Explaining Cognitive-Behavioral Therapy

Much has been written on the merits and principles of cognitive-behavioral therapy (or CBT).  As I have stated in a previous post, I utilize CBT as a primary style of doing therapy.

For most of my clients, one of my first interventions (a fancy term for essentially anything a therapist does in a session) is to explain the theoretical model.  Part of the rationale for this is what therapists call transparency, which is essentially the idea that clients should be informed about what the therapist is doing and why.

CBT has a relatively shorter history than other therapy models, and there are a number of branches and specialties stemming from the crux of the ideas.  What I discuss here is how I choose to explain the concept to clients.

At the center of CBT the basic premise that, within each person, there is an interaction among their thoughts, feelings, and behaviors.  These are in turn affected by a person’s biological responses and the situation in which a person finds herself.

I often draw the concept in this way: cbt

Typically, as I draw, I explain some examples of how this works, using the experiences and symptoms of my client.

One example I use frequently is this:

Let’s begin with a situation.  Let’s say that you are driving in traffic and someone cuts in front of you dangerously.  Most people will say that they feel angry and scared when that happens. Well, how do we know that we’re angry and scared?  Usually, our heart beats faster, our palms get sweaty, our muscles tense, our chest can feel tight, and we have this feeling like we want to move.  That’s the biology that’s happening.  Our thoughts often go something like this: ‘What a jerk!,” “I almost died!,” and things of that nature.  Then, we’ve got our behaviors; these vary widely person to person, and can include vulgar language shouted at the windshield, rude hand gestures, or smacking of the steering wheel.

Of course, some people don’t react this way, and are able to be calm, even in dangerous and frustrating situations.  Generally, though, the principle stands. When we are in a situation, our body and mind react quickly, often in ways we never think to control; much of this happens immediately and automatically.  When people seek treatment, often there is a pattern of these reactions that are unhelpful or disruptive to their lives.  CBT focuses on interrupting the feedback loop by working to change a client’s thoughts and behaviors to ones more congruent with their goals.

The way that is achieved varies greatly from person to person, and CBT therapists have developed a slew of interventions, worksheets, and scripts to address these concerns.

Overall, one thing that makes CBT different from, say, psychoanalysis, is that CBT therapists do a lot of teaching, use handouts, complete worksheets, assign homework, and generally take a more active and concrete role in the therapy.  The focus is on action and change; something that many clients find helpful and empowering (although certainly not all).

In the end, however, my job is to give my clients the best treatment possible, and if, for that person, CBT is a poor fit, I use the training that I have in various other methods to provide my clients with what they need.