Approach · CBT
Cognitive behavioral therapy
Some of what makes a week harder than it needs to be is a handful of sentences that run so fast you have never actually read them. They are not beliefs you would defend if someone said them out loud to you. They are more like habits of interpretation, worn in over years, and they arrive already sounding like fact. CBT is careful, unhurried work with those sentences. Not arguing with them, which never works. Reading them slowly enough to see what they actually claim.
Telehealth only, by secure video or audio, for people physically located in California. Laurie, LMFT.
What this looks like with me
We begin with one real moment rather than a general theme. Not 'I have low self-esteem' but 'Wednesday afternoon, after the meeting, when I could not get anything else done for the rest of the day.' I ask what happened first, and then what went through your mind, and I keep asking until we have the actual sentence rather than the tidy version. People are often startled by what turns up. 'They can all tell I am the weak one here' is a very different thing to examine than 'I felt a bit down.'
Then we look at it together, without either of us in a hurry to overrule it. What is the evidence for it? What is the evidence against it that you have been discounting, and how are you discounting it? What would you say if a friend told you this about herself in the same situation? That last question tends to expose the double standard fastest, because most people apply a rule to themselves that they would find unreasonable applied to anybody else.
I am careful to distinguish between an inaccurate thought and a painful truth. If you tell me that your father was cold to you and never changed, examining that for distortions would be both useless and insulting. Some sentences are correct. When that is the case, we stop doing this and do something else: grief work, acceptance-based work, or the slower work of what you do while carrying an unwelcome fact.
The behavioral half is where a good deal of the change actually happens. What has been dropped in the last year? What are you doing on the bad afternoons that reliably makes the following morning worse? We pick one small, specific change, we look at what happened, and we adjust. Small and repeated beats ambitious and abandoned, every time.
You have never read that sentence slowly. That is the whole reason it still works.
If the thought is true, we say so, and we work with something else.
Where I find this fits
Anxiety with a predictable script
The same forecast, running in the same situation, arriving before you have had a chance to think. When the sequence is that reliable, getting it written down in your own words is often the first real leverage on it.
Low mood and things quietly dropped
The walk you stopped taking, the friend you stopped calling, the music you no longer put on. Restoring a small number of those, deliberately and in order, does more than most people expect.
Perfectionism and the standard you use on yourself
A rule you would never enforce on anyone you love, applied to yourself without exception. Once it is written out plainly, it usually cannot survive being read aloud.
Sleep and the three a.m. rehearsal
The nightly review of everything you might have gotten wrong. There are practical structures for this, and they are not the same as being told to relax.
How we would work
We start with a free 20-minute consult by phone, text or video. You describe what has been happening and I tell you honestly whether this is a fit, including if I think something other than CBT is what you actually need.
If we go ahead, sessions are weekly by secure video or audio. I use this within a whole practice rather than as a program. When the thoughts turn out to be carried by a part of you with an old job, we use Internal Family Systems. When the alarm is faster than any thought, we work somatically or with mindfulness. When one memory is still supplying the charge we may use EMDR, and I am EMDR certified. When the same loop keeps closing on itself, we use my own Positive Re-Narrative and Repatterning.
I work with adults, seniors, couples and families. I do not treat bipolar disorder or schizophrenia, and I will tell you that early if it is relevant.
- One real moment at a time, in specifics
- Finding the actual sentence, not the tidy summary
- Examining rather than overruling
- Naming a painful truth as true when it is
- Small behavioral changes, reviewed honestly
- Dropping the approach when it is not the right one
Questions people ask about CBT
- I have done CBT before and it felt mechanical. Why would this be different?
- Usually because of how it was delivered rather than what it is. Done as a packet of worksheets by someone working through a manual, it can feel like being corrected by a stranger, and people learn to fill in the sheets accurately without anything changing. I use it as one instrument inside a warm, unhurried practice, on the specific thoughts that are actually costing you something, and only where it is the right tool. If it turns out that the material is grief or old trauma rather than faulty logic, we stop using it and use something that fits.
- What if the thought is true?
- Then we say so, and we do not pretend otherwise. This is where CBT gets misrepresented as forced optimism. Some of what people bring me is accurate: the marriage really is over, the diagnosis really is serious, the job really is not coming back. When a thought is true, examining it for errors is both pointless and insulting. What we work with then is not the thought but what you do while carrying it, which is different work and often better suited to acceptance-based approaches.
- Do I have to do homework?
- Something small between sessions makes a real difference, and I will always tell you why rather than simply assign it. Usually it is noticing: writing down the sentence that ran through your head just before the afternoon turned, in a few words, on your phone. Not a journal, not an essay. If a week goes by and you did not do it, we look at what got in the way rather than treating it as noncompliance. That obstacle is frequently more interesting than the exercise would have been.
- Can this be done well by video?
- Yes, and in some ways more easily. We can look at your own notes together on the screen. You are in the room where the thoughts actually happen, which makes them easier to reconstruct accurately than in an unfamiliar office. And because you are at home, you can try something out immediately after the session rather than waiting until the drive is over and the momentum is gone.
Worth reading slowly
If a handful of unexamined sentences have been running your afternoons, they are worth looking at with someone who is not in a hurry. Text or email and we will find a time to talk. Telehealth only, by secure video or audio, for people physically located in California. Laurie, LMFT.