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How Does CBT Work?

Cognitive Behavioural Therapy

Cognitive-behavioural therapists seek to learn what their clients want out of life (their goals) and then help their clients achieve those goals. The therapist's role is to listen, teach, and encourage, while the client's role is to speak, reflect, express concerns,and implement that learning.


Cognitive Behavioural Therapy is an integration of Cognitive and Behavioural approaches. You are helped to recognise patterns of unhelpful or distorted thinking and dysfunctional or unhelpful behaviours. Systematic discussion and carefully targeted and structured behavioural assignments or self-therapy are then used to help you evaluate and modify both your thoughts and behaviour. Some aspects of therapy have more cognitive (thoughts) focus and other a more behavioural (action) emphasis.

The CBT Approach

CBT looks at the connections between one’s life circumstances and situations, events and problems that give rise to difficulties, altered thinking, behaviour and physical and emotional feelings and symptoms. Broken down in component parts these are:

  • A Situation (a problem, event or difficult situation) leads to
  • Thoughts (extreme or unhelpful thoughts) which impact
  • Behaviour (reduced activity, avoidance or unhelpful behaviour) which affects
  • Emotions feelings (negative and unhelpful feelings) and
  • Physical feelings (physical feelings/symptoms)
  • Thoughts, Behaviours, Emotional and Psychical Feelings influence the way we act and
  • Respond to situations and events.
  • Thus, the cycle continues.

Unhelpful thoughts and behaviours can give rise to a vicious circle that becomes very difficult to break without help. This vicious circle can make you feel worse and can create new situations that continue the circle and distress. You can start to believe quite unrealistic or unpleasant things about yourself. This happens because, when we are distressed, we are more likely to jump to conclusions and to interpret things in extreme and unhelpful ways (making errors in our thinking).

Such negative thoughts and behaviour tends to become automatic so that our awareness of what is actually going on is distorted or simply absent. The aim is to bring thoughts and emotions into conscious awareness, in doing so one is better placed to deal them. Learning to become mindfully aware in this way can break this cycle of negative thought, feeling and behaviour. When you see the parts of the sequence clearly, you can change them - and so change the way you think, feel and behave.

The objectives of CBT are to identify unhelpful thoughts, assumptions, beliefs that are related to debilitating negative emotions and behaviours. CBT helps you to develop the skills o identify and break the negative cycle yourself and become empowered to continue with your own journey of positive change and development.

Goals: CBT focuses on the client's goals.Therapy aims to show clients how to think and behave in ways to obtain what they want. The therapist helps the client to clarify their goals for therapy. The therapist does not tell the client what to do, rather, they help the client see how they can do it to achieve the desired change that they want in their lives.

Problems: We all experience undesirable situations. If we are upset about our problems, we have two problems - the problem, and our upset about it. Most people want to have the fewest number of problems possible. So when we learn how to more calmly accept a personal problem, not only do we feel better, but we usually put ourselves in a better position to make use of our intelligence, knowledge, energy, and resources to resolve the problem. CBT can help you to make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you. CBT aims to get you to a point where you can "do it yourself", and work out your own ways of tackling these problems.

Questions: Therapists want to gain a very good understanding of their clients' concerns. That's why they often ask questions. They also encourage their clients to ask questions of themselves, like, "How do I really know that those people are talking about me?" "Could they be talking about something else?" The self-reflective emphasis of therapy leads to long term benefits. When people understand how and why they are doing well, they know what to do to continue doing well.

Thinking Errors: A central aspect of rational thinking is that it is based on fact. Often, we upset ourselves about things when, in fact, the situation isn't what we think it is. Therapy encourages us to look at our thoughts as being hypotheses or guesses that can be questioned and tested. If we find that our thoughts are inaccurate (because we have new information), then we can change our thinking to be in line with how the situation really is.


Homework / Self-Therapy: Self-Therapy is a central feature of CBT. If you were learning a new skill or language and only spent one hour per week studying, you would take a very long time to get anywhere with it. The same is the case with Psychotherapy. The achievement of therapeutic goals will be enhanced when you fully engage with therapy, inside and outside the therapy room, and through implementing techniques and exercises and thinking and reflecting about yourself and what you are aiming to achieve.

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