Structure of Cognitive Therapy Across Sessions

(adapted from Wells, 1997; and Beck, 1995)

Session Number

Main Focus


Initial Meeting

Collect information about current problems, maintenance factors and background. Beginnings of simple formulation. Engaging client in cognitive approach, showing collaboration. Education about cognitive therapy. First ‘homework’ (e.g. reading about CT, diary, etc.)


Formulation: building up a model. Engagement and socialising about how therapy works. Homework focusing on collecting information, e.g. thought diaries, behavioural methods such as activity diary.


Continuing formulation, engagement and socialisation. Working with information to start change – e.g. identifying negative thoughts and how to change these; activity scheduling in depression.


Using cognitive and behavioural methods to produce changes – thought challenging, beginning behavioural experiments.


As above, but beginning to identify and work with assumptions and rules. Testing out rules verbally and through behavioural experiments.


As above, introducing ideas of ending therapy. Looking at what client is learning and able to do outside sessions. Generalising learning to other problems and client’s life.


Ending – blueprint for ending. What client has learned and how to tackle future difficulties. Issues around endings.

6 month follow-up*

Review progress, troubleshoot difficulties and problem solve future problems.

Yearly follow-up*

As 6 months. Dealing with final ending.