Typical Session Format

Quite often, people will ask me to describe a typical session. However, every session is not necessarily "typical," Rather, it is unique to each person's growth during their therapy journey toward their goals, purpose, aspirations, and their authentic pursuit of happiness.

Nevertheless, it is accurate to say that we often used standardized manuals to develop, research, and expand CBT in the past. Regardless, in the real world, we practice a more process-based CBT by integrating critical findings from various evidence-based and evidence-informed therapies to reach the goals of unique individuals such as yourself.

During the first few meetings, we will set clear goals as a foundation for our work. Your goals express what you want to achieve or change in your life; therefore, it is often helpful to define your goals as "Start" instead of "Stop" dreams. Start goals help to take you towards what you want or desire. "Stop" goals focus on preventing, controlling, or avoiding what you do not wish to experience. Having only "Stop" goals generally do not work as "well because only stop goals can create a rebound effect and paradoxically shift the focus to worry about failure. Examples of "Stop" goals include "To be less anxious," "To stop worrying," or "To avoid arguments." Avoiding what you do not want is not the same as moving toward what you want. Examples of "Start" goals include "To discover my emotional resilience," "To replace worry with problem-solving," and "To learn social skills such as assertiveness."

Together we build and often revise our conceptualization of your past, present, and future, which serves as our growth or treatment guide. Whether meeting in person or through telepsychology, I generally like to begin each talk by reviewing how things have gone for you since the last time we met. Next, we will focus on your Action Plan to achieve your goals, values, and aspirations of hope and joy. Most importantly, in a warm, safe, therapeutic relationship, we will work as a team to promote growth and emotional regulation skills when necessary.

The Emotional Thermometer (link below) is one of several templates to help guide our work. The circle at the base of the thermometer describes one aim of therapy: the pursuit of Compassion without judgments and expectations but rather the pursuit of Curious Acceptance. Another way of looking at this aim of treatment goes back to the psychotherapies in the 1960s: "I am Okay, You are Okay, It's Okay. However, if I am not Okay, your not Okay, and it's not Okay- that is Okay" as all of these experiences are part of the human condition just as the ability to re-discover resilience is part of the human condition.

With these attitudes or trait beliefs, you will find it easier to cope with the inevitable challenges and struggles of being human and experience the magic of human potential.

Above the base of the Emotional Thermometer are numbers or steps on a ladder. For example, we want to be in the area of 4-7 (WINDOW OF TOLERANCE) to feel safe, balanced, connected, and free to pursue our aspirations (Ventral Vagal Complex). In 1-3, we may feel frozen (Dorsal Vagal Complex) or lack the motivation to pursue our hopes and dreams. Finally, in 8-10, emotions are vulnerable to dysregulation by the sympathetic and enteric nervous systems.

To the Emotional Thermometer's right side is a list of tools inspired by Dr. A.T. Beck’s Generic CBT model. For example, this list includes devices like validating feelings, applying self-compassion, and using multiple mindfulness practices to learn not to automatically engage in emotionally-driven behaviors such as avoidance in anxiety or withdrawal in depression. We may use some listed tools to evaluate or expand our perception and focus on the present moment.

Some of the other strategies we may use include:·       

We are discovering how our beliefs about ourselves, the world in general, or others will drive our focus or attention. Our guide or attention often goes behavior, forming a vicious cycle.

We identify your unique beliefs and their consequences. Sometimes, to determine your Core Beliefs, we may need to explore your developmental, attachment, and trauma history to discover how to develop safe connections and experience posttraumatic growth.

Discovering skills to respond differently to situations you can change and situations you cannot willfully change. Daily MEDITATION PRACTICES can help this for self-compassion and curious acceptance. Or perhaps by employing PROLONGED EXPOSURE and RE-LAPSE PREVENTION experiences to help you habituate to and learn to cope better with various anxieties. BEHAVIORAL ACTIVATION is a tool to help you cope with depression and other potentially maladaptive habits.

We guide you by evaluating both the emotional and thought-based pros and cons when deciding. In addition, we pay strict attention to dimensions such as your values, purpose, and certainty of the pros or cons happening.

It is working with you to identify and address obstacles in doing things that may be in your best interest.

·        Roleplaying different ways of handling a troublesome situation.

·        Collaboratively develop your "Own-Work"/Action Plan assignments to test out some of the material discussed to free you from pursuing your aspirations. Pursuit of pleasure or positive moments, engagement with focus and purpose, safe relationships, awareness of the meaning, and a sense of accomplishment.

·        Using the following: guided imagery, body scan or progressive relaxation, mindfulness meditation, breathing awareness meditation, or loving-kindness meditation within the session and, most importantly, in-between sessions.

We will often use other tools to fit your unique needs. For example, we may have you view YouTube links, including those on my website, or use popular apps, such as Calm, Headspace, Heart Math, etc., to assist you in reaching your full potential.

Stress the importance of nutrition, exercise, and restorative sleep. As well as discuss the complications of inflammation.

I invite you to review the Emotional Thermometer and skim the WEEKLY BRIDGE/Continuity of Care form. Also, please check CBT, Myths of CBT, in this TREATMENT LINK.