The structure of treatment is as follows: CBT starts with the initial interview. As with all forms of therapy it is essential to establish a rapport and use active listening skills to ensure that the client feels understood and listened to.
In the initial interview there is an assessment process. This gathers relevant information in regard to the cognitive model (fig.1). From this one can form a hypothesis and share this with the client. One is also on the look out for suicidal intent. A useful tool in assessing a client for depression is the Beck Depression Inventory (BDI) (Stephens 2008). This not only can act as an initial assessment tool but can also help to monitor progress as interventions have been made. One can gauge from it whether or not the therapy is successful. The lower the score on the BDI the less severe the depression is and vice-versa.
The next step is to define and focus on goals. A question like “how would you like this situation to be different?” would help in this area. This keeps a focus on the therapy and provides a benchmark.
One must next explain the way this form of therapy works, from a practical and a theoretical point of view. One deals with expectations from both parties such as duration of therapy and homework assignments. It is important to explain how negative thinking is a vicious cycle that needs to be broken and also it is important to emphasise that change is possible.
A target is agreed upon for immediate intervention. Appropriate homework, monitoring tools and reading are provided.
It is also important to get feedback from the client, and this should be ongoing throughout the therapy.