Imagine you're a mechanic, a carpenter, or an artist. Each job you do requires a unique approach and the right tools. How would you develop an understanding of what’s needed? What tools would you reach for to do the job? When faced with a challenge, how would you adapt? Now, let's apply this concept to therapy. How does a therapist understand your situation, choose the right methods, and navigate those moments when progress seems elusive?
Every person who comes to therapy for support has their own unique story, expectations, and needs. Because therapy isn’t a “one-size-fits-all" process, I use a variety of therapeutic modalities and theories to develop an approach to people’s individual needs and circumstances. You may see this referred to as “eclectic therapy”. Within this eclectic approach, there are some therapeutic frames I tend to draw from most often. In order to give you a sense of how I practice as a therapist, this series of blog posts will explore some of my most used approaches and how I apply them to my work. First, we’ll explore one of the basic principles underlying much of my work: Cognitive Behavioral Therapy, or CBT.
The Basics of CBT
CBT is, in a nutshell, a process of uncovering unhelpful thought processes and reframing or replacing them with more helpful thoughts. There are lots of resources available online to help you develop a better understanding of CBT, such as this one and this one, so I won’t go into a lot of detail here, but I will share an example of how I use this approach in my work.
The basis of much of my approach to therapy includes an exploration of the ways in which our thoughts, feelings and behaviors are all connected and influenced by each other. This is often referred to as the CBT triangle, which looks like this:
Let’s look at an example I often use in sessions to illustrate how this works.
Imagine two people sitting together in a room, having a conversation, feeling comfortable and relaxed. There’s a window in the room, but the blinds are closed, so they can’t see outside. Suddenly, there’s a loud BANG, as something outside hits the window.
Our brains like to understand our environment, so in the absence of information, we tend to fill in the blanks from our individual perspectives or experiences. So, each of the people in the room forms an immediate thought about what they just heard.
Imagine that for one of those people, this sound triggered a memory of another time when a bird flew into their window and was injured. Their thoughts, then, might be, “Oh no, a bird must have hit the window! Poor thing, I hope it’s okay.” This thought leads to the feeling of worry or concern for the bird. In this case, they may get up from their chair and start to open the blinds to check on the bird they imagine is lying on the ground. Their triangle might look something like this:
But say that for the other person, this sound triggered a very different memory, of a time when their house was broken into. Their thoughts would be very different, more along the lines of, “Oh no, someone is breaking in, we’re in danger!” This thought creates a feeling of fear or terror. This person doesn’t head toward the window, instead they head towards the door- maybe pulling out their phone to call for help. Their triangle looks like this:
Person number one looks at person number two, headed for the door yelling for help, and thinks, “Wow, what’s THAT about? It’s just a bird, what an overreaction!” Meanwhile, person number two looks back at person number one headed to open the blinds and yells, “Are you crazy? Get away from there! Run!”
Neither person understands the other’s behavior- the outside representation of their internal processes, so they may be confused about why they reacted that way. On the INSIDE, however, each person’s behavior makes complete sense based on the story they’ve told themselves about what that noise was.
The thing is, neither person really knows what that sound was. Either could be right. Both could be wrong.
CBT at heart is the process of figuring out the stories we tell ourselves (sometimes called Automatic Negative Thoughts (ANTS) or cognitive distortions) and how those stories impact how we feel and behave. CBT strategies include becoming aware of and checking these thoughts (Is it true? And if it is, how big a deal is it, really?) and changing or challenging those thoughts that don’t fit or may have other interpretations. We look at cognitive distortions or thinking errors, look for evidence to support or to refute underlying thoughts, and explore the impact of considering other possible ways of thinking about a situation.
CBT is a long-researched approach to helping with a wide range of emotional difficulties, including:
Anxiety Disorders
Depression
Obsessive-Compulsive Disorder (OCD)
Post-Traumatic Stress Disorder (PTSD)
Eating Disorders
Substance Use Disorders
Insomnia
Stress Management
Anger Management
Chronic Pain
Self-Esteem Issues
Relationship Problems
Phobias
General Psychological Well-Being
If you’d like to explore how I use CBT as part of my therapeutic approach and whether it might be helpful to you- or what other approaches I also use- feel free to reach out to schedule a 15-minute consultation call.