How Cognitive Behavioral Therapy Works in My Practice
Cognitive behavioral therapy can help people understand the relationship between what they think, how they feel, and what they do. I use CBT as a practical part of therapy, but not as a rigid formula or a substitute for understanding who you are as a person.
Cognitive behavioral therapy, or CBT, is one of the approaches I use in my clinical practice. It can be useful in helping you recognize irrational thinking and reduce cognitive distortions.
CBT provides tools to help with goal setting and techniques to reduce irrational thinking.
I combine CBT with psychodynamic techniques in our therapy sessions.
Key Points
- CBT can be helpful in identifying maladaptive thinking.
- CBT helps identify false assumptions or conclusions that can influence how you perceive the world.
- CBT techniques can help with anxiety, depression, and relationship issues.
What Is Cognitive Behavioral Therapy?
Cognitive behavioral therapy is based on the understanding that our thoughts, emotions, and behaviors affect one another. What happens to us matters, but so does the meaning we give to what happens.
Consider a simple example. You send an important text and do not receive a response. You might think, “They are probably busy.” You may feel mildly disappointed but continue with your day.
You could also think, “They are ignoring me,” or “I must have said something wrong.” That interpretation may lead to anxiety, anger, repeated phone checking, withdrawal, or another message seeking reassurance.
The situation is the same. The meaning assigned to it changes the emotional and behavioral response.
How Cognitive Behavioral Therapy Works
CBT helps make fast, automatic reactions more visible. Many thoughts occur so quickly that they feel like facts rather than interpretations. In therapy, we slow the sequence down and examine each part.
The goal is not to label every uncomfortable thought as irrational. Some fears are realistic. Some situations are genuinely difficult. CBT asks whether the thought is complete, accurate, and useful in deciding what to do next.
CBT Techniques I Use in Therapy
I do not use every technique with every client. The work depends on the person, the concern, and what we are trying to accomplish.
Identifying automatic thoughts
We identify the immediate thought or prediction that appeared in a stressful moment, particularly when the reaction seemed larger than the situation itself.
Examining assumptions
We look at the evidence for a belief, what may contradict it, and whether an old assumption is being applied to a current situation.
Socratic questioning
Rather than telling a client what to think, I ask questions that help the client examine the conclusion and reach a more considered understanding.
Cognitive restructuring
We develop a more balanced interpretation. This is different from replacing a negative thought with an unrealistically positive one.
Behavioral activation
When depression or low motivation has narrowed a person’s life, we identify realistic activities that can restore structure, involvement, and a sense of movement.
Behavioral experiments
Instead of continuing to assume that a prediction is true, we find a reasonable and safe way to test it through actual experience.
Problem-solving
An overwhelming concern is broken into specific decisions and manageable next steps rather than treated as one large, unsolvable problem.
Coping strategies
We may work on methods for managing anxiety, emotional reactivity, stress, avoidance, or other responses that interfere with daily life.
What CBT May Look Like During a Session
A CBT-informed session does not need to feel like a class or a worksheet exercise. The discussion usually begins with something that actually happened during the client’s week.
Sometimes this process identifies an inaccurate prediction. At other times, it reveals a deeper pattern. A client may realize that a present disagreement brings up an older fear of criticism, rejection, failure, or losing control.
CBT for Anxiety, Depression, and Feeling Stuck
Cognitive behavioral therapy techniques may be useful when thoughts and behaviors are contributing to distress or keeping a problem in place.
For anxiety, we may examine catastrophic predictions, reassurance seeking, or avoidance. For depression, the work may focus on withdrawal, hopeless conclusions, loss of structure, and reduced activity.
With procrastination, the problem is often not laziness. It may involve fear of failure, perfectionism, resentment, uncertainty, or feeling overwhelmed. Understanding what is driving the avoidance helps us choose a more useful response.
How I Combine CBT With Insight-Oriented Therapy
My approach is not limited to symptom management. Practical coping strategies are useful, but many clients also want to understand why they continue to react in certain ways.
CBT may help you respond differently before a difficult conversation. Insight-oriented therapy may help you understand why disagreement feels so threatening, why approval has become so important, or why conflict is repeatedly avoided until resentment builds.
Looking only at the immediate thought can miss the history behind the pattern. Looking only at the history can sometimes produce insight without enough practical change. I generally find it more useful to work with both.
This reflects my broader approach to individual therapy: understand the pattern, consider where it came from, and work on responding differently in the present.
Using Self-Assessments and CBT Goal Setting
When clinically appropriate, I may use standardized self-assessment measures to gather additional information about symptoms. These measures can help establish a baseline, identify areas that require attention, clarify treatment goals, and monitor change over time.
A score does not explain the whole person. It cannot fully account for history, relationships, personality, strengths, current stressors, or the meaning a person gives to an experience.
Self-assessments support clinical judgment; they do not replace it. They are one source of information within a larger therapeutic process.
CBT goal setting is most useful when the goal is specific enough to observe. “I want to feel less anxious” is understandable, but it may help to identify what feeling less anxious would allow the person to do differently.
A more specific goal might involve speaking up during meetings, completing an avoided task, sleeping more consistently, reducing reassurance seeking, or responding more calmly during relationship conflict.
Is Cognitive Behavioral Therapy Right for Everyone?
No single therapy approach is right for every client or every concern. Some people prefer a highly structured approach. Others need more time to understand emotions, relationships, grief, trauma, or long-standing patterns before focusing on specific behavioral changes.
CBT can also become too simplistic when it is reduced to “change your thoughts and you will feel better.” People are affected by real losses, difficult relationships, financial pressures, health concerns, and other circumstances that cannot be thought away.
Good therapy should make room for reality while also examining the parts of a reaction that may be open to change.
Frequently Asked Questions About CBT
Is CBT just positive thinking?
No. CBT does not require pretending that a difficult situation is better than it is. It involves examining whether a thought is accurate, complete, and helpful in deciding how to respond.
Does CBT involve homework?
It can. Between-session work might involve observing a pattern, practicing a coping strategy, recording reactions, completing an avoided task, or trying a different way of responding. Assignments should be connected to the client’s actual goals.
Is CBT always short-term?
CBT is often used in shorter-term treatment, but there is no single timeline that fits everyone. The length of therapy depends on the concerns being addressed, the client’s goals, and the complexity of the underlying patterns.
Can CBT be used in online therapy?
Yes. CBT discussions, exercises, goal setting, and between-session practice can be incorporated into online therapy. I provide online therapy to adults who are located in Colorado or Florida at the time of the session.
How do I know whether CBT is helping?
Progress may include less avoidance, more balanced thinking, improved emotional regulation, better communication, or a greater ability to respond intentionally instead of automatically. Progress is reviewed throughout therapy rather than assumed.
A Practical Approach Without Losing the Bigger Picture
Cognitive behavioral therapy can provide useful ways to examine thoughts and change behavior. I use those tools within a broader therapy process that also considers history, relationships, personality, and the patterns that continue to repeat.
Sources and Further Reading
- American Psychological Association: Cognitive Behavioral Therapy
- National Institute of Mental Health: Psychotherapies
This article is for general educational purposes. It does not establish a therapist-client relationship and is not a substitute for individualized mental health or medical care.