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Fostering Engagement in Early Sessions of Transdiagnostic Cognitive-Behavioral Therapy

This article describes the early sessions of a transdiagnostic cognitive-behavioral treatment for emotional disorders that is designed to target temperamental characteristics, particularly neuroticism and resulting emotion dysregulation, underlying all anxiety, depressive, and related disorders. These sessions facilitate clinical improvement by setting realistic expectations, fostering a collaborative therapeutic alliance, and improving motivation for change. Addressing these common factors in early sessions strengthens patient engagement, which is necessary for patients to benefit most greatly from subsequent treatment elements. We begin with a brief description of the treatment protocol and theoretical model. Next, we describe how the early sessions, specifically, are used to help facilitate application of later treatment skills that target specific psychopathological mechanisms. Finally, we present a clinical case example and utilize clinical vignettes from the early sessions to illustrate the therapy process. Specific clinical exchanges are highlighted to offer advice on how therapists can most effectively implement these procedures.