What is the first step in the practice of CBT?

• A. Develop a joint formulation with the client.
• B. Build rapport and establish goals.
• C. Access clients' irrational or maladaptive thoughts.
• D. Implement exposure to feared stimuli.

Answer: (C)

In CBT, the therapy starts with building a collaborative relationship and clarifying goals. Establishing rapport creates safety, trust, and a shared understanding of what the client hopes to achieve, which primes motivation and engagement in the process. With that foundation, you gather information about the client’s problems, triggers, and the thoughts, emotions, and behaviors involved, which helps you map out a practical plan.

Accessing and examining automatic thoughts is a core cognitive technique, but it typically follows the initial alliance and goal-setting. You need that sturdy ground first so the client feels supported and understands the approach before you dive into identifying distorted thinking. Joint formulation and later behavioral techniques like exposure are important steps as treatment progresses, but they usually come after the initial rapport and goal-setting have been established.