What is it like to do CBT?
Cognitive Behavioral Therapy feels like regular therapy, but with direction, goals, and a plan. We are very supportive. But we are not only here to support you. A CBT therapist does not want you to need them for the rest of your life life. We want you to have friends and other supportive, fulfilling relationships. We want you to get bored with us (later, of course) because you feel good and you have other people in your life who support you and bring you joy. Therapy usually follows this basic sequence:
- Articulating your needs: Your therapist will help you clearly and concisely articulate the reason that you have come to see them and what you want to get out of therapy. We call these the “Presenting Problem” and the “Treatment Goal.” For many people, simply learning to articulate the problem and the goal is a major step forward. It empowers you and your therapist to start working together in a way that is more likely to work.
- Assessment and Treatment Planning: You and your therapist will work together to better understand the causes of your struggles, and your therapist will recommend steps or smaller goals that we call objectives, and integrate them into a written treatment plan that will guide therapy going forward. The treatment plan will usually start out fairly sparse, as it can often take several weeks to truly grasp what needs to be done.
Therapy will then involve talking through your situation and learning to more clearly understand how the things that happen to you, the way you think, and the things that you do all impact how you feel and what you get (or don’t get) out of life. Your therapist will help you better understand your emotions and your thoughts, and will help you think in ways that more accurately represent what happens in your life. For example, if you believe that others frequently reject you, your therapist will help you evaluate the extent to which that is true. If it is not true, many people begin to feel better as the begin to realize that they are not being rejected. If it is true, your therapist will help you discover why the rejection is happening, and what you might be able to do about it. Your therapist will also help you problem-solve so that you can get better results with whatever you need or want to do. Your therapist might help you learn to tolerate small discomforts so that you can slow down and think through reactions without reacting impulsively.
What is Cognitive Behavioral Therapy?
You don’t have to know any of this to work with a CBT therapist. This is only if you feel like going down the rabbit hole.
There are only five things that exist in human psychology: 1) emotions, 2) thoughts, 3) your environment, 4) biology, and 5) behaviors. Your emotions cannot be changed through sheer will. If you want to feel better, the other four factors all have to be addressed – because they all affect how you feel.
We call it Cognitive Behavioral Therapy because everything comes back to how you think and what you do. Next, we will describe the five factors, how they all interact, and why it always comes down to 1) how you think, and 2) what you do. This is why we call it Cognitive (thinking) Behavioral Therapy.
Emotions: This is what you feel. Joy. Excitement. Frustration. Sadness. Anger. Amusement. Fear and dread. Emotions can feel good or bad in and of themselves. But they also involve physical feelings. Like a pit in your stomach, or trembling. And they push you to do things. Emotions can cause you to want more of something, or they can drive you to avoid. Emotions are the real reason that most people seek out therapists. Has anyone ever told you “stop being so anxious” or “stop being so angry”? Or sad? It doesn’t work. We have to address the other factors discussed here if we want to feel better.
Thoughts: Our feelings are largely driven by the way that we interpret things that happen to us and inside of us (for example, physical sensations). If another person looks at you because they think you are attractive, and you believe that they are judging you negatively, you are going to feel bad, when you could be feeling good. If you are actually in danger, and you interpret your surroundings accurately, you will feel fear, which in this case can be a good thing. But if you interpret your environment to be dangerous, and it is not, you will likely feel needless anxiety that not only feels bad, but causes you to avoid things that might otherwise make you happy.
Environment: The way you feel is impacted by the way you are treated by others, the extent to which you like your job or your living arrangement, and the opportunities you have or don’t have. To think that you can feel good without considering these factors is just unrealistic. To change your environment, you have to do something. Sometimes that something is big. Sometimes it’s small. But it always involves behavior. In other words, you cannot change your environment without changing your behavior.
Biology: The way you feel is heavily influenced by biological factors such as genes, hormones, sleep, and substance, whether they are prescribed (medications), recreational, or an attempt to control your symptoms without professional help (marijuana and alcohol are big ones). You can’t do anything about your genes. But modern treatments are made with that in mind. You can usually do something about your sleep and the things that you ingest. And that all falls under the category of behavior. The only direct path between biology and emotions is medication. Sometimes medication is appropriate. Your therapist will help you think through whether this is the case for you.
Behavior: To behave does not mean to follow the rules. It means to move muscles. Talking, sitting, standing and walking are all behaviors. So is drinking a beer. So is exercise or watching a show. If you assert your needs to another person, or if you try to initiate a friendship, those are behaviors.
So why isn’t it called “Emotional Cognitive Environmental Biological Behavior Therapy?”
- Your emotions cannot be treated directly, except by taking medication (which is a behavior). The other factors are what drive your emotions, and medication typically does not address them.
- Your environment can only be changed through behavior.
- Your biology can only be changed through behavior.
- Your thoughts directly influence your emotions. And they partially guide your behavior. There is a mountain of evidence that hey can be changed.
Conclusion: it is all about thoughts and behaviors. Hence, Cognitive Behavioral Therapy.