Descriptors of the 12 Sessions of Cognitive Processing Therapy (CPT)

1. Introduction and Education

  1. Meaning of the Event (impact statement)
  2. Identification of Thoughts and Feelings (ABC)
  3. Remembering Traumatic Events (accounts)
  4. Remembering Traumatic Events
  5. Challenging Questions
  6. Patterns of Problematic Thinking
  7. Challenging Beliefs Worksheet (CBW) & Safety Issues
  8. Trust Issues
  9. Power/Control Issues
  10. Esteem Issues
  11. Intimacy Issues and the Meaning of the Event

Copyright: Resick, Patricia A., Ph.D., Kathleen M. Chard, Ph.D., and Candice M. Monson, Ph.D. “CPT Resources.” Cognitive Processing Therapy. 2016.






The 4 Steps of Careful Communication

The Four Steps of Careful Communication

(1) Say what you think or feel.
(2) Say what is happening to make you feel that way.
(3) Say what you think the other person thinks or feels.
(4) Say what you want the other person to do.


I feel______ when you do _______. I realize you must feel ________. But what I want from you is _______.

Appendix G: Beth and Dr. Jaremko’s “Duet” (Commentary) about the “Steady On” Playlist

“Steady On” by Shawn Colvin

Beth: The message is, “I hear you. I see where you are. I get it.” Dr. Jaremko acknowledged how hard this journey is and that because of the trauma I endured, I would never be the same again—but I could find a new way of being if I stayed the course, which I interpreted as choosing to stay alive. The song’s tempo and percussion fit in very well with the metaphor of recovery being a barefoot walk from Texas to Alaska and back again.

Dr. Jaremko: The email I got from Beth clearly showed her to be suffering and desperate. She needed to be heard and acknowledged. A few years before, I had been on a trip driving along the Missouri River in South Dakota in a violent rainstorm. The rain was thick and horizontal; the wind was violent. I was terrified, in the middle of nowhere, with no choice but to keep going.

Not long after that, I heard Shawn Colvin’s song, Steady On. It described perfectly what I had to do to get through that rain storm in my travels, and it also described ideally what Beth had to do to get through her own storm. It was the exact centerpiece for the music of her recovery.
“Unfinished Life” by Kate Wolf

Beth: This song told me that my support system (Dr. Jaremko and my husband, Daniel) could not do the work of healing for me. I was the injured creature that the lyrics speak of, and they reinforce the metaphor of recovery as a journey. Further, the words give a shout-out to the truth: I’ve spent a lifetime running from myself, but the only way I will reach “Alaska” is to stay the course, even when it’s scary.

Dr. Jaremko: Kate Wolf wrote some of the most beautiful songs I have ever heard: great lyrics, minor cords, tender presentations. Unfortunately, this talented songwriter died at age 44, due to a long battle with leukemia. Kate knew she was dying and continued to write great songs. Beth thought her life was over and incapable of change. I added this selection to remind her that no life is finished, regardless of the pain level. Hope could be manufactured by the decisions one makes and the efforts one puts forth.
“All the Roots Grow Deeper” by David Wilcox

Beth: The meaning of this song is grief, loss, and the futility of trying to force my mom to be the person I needed her to be. I also interpreted the imagery of roots growing longer to provide stability and nourishment as the potential for my family of five to grow closer.

Dr. Jaremko: We know from research on trauma and recovery that as many as 40% of trauma victims experience growth as a result of being traumatized. After an initial deterioration, the victim grows into a stronger person whose life is more meaningful and in many ways, better that it was pre-trauma. As incredible as it sounds, there is something in the human ability that allows us to take the most awful circumstances and build a superior life from the horror. In the pages that follow, we will discuss in detail the personality and historical features that lead to this “trauma-induced growth.”
Moreover, I typically ask people at the start of their recovery if they would rather be one of the 40% that grow better after trauma, or merely be one who just “gets through it.” David Wilcox, whose songs are some of the richest metaphors I’ve come across, uses this pleasing botanical imagery to describe such growth, and I wanted Beth to be aware of how nature works in this regard.

