Planning the process after the first session means setting goals, the meeting schedule and the way of working together with the person, based on what was learned in the first session. The psychological support process may proceed differently depending on each person’s reason for seeking support, needs and life circumstances. For this reason, sessions are shaped not by a one-size-fits-all structure but by taking into account the difficulties the person experiences and the needs that emerge during the process.
What stages can the psychotherapy process include?
Although the process varies from person to person, sources describe a general flow. According to the Royal College of Psychiatrists, in cognitive behavioral therapy the therapist checks in the first 2–4 sessions whether this kind of work suits the person, and during the work the person sets goals with the therapist for what they want to change. For the topics covered in the first session, see What Is Covered in the First Session?.
In this process, generally:
- The difficulties the person experiences and their effects on their life are addressed.
- Patterns of emotion, thought, behavior and relationships are considered together.
- The person is supported in understanding themselves, their needs and their experiences better.
- When deemed necessary, the goals of the process are determined together.
- Coping strategies suited to the person’s life and more functional options are evaluated.
The aim of the process is less to offer ready-made solutions to the person than to support them in understanding the difficulties they experience in a more holistic way, developing awareness and discovering ways that suit their own life.
How does a session generally proceed?
The structure of a session varies with the approach. The Royal College of Psychiatrists notes that in CBT the person and the therapist begin each session by agreeing on what to discuss that day. The Beck Institute adds that a session begins with gathering information and setting an agenda, that an “action plan” for the person to work on between sessions is created later in the session, and that a CBT session generally lasts 45–60 minutes. In psychodynamic psychotherapy the structure of a session may differ; details are in What Is Psychodynamic Psychotherapy?.
What can be done between sessions?
According to the Royal College of Psychiatrists, in CBT the therapist recommends regular “homework.” The NHS states that the person is usually asked to practice what they have learned between sessions and that this is important for CBT to work. If the tasks seem too hard or do not seem to help, this can be discussed with the therapist.
How is progress tracked?
NIMH notes that, before starting therapy, a person can ask about the goals and how progress will be assessed. Goals are discussed at the outset and progress is reviewed together, so that the process can be revisited as the person’s needs change.
Why does the working relationship with the therapist matter?
Research reports that the collaboration between client and therapist (the therapeutic alliance) is related to therapy outcomes. A meta-analysis by Flückiger and colleagues covering 295 studies and more than 30,000 patients found a positive association between alliance and outcome (r = .278); this finding does not show causation and is not a promise of results. NIMH likewise states that rapport and trust are essential in therapy.
What can be done if the process is not going as expected?
According to NIMH, if no progress is felt after what seems a reasonable amount of time, this can be discussed with the therapist, and other mental health professionals or approaches may also be considered. How a suitable way of working can be assessed is covered in How Is the Suitable Way of Working Assessed?, and the session schedule in How Are Session Frequency and Length Determined?.
Expert note
Clinical Psychologist Özgün Emre Yaylacı’s perspective draws on cognitive behavioral and psychodynamic psychotherapy theories. From this perspective, planning the process looks not only at symptoms but also at the person’s life story, relationships and recurring patterns; goals and the meeting schedule are set together with the person and reviewed as the process unfolds.
Session frequency, length and the scope of the process are specific to each person and are clarified together in the initial evaluation. The information on this page is general and does not replace an evaluation.
Clinical Psychologist Özgün Emre Yaylacı
Frequently asked questions
Who decides what is discussed in a session?
Topics generally take shape around what the person brings and the goals set together; the psychologist can give the session structure and direction. Goals are set together when deemed necessary and can be reviewed as the process unfolds.
Does every session proceed the same way?
It varies with the approach. CBT sessions are usually structured around setting an agenda, working on it and planning practice between sessions; the structure can differ in other approaches.
Is “homework” between sessions mandatory?
In CBT, practice between sessions is recommended, and the NHS states that it is important for CBT to work. If tasks feel too hard, this can be discussed with the psychologist.
Is the length of the process decided in advance?
According to the Royal College of Psychiatrists, the length of psychotherapy is in most cases agreed with the therapist within about a month of starting. For more detail, see How Long Does Psychological Support Take?.
What happens at the end of the process?
According to the Royal College of Psychiatrists, at the end of a CBT course the person creates a personal “staying well” plan covering the skills learned and how to use them in the future; if necessary, a “refresher” course can be arranged.
Sources
This article was prepared for general information; the following sources were used in preparing it (in English):
- Royal College of Psychiatrists: Cognitive behavioural therapy (CBT)
- Royal College of Psychiatrists: Psychotherapies and psychological treatments
- Beck Institute Cares: What Are CBT Sessions Like?
- NHS: Cognitive behavioural therapy (CBT) – Overview
- NIMH: Psychotherapies
- Flückiger et al., Psychotherapy 55(4): The alliance in adult psychotherapy: A meta-analytic synthesis
This article was prepared by Clinical Psychologist Özgün Emre Yaylacı. Last updated: October 23, 2026. The content is for general information only and does not constitute diagnosis, treatment or personal guidance.
