Common Misconceptions of Cognitive-Behavioral Therapy

In this previous post I provided an overview of cognitive-behavioral therapy (CBT), a therapeutic approach based on the idea that our thoughts (i.e., running commentary in our heads), feelings (i.e., emotions), and behaviors (i.e., things we “do”) are all related to and influence each other. To follow up, I thought it would be useful to address some of the common misconceptions people have about CBT. Given how popular it is, there is plenty of information about CBT on the web, not all of it good or accurate.

CBT teaches you to think positively.

Because CBT theory emphasizes the interaction of thoughts and emotions, a major component of therapy is challenging unhelpful patterns of thinking (i.e., cognitive distortions), such as all-or-nothing thinking (“My girlfriend recently broke up with me, I’ll never find anyone to love me”) or catastrophizing (“Since I got a bad grade on this test, I’ll likely fail this class and won’t graduate”). Because the vast majority of these distortions are negative, many people assume that one goal of CBT is to replace negative thoughts with positive thoughts. However, that is not quite correct. The key is the word “distortion” – the goal of therapy is to challenge thoughts that are not rational, helpful, or based on evidence, and replace them with more adaptive thinking. See this video from the Beck Institute for a great explanation of this issue.

CBT is rigid and manual-based.

A common misconception of CBT is that it is a rigid, one-size-fits-all therapy based on manuals. I believe this belief is popular because there are a variety of CBT manuals for therapists attempting to learn the technique and for use in clinical trials evaluating the effectiveness of the therapy. However, well-trained therapists are skilled in tailoring the approach to the needs of individual clients, and most will also incorporate techniques from other therapy approaches as needed (see my example below of how to use motivational interviewing and CBT together!).

CBT only works with motivated clients.

Because it often includes exercises (homework!) done outside the therapy session, it’s commonly assumed that CBT is only effective with very motivated clients. There are a few reasons why this is not true. First, any therapist, regardless of their orientation, should be trained in how to engage clients through the careful use of language, matching their interpersonal style to that of the client, or by leveraging the rapport built in the therapeutic relationship.

Second, many therapists are trained in a range of therapeutic approaches and can combine approaches as necessary to meet the needs of their client. One approach I’ve found effective is blending techniques from Motivational Interviewing with CBT. It’s a relatively common approach (common enough for an entire book to be written about it!). The thing I like most about motivational interviewing is that it is a “meet your client where they are at” approach that is supportive, gentle, and non-judgmental.

Lastly, one nice feature of CBT is the notion that the therapist and client work on small, approachable goals throughout therapy. A client is not asked to take on more than feels manageable or reasonable, and they get to quickly see tangible results of their efforts. This is reinforcing and often strengthens motivation.

CBT is only supported for use with anxiety and depression.

Cognitive behavioral therapy was developed by Dr. Aaron Beck, who originally applied his theory to the treatment of depression. Since then, it has also become recognized as the gold standard for the treatment of anxiety. However, CBT is recognized as an effective therapy for a wide range of psychological disorders including schizophrenia, ADHD, and eating disorders. See this analysis by the American Psychological Association evaluating the evidence supporting the use of CBT for a variety of disorders.

I hope that you have found this blog post helpful today. If you are in the Austin area and contemplating starting psychotherapy, I am happy to speak with you on the phone to answer any questions you may have, including those about CBT. Please reach out to me at laura@drlaurawahlstrom.com or 512-521-1531.

The Importance of the Therapeutic Relationship

As humans, we not only desire relationships with others, but need them. Research indicates that social support increases our odds of survival by 50%. So, if we need supportive relationships to survive, it makes sense that we also need a strong relationship with our therapist for treatment to be effective. My blog post today will focus on aspects of the client-therapist relationship that contribute to better outcomes in psychotherapy.

The therapist-client relationship (often referred to as “therapeutic alliance”) has been studied extensively, with data indicating it is a consistent predictor of therapy outcomes. Individuals who have a strong relationship with their therapist are more likely to comply with therapy, experience greater symptom relief, and report a greater satisfaction with the therapy process.

