Cognitive Behavioral Therapy

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Life doesn’t come with an instruction manual. You have emotions, but they’re often at odds with your best thinking. Thoughts come along, but a lot of them are as crazy as the emotions. You have habits, but some will be your undoing. What are you supposed to do with these emotions, thoughts, and behaviors? How do you get rid of the ones you don’t want and cultivate the ones you do? Somewhere, close by, a cognitive behavioral therapist is ready to roll up his sleeves and tell you.

Cognitive Behavioral Therapy (CBT) is a very different approach than the first method I described, Rogerian Client Centered Counseling. The Rogerians start with the assumption that you already possess everything you need to thrive. All a counselor has to do is construct a healthy environment, get out of the way, and you’ll grow. To a CBT therapist, you’re doing it wrong and you need someone to tell you what to do.

If you go see a therapist who practices CBT, first she’ll see what’s troubling you, be it anxiety, depression, addiction, or whatever. She’ll ask for numbers as well as stories because she wants to be able to quantify your suffering, the better to compare how you’re doing before and after.

Then she gets in your head. She’ll want to know how you think about your problem. She’ll zero in on the thoughts that keep the problem locked into place, impervious to change. Thoughts like,“I’m never going to get better,” or, “I can’t bear it,” or, “I’m a failure.” She’ll challenge the rationality of such thoughts and ask you to dismiss the irrational ones whenever they come around. This is the C part of CBT; the cognitive portion.

Next comes the B part: the behavioral. You’ll get homework. Your CBT therapist will teach you a new skill and ask you to practice it. She’ll have you challenge irrational thoughts on your own. She’ll urge you to change outward behavior. CBT therapists are big on relaxation, having you take deep breaths, and choosing a course of action different from the one you usually take.

If you want some examples of specific CBT tips and techniques, go to my post on Grounding. I do a lot of CBT with clients because I believe that when a person is in a great deal of distress, it’s best to give them things that help. The skills you learn in CBT, how to challenge irrational thoughts and how to change maladaptive behavior, are so basic that everyone ought to know them. They ought to be taught in school like the three R’s. To reading, ‘riting, and ‘rithmetic, I would add relaxation and rethinking. Just as a physician might advise bedrest as the standard, first line of defense for nearly everything; I would advise CBT for everything, once. If you haven’t tried CBT, then you haven’t tried the simplest, most effective solution to your problems.

As I said, I do a lot of CBT; but not always. I get some people who’ve tried it, whether they can name it or not, and it didn’t work. There’s many who can’t use CBT because they don’t like to be told what to do. Then there’s a third class of clients who have what I call Whack-a-Mole symptoms. No sooner do they clobber one symptom over the head with CBT, than another symptom pops up. With only the blunt mallet of CBT, we could be whacking those symptoms forever. In that case, we need to get underneath by some other means to find the mechanism behind the symptoms.

CBT is the great, great, great, great, great grand daddy of psychotherapies. Many people believe psychotherapy started with Freudian Psychoanalysis; but no, it began with the ancient Roman and Greek Stoics. Their philosophy, Stoicism, is essentially what we now call CBT. Modern CBT is little more than the ideas of Marcus Aurelius, Epectetus, and other toga dudes, dressed up in a lab coat to look up to date. This transformation has been so convincing that many have forgotten these ancient roots, or never knew. Many believe that CBT came into being because Psychoanalysis didn’t work, when it was actually the other way around. Psychoanalysis had to be invented because Stoicism, or CBT, as we now call it, just wasn’t cutting it.

True to its great age and powerful stature, CBT has spawned a great number of variations based on its fundamental tenets. You got ACT, DBT, EFT, REBT, and MET. Not all of them have initials; there’s also relaxation therapy, mindfulness-based cognitive therapy, reality therapy, relapse prevention, stress inoculation, and systematic desensitization. They emphasize different things, but they all have in common the idea that you’re doing it wrong and they can teach you to do better. In many cases, they can.
Click here to read more about CBT.