  “Pay the Alligator” by The Flatlanders

Beth: In a humorous way, this song reminded me that I needed to stay aware of my impulse disorder and be careful to avoid making more problems than I was already dealing with. I had a tendency to become so overwhelmed emotionally that I made careless choices to try to find immediate relief from the pain. “Paying the alligator” is about the inevitability of consequences for choices.

Dr. Jaremko: Humor is, of course, vital to making a recovery journey, and “Americana Music” (the category musicologists use to describe the music type I was sharing with Beth) is riddled with whimsy and mirth. If one is laughing, one can’t cry as hard. This is what I hoped would happen for her when she listened to this song. A smile can balance the pain if for no other reason than that it’s a distraction. But then too, behavior is a matter of consequences and outcomes: the point this song is making. Our behavior is modified by its results and outcomes. All of us need to learn that we pay for our actions sooner or later. It has always been a crucial predictor of success when my clients begin to admit they are responsible for the outcomes of their actions. Even when one has been brutally victimized by others or circumstances, change can only come when responsibility is taken for our own actions.

“Box of Visions” by Tom Russell and Iris Dement

Beth: This song is like a hug and having a loved, trusted person whisper, “You can make it. Even though the pain is great right now, it will pass.” “Box of Visions” kept me alive. It felt like love. Even though my life as an author and teacher is rooted in crafting language, I do not have words for what this song means to me.

Dr. Jaremko: Tom Russell wrote this song for his daughters when they were small children. It describes the power of hope and vision. When one is blinded by pain, vision is an especially valuable gift. An especially pernicious aspect of trauma is the loss of trust in others or belief in valued ideals. In the “Values Vacuum” chapter, we discuss the hole in the soul that results from experiencing traumatic events. Patriotic soldiers often decide to volunteer for wartime duty because they believe so strongly in the cause(s) of the conflict. But if and when the war proves to be politically shallow and expedient, many of the once-principled individuals can feel duped. They lose that patriotic value to a meaninglessness that makes coping with stress and pain much more difficult. This process happened in the Vietnam War to many military people. The values vacuum must be filled for the hard work of recovery to be tolerated. Beth’s horrible trauma from Childhood Sexual Abuse (CSA) left her with a broken ability to trust. “Box of Visions” was selected on her mix tape to begin the process of values clarification and growth.

“Walk on Water” by Neil Diamond

Beth: I had no idea who or what I was, and this song helped me solidify my identity as a teacher. Dr. Jaremko saw me as being amazing at my job, and because he identified that and he never lied to me, I figured he must be right. I started to see teaching as a huge piece of who I am. PTSD symptoms of nightmares, flashbacks, and dissociating were frequent at the time I wrote Dr. Jaremko that desperate email[1]. Walk on Water’s lyrics communicate optimism about a new day. I found structure in going to work every day and feeling good about my job. Finally, the motif of walking on water applied to our journey metaphor and inspired the belief that I could keep going; after all, I can stay afloat, so I can certainly keep moving forward on this journey.

Dr. Jaremko: For me as a therapist for 40 years, the key to successful work with my clients was recognition of their strengths and thereby beginning to introduce to them precisely how valuable they were/are. I call this the “cheerleader” part of psychological treatment. Being a cheerleader for another person is easy when the other person is talented, as Beth is. Teachers of children do indeed “walk on water,” and this song celebrated that culturally valued role. I intended to push Beth pretty hard during her recovery journey (because it’s usually necessary,) but I wanted to affirm how valuable she was to our world. Plus, the Gospel music tempo and melody of this song is relentless and upbeat, something Beth was going to require.
“Break in the Cup” by David Wilcox

