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Typical Session Outline
1. Briefly review patient’s mood and/or physi
cal functioning (5 minutes).
Elicit responses concerning the patient’s mood
, and consider any and all discrepancies (e.g.,
change in strength or nature of usual mood, c
hange from last week or beginning of treatment).
Medically ill patients may benefit from regular
assessments and updates on their physical health
symptoms and functioning. Also ask the patie
nt to offer explanations for mood improvement or
decline. This brief update allows you to gauge
how the patient is progressing and identify
p
ositive and negative change. If medication management or physician collaboration is part of
th
e patient’s treatment, this is also a good time to check on any side-effects the patient might
b
e having from medication and make adjustments as needed.
2. Bridge discussion from previous session with the current session (5 minutes).
In bridging sessions, you are checking the patient’s understanding of what was discussed in the
previous session. Reinforcing what the patient learned in past sessions is essential to the
improvement that the patient makes outside the therapeutic relationship. Having the patient
complete a Bridging Worksheet
can assist in this stage of the agenda. Some issues discussed
during this phase could become items on the agenda for the current session.
3. Set the agenda for the current session, and prioritize the items (5 minutes).
First ask the patient what he/she would like to discus, and then offer an item. If a patient brings
several agenda items, he or she might need to indicate which is the most important to discuss
first. When a situation (e.g., fight with boyfriend followed by food binge) is offered by the patient
a
s an item, you can use the situation as part of his/her agenda item, that is, as part of the skill
b
eing taught. For example, you can use the above scenario to teach/review a thought record.
4
. Review any homework given in the previous session (5-10 minutes).
P
atients who do between-session homework show greater improvements than those who do not.
T
o reinforce and troubleshoot between-session learning, it is important to review homework. In-
se
ssion review serves two purposes: it reinforces the importance of homework and allows you to
a
ssess ski
ll acquisition. If you identify errors in homework, you can use additional session time to
re
view the skill. Reviewing homework can take a small amount of time; or it can take the entire
se
ssion, depending on what the patient has learned from doing it and what difficulties he or she
has encountered in completing it.
5. Discuss agenda items and set up homework (20-25 minutes).
Discuss agenda items, starting with the first and most important. If you are running short on time,
inform the patient that you will discuss the other items at your next appointment. Set up
homework that is directly connected to what has been discussed in the session.
6. Summarize the current session and exchange feedback (5 minutes).
Two types of summarizing are recommended. The first is a brief summary that should be done
after the conclusion of each section of the agenda to reinforce what has been discussed. The
second type is used to clarify and remind the patient of the thoughts he/she has presented and
how those thoughts changed as a result of the exercise. It is important to use the patient’s
specific words in summarizing his or her thoughts. At the end of the session, summarize the main
points of the entire session. As the sessions progress, ask patients to do the summaries. Finally,
exchange feedback about the session, skill, or progress of therapy. This is a time for you to
encourage and motivate patients to continue working towards change.