The Underlying Theory

Cognitive behavioral therapy is partially based on the premise that emotions cannot be changed simply by talking about them. Instead, our emotions are a result of our thought, our behaviors, our biology, and our interaction with our environment (family, friends, co-workers, our jobs, culture, living conditions, etc.). Only by changing the way that we think and act can change the way we feel. Our thoughts have a lot to do with why we act the way that we do, as well as how we feel. And our behaviors have a significant impact on both our emotions and our environment (for example, how the people in our lives treat us).

The Method

Cognitive Behavioral Therapy (CBT) is a combination of cognitive therapy and behavior therapy.  The primary goal of cognitive therapy is to change self-defeating thought processes so that they are more accurate and so that they lead to more adaptive behaviors and emotions.  The primary intervention is Socratic questioning which is designed to help clients learn to think more logically about the way that they see, for example, themselves, their environment, their future and the actions of others.  Cognitions (thoughts) are viewed as the driving force behind emotions (and many behaviors), which thus makes them, and not emotions, the target of intervention.

Behavior therapy has two potential focuses, depending on the client: behavior change and conditioning.  Interventions for behavior change include identifying factors that motivate maladaptive behaviors as well as barriers to adaptive behaviors; helping clients actively engage in adaptive behaviors by making them easier, by removing barriers and through detailed education about how those behaviors will likely be helpful.  Conditioning, which is particularly relevant to anxiety (e.g., GAD, Panic) and anxiety-related disorders (e.g., OCD), is typically treated with exposure and by teaching clients adaptive ways to NOT avoid anxiety-inducing stimuli so that they can become habituated to anxiety.

A scientific approach to therapy

Aside from it’s empirically-derived foundation and the empirical support that it has achieved, CBT is also scientific in the way that it is practiced.  Cognitive behavioral therapist think of therapy as a form of “collaborative empiricism,” in that it involves a series of both thought experiments and real-world behavioral experiments where clients learn to think more accurately and adaptively, as opposed to a common tendency to “catastrophize” (blowing things out of proportion – anxiety) or think in black and white terms (“no one loves me” – depression).  We also work with clients to extinguish conditioned fear responses, including panic, avoidance and reassurance-seeking; and to encourage adaptive behaviors such as exercise, finding employment and making and engaging with friends.

Client Education

Psychoeducation part of the foundation of cognitive behavioral therapy.  Therapy involves teaching clients how to recognize thoughts and behaviors that maintain or escalate their problems; as well as patterns of thinking and behaving that have the potential to alleviate or solve those problems.  In order for that to happen, clients must not only clearly understand maintaining factors and adaptive responses, but also why and how they work so that they are motivated to use them and so that they can use them flexibly in novel situations.

If you are a therapist, and you are considering joining our practice, we are seeking a child therpist. Send your resume and a cover letter to Dr. Young at rob@cvillecbt.com.

Our approach to therapy is much more than just talk.  It focuses on making your life better in the most effective, efficient way possible.  It is based on the most current research, it makes sense to our clients, and it is always designed to fit each person’s personal strengths, needs, and resources.  Read more below, and for information about sessions and fees, visit the Frequently Asked Questions page.  For information about about your specific needs, go to the menu bar above.

Therapy begins with a thorough assessment of the problems that you are experiencing so that we can determine which treatment approach is most likely to work.  We want to be able to help you better understand what is going on and what we need to do in order to make it better.  We will then work together to form a structured treatment plan that is based on the most current scientific findings. We will carry that plan out in subsequent sessions, and you will be asked to practice certain skills at home between sessions.  Techniques include, among other things, education, practicing behaviors, problem solving, gradual exposure to fears at a pace that you are comfortable with, and learning to more accurately interpret others’ intentions.

We are not experts in medication, and we are not licensed to administer it. There is also overwhelming evidence that CBT is a significantly better option for the treatment of anxiety and OCD, and is equal to (and significantly) more long-lasting than medication for depression.

Our Philosophy:

You always have control

You should never be left in the dark.  What happens in therapy should always make sense to you, and you should always be informed so that you can make your own decisions about treatment, and you should be given control of it.  You should be informed of your condition, what causes and maintains it, how to fix it, and why.  If anything does not make sense to you, it should be clarified.

Increasing the good while reducing the bad

While almost all of our clients come to us because they are facing a problem in their lives such as stress, anxiety or relationship problems, it is important to remember that reducing problems is only part of what must be done.  One of the first things that we do when working with clients is to help them identify areas in their lives that can be enriched through fun, connection with others, or self-fulfillment.  And then we help them find ways to pursue these goals.

