Where the Action is in Therapy

When a former counseling client says, “I’ll never forget what you said. It’s always stuck with me,” I hold my breath praying, “please, let it be something I wouldn’t regret saying or at least let it be helpful.” The conversations between counselor and client make up an essential piece of the therapy process. Still, those who practice cognitive behavior therapy believe changes occur between office sessions more than during them.

I’m not minimizing the importance of what counselors say because how we interact in sessions may account for as much as 40% of therapeutic change. If a teen or an adult thinks that I’m judgmental, don’t listen, or just don’t care, the likelihood they will take the steps between sessions that could improve important parts of their life is nil. So, given a collaborative relationship with a counselor, both the counselor and client develop the plan. Then, behavioral activation begins when the client walks out of the office and into their world. More than 60% of the change that takes place will occur in their day-to-day world.

Behavioral activation? We, therapists, have a name for virtually everything that people do or think or feel. Behavioral activation means doing things differently and observing the results in thoughts and feelings. Clients experimentally change behavior to trigger changes in beliefs and feelings, then evaluate these results along with their counselor (collaborative empiricism, if you want more terminology).

As improvements in mood, behavior, thinking, and outcomes take place, the client notes the improvements and what they are doing that account for the improvements. Only one tool in the toolbox of CBT, behavioral activation, becomes significant in future problem solving, stress management, and relapse prevention.

David Barnhart, EdD
Licensed Counselor
Certified Clinical Mental Health Counselor