How it works
Cognitive Processing Therapy, session by session
Twelve sessions with a defined beginning and end. This page is the long version — what happens, what the homework is, and what it feels like in week three.
CPT is one of two treatments the VA and Department of Defense clinical practice guideline recommends most strongly for PTSD. It is manualised, which means it is not open-ended and it is not improvised. You will know at the start what each phase is for and roughly when you will be done.
It works on stuck points — beliefs that formed at the worst moment of your life and have been running unexamined ever since. “I should have known.” “I can’t trust my own judgment.” “If I let my guard down, it happens again.” These are not irrational. They were reasonable conclusions from real evidence. They have just never been re-examined with everything you know now.
Sessions 1–3 · Learn the model
How trauma changes belief, not just mood. In the first week you write an impact statement: what you currently believe the event says about you, about other people, and about the world. It is usually a page. We keep it, and it matters later.
Sessions 4–7 · Find the stuck points, learn to question them
We identify the specific beliefs doing the most work, then you learn a structured set of questions to apply to them. This is not positive thinking and it is not arguing with yourself. It is closer to reviewing evidence — what actually supports this, what contradicts it, and is it a habit or a conclusion.
Sessions 8–12 · Work the five themes, then re-read what you wrote
Safety, trust, power and control, esteem, and intimacy — the five areas trauma most reliably distorts. One at a time. In session twelve you write the impact statement again and then read the original. Most people don’t need that moment explained to them.
The homework is the treatment
You will have written work between sessions, usually twenty to forty minutes. This is the part people underestimate. The hour with me is where you learn the tool; the week is where it changes anything. People who do the worksheets get better; people who don’t, mostly don’t. I would rather tell you that now than at session six.
What week three feels like
Worse, often. You have spent years organising your life around not looking directly at this, and we start looking at it. That is the point at which people want to stop, and it is also the point at which stopping costs the most.
It is short-lived and it is expected. Knowing it is coming makes it survivable, which is the only reason I am telling you about it on a website.
An emotion changing is not the same as an emotion shrinking
This is the distinction that does most of the work in CPT. Some feelings are manufactured by a distorted belief — guilt produced by “I should have known” is guilt about a thing that was not actually knowable. When the belief is examined, that guilt goes down because it was never accurate.
Other feelings are accurate. Grief about losing people is correct. It is not a symptom and it is not a target. CPT does not try to talk you out of it. Part of what treatment does is separate the two so you stop fighting the grief and stop carrying the guilt.
Who this isn’t right for
CPT is a specific tool. It is not the right first step if you are in acute crisis, actively suicidal, or in the middle of untreated substance dependence — those need stabilising first, and I will help you find that rather than start a protocol that assumes stability you don’t have.
It is also not the right fit if what you actually want is open-ended supportive therapy. That is a legitimate thing to want. It is a different thing, and there are good clinicians who do it.
Do I have to talk about the details of what happened?
Less than people expect. CPT focuses on the beliefs rather than on repeated retelling of the event. You will write about it once, and after that most of the work is on what you concluded from it.
Does it work over video?
Yes. CPT has been delivered and studied by telehealth extensively, including across the VA system, with outcomes comparable to in-person delivery. The homework and the structure are the same.
What if twelve sessions isn’t enough?
Sometimes it isn’t, and we extend. The protocol is twelve sessions because that is what the research supports as a course, not because I stop taking your calls at thirteen. What matters is that we both know what we are doing and why.
Can we do CBT instead, or as well?
Yes. CPT sits inside the cognitive behavioural family, and for some presentations a broader CBT approach fits better. We decide that in the consult and the first session rather than in advance.
Fifteen minutes, no charge, no commitment.
We talk about what brought you here and whether this is the right fit. If it isn’t, I will tell you and point you somewhere better.