“I’ve heard that CBT is overly structured and inflexible?”
There is a lot of room for creativity and thinking outside the box within CBT. Therapists can use more active tactics in session (e.g., role plays, exposures) to help clients feel more comfortable with anxiety-provoking situations and explore new ways of engaging with more meaningful activities. CBT can often involve leaving the office to more actively apply skills that are being developed and foster a sense of flexibility. In short, CBT can often emphasize “walking the walk” much more than just “talking the talk” and is catered specifically to the individual client’s needs.
“CBT is short-term (e.g., 8-12 sessions)”
The length of treatment varies depending on symptoms and individual preference. Although most therapy manuals are often based on 8-12 sessions, my approach to CBT is aimed at going beyond the manual to more actively collaborate with the client about how to best integrate skills into their life. I also can continue treatment as needed with less frequency to ensure maintenance of treatment gains.
"CBT is just too manualized and mechanical"
CBT has spent a lot of time creating and refining protocols and techniques grounded in science and research, which can help people. The CBT therapists use these protocols and techniques as frameworks, which can be applied in a way that is tailored to client's needs and in the context of what is happening for the individual. When these skills are applied in the moment and at the right time, it can have the potential to make powerful changes in an individual's life.
"Where is the relationship? Do I need to go to a separate therapist for that?"
The CBT framework often asks individuals to work on thoughts, feelings, and bodily sensations that have been there for a long time, and at times, can be uncomfortable and distressing. For many of us, launching into this type of work is possible when there is someone who you trust guiding you through this process. The role of a therapist is even more crucial in CBT because we are asking you to actively change your relationship with thoughts, feelings, and bodily sensations which are not working for you, but can be distressing to let go. Therefore, rapport building and the therapeutic relationship is foundational to the work involved in CBT rather than being separate.
“CBT only treats symptoms without addressing the source of problems.”
While CBT absolutely targets symptom reduction, treatment also takes into account the person as a whole. CBT aims to identify how an individual’s unique underlying, pervasive thought patterns and behaviors (for example, avoidance) contribute to current symptoms as well as to problems in the past and outlooks on the future. CBT is highly personalized, and physical, emotional, and social factors play integral roles in treatment of not only symptoms, but also the person as a whole.
Although CBT places less emphasis on discussing one’s past compared to other types of therapy, we do strive to understand individuals holistically, and thus, we are interested in learning about one’s past and present experiences. Moreover, discussing the past can help clarify the adaptive function that behaviors played during earlier time points in life, thereby helping one to develop self-compassion for current difficulties. However, one advantage of CBT is that insight related to how a problem developed is not necessary for an individual to change. Each of us is not the same person that we were 15 years ago, 5 years ago, or even 2 years ago, and thus, whatever was maintaining a behavior has likely changed. By emphasizing the present, we are able to focus on a person’s present-day values and current barriers to living according to these values.