forgot do complete them. Make sure you do those! You won’t get kicked out for not doing them or anything, but they’re super handy for your therapist when monitoring your mood/behaviour.

Tell your therapist what you need

Make sure you know why you’ve decided to come to therapy. Why are you there – what do you want to get out of it? A lot of people go into therapy expecting to be immediately fixed and it doesn’t really work that way. Therapists aren’t mind readers and need some guidance from you initially, so they can help you properly and appropriately. And if you’re going through the NHS, there will likely be a limit to how many free sessions you can sign up for and a bit of a waiting list, so don’t be afraid to just tell the therapist what you think you need. Don’t leave anything out – they are not going to judge you for anything.

If you don’t hold back and you’re totally honest about your problem points and improvement s you’d like to make/changes you’d like to see, your therapist can adjust their therapeutic approach to help you as effectively as they can.

Don’t be afraid to ask for something different

If your therapist is worth their salt, they’ll value your feedback on how your finding the experience so far and use that feedback to adjust their approach in your remaining sessions. They should also ask you how it’s affecting your mental health (you’ll also fill out regular questionnaires about this, usually just before or after each session) Therapy is a lot more ‘bespoke’ and individual than it seems! My therapist asks me after every session how I’ve found the resources she’s provided me and any activities we’ve done and methods we’ve practiced. She also sort of ‘pitches’ other activities to see which options appeal to me, and what I think might help.

For example, with activity we do, she asks my preferred presentation for learning, i.e., whether I want to read it, or if I’d like her to draw/use presentations if I’m more of a visual learner, or if I want to just talk it through (university lecturers could learn a thing or two about accessible learning from therapists). In my last session, we practiced a mindful meditation approach to use when flashbacks happened, and it was an option for me to read about the activity, watch something about it, or just simply act it out together then jump into the method.

My therapist always takes my feedback on board, and it’s reassuring to know that all her approaches are being adjusted to suit how I learn, and what I’m comfortable with.

Don’t be afraid to ask for someone different

Before I had my current therapist, I had a different one for the first couple of sessions and I couldn’t stand him for a number of reasons. I do my CBT through Talk Plus and asked for someone else and said I’d be willing to go to another location as long as it wasn’t too far, and they arranged that for me. I was then assigned the therapist I have now, and I told her why I had such a difficult time with the original person. She fed that back to the team at Talk Plus for me (with my permission) and it’s been taken into consideration.

It’s important for you and your recovery to get along with your therapist and have a positive relationship where you feel you can trust them. If that’s not the case, it’s always worth speaking up. 

Don’t overthink it

Easier said than done when you have poor mental health, I know. And I apologise for using such a dumb phrase. But there was so much running through my head the night before therapy; what do I wear? How do I convince her I’m broken enough to deserve treatment? What if I overdo it and end up getting sectioned? None of it mattered. Just turn up. Be honest. Use the services. Nothing bad is going to happen to you. Sure, some of the sessions might open some lost files from your brain and result in some tears, but that’s the worst that could happen. Your therapist is paid in actual money to listen to you and help you, and that’s exactly what they’re going to do.

Beth Ashley
Beth Ashley

Writer/wronger. Provides words about mental health and feminism and runs this very blog. Copywriter for Godaddy and editor of Paperfox Literary Magazine.

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