We use the best approaches

Only the most proven, most current, and most appropriate approaches should be used.  Specific approaches should be used for specific problems, and they should be administered by a psychologist or a counselor who understands and knows how to administer them properly.  Clients should be given choice and power to make their own decisions about therapy.  Therapy should never take longer than it needs to, and it should fit the specific needs and strengths of the client.  And if treatment isn’t working after an appropriate amount of time, it should be altered to give the client a better chance of getting better faster.

Our work focuses on the whole person

It is not enough to focus only on one’s thoughts and feelings.  If we try to understand problems in overly simplistic ways, they are often more difficult to solve. Problems with our emotions, our thinking patterns and our relationships cannot be properly solved without a holistic understanding of the biological, the psychological, and the social aspects of the person.

• Biology: Biological issues such as hormone imbalances, medication side-effects, smoking, fatigue from problems sleeping, and diseases such as diabetes can have a dramatic effect on emotional well-being, intellectual functioning and memory, and relationships with other people.  We typically refer our clients to a physician for a medical evaluation in order to ensure that a given problem is not at least partially medical in nature and so that we have a full understanding of medical problems that the person might be suffering from.

• Psychology: An ability to think flexibly about routine daily problems, to see safety in a safe situation, and to see the good even in people you don’t like can make you physically healthier, while making your relationships with family and friends stronger and more rewarding.  But it c an also go the other way.  Mental processes such as worry, a tendency to jump to conclusions or to blow things out of proportion, or overly negative views of one’s self or others can have dramatic effects on physical well-being and on relationships with others.

• Social Relationships: Extensive scientific studies have demonstrated that positive and rewarding relationships can have a positive (and sometimes curative) effect on both psychological and medical problems.  On the other hand, relationship problems can drastically increase both physical and mental stress and lead to physical and mental disorders, which in return can have a negative effect on relationships, creating a self-perpetuating cycle.  Thus, social relationships are almost always a significant focus of our practice, assuming that is what a given client wants.
• Lifestyle change: We also help our clients to find better ways of living a healthier lifestyle, which can have a dramatic effect on the mental well-being of any person, including reducing the severity of depression and panic attacks, as well as overall stress levels.  But because lifestyle change is hard, our skills are often necessary to help our clients find easier and more effective ways of motivating themselves toward positive change.

How deep do we go?

A lot of clinicians beleive that cognitive behavioral therapy is only for simple or superficial problems. This is far from true.

Unless you are seeing us for OCD or a phobia, cognitive behavioral therapists focus heavily on deeply held beliefs. These might include beliefs about yourself, the world, other people, past and current events in your life, the effectiveness of coping strategies, and hope or hopelessness about the future, and any other beliefs that might be impacting your sense of well-being and your ability to function.

We will explore and discuss where those beleifs came from. But we will focus more on how to change the beliefs that are getting in your way – not necessarily to make them more positive – but to make them more accurate  and helpful. For example, if you believe that you are in danger, and you are not in danger, thinking more accurately can make you feel better. On the other hand, if you are endangering yourself, and you are not worried about it, being more accuate can make you safer.

Your childhood might be an important topic of conversation

Many people believe that, to talk about your childhood, you have to see a psychodynamic therapist, because CBT does not address childhood. The truth is, we do address childhood when it is relevalant. The only way to know if it’s relevant is ask about it early on in the therapy process. If you are having trauma symptoms becasue of something that happened to you as an adult, and your childhood was relatively stable and happy, we’re not going to try to dig into childhood when we could be addressing the acutal trauma. If we don’t know why you are depressed, we are not going to try to come up with a trauma from childhood. We are going to look at your entire history – and what is happening right now. We are going to focus on what is most relevant.

Sometimes  a person’s childhood and adolescence is the central cause of their current plight, or it has at least set off a chain reaction that led them to where they are. If this is the case, we as providers need to know. In some cases, talking about childhood and adolescence can lead to solutions.

If you think that childhood is an issue, tell us. We need to know. We can dig into it as much as we need to. If you don’t think your childhood is an issue, briefly tell us anyway. Just in case. Either way, in the end, we will mostly talk about what you can do in the here-and-now to make your life better.

A lot of clinicians beleive that cognitive behavioral therapy is only for simple or superficial problems. This is far from true.

Unless you are seeing us for OCD or a phobia, cognitive behavioral therapists focus heavily on deeply held beliefs. These might include beliefs about yourself, the world, other people, past and current events in your life, the effectiveness of coping strategies, and hope or hopelessness about the future, and any other beliefs that might be impacting your sense of well-being and your ability to function.

Your therapist will help you explore and discuss where those beleifs came from. But we will focus more on how to change the beliefs that are getting in your way – not necessarily to make them more positive – but to make them more accurate  and helpful. For example, if you believe that you are in danger, and you are not in danger, thinking more accurately can make you feel better. On the other hand, if you are endangering yourself, and you are not worried about it, being more accuate can make you safer.