Cognitive-Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is a structured, goal-oriented, and educational approach to treatment.  CBT operates under the belief that negative feelings and behaviors result from the way you perceive and interpret situations around you, rather than the situations themselves.  By working to change the thinking patterns that bring on negative emotions, CBT empowers you to become your own therapist and problem-solver, so that you not only feel better, but stay better.

You text a friend, and they don't respond.
You text a friend, and they don't respond.
You text a friend, and they don't respond.
You text a friend, and they don't respond.
"Did I say or do something wrong? Is she mad at me?"
"Is she okay? What if she was hurt/in an accident?"
"She's probably busy.  I'll check in with her later."
"She's always doing this! Is it that hard to text me back?"
Anxious (on edge, replaying conversations, poor focus)
Scared (racing heart, rapid breathing)
Calm (will continue with
daily routine)
Angry (feeling tense, raising voice, banging fists)

In the example above, you will notice that the situation remained the same, but the resulting feelings and behaviors varied.  This shows that it is not a situation that determines our emotions and actions, but the way we think about and perceive them.  The goal of CBT is not to think more positively, but to think more realistically/rationally about situations, and to strengthen our problem-solving abilities.  In addition to challenging unhelpful thinking, CBT targets unhelpful behaviors and coping strategies, such as avoidance, worrying, checking, always saying "yes," among others.  

  • Sessions begin with a brief review of how you've been feeling since we last met, summed up in a few sentences.

  • We will then review your homework, including your successes, as well as challenges.

  • Next, we will set the session's agenda.  This is a list of 1 or 2 points that you want to make sure we address during the session. These points may include learning to cope with a specific stressor, reducing an unhelpful behavior, learning more about specific symptoms you've been experiencing, etc...  Setting the agenda helps us establish goals for each session. 

  • We will address each item using an educational and problem-solving approach, and work to develop skills to identify, evaluate, and restructure any unhelpful thinking patterns that may be contributing to your distress.  We will collaboratively design homework while working through each point, so that you can practice and reinforce your new skills between sessions.

  • I will have you summarize the session, answer any questions you may have, and ask you to provide me with feedback on how you feel the session went.  Feedback is important, as it allows me to make sure we are on the same page, and that you are feeling heard.

How are CBT Sessions Strutured?

Exposure and Response Prevention (ERP)

ERP is a specific form of Cognitive Behavioral Therapy, and the number one treatment for Obsessive-Compulsive Disorder, as well as other anxiety and avoidance-based conditions.  The goal is to gradually expose you to your obsessions, triggers, and avoided situations, without engaging in any rituals to reduce the accompanying anxiety.  While initially this is challenging, after repeated exposures, your body learns to habituate.  Think about jumping in a cold pool during the summer.  Initially, the water is cold, and you want to get out, but after staying in for a period of time, your body gets used to the water.  This is called habituation.  Exposures are done in a hierarchical manner, which allows for your confidence to build as you confront more challenging triggers. 


I take a team approach with clients, helping them to engage in exposures during session first, before collaboratively assigning homework to continue practicing at home.  With treatment, clients feel a greater sense of freedom, independence, and confidence, knowing that rituals/compulsions are no longer a necessary, and time-consuming part of their everyday lives.