Example of sessions Flashcards
Session Transcript: CBT Therapy Session with “Jane”
Therapist: Good morning, Jane. How have you been feeling since our last session?
Jane: Morning. It’s been a mixed week. I had some really good days, but yesterday was particularly tough.
Therapist: I’m sorry to hear that. Can you tell me more about what made yesterday difficult?
Jane: I had a presentation at work, and the entire time leading up to it, I kept thinking I would fail, that everyone would judge me, and I’d be embarrassed.
Therapist: It sounds like you were experiencing some distressing automatic thoughts. Did you use the thought record sheet we discussed?
Jane: I did. I noted down my thoughts before, during, and after the presentation.
Therapist: Great. Can you share some of the thoughts you wrote down?
Jane: Before the presentation, I thought, “I’m going to forget everything,” “People will think I’m incompetent,” and “What if I embarrass myself?” During the presentation, I had the thought, “They look bored. I must be doing this wrong.”
Therapist: Thank you for sharing. Let’s break these down. Starting with your first thought, “I’m going to forget everything.” Is there any evidence that supports this thought?
Jane: Well, no. I prepared a lot. I just felt that way.
Therapist: And is there any evidence that counters this thought?
Jane: Yes, I’ve done presentations before, and I usually remember what I have to say. And I had my notes with me just in case.
Therapist: That’s a good observation. Let’s move on to the next thought, “People will think I’m incompetent.” Was there any evidence from the audience or afterward that supported this thought?
Jane: Not really. No one said anything negative, and my boss even complimented me afterward. I just kept thinking they were judging me silently.
Therapist: It’s common to think that way, especially when we’re anxious. What we want to do is challenge these automatic negative thoughts. For the thought, “They look bored. I must be doing this wrong,” could there be alternative explanations?
Jane: I suppose some of them might have been thinking about their own work or maybe they just have a resting face that seems uninterested?
Therapist: Exactly. Not all reactions are a direct response to what you’re doing. Now, based on our discussion, how would you reframe some of these thoughts?
Jane: Maybe: “I’m prepared for the presentation, and even if I forget something, I have my notes.” And “People have their own concerns; just because they aren’t visibly excited doesn’t mean they think I’m doing poorly.”
Therapist: Those are excellent reframes, Jane. Remember, the goal isn’t to turn negative thoughts into unrealistically positive ones, but to challenge and balance them. How do you feel now, revisiting these thoughts?
Jane: I feel a bit lighter, honestly. I realize I was being too hard on myself.
Therapist: I’m glad to hear that. Let’s continue practicing this skill, and next time we can delve deeper into understanding where these core beliefs about judgment and competence come from. How does that sound?
Jane: Sounds good. Thank you.
Initial CBT Session with a Child Who Has Experienced Trauma
Therapist: Hey there! My name is Dr. Taylor. I’m so glad you came to visit me today. This is a special room where we can talk, play, draw, or just hang out. How are you feeling?
Child: (looking down) Okay, I guess.
Therapist: That’s alright. Sometimes it’s hard to know how we feel, and that’s okay too. I have some cool coloring books and toys over here. Would you like to pick one out?
Child: (nods and picks up a coloring book)
Therapist: I love that one! While you color, I wanted to let you know that this is a safe place. We can talk about anything you want, or we can just color together. Sometimes talking can help, but it’s always your choice.
Child: (starts coloring) My teacher said you can help me with the bad dreams.
Therapist: I’ll do my best to help you with that. Bad dreams can be really scary. Do you want to tell me about them?
Child: There was a loud noise, and then everything was broken. I keep seeing it when I close my eyes.
Therapist: That sounds really scary. I’m so sorry that happened. But you’re really brave for sharing that with me. We can work together to understand these dreams better and find ways to make them less scary.
Child: Will they go away?
Therapist: We’ll work on it together. It might take some time, but many kids I’ve talked to have found ways to feel better about their dreams and memories. For now, whenever you have those dreams or thoughts, it might help to remember you’re in a safe place right now.
Child: Okay. Can we color some more?
Therapist: Absolutely! Let’s color together. And whenever you’re ready, we can chat a bit more, but there’s no rush.