Beth: As an emotionally numb person, no matter how much love other people had for me, I could not feel it. At the time I began treatment, even though we’d been together for twenty-five years and married for twenty, I fully expected my husband, Daniel, to walk out the door at any time. Every person I’d loved or trusted had rejected, abandoned, or abused me; therefore, I believed it was inevitable that any day now, my husband would turn on me, too. I believed that my children loved my mother more than they could ever love me, and I expected them to join her on The Dark Side, i.e. the side of my family for whom the abuse I endured was apparently of no consequence. Even though I had begun to lose the fear that Dr. Jaremko would try to abuse me like my stepfather had, I expected him to ditch me any minute as well. This song’s lyrics had the effect of cracking my fears open and exposing them to light, and I knew without a doubt that my therapist saw me for what I was: a person who was desperate not to be left again. The song helped me begin to understand that my sense of trust was broken. I began to question my perception of what love and caring for other people is, as well as gain a rudimentary understanding of boundaries.

Dr. Jaremko: Just like music and melody, metaphors can have an easy way of taking up residence in the front of a person’s mind. Like some perfect puzzle piece, they fit well and come to mind and heart often. I hoped this metaphorical song about a broken cup would begin Beth on accepting her role in the interpersonal struggles she had been having. Yeah, her “truster” was broken, and it should have been, given what she went through. But only she had the agency to start taking different actions. It’s a fine line for a therapist to push another when he/she has been beaten down by the horrors of a traumatic experience. David Wilcox’s song walks that fine line far better than I have ever been able to do. Thus, we ask clients to take a careful and thorough look at themselves, and only in that way can they progress in recovery. Was Beth strong enough to look at herself that critically? It turns out that, yes, she was, but it was not always a seamless, steady state of strength. Moreover, some clients are not up to such self-honesty at a particular time. A therapist could do harm by “pushing” too much, only breaking the cup more. Timing is crucial.

“I’ll Find My Way Home” by Anderson and Vangelis

Beth: This song felt like one of the most personal in terms of Dr. Jaremko reaching out to me as a steadfast presence and letting me know he understood how I felt, even though I was convinced that nobody could possibly do that. It’s another song for which I have inadequate words to express its meaning. Nothing I say will communicate how it touched me.

Dr. Jaremko: Recovery is essentially the process of sustaining hope: continued effort, emotion, and thought, in order to persevere. No human being can cope with life’s challenges alone. We are social: we need each other. In fact, sometimes the lack of having others with us on the journey is the most traumatic aspect in life. Victims get so lost that they give up asking for help. Or, they ask for help in such unhealthy ways (we discuss much more of this ugly aspect of trauma) that others can’t begin to offer balanced and authentic help. All Beth, and countless like her, need do is “reach out,” using a healthy balance of humility and self-responsibility. This song by classical musicians was meant as inspiration for Beth to find that balance in her social relationships.

“Rider On an Orphan Train” written by David Massengill; performed by Tom Russell

Beth: These lyrics communicate loss of relationships. I related to the words because even though I was nearly 40 years old when I began treatment, my mother abdicated her role as “my mom” and chose my abuser, her husband, over me. My understanding of the trauma I experienced was still very childlike, and I felt “orphaned.” I could relate to the singer’s grief at being separated from his brother and his desire to reunite, as my own brother and I were estranged, and the source of our separation was the trauma we respectively endured in our family of origin. At the same time, while the song communicates an understanding of grief, it inspires resilience when it compares life to a wall that one can successfully scale or tumble down. I perceived myself as having a choice to keep going or give up (“fall.”)

