There are many strategies that a therapist may use to try to help you with your mental health. One of the most highly researched, highly regarded, and extensively utilized psychotherapeutic process is known as cognitive behavioral therapy, or CBT.
CBT helps individuals identify and change negative thought patterns and behaviors. While CBT is based on a structured framework, the way it is delivered can vary significantly between therapists. These differences stem from variations in training, experience, personal therapeutic style, and the specific needs of the client.
Despite being grounded in a standardized approach, CBT is not a one-size-fits-all treatment. Therapists adapt the techniques, focus, and style of delivery to better align with the client’s personality, presenting issues, and treatment goals. That’s why not all therapists that provide CBT are going to approach your care the same way, and it can he helpful to know how therapists may differ.
Core Structure of CBT
All CBT approaches share a common foundation focused on identifying and modifying negative thought patterns and behaviors. A typical CBT session includes:
- Identifying Cognitive Distortions – Helping the client recognize irrational or unhelpful thought patterns that contribute to emotional distress or problematic behavior.
- Challenging Negative Thoughts – Teaching the client to test the accuracy of their thoughts and develop more balanced, realistic thinking.
- Behavioral Activation – Encouraging the client to engage in positive or rewarding activities to improve mood and reduce avoidance behaviors.
- Problem-Solving and Coping Strategies – Helping the client develop practical skills to manage stress, anxiety, and other mental health challenges.
When you see it written down like this, it can occasionally appear like a simple process. But within therapy, the process is far more detailed, involved, and challenging (in a good way, of course). That’s where certain therapists can make a difference.
How Therapists Modify CBT Delivery
While the core structure of CBT remains consistent, therapists may differ in how they apply it based on their training, experience, and therapeutic approach. For example:
Level of Structure and Flexibility
Some therapists follow a highly structured, manualized approach to CBT, working through specific exercises and homework assignments in a step-by-step format. Others take a more flexible approach, adjusting the structure based on the client’s progress, personality, and immediate concerns.
- Highly Structured Approach – Focused on following a set CBT protocol, including worksheets, goal-setting, and step-by-step cognitive restructuring.
- Flexible Approach – Adapts CBT techniques to the client’s emotional state and immediate concerns, allowing for more conversational and less rigid sessions.
Some therapists also may choose between both depending on the patient as well. There may be situations where it’s clear that a structured approach would be the most valuable. There are other situations where the flexible approach may be more useful, especially for those that need someone to talk to on a more ongoing basis.
Focus on Thought Patterns vs. Behavioral Change
CBT targets both cognitive distortions (thoughts) and behavioral patterns (actions), but different therapists may emphasize one over the other depending on their training and the client’s needs.
- Cognitively Focused CBT – Centers on challenging irrational thoughts and developing healthier thinking patterns.
- Behaviorally Focused CBT – Prioritizes changing habits and encouraging positive behaviors through exposure therapy, activity scheduling, and reinforcement.
For example, a therapist working with a client with social anxiety may either focus more on challenging negative self-talk or place greater emphasis on helping the client engage in social situations through exposure exercises.
Therapist Communication Style
The way a therapist communicates CBT principles and engages with the client can vary significantly:
- Directive Style – A therapist with a directive style may take a more instructional approach, guiding the client through exercises and providing clear, structured feedback.
- Collaborative Style – A therapist with a collaborative style may encourage the client to explore solutions more independently, facilitating open-ended discussions rather than providing direct answers.
- Supportive Style – Some therapists lean toward a more emotionally supportive and validating approach, balancing cognitive restructuring with emotional processing.
Once again, the client themselves can help inspire this approach either intentionally or unintentionally depending on what they need in order to thrive.
Use of Homework and Between-Session Exercises
CBT traditionally includes homework assignments to reinforce the skills learned during sessions. Therapists differ in how much they emphasize homework and accountability.
- Homework-Heavy Approach – Some therapists assign structured worksheets and exercises to complete between sessions, reviewing them during each session.
- Minimal Homework Approach – Other therapists may focus more on in-session work and offer suggestions rather than formal assignments.
Clients who benefit from structure and accountability may prefer a homework-heavy approach, while those who respond better to conversation and exploration may prefer a less structured format.
Incorporation of Other Therapeutic Techniques
While CBT is a standalone therapy, some therapists blend CBT techniques with other approaches depending on their training and the client’s needs. For example:
- Mindfulness Techniques – Incorporating breathing exercises and body awareness to improve emotional regulation.
- Exposure Therapy – Gradually exposing clients to feared situations to reduce avoidance behaviors.
- Acceptance-Based Techniques – Encouraging clients to accept difficult emotions rather than trying to control them.
Therapists who have training in multiple modalities may integrate these techniques into CBT sessions, providing a more tailored and comprehensive treatment experience.
How to Find the Right CBT Therapist
Finding the right CBT therapist often involves understanding your own therapy preferences and goals. Questions to consider when selecting a therapist include:
- Do you prefer a structured or more conversational approach?
- Are you more comfortable focusing on thoughts or behaviors?
- Do you respond better to direct guidance or collaborative problem-solving?
- Do you want homework assignments or prefer to work through issues in-session only?
It’s also important to consider the therapist’s background and experience. Some therapists have advanced training in specific areas such as trauma, anxiety, or depression, which may influence their CBT style and focus.
Finding the Right Fit in CBT
CBT is highly adaptable, which allows therapists to modify their approach based on the client’s individual needs. While the core principles of CBT remain consistent, differences in structure, communication style, and focus can significantly affect the therapy experience.
If you’re looking for a therapist that specializes in CBT, and want to discuss the different options that are available to you, please reach out to South Shore Counseling, today.