Throughout most of my adolescence, I met with a therapist. Each week, I would bring in a mess of thoughts, fears, and emotions. I'd throw these down like puzzle pieces on the floor.

"They hate me." I might say. "Do you hate people who are different? Do you think they should be hated?"

A traditional cognitive challenge. Each week, a few more pieces came together. I was free to leave the corner these limiting thoughts had held me in. I felt empowered.

As I entered college with aspirations to become a therapist myself, cognitive behavioral therapy seemed like the holy grail and I hoped to learn and master the technique. Simple. Evidence-based. I dug it.

But then a new session with a new therapist left me with a new outlook.

"I can't focus," I blurted across the room.

"You came to this session on time today," the therapist pointed out.

"I'm struggling in my classes," I said.

"The first year of college is difficult for a lot of students. It's not like high school. You have to work a lot harder," came the reply.

"I'm a sophomore. Last year I did okay."

The psychologist looked up at me, perplexed.

"I skipped a grade," I said.

"Students with attention problems don't typically skip grades," the therapist noted.

Though I imagine they meant well, it felt invalidating. I would have loved for there not to be a problem, but there was. Trying to make me think otherwise wasn't what I needed.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a psychotherapy rooted in the cognitive model, which proposes that our thoughts affect how we feel and act. When done well, CBT helps a person understand their beliefs, including those that might be unhelpful to achieving the goals one values. Many of us carry longstanding problematic thoughts like "I'm stupid" or "I can't make friends" that follow us, tripping up our efforts to move forward in life. Through strategies such as Socratic questioning, cognitive restructuring, and behavioral experiments, CBT puts these beliefs to the test with the potential to create real change in a person's life.

A problem arises, however, on the matter of what's true. Psychotherapists, despite their training, are not arbitrators of the truth.

While we can challenge what we consider to be unhelpful beliefs, most beliefs are subjective.

My collegiate belief that I couldn't concentrate might indeed have been, in a technical sense, untrue. I could concentrate sometimes. Yet, the foundations of my difficulty did not lie beneath a stack of unhelpful beliefs. Challenging my complaint only led me to feel more alone. Other CBT strategies, such as skills building or exploration into what allowed me to concentrate when at my best, may have been more helpful.

I think there's a misconception that therapists should somehow lead clients to the true, conveniently optimistic, view of reality, and it can be harmful. The good news is that this is not what effective cognitive behavioral therapy looks like.

Rather than an argumentative or persuasive stance, the spirit of CBT rests in a partnership between the client and the therapist as equal observers of reality. The therapist seeks to implement a strategy of guided discovery within this relationship. In many cases, a strong therapeutic alliance is just as important as the technique utilized (Beck, 2020). In other words, through guided discovery, the CBT allows a client and therapist to talk things out as equals searching for what is effective for a person to reach their goals.

The Many Types of CBT

Traditional CBT came into being in the 1960s, through the work of psychiatrist Aaron Beck. Before then, psychotherapy primarily came from a psychoanalytic tradition that focused on one's past and the investigation of unconscious phenomena. Psychoanalysis could take years and often focused on a deep understanding of oneself rather than measurable goals. CBT revolutionized psychotherapy by offering a more time-limited psychotherapy that could help people tackle their difficulties in the here and now.

Since the 1960s, there have been many iterations and variants of CBT. Some of these psychotherapies, such as dialectical behavioral therapy and mindfulness-based cognitive therapy, integrate mindfulness and skills-building as important components. Acceptance and commitment therapy, another variety of CBT, adds a strong focus on clarifying one's values and flexible ways of relating to oneself, one's experiences, and the world to the mix. Trauma-focused CBT and cognitive processing therapy integrate a narrative component for PTSD. Exposure therapies assist with phobias. The list goes on.

There is a flavor of CBT for most psychological struggles, it seems.

All of these psychotherapies are supported by evidence to assist with specific challenges and emphasize the relationship between the therapist and the client. What most variants of cognitive behavioral therapy popular today have in common is that they are contextual. These therapies are meant to be tailored to the individual and their environment.

In Closing

Cognitive behavioral therapy provides a set of tools that can be extraordinarily useful when utilized effectively. When used poorly, the tools are dull. But CBT is as much about the people using the tools than the tools themselves. Effective therapy requires the clinician and patient to be on the same page, working the tools as a team.