When Self-Help is Not Enough
Learning to manage anxiety on your own can be challenging. Using self-help materials and gathering the support of friends and family can all be great resources for helping you develop and practice new skills. However, sometimes we need extra help. This is particularly true when symptoms are causing a lot of distress or getting in the way of living life, such as stopping you from going to work or school, from running daily errands, or from spending time with others. If you’re having trouble using these skills on your own, it’s a great idea to get some professional help. Talk to your family doctor about your options. Working with a CBT therapist may give you the additional guidance you need to start effectively managing your anxiety!
What to Expect if you see a CBT therapist
If you decide that you need some guidance in CBT and would like to see a trained CBT therapist, here are some aspects of what to expect:
Therapy is structured: Treatment sessions in CBT involve learning new ways to think about and understand your symptoms. Because of this, sessions are fairly structured so that you’re usually reviewing the goals or tasks you worked on during the week (or issues that came up), learning new information and skills, and then developing a new set of goals to complete for the next session.
Therapy is collaborative: CBT is a very active therapy. Both you and your therapist will be working together to better understand your symptoms and identify ways to help you manage them. You can expect to participate actively in your treatment both during and outside of sessions in order to see positive changes and eventually become your own therapist.
Therapy is time-limited: People being treated by a CBT therapist will usually have between 8 and 20 treatment sessions, lasting approximately one hour each. Seeing a CBT therapist is not supposed to be a lifelong process. Rather, you’re learning to become your own therapist. Once you’ve learned new skills, have had a chance to master them, and have started to see some positive changes in your life, it will be time to leave therapy and continue to use the skills on your own.
KEEP IN MIND: When it comes to CBT, you get what you put in. If you don’t put your best effort into managing your problem, you probably won’t get as much benefit from CBT as you could.
What does a typical first session (assessment session) look like?
During the first session (or sometimes two), you’ll be asked questions about why you’re seeking therapy, your personal history, your family, your education and work life, and your current relationships. You may also be asked to complete some questionnaires about your symptoms. This information will help your therapist understand your difficulties and decide which interventions will be most helpful for you.
For anxiety treatment, you may be asked questions such as:
- Can you think of a time recently when you felt very anxious?
- What was going on in that situation? Who were you with? What were you doing?
- What was going through your mind at that time?
- What did you do to try to cope with feeling that way?
- How long have you been feeling this way?
- How is anxiety interfering with your life (with work, school, family, relationships, etc.)?
Ideally, at the end of your assessment session, your therapist will be able to give you feedback about the assessment result, an estimate of how long therapy is likely to last, and an overview of how your therapy will proceed. Your therapist will also likely point you to some additional information and self-help materials to help you better understand and start coping with your difficulties.
Once I start therapy, what can I expect?
- The relationship between you and your therapist is intended to be caring, respectful, non-judgmental and empathic. The therapist will work with you to explore your problem and find potential solutions.
- Sessions usually occur in the therapist’s office. However, some skills or interventions may need to be practiced outside the office (e.g., exposure exercises). So depending on the nature of your difficulties, your therapist may ask to meet you elsewhere (e.g., meeting in a car to help a client with a fear of driving).
- The therapist may take notes, and you would be invited to do so as well. Whiteboards and flip charts may also be used to share information.
- A therapist may offer to audiotape sessions for you. This can be a useful tool for you to review the material that has been covered.
- You and your therapist agree on the tasks that you will work on between sessions (or "homework"). This may include activities such as gathering more information, trying out a new behaviour, or keeping a record or log of anxiety-provoking situations.
What about CBT with children?
- The therapist will usually ask to meet with the child’s parents first, to find out more about the problem and to explain the treatment approach and rationale. Depending on the problem, the therapist may ask to meet with other adults in the child’s life (e.g., teachers).
- Parents are usually asked to attend sessions with their child, or at least parts of sessions. This is because it’s important that parents have a clear understanding of what the child is learning and practicing in therapy. Parents can reinforce these skills outside of the therapy office.
- Parents are expected to act as coaches and models for their child and to encourage their child to complete any therapy "homework."
- Older children are often asked to keep a diary of their thoughts, feelings and behaviours related to difficult situations. Their entries will then be discussed in session. For example, the therapist will teach ways of turning the scary thoughts into more positive, helpful ones.
- Therapists aim to make therapy engaging and fun for children and may use such materials as puppets, games, drawings and other activities to teach CBT principles in a child-friendly manner.
OK, I think that CBT is right for me. What questions should I ask a potential therapist?
If you’d like to find a CBT therapist, you may need to call around to find one who is adequately trained in CBT and is comfortable using this approach with your particular problem. When you first speak to the therapist over the phone, you may want to ask him or her questions such as:
- What’s your approach to working with clients with my problem? (or)
- Do you use a CBT approach to working with clients with my problem?
- What can you tell me about your experience with CBT?
- How many sessions would you recommend for treating someone with my type of problem?
- When you’re working with clients with my problem, what does a typical session look like?
- Do you give your clients homework or tasks to complete between sessions?
Remember that it’s important to find a therapist you feel you can work with. After the initial phone call, ask yourself how you feel about this prospective therapist. Did you feel comfortable talking to him or her? Does he or she have the experience and knowledge you’re looking for?
If it didn’t feel like a good match, call another therapist and try again. You have the right to find the very best therapist for you!
Do I really need a therapist? Can I just do CBT on myself?
One of the advantages of a CBT approach is that individuals can use many of the strategies on their own. There are many self-help workbooks available that incorporate CBT-based exercises and activities. Often, these workbooks will guide learners to understand more about their own problems, provide questionnaires, charts and exercises to complete, and encourage the learners to set goals for themselves. More recently, interactive CDs and websites are being developed for self-directed CBT for a variety of conditions.
Of course, one potential drawback of self-directed CBT is keeping up the motivation and self-discipline to seriously commit to a plan. Without the encouragement and direction provided by a knowledgeable therapist, some individuals find it hard to keep up the momentum on their own, especially when things get tough. This is especially true for more chronic and debilitating problems, such as severe agoraphobia, in which the individual finds it very difficult to even leave the house to perform simple tasks. It can help to enlist trusted friends or family members for support during self-directed treatment so they are aware of your goals and can help encourage you to stay on course.
Another thing to keep in mind is that, as humans, we are rarely as objective as we think we are. It can be an enormous help to have someone objective monitoring your progress and suggesting additional tools and strategies along the way.
If finances or accessibility are barriers to receiving therapy on a regular basis, one option would be to have a few sessions with a therapist (either in person or over the phone) to help you map out a plan for yourself, and then continue to have monthly "check-ins" with the therapist to assess progress and to troubleshoot. Although this isn’t a conventional approach to CBT, some therapists may be open to such an arrangement.
If you are still trying to decide whether to embark on a self-help approach or to hire a professional, some questions you may want to ask yourself are:
- How severe is my current problem?
- Does my problem interfere with my ability to concentrate and use self-help material?
- Have I tried self-help approaches in a consistent and systematic manner long enough to know if they’re working?
- Do I understand what I should do, but have trouble applying the techniques to my own life?
- Have I reached an obstacle that I can’t seem to get beyond on my own?
- Am I ready to share my problems openly with a therapist?
How do I find a CBT therapist?
To find a therapist who specializes in CBT, contact your family doctor for a referral or look up professional organizations, such as the The Canadian Association of Cognitive and Behavioural Therapies - CACBT