What is cognitive behavioral therapy?

Cognitive behavioral therapy (or CBT for short) focuses on present problems and conflicts, although past issues may be part of treatment if they impact on present life adjustment. This approach assumes that psychological problems develop because of maladaptive expectations, assumptions, beliefs, and perceptions about ourselves and others, which lead to ineffective coping behavior.

By examining your thoughts (what you think), your behaviors (what you do) and your emotions (what you feel), you can begin to change the way you think and act to help improve the way you feel. CBT has a number of important components, including:

CBT uses models to help you develop a new understanding of your difficulties;
CBT is skills-based, so it encourages the development of new skills to manage difficulties;
CBT is a structured treatment, ensuring that therapy is efficient and remains focused;

CBT deals with the “here and now”, focusing on factors that are maintaining the problem, rather than what started it. Since you cannot change the past, CBT deals with factors in the present that you can control;

The most important treatment component of CBT is “homework” that is completed between sessions. The homework exercises are designed to help you practice skills learned in treatment sessions. This helps make progress as rapid as possible and helps you to develop a sense of control in your ability to manage difficulties.

Homework? What if I don’t do my homework?

You are encouraged to practice your new skills outside of sessions. Trying your homework allows you to gather information about what works and what doesn’t and to learn how to solve your problems. Not to worry, you will not be graded!

How long does treatment usually last?

Cognitive behavioral therapy is designed to be a brief, skills-based treatment approach. Many people are able to make significant improvements after 8 to 24 sessions.

Of course, showing improvement is not the same as successfully completing treatment. Most psychologists will tell you that the length of treatment depends upon the nature of the problem, the severity of the problem, the number of conditions being treated, and the treatment goals selected. A vague response like this can be frustrating, but rest assured that most individuals complete psychological treatment within three to six months.

My primary physician gave me a prescription for anti-depressant medication, will it help to talk to a psychologist too?

Depression is a psychological condition that changes how you think and feel. Sleep and concentration problems, chronic fatigue and a lack of motivation are common symptoms. When these symptoms are severe, it is difficult to manage everyday life tasks. Both psychotherapy and medication are used to treat depression. Research has found that cognitive therapy is more effective than other treatment approaches, including medication. However, some people respond better to a combination of both cognitive therapy and anti-depressant medication.

Anti-depressant medication provides some relief from the physical and emotional symptoms of depression. This can help you to manage you life better, but you should also see a psychologist for cognitive psychotherapy, to resolve the life problems and change the thoughts and beliefs that caused the depression to develop. While some people may continue on anti-depressant medication after they have completed a course of psychotherapy with a psychologist, it may not be advisable to continue on medication long term without combining that treatment with psychotherapy.

Why does a treatment visit with a psychologist cost more than a treatment visit to my family physician?

Part of the cost of psychological treatment is related to the personal attention and individual treatment you receive. Sometimes when you seek your family physician, you are seen by a nurse practitioner or a physician’s assistant, instead of the physician.

Also, when you visit your family physician for a problem, you might receive between five and fifteen minutes of one-on-one attention from your physician during an office visit. However, psychotherapy appointments are for 50 to 60 minutes, and sometimes longer for testing and evaluation services. The fees charged for psychological services reflect this time and personal attention.

If you look at the amount of time spent in treatment, psychological treatment is much less expensive than medical treatment.

Do I have to talk about my mother?

Not unless she is currently one of your problems. CBT focuses on problems you are having now, and although your childhood may have contributed to your current problems, importance will be paid to factors that are maintaining the problem.

If my insurance does not cover all the necessary treatment, will the psychologist use a sliding scale fee, that takes into account my income, for the balance of my treatment?

If treatment is no longer covered by your insurance, there are several options available to you and your psychologist, which will allow you to continue in treatment. If treatment is almost complete, and your income allows it, you may choose to pay for the remainder of sessions out-of-pocket. If the full fee is not manageable, you may ask your psychologist whether a reduced fee would be appropriate.

Most importantly, if the cost of treatment is preventing you from receiving necessary treatment, please discuss this with your psychologist. Payment for the remaining sessions could be made over time. Almost always, an acceptable payment arrangement can be worked out.

Do I need a referral from my family physician?

A referral from your family physician is only required for a medical consultation with a psychiatrist or if an insurance company requires a referral for reimbursement purposes. Please inquire with your insurance company regarding the conditions of reimbursement.