The problem with “CBT-informed”
Almost every therapist directory lets a clinician tick CBT. Very few make them show that they run exposure. The result is a market where the label is everywhere and the treatment is rare — and where a client can spend a year in weekly sessions discussing a fear they have never once approached.
The gap is not dishonesty. Exposure is uncomfortable to deliver, it is under-taught on training courses, and a clinician who has never been supervised through it will reasonably drift toward what they know. Your job on an intro call is to find out which you are dealing with, kindly and quickly.
The eight questions
Ask these on a free consultation. You are not testing them; you are matching. A good exposure clinician enjoys these questions, because they are the questions they wish more clients asked.
- “What would the top of my hierarchy look like?” — a specific, slightly alarming answer is a good sign. Vagueness is not.
- “What happens in a typical session, minute by minute?” — you want planning, doing, and reviewing. Not fifty minutes of discussion.
- “What will I be doing between sessions?” — there should be homework, and it should be most of the treatment.
- “How do you handle reassurance if I ask for it?” — the right answer is that they will decline it, and explain why in advance.
- “Do you leave the office?” — for phobias, agoraphobia and social anxiety, in-vivo work outside the room matters.
- “How will we know it is working?” — look for measurement: SUDS, a standard measure, avoidance reducing.
- “What is your training in ERP specifically?” — supervision matters more than a certificate.
- “How long do you expect this to take?” — exposure therapy is usually months, not years. An open-ended answer is a flag.
Answers that should give you pause
“We will start when you feel ready” generally means never; readiness is built by doing, not waited for. “We will work on the underlying cause first” is the most common way a course of treatment quietly becomes something else. “I will teach you breathing exercises to use during it” describes a safety behaviour, and it blunts the learning the exposure exists to produce.
None of these make someone a bad therapist. They make them a therapist who does something other than exposure — which is worth knowing before you commit six months to it.
If the fit is right
Expect the first two or three sessions to be assessment and ladder-building, then expect to start climbing. Expect to be a little scared before homework and mildly bored of the item by the end of the week. That boredom is the treatment working.