Cognitive behavioural therapy (CBT) is known for being a short-term, action based treatment, and this might lead some patients to expect to start feeling a lot better after their first session. This may not necessarily be the case, however – and if you don’t feel all that different afterwards it’s definitely nothing to worry about.

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Some people are hopeful, inspired or relieved after their first CBT session. Others are exhausted – and it’s not unusual to feel a bit worse than you did before, if you’ve brought some difficult things to the surface. But if you feel a bit ‘meh’, or that you haven’t really learned anything new, this doesn’t mean that nothing is changing!

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When you visit a physiotherapist, the practitioner will spend the first session gathering information, examining your problem, and teaching you some exercises and stretches to do at home. It’s unlikely that you’ll experience an improvement in your symptoms straight away.

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It’s a similar process with CBT: the first session will be an assessment, where the therapist will work to explore your symptoms, ask lots of clarifying questions, and discuss techniques and strategies that could help you. You might not get to the stage where you’re actively ‘doing’ something, yet.

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This could feel like a bit of an anti-climax, especially if you’ve been waiting a while to start treatment, or it was a major decision to sign up. But rest assured, CBT is a gradual process, and you’ll have done some valuable work in that session which you’ll build on in the coming weeks. You and your therapist will both have come away with a better understanding of your problem, and you’ll have the beginnings of a solution to move you forward.

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It's early days, so try not to worry, or to assume it’s not going to work if you don’t feel as different as you envisaged you would. You’ve taken the first step, and started the journey, and there’s no reason you shouldn’t still feel motivated to continue.

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We always encourage patients to give us honest and open feedback about their treatment. It’s not always easy for the therapist to know how things went from your perspective, so please do tell them if you’re worried about your progress, or concerned that CBT might not be for you, so they can talk this through with you and help to put your mind at rest.

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If you haven’t yet begun your treatment, you might find it useful to read up on the process in advance, as well as what to expect from your first session. Discuss your expectations with your therapist when you first get together, so they can answer any questions and address any misunderstandings.

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With online CBT, you can message your therapist in between sessions, which can be useful if you didn’t get the chance to mention something in the session, or it took you a while to get your head around how you felt.

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If you’ve just had your first CBT session and you’re wondering how to move forward…do your homework! Your therapist will have set you a task to do, or something to practice, and we’d recommend you take the opportunity to complete this, however you may be feeling. It’ll help make sure you get the most from your next session.