CBT Session: Cognitive Restructuring for Social Anxiety
Therapist: Alex, last session you mentioned feeling particularly anxious during lunchtime at school, fearing that others were judging you. Can you describe a specific incident?
Alex: Sure. Last Thursday, I walked into the cafeteria and felt like everyone was staring at me. I immediately thought, “Everyone notices how awkward I am,” and felt a strong urge to just leave.
Therapist: That sounds distressing. Let’s work on that thought: “Everyone notices how awkward I am.” How did that thought make you feel?
Alex: Super anxious. And embarrassed.
Therapist: Alright. Let’s explore this thought using cognitive restructuring. First, Identify the Evidence: What evidence supports this thought?
Alex: Well, sometimes people laugh, and I think it’s about me. And I don’t always know what to say in conversations, so there’s that…
Therapist: Okay. Now, let’s Challenge the Thought: What evidence goes against it?
Alex: I guess…not everyone was looking at me. Some were just talking to their friends or eating. And no one actually said anything to me.
Therapist: That’s good insight. Next, let’s Consider Alternative Interpretations: Could there be other reasons why some people might have been looking your way or laughing?
Alex: Maybe they were looking at something behind me? Or they were laughing about a joke or something that happened earlier?
Therapist: Exactly, there could be numerous explanations. Now, Assess the Impact of Believing the Original Thought: How did it affect your behavior?
Alex: I sat at the last table, didn’t talk to anyone, and ate quickly so I could leave.
Therapist: Understandable given how you felt. Let’s now Visualize a More Balanced Thought: How can we reframe the original thought in a more objective way?
Alex: Maybe something like, “Some people might notice me, but many are focused on their own things. I can’t know for sure why they’re laughing or looking around.”
Therapist: That’s a great reframing! Lastly, how does this new thought make you feel?
Alex: It feels less heavy. Still a bit nervous, but not as overwhelming.
Therapist: That’s progress. Cognitive restructuring is about practicing these steps to challenge and modify distressing thoughts over time. As you continue to apply it, you’ll likely find that many of your fears aren’t as intense or factual as they first appear.
Therapeutic session utilizing guided imagery for a patient named Sarah who recently lost a parent:
Therapist: Sarah, today, I’d like to introduce you to a relaxation technique called guided imagery. It’s a way to help you find a sense of peace and possibly connect with the cherished memories of your parent. Would you be open to trying it?
Sarah: I’ve been feeling really overwhelmed lately. If it might help, I’m willing to give it a shot.
Therapist: It’s okay to feel overwhelmed. Guided imagery can be a safe space to process your feelings. Before we begin, find a comfortable position in your chair. If you’re okay with it, you can close your eyes. Remember, you’re in control, and you can stop at any point. Let’s start by taking a few deep breaths.
[Pause as Sarah takes a few deep breaths.]
Therapist: Imagine yourself standing at the entrance of a serene garden. The weather is perfect, warm with a gentle breeze. You can hear birds singing and the rustling of leaves. As you walk in, you feel the soft grass under your feet.
Sarah: Okay, I can picture that.
Therapist: In the center of this garden is a beautiful bench, next to a calm pond reflecting the clear blue sky. You decide to sit on this bench. As you do, you notice a familiar feeling of warmth and safety.
Sarah: It feels peaceful.
Therapist: As you sit there, absorbing the beauty and tranquility, you sense a presence next to you. Turning your head, you see an ethereal, comforting image of your parent, radiating warmth and love. They’re not here to evoke sadness, but to offer comfort.
Sarah: (teary-eyed) I can see my mom. She’s smiling.
Therapist: She’s here with you in this garden of memories. You can speak with her, share your feelings, or simply sit silently, feeling her comforting presence.
[Pause for Sarah to have her personal moment.]
Therapist: Whenever you’re ready, know that you can leave this garden with a sense of peace, carrying the love and memories with you, and you can always return whenever you wish.
Sarah: (softly) Thank you. That was… I felt her close to me.
Therapist: I’m glad you found comfort in the imagery, Sarah. Remember, the connection and the memories you have with your mom are enduring. Guided imagery is just one tool to help you access and cherish them.
