Starting therapy: what to expect
A plain guide for clients starting CBT: how sessions run, what between-session tasks are for, why you are asked for ratings, how privacy works and how therapy ends, with space for your questions, what would help and your hopes. Based on Roth and Pilling (2007) and Beck (2021): the client guide and the three question boxes are our own.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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Starting therapy: what to expect
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What this sheet is for
Starting therapy can feel strange, and it helps to know what to expect. This sheet explains how CBT usually works.
Your therapist may do some things differently, and they will tell you if so. Ask about anything that is unclear.
How sessions work
Sessions usually last about an hour and happen at a regular time, often once a week. Your therapist will talk with you about how many sessions you are likely to have, and you will look at this together as you go.
Most sessions follow a similar pattern. You look back at how things have been since last time, agree a short list of things to talk about (an agenda), work on one or two of them, and end by summing up and agreeing a next step. You can add your own items to the agenda.
CBT is something you and your therapist do together. Your therapist brings knowledge of what tends to help. You bring knowledge of your own life. You decide together what to work on.
Tasks between sessions
Most of life happens between sessions, so you will usually agree a small task to try before next time. It might be noticing something, writing a few lines, or trying something new.
Tasks are agreed together, not set for you. If a task does not get done, that is useful to talk about, not a failure. Knowing what got in the way helps you both change the plan.
Ratings and questionnaires
Your therapist may ask you to fill in short questionnaires, or to rate things such as your mood from 0 to 10. This helps you both see what is changing and what is not, so the plan can be changed if it needs to be. There are no right answers: your ratings are your own view. You can ask what any questionnaire is for and what happens to your answers.
Privacy and confidentiality
What you talk about in therapy is treated as private, with some limits. Your therapist may talk about your care with a supervisor, and may write to your GP with your agreement. If your therapist is seriously worried that you or someone else could come to harm, they may need to share some information. Where they can, they will tell you first.
Your therapist will explain what is written down, who can see it, and when information might be shared. Ask them if anything is not clear.
How therapy ends
CBT usually has a planned ending. Towards the end, sessions may be spaced further apart. You and your therapist will look back at what you have learned and make a plan for keeping it going, including what to do if old problems come back.
If you want to stop early, or if therapy does not feel right, please say so. It helps to talk about it, and there may be changes that would help.
My questions and needs
Bring this to your next session. You can leave any box blank.
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When to use ‘Starting therapy: what to expect’
‘Starting therapy: what to expect’ is a psychoeducation handout based on cognitive behavioural therapy (CBT). It draws on core CBT skills used right across the model, with presentations including depression, anxiety, OCD, trauma and low self-esteem, rather than being tied to a single diagnosis.
It is designed to be read within therapy rather than as a standalone self-help tool: a therapist introduces it and discusses it with the client. You can preview the full handout above, then assign it for clients to read between sessions on any device or download it as a print-ready PDF. Where a short reflection is included, it offers space to respond to the reading.
How it works
Most people work through it in around 10 minutes. It moves through six short sections to read:
- What this sheet is for: Starting therapy can feel strange, and it helps to know what to expect. This sheet explains how CBT usually works. Your therapist may do…
- How sessions work: Sessions usually last about an hour and happen at a regular time, often once a week. Your therapist will talk with you about how many…
- Tasks between sessions: Most of life happens between sessions, so you will usually agree a small task to try before next time. It might be noticing something,…
- Ratings and questionnaires: Your therapist may ask you to fill in short questionnaires, or to rate things such as your mood from 0 to 10. This helps you both see what…
- Privacy and confidentiality: What you talk about in therapy is treated as private, with some limits. Your therapist may talk about your care with a supervisor, and may…
- How therapy ends: CBT usually has a planned ending. Towards the end, sessions may be spaced further apart. You and your therapist will look back at what you…
The handout can be read on a phone, tablet or computer, or downloaded as a print-ready PDF. If it includes a reflection, answers entered on the Formulate platform are saved automatically and shared back with the therapist for review before the next session.
The CBT approach behind it
‘Starting therapy: what to expect’ introduces a CBT approach that involves noticing the links between situations, thoughts, feelings, physical sensations and behaviour and finding practical ways to change unhelpful patterns. The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This handout is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Roth, A.D., & Pilling, S. (2007). The competences required to deliver effective cognitive and behavioural therapy for people with depression and with anxiety disorders. Department of Health.
- Beck, J.S. (2021). Cognitive behavior therapy: Basics and beyond (3rd ed.). Guilford Press.
- Kazantzis, N., Whittington, C., & Dattilio, F. (2010). Meta-analysis of homework effects in cognitive and behavioral therapy: A replication and extension. Clinical Psychology: Science and Practice, 17(2), 144-156. doi:10.1111/j.1468-2850.2010.01204.x
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
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