Therapy Approach
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy, or CBT, looks at how your thoughts, feelings and actions keep each other going. Vanessa Gross, LMFT, uses it to help you catch the thinking behind a hard moment and try a different response. You have a say in every step of that work.
What CBT Is and How It Works
CBT is a structured, practical form of talk therapy. It rests on an everyday observation: how you read a situation shapes how you feel, and that feeling shapes what you do.
Most of the work looks at what keeps a problem going today rather than where it began. CBT sessions usually have a clear focus, and they often end with something specific to notice or try before the next one.
How Thoughts, Feelings and Behavior Connect
CBT treats these three as a loop: a thought sets off a feeling, and the feeling pushes you toward an action. That action often produces what looks like evidence for the original thought.
Take a friend who has not answered the text you sent this morning. By mid-afternoon, the loop can look like this:
- Thought: "She's annoyed with me, I must have said something wrong."
- Feeling: a knot in your stomach, some hurt and a lot of dread.
- Behavior: rereading the thread, sending an apology, or going quiet before she can pull away.
- Result: the next exchange feels stiff, which seems to prove the first thought right.
What a CBT Exercise Looks Like in a Session
In a session, you and Vanessa might take a moment like that unanswered text and slow it down, using what CBT calls a thought record. You describe what happened, what went through your mind, what you felt and how strongly, and what you did next.
Then you examine the thought together: what supports it, what does not fit, and what you would say to a friend who described the same afternoon. The aim is a more accurate version of the thought, which can still include real worries, plus one or two responses to try next time.
Sessions can also include rehearsing a hard conversation out loud. Another option is breaking a task you keep avoiding into a first step small enough to start today.
CBT Practice Between Sessions
CBT includes some practice in daily life, since that is where the patterns you want to change actually happen. What you try depends on what you are working on, and you decide how much fits into your week. Between sessions, you might try something like this:
- Writing down a hard moment the same day: the situation, the thought, the feeling.
- Sending an email after one read-through instead of five, then noting what happens.
- Saying one thing in a meeting that you would normally keep to yourself.
- Planning one activity that used to matter to you on a day when your mood is low.
- Noticing the thought "I'll start when I feel ready" and starting anyway for ten minutes.
How Vanessa Blends CBT With a Client-Centered Relationship
Vanessa's work is client-centered, which means your priorities set the direction. She explains why she is suggesting an exercise, asks how it went, and changes course when something feels forced or does not suit your life.
She also draws on attachment-based and mindfulness-based work, so CBT sits alongside attention to your relationships and to what you notice in your body. In a single session, you might work through a thought record about a deadline, then talk about why criticism from a manager hits so hard.
Who CBT Tends to Suit
CBT often suits people who like practical tools and want to see what they are working on. It tends to fit when your mind jumps to the worst case, or when you criticize yourself in the same words over and over. It also fits when avoiding things has slowly made your days smaller.
CBT is commonly used for anxiety, depression, and stress and burnout, all of which Vanessa works with. It can also support the planning and self-talk side of adult ADHD. If you would rather understand where a pattern started, psychodynamic therapy may suit you better, and plenty of people end up with a mix of both.
CBT sessions are planned in advance, so if you are in crisis or thinking about suicide, call or text 988, or call 911 if you are in immediate danger.
Questions
Frequently Asked Questions
CBT aims for thoughts that are accurate and fair to you, which is different from forcing yourself to look on the bright side. If layoffs are rumored where you work, CBT helps you weigh how likely the worst case is and what you would do if it happened.
Usually there is something to try, and how much is up to you. Some people like a written record of their week, while others prefer one thing to notice, such as the moment they start putting off a task. If practice keeps slipping, bring that to the next session, since it often shows what gets in the way the rest of the week.
Say so, because that tells Vanessa something useful about how you work. She can loosen the structure or spend more of the session talking through what comes up. She might also bring in ACT, which focuses on making room for hard thoughts instead of arguing with them. You can ask for that change at any point, even halfway through an exercise.
Related Pages
ACT
ACT helps you make room for difficult thoughts and feelings and put your energy into what matters, using values, willingness, defusion and committed action.Read MoreAnxiety
For worry that shows up as tension, what-if thinking and avoidance, using CBT, ACT and mindfulness in online sessions.Read More
Depression
Support for low mood, lost interest and pulling away from people, combining small CBT steps with psychodynamic work and self-compassion.Read More
Anxiety or Burnout?
How anxiety and burnout differ, where they overlap, how each can feed the other, and when to talk with a therapist.Read MoreA gentler next step
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