“I don’t want people to think I’m crazy.” As we field calls and emails from potential clients, this sentiment is often communicated. Thank goodness we live in a time where the stigma of mental health has decreased significantly compared to the past. According to a 2004 study by the American Psychological Association, more than a quarter of the United States adult population has received professional counseling. With continued awareness, there is hope that psychotherapy can continue to be increasingly accepted as helpful, effective, and widely supported. At Tobin Counseling Group, we are psychotherapists who practice from a cognitive behavioral therapy (CBT) model. With so much information out there about different types of therapies and counseling, it can be confusing. We’re going to break it down to help you understand our approach.
What is CBT?
In 1950, psychologist Dr. Aaron T. Beck was treating depressed clients and began taking a closer look at his patient’s thoughts about themselves, the world, and their futures. According to Dr. Beck, the depressed clients experienced negative automatic thoughts which, when identified, allowed him to work on conceptualizing their depressive symptoms in a different way. Dr. Beck’s work informed the treatment model of CBT by allowing therapists to work with clients to challenge negative patterns about themselves and the world to change maladaptive behaviors. CBT is based on the notion that our thoughts, feelings, and behaviors are functionally intertwined. According to the National Alliance on Mental Illness (NAMI), “Studies of CBT have shown it to be an effective treatment for a wide variety of mental illnesses, including depression, anxiety disorders, bipolar disorder, eating disorders and schizophrenia. Individuals who undergo CBT show changes in brain activity, suggesting that this therapy actually improves your brain functioning as well.”
What does CBT look like?
In working from a CBT framework, the goal of treatment is to identify and change the client’s negative thoughts and problem behaviors through cognitive restructuring and behavioral changes. In making small changes to our relationships to our cognitions and actions, our mood can improve and we can feel better. CBT therapists are collaborative and speak to our clients from a problem-solving perspective that is focused on the present. We want to understand our clients’ thoughts; often this involves a thought log. A traditional CBT thought log is a chart with various columns that requires a client to write down their negative automatic thoughts or images and describe what is happening when these thoughts occur (e.g, where they were, who was with them, and what happened). A client also records the emotions they are experiencing when experiencing these thoughts and what evidence they have to support these thoughts. The important next columns are about finding evidence that does not support the original negative thoughts and then developing an alternative, more neutral or balanced perspective. Finally, the client rates how much they believe this new perspective to be true and again rates their mood. By slowing down and analyzing the automatic process of having a negative thought and then feeling bad, a client is empowered to make changes and feel better. Exploration into our thoughts and being able to challenge them is why CBT can be so helpful and effective. Although CBT is focused on the present and making changes, the work often involves understanding where the core beliefs about ourselves and the world started. Instead of just believing every thought we have to be true, we start to examine which thoughts are catastrophizing ones or depressive ones or are our anxiety talking.
There is also a behavioral component of CBT, which speaks to the idea of not just thinking our way into feeling better but the necessary steps of acting our way into feeling better. In conjunction with exploring thoughts and feelings, we also have to look at the other arm of this triangle: what we are doing. Taking a look at sleeping and eating patterns or our day-to-day activities can allow us to make some healthy changes. We also want to determine if there are ways to improve our moods by changing our environment, like getting outside, utilizing breathing and relaxation techniques, or increasing activities like exercise. Just like our thoughts can be automatic, our behaviors can become mindless as well. Setting intentions and being purposeful when we choosing to engage in or abstain from certain activities can really change our perspective. The beauty of CBT is that it does not require drastic change. We explore what works and what doesn’t and we look at what small changes we can make or what we need to keep doing that already works. The therapist’s role is to help the client discover these insights and then feel empowered to challenge their thoughts and utilize good coping strategies and make positive choices on their own.
How CBT can help you
Here is a snapshot of what CBT can look like in action at Tobin Counseling Group. A potential client reaches out to our practice, schedules an initial consultation, and reports they are experiencing anxiety at work. The first session is focused on information gathering in order to give the therapist a good idea of what the anxiety looks like for the client, as well as who the client is by collecting details about the client’s family, medical, work, education, and relationship history. The therapist also works with the client to establish goals and expectations for treatment. At the end of the first session, the therapist shares their initial impressions and any connections or patterns they notice and what they think needs to be put into place to work towards the goals. Using a CBT model, subsequent sessions would involve getting to know the client more and understanding how the anxiety manifests for the client throughout the day. The therapist would want to understand what thoughts and beliefs the client has about themselves and their work.
While all of this data is gathered and processed, the therapist would also likely give the client some homework to focus on outside of sessions. The goal of therapy is not to continue forever; by giving a client things to work on outside of sessions, the client is able to integrate this work more than just once a week in the therapy office. Homework assignments might be breathing techniques to try at work to decrease the symptoms of anxiety when the client starts to feel activated, or they might be a thought log to start challenging those fears and worries that pop up during the workday. With time and support, psychotherapy can help the client feel less overwhelmed by their workday and negative thoughts.
Cognitive behavioral therapy can be very effective when the therapist and client are working together towards that shared goal of the client having an empowered relationship with their thoughts, feelings and behaviors. Instead of going on autopilot and being a victim to negative thoughts and poor coping skills, a client can learn to have a different relationship to these parts of themselves and make positive changes. Therapy can be challenging at times, but a therapist at Tobin Counseling Group is invested in helping future clients feel better.