Reporting Script – Chapter 7: Session 2 and Beyond
Good day, everyone.
Today, I’ll be discussing Chapter 7, which focuses on the structure and format of CBT sessions
starting from Session 2 and moving forward in treatment.
Initial Part of the Session
The first part of the session is structured and consistent. It typically involves five steps:
1. Mood and Medication Check
At the start of the session, the therapist checks in on the client’s mood and symptoms. If the
client has filled out a symptom checklist, the therapist compares it to previous scores to track
progress or identify new issues — for example, suicidal thoughts, feelings of worthlessness,
sleep difficulties, or increased irritability.
If the client is on medication, the therapist will briefly check for any side effects or issues with
taking the medication. If they’re not taking any, but medication might help, the therapist may
suggest a medical or psychiatric consultation.
2. Setting the Agenda
The therapist then collaborates with the client to set an agenda. Clients are asked, “What
problems do you want help solving today?”
This helps guide the session in a focused, problem-solving direction and encourages the client to
take part in structuring the session.
3. Update of the Week
This step bridges the gap between the last session and the current one. The therapist asks how the
client’s week went — both in general and emotionally. This is also an opportunity to point out
any positive experiences that the client may have overlooked, which helps balance negative
thinking and reinforce small improvements.
4. Homework Review
Reviewing homework is a critical part of CBT. If it’s not reviewed, clients may stop completing
it.
The therapist asks the client to read their homework assignments aloud and discusses how it
went. In some cases, this review becomes the main part of the session if it connects strongly with
current problems.
5. Prioritizing the Agenda
Sometimes, clients bring multiple concerns. The therapist and client work together to prioritize
the items and decide what to focus on now, and what to postpone for a future session.
This step also helps avoid getting distracted by unrelated or low-priority issues.
Middle Part of the Session
The middle of the session is focused on solving problems using CBT strategies. This includes:
1. Working on a Specific Problem
Once the top priority problem is identified, the therapist gathers more information and applies
the cognitive model to understand what’s going on.
Together, the therapist and client decide which part of the model to work on — this could mean:
• Evaluating automatic thoughts
• Changing behaviors
• Reducing emotional distress
• Or lowering physiological arousal
2. Teaching CBT Skills and Setting Homework
While working on the problem, the therapist teaches relevant CBT skills. This could be helping
the client reframe thoughts, test beliefs, or change behaviors.
Then, together, they collaboratively set homework based on what was discussed. The goal is
always to keep it relevant and manageable.
3. Optional: Work on a Second Problem
If there’s still time and energy, they may move on to a second agenda item using the same
process. However, this only happens if the first problem has been thoroughly addressed.
End of the Session
The session ends with three key steps:
1. Summary of the Session
Either the therapist or client provides a summary of the key takeaways. This reinforces what was
learned and ensures both are on the same page.
2. Reviewing New Homework
The therapist confirms that the client understands and agrees to the new homework.
This helps the client feel prepared and more confident about applying CBT skills outside the
session.
3. Eliciting Feedback
Finally, the therapist asks the client for feedback about the session.
This can be as simple as, “How was today’s session for you?”
It gives the client a chance to share any concerns or reactions, which helps strengthen the
therapeutic relationship.
