As a psychiatrist, many of my patients often ask, “What does a Cognitive Behavioral Therapy (CBT) session actually look like?” It’s a question that reflects curiosity and sometimes apprehension, especially for those new to therapy. CBT is a structured, goal-oriented approach that focuses on understanding and reshaping the thoughts and behaviors contributing to emotional distress. While each session is tailored to the individual, the process typically involves identifying unhelpful thought patterns, exploring their underlying beliefs, and collaboratively working on practical strategies to address them. Here’s an overview of what a typical CBT session might entail, adapted to our cultural and personal contexts.

1. Building Rapport and Setting the Stage

The first step in any therapy session is establishing a comfortable and safe space for the client. In CBT, the therapist might start by asking what brought the client to therapy and exploring their immediate concerns. For example, a client may say, “I feel like I’m not good enough because I couldn’t meet my family’s expectations.”

The therapist listens empathetically, helping the client feel heard and understood. This initial phase is crucial for building trust and ensuring the client feels open to discussing their thoughts and feelings.

2. Identifying Negative Thoughts

CBT focuses on identifying “automatic thoughts”—the immediate, often unexamined reactions to situations. The therapist may ask, “What went through your mind when you felt like you didn’t meet expectations?” The client might respond with, “I feel like I’ve failed my family.”

The therapist helps the client recognize that these thoughts often stem from deeper beliefs or assumptions and that they are not always accurate reflections of reality.

3. Exploring Core Beliefs

Using techniques like laddering, the therapist guides the client to uncover the deeper “core beliefs” that drive their automatic thoughts. For example:

• Automatic Thought: “I’ve failed my family.”
• Deeper Belief: “I’m a disappointment” or “I’m not capable.”

In this phase, the therapist explains that core beliefs are often fears or assumptions shaped by past experiences or societal pressures, rather than absolute truths. Understanding these beliefs is a significant step in the therapy process.

4. Recognizing Cultural Assumptions

In the Indian context, societal and familial expectations often play a significant role in shaping thoughts and behaviors. The therapist may discuss how cultural norms influence the client’s beliefs, such as:

• “I must always prioritize my family’s needs over mine.”
• “Success is defined by securing a prestigious job or fulfilling traditional roles.”

By acknowledging these cultural influences, the therapist helps the client see their thoughts in a broader context, reducing self-blame.

5. Designing Behavioral Experiments

CBT is action-oriented, meaning clients are encouraged to test their beliefs in real-world scenarios. For instance:

• A client who believes, “I must never share my struggles because it burdens others,” might be asked to share a minor stressor with a trusted family member or friend.
• The goal is to observe the reaction and gather evidence to challenge the assumption.

The therapist and client collaborate to design manageable, low-risk experiments that feel achievable yet meaningful.

6. Reflecting on Results

After completing the experiment, the client reflects on the outcome:

• Did the feared reaction occur?
• How did it feel to share their thoughts or needs?
• Did the response align with their assumptions?

For instance, if the client shared their stress with a family member and received support rather than criticism, it challenges their belief that opening up is burdensome.

7. Building Practical Skills

CBT sessions often include teaching skills to manage negative thoughts and emotions, such as:

• Cognitive Restructuring: Reframing negative thoughts into more balanced perspectives.
• Mindfulness Techniques: Staying present and reducing anxiety.
• Problem-Solving Skills: Breaking down overwhelming challenges into smaller, actionable steps.

These skills empower clients to handle future situations independently.

8. Iterative Process

CBT is a journey, not a quick fix. Over multiple sessions, the client continues to test beliefs, gather evidence, and refine their understanding of themselves and the world around them. The therapist supports this process by providing a structured yet flexible framework.

Why CBT Works for Indian Clients

CBT’s practical and structured approach makes it highly adaptable to Indian cultural and societal contexts. By addressing the interplay of personal beliefs, family dynamics, and societal expectations, CBT helps clients build healthier thought patterns and coping strategies. It is especially effective in empowering clients to navigate the unique challenges of balancing traditional values with modern aspirations.

Final Thoughts

A CBT session is a dynamic process, combining introspection, practical exercises, and meaningful conversations. It’s about understanding yourself better, challenging the beliefs that hold you back, and taking small, actionable steps toward emotional well-being. Whether you’re dealing with stress, anxiety, or relationship issues, CBT offers a clear and structured path forward, tailored to your unique experiences and cultural context.

If you’re considering therapy and wondering if CBT is right for you, I encourage you to take the first step. As I often remind my patients, seeking help is not a sign of weakness—it’s a testament to your strength and commitment to your well-being.