Q: What is cognitive-behavioral therapy and how is it different from other types of therapy?

A: Cognitive-behavioral therapy (often called cognitive therapy or CBT) is an active type of therapy that is more focused on changing the present than on exploring the past. The goal of cognitive therapy is to help people improve the quality of their lives as quickly as possible.

Cognitive therapy was originally developed as a treatment for depression, but it has also been proven to be an effective approach for managing stress and anxiety, resolving relationship conflicts, altering unhealthy behavioral patterns, and reaching life goals.

The field of cognitive-behavioral therapy emerged several decades ago when therapists realized that feelings tend to follow thoughts and actions. Therefore, the central principle in CBT is: If your change your thoughts and your actions, new feelings will follow.

A major focus in cognitive therapy is on changing self-defeating thoughts — including attitudes, beliefs, and self-concepts — to self-supportive alternatives. Another equally important focus is on adopting self-respectful behaviors, self-empowering actions, and living life in a way that accords with your values.

The therapist and the client work together actively, as a team, to develop these types of changes. As the client practices the new, self-supportive thought patterns and behaviors, new emotions can follow.

Cognitive therapy differs from other forms of therapy in several major respects. To clarify some differences, let me present a brief overview of three common types of psychotherapy.

Three Major Schools

Speaking broadly, there are three major schools of psychotherapy:

  • Psychodynamic therapy
  • Client-centered therapy
  • Cognitive-behavioral therapy

Psychodynamic therapy originated with the ideas of Freud, and grew out of the psychoanalytical tradition. Psychodynamic therapy tends to be longer-term than other forms of therapy, and focuses on exploring past events and their impact on both self and relationships. In psychodynamic therapy, the relationship between the therapist and client is of primary importance. Psychodynamic therapists find that clients often "re-enact" past relationships patterns with the therapist, and that the therapeutic relationship can help to form new ways of relating. This type of therapy is sometimes called "insight-oriented therapy."

Client-centered therapy was inspired by the ideas of Carl Rogers. Client-centered therapists believe that clients already have the answers that they need within themselves, and that the primary role of the therapist is to actively, supportively listen. In client-centered therapy, the therapist "follows" the client, and doesn't attempt to lead the direction of therapy. Client-centered therapy tends to be gentle, kind, and supportive. The therapist's primary goal is to treat the client with unconditional positive regard, while simultaneously being authentic and empathetic. This type of therapy is sometimes called "supportive therapy."

Cognitive-behavioral therapy was developed in the 1960s by Albert Ellis and Aaron Beck. The focus of cognitive therapy is on helping clients to make active, practical changes in their lives. In cognitive therapy, the therapist and client work collaboratively and actively as a team. Clients are encouraged to try out various "experiments" and practices in their lives, in order to spark change and growth. Cognitive therapy is generally briefer than other forms of therapy. The emphasis is more on improving the present than on discussing the past. This type of therapy is sometimes called "change-oriented therapy."

There are, of course, many other forms of therapy, including Jungian analysis, Gestalt therapy, Adlerian counseling, family therapy, and others. However, speaking broadly, most therapists orient toward one of the three major schools listed above.

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