Cognitive
Behavior
Therapy
Chapters 5
&6
Structure of the First Therapy
Session & Behavioral Activation
Based on Judith S. Beck (2011)
PSYC 547
Mehak Hafeez, LCPC. CRC.
Chapter 5 – Goals of the First Session
01 02 03 04
Establish rapport Normalize Provide initial Collaboratively
and therapeutic symptoms and conceptualization set goals for
alliance instill hope of problems treatment
Initial Part – Agenda, mood
check, update, diagnosis
Structure discussion
of the Middle Part – Problem
First identification, goal setting,
teaching the cognitive model
Therapy
Session End Part – Summary,
homework assignment,
feedback
Agenda setting – collaborative
and flexible
Mood check – quick
Initial assessment of emotional state
Session
Components Update on week and
functioning
Diagnosis explanation (brief,
clear, supportive)
Middle 01 02 03 04
Part of Identify main
problems and
set specific goals
Introduce and
explain the
cognitive model
Begin initial
behavioral
activation if
appropriate
Encourage active
patient
participation
Session
Summarize key
points discussed
End of Assign practical
homework (small,
Session achievable)
Elicit patient
feedback about
the session
To accomplish these goals, you will use the following format:
Initial Part of Session 1
1. Set the agenda (and provide a rationale for doing so).
2. Do a mood check.
3. Obtain an update (since the evaluation).
4. Discuss the patient’s diagnosis and do psychoeducation.
Middle Part of Session 1
1. Identify problems and set goals.
Overview 2. Educate the patient about the cognitive model.
3. Discuss a problem.
End of Session 1
1. Provide or elicit a summary.
2. Review homework assignment
3. Elicit Feedback
Chapter 6 – Behavioral Activation
Focuses on increasing Targets inactivity and Addresses lack of Uses structured activity
activity to reduce withdrawal patterns mastery and pleasure scheduling
depression
Conceptualizing Inactivity
Patients often withdraw due to negative
predictions
Avoidance reinforces depressed mood
Breaking the cycle with gradual re-engagement in
activities
Conceptualizing Lack of
Mastery/Pleasure
Depressed patients underestimate likelihood of
enjoyment
Activity charts help compare prediction vs actual
experience
Therapist highlights evidence of mastery and
pleasure
Collaborative planning
of activities
Record predicted vs
actual pleasure/mastery
ratings
Activity
Scheduling Reinforces adaptive
behavior through direct
evidence
Encourages persistence
even when motivation is
low
Initially predicts no enjoyment from activities
Case Example
•
• Records actual ratings higher than expected
– Sally •
•
Learns that action precedes motivation
Gradual increase in social and academic
engagement
Overcoming Obstacles
Clients may resist or forget to record activities
Therapist emphasizes small steps and persistence
Giving credit for effort, not just success
Use of guided discovery to challenge negative predictions
Integrating Chapters 5 & 6
First session lays Behavioral activation
foundation through provides immediate,
structure and alliance practical intervention
Both emphasize Synergy: Structured
collaboration, goal setting, sessions support consistent
and homework activation work
Key Takeaways
Therapy structure increases
efficiency and predictability
Behavioral activation is central
in treating depression
Small, achievable steps build
mastery and hope
Feedback and collaboration
enhance engagement
Final Discussion Questions
• How can therapists adapt session structure for different patients?
• What strategies help increase adherence to behavioral activation?
• How do structure and activation complement each other in practice?
