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Explaining Cognitive-Behavioral Therapy
What cognitive-behavioral therapy is, and how it can help
La'Quesha Barner

When my editor told me about cognitive-behavioral therapy (CBT), I was surprised to hear that not all therapy is the same. I found out that CBT is a kind of a therapy that focuses on how you think and act, and how you can change. I thought that sounded useful.

To learn more, we went to see Dr. Carrie King, a psychologist who works with kids and teens using CBT.

Not What I Thought

When I got to Dr. Carrie’s office I was shocked at first, because it was not what I thought a therapist’s place is supposed to look like. I thought all therapists had a long stretched out couch for the clients, in a not-so-comfortable room where you feel stuck.

But Dr. Carrie’s office was a nice-sized room so you wouldn’t feel trapped. She has a little playroom for the kids she sees, and inside her office are two comfy chairs, two big, wide windows, a bookshelf and her own kitchen set-up with a microwave and a mini-refrigerator.

I’m new at interviewing and I was nervous, but Carrie was a very comfortable person to talk to. And the more she explained CBT, the more interested I became. I found out CBT is very different than what I thought therapy was supposed to be.

Carrie explained that “cognitive” means thinking, and behavior is how you act. So “cognitive-behavioral therapy” is therapy that looks at your thoughts and your actions and how they affect each other.

“What CBT therapists do is make people explain the thoughts that led up to their behavior,” Carrie said.

Therapy With Homework

“The biggest difference between CBT and regular therapy is that in CBT, the therapist asks you to do things,” Carrie told me. “In other kinds of therapy, the therapist does less. They listen a lot, and they help you think about your life, but they don’t tell you to do something. In CBT, you get homework: the therapist will ask you to try something out and then report back on how it went.”

I thought that was cool, and that getting homework is probably good for patients who don’t know what to do about their problems and need some direction. She gave me an example.

image by John Morgan

“If you were having a problem getting out of bed in the morning, I might ask you to keep a diary of all the times you didn’t feel like getting out of bed, and what you were thinking during those times. And then you’d bring it in the next week and we’d talk about it.”

Carrie says she uses CBT because she works with lots of teens and kids, and this kind of therapy works particularly well for us. “CBT involves a lot of practicing and role-playing,” Carrie told me. “That’s much easier for kids than just talking about their feelings.” Carrie and her patients act out the kinds of situations that the kids have problems with, so they can see why they react the way they do and practice responding differently.

Focusing On the Present

Carrie said that another difference between CBT and other therapy is that CBT focuses on the present, not the past. I always figured that in therapy they make you go back to the past to find out why you act the way you do. But Carrie said that in CBT, they only talk about the past if you want to. That was kind of confusing to me. How can you get to the core of the problem if you don’t know how it started?

Carrie explained that CBT therapists believe you can accomplish more if you work on the behaviors, thoughts and feelings that are most accessible—the ones that are occurring right now. “You can’t touch the past or change it, so you should focus on what the past is doing to you right now, and change what is happening for you at this moment,” she said. “CBT does care about the root of a problem, and the therapist will search for that root. But most of the therapy is focused on trying to change what you don’t like about what’s happening now. We have a clear goal, and we work until we reach it.”

Can CBT help?

I liked the sound of that. Picking a goal to work on seems more effective to me than just talking about whatever comes to mind. I wondered how you would find a therapist who works with CBT.

“You’d have to ask,” Carrie told me. “You’d have to say, ‘I’d like to see a therapist who uses CBT.’ And with any kind of therapy, you have to go and meet the person and see if you like them.”

“You’d also want to ask the therapist’s opinion about whether CBT would be useful for you. I’d go and say, ‘This is my problem, this is my goal, do you think CBT would work?’ If the therapist is good, they’ll be honest with you about whether they can help you or not.”

“Sometimes, people need help figuring out what their problem is—they feel bad, but they don’t know why—and CBT is not a great place for them. But if it’s something like, ‘I’m afraid to leave my house’—well, that’s a very narrow, clear problem, and CBT can help.”

I’d always been a little afraid of therapists, and I thought therapy was for crazy people. But I would certainly go to a CBT therapist. It seems like they just get to the point. I thought therapy meant you lay back on a couch and talk while the therapist does something else, and then you get medicated. But in CBT, they make you focus on what’s really getting in the way of your life, so that you can face forward to the future.