What Is Cognitive Behavioral Therapy (CBT)?

Cognitive Behavioral Therapy is one of the most thoroughly researched and effective forms of therapy available. It is practical, goal-directed, and designed to help you feel better and function better — without keeping you in therapy longer than you need to be.

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How CBT Works

Most forms of therapy focus on talking about your feelings. CBT goes a step further. It is based on a simple but powerful idea: the way you think affects the way you feel, and the way you feel affects the way you behave (behavior does not mean following rules – it means acting, or doing things). By learning to think more accurately and behave more effectively, you can change how you feel — even about things that happened long ago.

CBT is not about thinking positively. It is about thinking more accurately. And it is not about endlessly revisiting your past. It is about understanding what is getting in your way right now and learning concrete skills to address it.

For example…

Childhood trauma: Say that your parents were abusive to you when you a child by telling you (or implying) that you were worthless. Or they told you that you were going to get cancer or die in a gutter or get attacked by strangers. Maybe your mother constantly called herself fat. Maybe your father put his fists through walls and physically hurt or intimidated you. This is commonly referred to as trauma.

A big problem with therapy: “Trauma” is a vague term. And it ends up being treated in a vague manner. Psychoanalysts ofter refer to therapy as “re-parenting.” They say that you unconsciously view your therapist as a parent figure (known as transference), and that if that parent figure (your therapist) is kind and accepting, they can erase the effects that your parents had on you. This is how Dr. Young at our practice was originally trained. In fact, Aaron Beck and Albert Ellis, the original founders of CBT, were trained in similar theories. They realized in the 1950s and 1960s that it was nonsense. And it is nonsense. But most therapists still believe it. And it is still taught in graduate programs.

CBT is based, at least partially, on the proven idea that trauma changes people’s beliefs. About themselves. About the world. About the future. About others. If your parent hits you, you might come to believe that the world is a hostile place. And that belief will likely cause anxiety. But it might also cause you to cope by being hostile to others before they ever get a chance. And they learn not to trust you. In other words, your beliefs at least partially caused by your experiences – and your beliefs guide the way you feel, and the way that you act. Your actions (behaviors) impact the way that others treat you. It all comes back to beliefs.

We don’t try to change your political or religious beliefs, or your values. But we help you better undestand whether the things that you believe (e.g., the world is dangerous place, I am worthless, my heart pounding means that I’m dying, my OCD intrusive thougths are real) are based on true facts, or incorrect ideas that you have learned or been told. If it turns out that you really are in danger, we help you problem-solve to become safer. If it turns out that you are safe, and you start to believe it, your anxiety decreases. If you can’t learn that you are safe because you avoid too much, we help you learn to toleate discomfort enough to get out into the world and learn that you are safe.

What Happens in Sessions?

CBT is structured and purposeful. Here is what you can generally expect:

First session — Understanding your goals. You and your therapist will talk about what is bringing you in and what you want to get out of therapy. Your therapist will ask a lot of questions to understand the nature of the problem, what is maintaining it, and what your strengths and resources are.

Early sessions — Building a treatment plan. You and your therapist will work together to identify specific, achievable goals. For example, if you have social anxiety, your goals might include learning to evaluate situations more accurately, tolerating small amounts of anxiety without avoiding them, and building more effective social skills.

Ongoing sessions — Learning and practicing skills. From session two or three on, you will learn to slow down and examine your thoughts, understand how they connect to your emotions and behaviors, and practice new ways of thinking and acting — both in session and between appointments.

Our Philosophy

You are always in control. Therapy should never feel like something being done to you. You will always know what we are doing and why. If something doesn’t make sense, we will explain it until it does. You make the decisions about your own treatment.

We address the whole person. Problems with emotions, thinking, and relationships rarely have a single cause. We look at biological factors, psychological patterns, and social relationships together — because that is the only way to understand and solve most problems effectively.

We focus on increasing the good, not just reducing the bad. Most people come to us because something is wrong. But reducing problems is only part of what needs to happen. Early in treatment we help you identify areas of your life that can be enriched — through connection, purpose, and enjoyment — and help you find ways to pursue them.

We use only what works. We use the most current, most evidence-based approaches available. Specific treatments are used for specific problems, administered by therapists who understand how and why they work. If something isn’t working after a reasonable amount of time, we change course.

Does CBT Address Deep Issues?

There is a common misconception — taught in many graduate programs and repeated widely in the field — that CBT only works for surface-level problems. That is not true.

Unless you are being treated for OCD or a specific phobia, CBT involves significant exploration of deeply held beliefs — about yourself, other people, the world, and your future. These beliefs shape how you feel and how you behave, often in ways you are not fully aware of. But beliefs are not the only focus. We also work on behavior patterns, avoidance, relationship dynamics, and the ways your environment and biology interact with your psychology.

We will help you examine whether your beliefs are accurate and helpful — and change the ones that are getting in your way. We find that understanding where beliefs came from is far less important than examining them and moving forward. This is not superficial work. It is some of the most meaningful work a person can do.

Will We Talk About My Childhood?

We always ask about your history early in treatment — including your childhood. Sometimes early experiences turn out to be central to what is happening now, and we address them. Other times we find that childhood is less relevant, and we move on.

If you have spent years in therapy talking about your past without feeling like it led anywhere, you are not alone. CBT is different. Our primary focus is always on what you can do right now to make your life better — not on endlessly revisiting where you came from.

How Does CBT Compare With Medication?

For anxiety and OCD, the research is clear: CBT produces significantly better outcomes than medication, and the gains last longer after treatment ends. For depression, CBT is at least as effective as medication — and again, the improvements tend to last longer.

We are not licensed to prescribe medication and we do not claim expertise in it. But we are confident that what we do works, and we are committed to helping you get better as efficiently as possible.