Cognitive processing therapy

Domain II · Behavioural & cognitive · Patricia Resick · 1988

What it is

CPT is a manualised, trauma-focused cognitive therapy for PTSD, developed by Patricia Resick from 1988. Its model treats PTSD as a disorder of non-recovery. After trauma, natural recovery stalls because of two things. The first is beliefs about why the event happened and what it means ("stuck…

Format

• Format. The individual format is 12 sessions of 50–60 minutes, once or twice weekly, with practice assignments between sessions. Group CPT is 12 sessions of 90–120 minutes, usually with two co-therapists and 8–10 clients. A mixed format adds individual sessions to the group. Intensive formats…
• Phases. The manual organises CPT session by session, not in named phases. The three-phase grouping below is the common secondary description, mapped onto the 2nd-edition session chapters.

Who practises it, and how they are trained or regulated

• Moving on: the manual has a chapter on whether "pretreatment" (stabilisation) is needed and on when the protocol should begin. The authors' general position is that most clients can start CPT directly, once imminent danger, serious current suicidal or homicidal intent, and uncontrolled substance use or psychosis are managed.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• a vague plan ("I'll try"). Get specifics.
• agreement that sounds hollow. Ask what might get in the way, and plan for it now.
• stuck points that still remain. Name them as the targets for ongoing self-practice.
• themes already resolved for this client. Spend less time there and more on live themes.
• fear of ending. Treat it as a stuck point (for example "I can't cope without therapy").

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.