What do you do in CBT therapy?
Written by the clinical team at The Lyceum Clinic. Clinically reviewed by Sanah Younis, Clinical Director, BABCP-accredited (no. 1000792). Published 28 October 2026. Last reviewed 28 October 2026.
In CBT you and your therapist work out what keeps a problem going, then test ways of changing it. The first sessions map the pattern. Every session after that has an agenda, ends with something to try, and the work between sessions is where change happens.
The first session: the house is on fire
People arrive expecting to tell their life story. We stop them, gently. The past matters and we will get to it, but right now the house is on fire, so we look at what happened yesterday at four o'clock when the spiral started. We map that one episode: the situation, the thought that landed, the feeling in the body, and what you did next.
That map goes on a whiteboard as boxes and arrows linking thoughts, physical sensations, emotions and behaviour. It is messy and collaborative. Almost everyone says some version of "that's it, that's my entire life on a page". The chaos in your head becomes a predictable machine, and a machine can be changed.
What a typical session looks like
Every session starts with an agenda, agreed in the first five minutes, even if you arrive in tears. We do this because venting feels good and changes nothing; the hour has to be useful. Then we work: examining a belief that feels certain but has never been checked, planning a behavioural experiment for the coming week, or working through a feared situation in a graded way. We finish by agreeing what you will practise before next time.
For more detail, read about how CBT works.
What are the five steps of CBT?
Different books count them differently, but the shape is the same: understand the problem, map the cycle that keeps it going, test the thoughts and predictions inside that cycle, change the behaviours that feed it, and build a plan so the gains hold. At The Lyceum this runs through The Lyceum Protocol, which adds the foundations around the sessions: sleep, movement and steady fuel, because new learning is fragile and those three decide how much of it survives the week.
The first homework
For the first fortnight we ask you to do nothing to change anything. Write down the exact thought, the emotion and what you did next. Just track it. Everyone wants to fix it immediately, and we ask you to observe the machinery first, because we need the data before we can change the system.
What tells us it is working
The turn usually comes when someone laughs at their own catastrophic thought. "My brain told me I was going to get fired today, and I just said okay, whatever, and went back to typing." The thought has lost its teeth. Progress is also measured formally at every review, so neither of us is guessing.