CBT notes with additional session request example

CBT notes with additional session request example

Authors:	Angela Jones and Jen Clue (Senior CBT Therapists)
Date:	20/08/2025

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Treatment Session Notes

Patient First Name: James

Patients Last Name: Smith

Date of Session: 22/05/2024

Session Number: 9

Treating Clinician: A Therapist

Treatment Type: CBT

Treatment Modality: CBT

If cCBT please enter Silvercloud ID: ID number or N/A

Current Pathway: In Treatment

Current Work Status: Full duties

Primary Working Diagnosis/Primary Presentation: Depression

Agenda/Session focus:

· MDS review

· Risk review.

· Review of home task

· Continue behavioural experiments.

· Set home task.

· Feedback on session.

· Client item: Nothing to bring today

Problem Statement/Formulation details:

Reports a steady decline in mood over the past few years. Struggles with thoughts of losing his job and easily becoming stressed over daily tasks. Significant levels of self-critical thinking linked with various difficult life experiences.

Goals: To focus on being more optimistic and to reduce negative thinking – by capturing the positive aspects of his day, not just the problems being faced. To reduce rumination and self-critical thinking and to be more positive about the future.

Current rating of success around goals: 6/10

Beckian longitudinal formulation completed.

Review In-between session:

Last session James identified a rule for living that has a significant impact on his day-to-day life: “If I make a mistake then people will think badly of me”.

We then set a home task form James to look at changing this into a guideline – please see uploaded documents for a thorough overview of the process worked through.

James was able to develop the guideline:

“If I make a mistake whilst it’s not ideal, people will not necessarily think badly of me, I am only human”.

We spent time reflecting on this guideline and James could see that this would be beneficial for him to live by, he said for example that it would take some pressure off him at work which would help him gain a better work/life balance.

Content of Session:

MDS review: James’s scores on the PHQ9 and GAD7 have remained the same since last session. We explored this further, and this appears to be an accurate reflection. Overall, his scores have reduced from severe to moderate on both the PHQ9 and GAD7.

Today’s session was spent considering behavioural experiments that could be used to test out the new guideline (as generated for his home task). Please see the uploaded document for a full overview of the experiment we designed, and James’s predictions.

We reflected on the experiment that we designed (for James to make a spelling mistake in a work email), James felt anxious (75%) at the thought of doing this, but he was able to acknowledge the benefits of doing so.

We then considered this new guideline in the context of his initial formulation. James was able to identify that his initial rule (“If I make a mistake then people will think badly of me”) was linked to his core belief “I’m a failure”, James felt that through the work we have done to date this core belief has lessened in its intensity (100% belief at assessment to 65% today) and he hopes that acknowledging this reduction will give him “some confidence” in testing the new guideline out.

Agreed between session task:

James to carry out the behavioural experiment as designed in today session (please see document in health history for full details and predictions).

James said that he was anxious about the experiment however he was keen to engage with the task set as he said that he could see the “huge benefits” that this could have with cementing his new guideline.

Treatment Plan:

We are using Becks cognitive model of depression.

We have completed thought psycho-education, thought challenging, rules for living and core belief-based work. We are now incorporating behavioural experiments to test out new rules/beliefs.

James asked if he would be able to have any more sessions, as he felt that whilst he has made progress, there is still scope for more improvements to be made. We discussed the process for requesting additional sessions and I advised him that they can’t be guaranteed. Agreed to request 5 more sessions – please see request below.

Session feedback and Learnings:

James reported feeling “anxious” at the thought of carrying out his behavioural experiment, but he said that he is “determined” to work towards his goals and acknowledges this as a step towards these.

Risk Assessment

Please do not use N/A. Please indicate that you have explored this with your client and document their response.

Suicidal Thoughts: