In a CBT session the focus is on a target area. How a patient thinks, feels, and reacts to a situation or thought is causing problems in their life. There may be multiple target areas, but usually only one is addressed in each session. 

The first step in CBT is to address core beliefs about one’s self or the world around them. Specifically, these are “negative” beliefs.

In my previous post, I mentioned a fear of speaking in public. I’ll continue with this example as it is less likely to involve trauma and the last thing I want is to exacerbate the struggles of anyone reading.

A therapist will first help their patient create a list of their negative beliefs. For public speaking, the list may look something like this:

• People will laugh at me.
• I’m not important enough to deliver this speech.
• I’ll make a mess of this and never have another opportunity.
• I don’t look good enough to be on that stage/camera.
• My voice annoys people.
• I’m not smart enough.

Each of these are perceptions about what might happen when giving a speech, negative self-talk, and distorted perceptions about other people. It may be sourced in the past – a speech in a high school classroom resulted in being laughed at and bullied, for example. Or, it may be that the patient has never spoken publicly because of their fears.

With the perceptions isolated, the therapist will then begin helping the patient take them apart.For example:

People will laugh at me:

• It happened to me.
• It happened to someone I know.
• I was in high school.
• The teasing/bullying over the mistake lasted for weeks.
• I lost status/security/confidence/etc because of that speech.
• I can’t afford to have that kind of thing happen in my career.

The fact of when it happened and what followed aren’t disputed. Those events are real, and the response – especially given the intensity of events experienced as a teen – is completely valid.

I know the first time someone told me my feelings about an event from my teens were valid, I cried for almost 20 minutes. I had been told to get over it, not let it bother me, and criticized when I failed to do so. No one had said, “That must have hurt. I understand why you’re upset.” The simple act of validation in a therapist’s office took away a great deal of pain, so, whatever your situation, let me tell you: How you feel is absolutely valid. It doesn’t have to be morally or logically correct, but it’s valid.

A therapist will work at the core beliefs surrounding these perceptions. You’ll look at the emotions each thought triggers. We’ll go more into that process next week.

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