What are some of the therapist characteristics that promote a strong therapeutic alliance?

  • A collaborative approach to therapy, as opposed to an authoritative or direct approach.
  • An ongoing communication of hope regarding the outcomes of therapy.
  • A warm, genuine, and friendly demeanor.
  • Objectivity and honesty (even if sometimes you don’t like it!).
  • The use of plain, straightforward language as opposed to jargon.
  • A flexible treatment plan.

Not all of these qualities are immediately evident when first meeting someone, so what should you be looking for when deciding on a therapist? First, you should look for a therapist who specialize in approaches that fit with your personality and preferences (e.g., does a cognitive-based approach resonate with you, or do you feel a humanistic approach is more your style?). Second, take some time to talk with a potential therapist and ask questions before scheduling a session. While relationships take time to develop, research also suggests our initial impressions of kindness, trust, and compassion are pretty accurate. Don’t be afraid to trust your gut!

Given the importance of the therapeutic relationship, I offer a free 15-minute phone consultation prior to scheduling my first session with any Austin-area client. This gives us an opportunity to learn more about each other, and you a chance to decide if I seem like a good fit for you. If we determine that we aren’t a good fit to work together, I’m always more than happy to help you find someone else in the area better aligned to your personality and therapy goals.

Please reach out to me at 512-521-1531 or laura@drlaurawahlstrom.com if you would like to discuss your situation and see if I may be able to help you!

What IS a Psychologist?

Finding and reaching out for help can be overwhelming. You may already be struggling with low energy, little motivation, and difficulties making decisions, which makes that process feel like you are embarking on a drive from South Austin to Round Rock, on I-35, during rush hour. Then, once you start looking for help, how do you figure out what type of mental health provider to reach out to? My blog post today will explain the education and qualifications required to be deemed a ‘psychologist,’ and the specific ways in which a psychologist’s training sets them apart from other types of mental health providers.

A psychologist has a doctoral degree (PsyD or PhD) in either clinical, counseling, or school psychology. Graduate training is typically between 5-7 years, and includes rigorous coursework in a variety of areas of psychology, research (though less of an emphasis for PsyD), training in assessment and treatment of psychological disorders, and completion of a year-long, full-time clinical internship. Following completion of the doctoral degree, post-doctoral supervised experience is required (typically 1-year) prior to becoming licensed to practice independently. The licensure process differs by state, but Texas requires an individual possess the necessary degree, training, and clinical hours, as well as pass the Examination for Practice in Professional Psychology (EPPP) and a Jurisprudence exam (a test of state laws and rules psychologists must follow). They also previously required an oral exam, but did away with this requirement in 2017. After licensure, psychologists are required to complete a certain number of continuing education hours each year to help them stay current on issues related to treatment, ethics, and cultural diversity in the field.

Does this sound like a long process? Well, that’s because it is! While the type and quality of training a psychologist receives can vary greatly, there are a few things that you can expect when working with a psychologist.

First, the primary thing that sets a psychologist apart from other types of mental health practitioners is training in assessment. This includes intelligence, cognitive, and personality testing, that is often used along with a clinical interview and self-report measures to establish diagnoses and make recommendations.

Second, psychologists are trained to diagnose psychiatric disorders. During graduate school, they take courses on the diagnostic criteria and interviewing skills. These areas are then put into practice during their practicum, where they see clients under the supervision of a licensed psychologist.

Lastly, psychologists are trained in psychotherapy. This includes ways to connect with clients and develop a strong relationship, as well as specific treatment approaches for different problems.

I’ve provided a link below that further explains the different types of mental health professionals. If the type of training a psychologist has sounds like a good fit for your needs and you live in the Austin area, please give me a call at 512-521-1531 or email me at laura@drlaurawahlstrom.com to discuss your situation and see if I may be able to help you.

Types of Mental Health Professionals