Dr. Jaremko: Beth had experienced some very bad CSA (Childhood Sexual Abuse), but it was made worse by the lack of support by and from her mother. Beth used too much energy to minimize the impact that her mother’s reaction to the abuse had on her. This wasted energy had an adverse effect on the ability to cope and recover. In Beth’s mind, she needed her mother so much that she was willing to accept “crumbs and leftovers,” rather than hold out for the totality of what a child needs from a parent: unconditional and complete love and acceptance. In fact, even in adulthood, what Beth was getting from her mom was making things worse. Unless Beth’s mom admitted the truth about the horrible abuse her daughter went through, no progress was possible. I included this song because being an orphan is indeed sad but can be dealt with in the light of truth. In the song, James and his brother had each other even if they never connected. Beth was not quite ready to be truthful about her “orphaned” status, but she needed to head in that direction. Tom Russell’s version of this haunting song was a train headed in that direction.

“Show the Way” by David Wilcox

Beth: Similar to “Box of Visions” for what it felt like, “Show the Way” communicated confirmation that the hopelessness I felt was understood. I felt loved and safe, and it was like turning my face toward the sun, away from the darkness. I cannot possibly tell you how many times I fell asleep to this song in my ear-buds. It is another one that kept me alive, and another one for which the lyrics say so much more than I ever could.

Dr. Jaremko: Hope is about hanging in when times are tough. It is about sticking to an action plan when little seems to suggest such a course. To hope takes belief that something good can and will happen when efforts are focused on behavioral steps toward a goal; an outcome. It’s not about being there; it’s about getting there, eventually. In “Show the Way,” David Wilcox sings about such hope, but he is saying much more: There is a “WAY.”
If discovered through thoughtful analysis, an action plan can be developed and couched in such terms that it can be attained little by little. Beth, like many of us when we feel confused and discouraged, needed to “see” that there is a way; even several ways. In the midst of David Wilcox’s exquisite guitar work, I hoped she would get a dose of hope that doing something was possible.

“We Walk the Same Line” by Everything But the Girl

Beth: This was a super-powerful song for knowing I could count on Dr. Jaremko to have my back throughout this journey. It was as if he was telling me that even though I clearly doubted my ability to survive, I could trust him to help me make it through. It was very powerful, too, because it so clearly communicated what it felt like to dread the dark and sleep because of what my mind would produce when I wasn’t conscious to resist it. There were no shortcuts to healing, but Dr. Jaremko let me know that I was not alone in the scary parts of the journey. Having this overtly communicated blew my mind since, as stated before, I fully expected him to ditch me any time, just like most people in my life had done.

Dr. Jaremko: A common feature of hopeless people, those battered by the hardest hits life can give, is that they think no one else has their same conscious experience. The simple fact is this: all people have the full range of emotional, behavioral, and social ups and downs. “We Walk the Same Line” was included in Beth’s mix tape because she needed to realize that she was not unique. Everyone can have the feelings, doubts, behavioral excesses, and deficits that Beth thought were unique to her. The difference is that some survive and flourish and some don’t. I wanted her to feel and think “normalcy.”

“Love Abides” by Tom Russell

Beth: The last song on the playlist, “Love Abides” reinforced the metaphor of our journey from Texas to Alaska and back home. The lyrics communicate hope that I could reach a place that did not hurt; where I would be able to feel loved and worthwhile, and maybe, just maybe, I would no longer hate myself.

Dr. Jaremko: Tom Russell wrote this lovely little song as part of an opera describing his family of origin’s immigration to the United States from Ireland and Norway. Third and fourth generations of Tom’s progenitors made a series of journeys: geographical, economic, social and spiritual, to result in him being where he currently is. It’s pretty simple to see what they were all looking for: a place where love abides.
But in the process of trauma recovery, love does not refer to what one feels. Rather, 90% of what is being referred to when the word love is used must convey action. Love is mostly caring action taken by each other for each other. If Beth could see she had control over where love abides, she could reconstruct her life in the manner she saw fit, not in the manner her mother or her perpetrator saw fit. Such little-by-little progress toward harmony is a reproducible history that can take Beth and other trauma victims out of their misery and into places where love abides.
To access the “Steady On” Playlist, please visit our website, .

[1] See Chapter 1, Sessions With Dr. Matt book, “Come on In”/How Music Inspired My Recovery