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how does cognitive therapy work

Updated: Aug 25, 2021

How Does Cognitive Behavioral Therapy


Cognitive Behavioral Therapy (CBT) is the most commonly practiced form of psychotherapy practiced today. Indeed almost all psychotherapy experiences will have some CBT aspects in them even if the practitioner has a different theoretical o


This is an article from very well mind that has additional information about CBT and it’s connection to Rational Emotive Therapy.


Dr. Mike Mohan 0:13

Welcome to the site with Mike library. This is Dr. Michael Mohan and I am here on a beautiful summer morning with my good friend and colleague, Mr. Brett Newcomb. It's a great day in St. Louis. So before we start today, I just wanted to tell everybody about all of the things that we do. It's like with Mike and I do that on the front end, rather than on the back end. Because then if people don't stay around until the end, then at least they hear the information. So site with Mike is not only a podcast, but we also have a YouTube site, which is site with Mike as well. So you can get us at site with Mike calm, or you can search site with Mike on YouTube. If you do watch the YouTube videos. In the bottom right hand corner of the screen is a little site with Mike icon and you can click on that and subscribe to psych with Mike, if you do get us on the YouTube and you enjoy the content of the show, we would really appreciate if you could like the videos and to subscribe, because that really helps us out. So I can honestly say that we have a growing audience, which is fantastic. I feel so good about that. And we've been getting some really, really positive comments of late. And so I feel really, really good about that. So please, if you are a fan of the show, get in touch with us either through the website psych with Mike comm or through YouTube. And let us know what you think. And if you have any ideas for things that you would like for Brittany to talk about, then please let us know. Perfect. Yeah. So today we are going to talk about something that is very near and dear to my heart, mostly because I don't know about you, I don't know how you felt when you left grad school. But when I left grad school, I felt like that I had been indoctrinated into a whole new universe of ideas that I didn't know existed before I went to graduate school. So undergrad was a process and I felt like Okay, you got to get a bachelor's degree. And that was something that I felt really was important, at least for me, because I had come from a family that no one had ever gone to college. And so that kind of was just a grind in I was using at the time. And it was just a really, really tough process. I was struggling with starting a family and getting sober and things during those years. But I got through it. When I went to graduate school. All of a sudden, I was indoctrinated with all of this new information. And it seemed really magical. And one of the things that we were taught when we were in graduate school was this idea of cognitive behavioral therapy. And at that time, really more rational emotive therapy. Yeah. And so when I left grad school like now, I'm much more psychodynamic much more object relations after so many years and in the business. But at that time, when I first left graduate school, when I first heard about cognitive behavior therapy, I was like, wow, this is the answer this is it. This is this answers for me, all of the questions that I ever had about human psychology. You

Unknown Speaker 3:39

know, I think that's a fairly typical response. I think I taught high school psychology for a number of years before I started teaching at the university. And whenever we would do the units on abnormal psych, I would constantly, you know, warn my students that, you know, you're going to learn just enough about this to decide that that's what you have, or that what your mother has your next door neighbor, your sister, and you're going to diagnose yourself and your family, just from this little survey. But it's just a survey, it's not an in depth course, you're not going to learn enough to know what you need to know. And so that went to graduate school and I I encountered mines that were steeped in the subjects at a much deeper level than I was and had much more information at their fingertips. And so there was a competitive challenge. Can you get up to speed? Can you learn what you don't know? Which I think continued? Pretty much throughout my career. I've always kind of you encounter a client with a situation and you want to say, Do I know enough about that? Where can I go and learn this? How do I understand it so that I can be helpful and that's the goal is to be helpful to the client. But at where I thought you were going to go with this comment is when I graduated from grad school, I didn't feel particularly competent to practice. I wasn't sure that I had the skills that I needed to be a good therapist. I had knowledge that I hadn't had before I started grad school and that helped me by I wasn't sure I knew what to do. And so when you and I both worked in that program, and I eventually ran that program, my focus in running that program was on training for skill sets, so that graduates could go out and do the job from day one. And I think the program that we taught him has subsequently moved away from that approach. And now that it's a continuation of what you're saying, You got a level of inflammation, there's another level above you, you have to go and get it. So I think the focus is different. But well,

Dr. Mike Mohan 5:29

as far as any mean to cut you off. But as far as just the idea of doing psychology, I think that my experience may be very unique. I had been working at a hospital when I was 16. And when I was 19, I was going to college. And so I was able to get a job in behavioral health based on the fact that I was

Unknown Speaker 5:53

you have skills you learned on the job, as well as what you learned.

Dr. Mike Mohan 5:56

I mean, I was 19 years old and doing groups and and didn't know that you shouldn't be doing that. Because I was working, it was my job. And people would say, here go. And, you know, I was working as a psych tech. And for people who don't know what that means a psychiatric technician, is the entry level into psychology careers. And essentially, if you are a psychiatric technician, and you are in a facility, you are primarily responsible for a lot of the therapy that goes on, you're doing the groups, you're working with the clients, they call patients, because they're usually in an institution. And so I was doing groups and taking care of people psychological needs at the age of 19. Because that was my job. I was I didn't know that, that you weren't supposed to do that. So when I went to graduate school in my late 20s, you know, I would be in in classes. And one of the things that we were really good at at in the program were you taught at the time, and I was attending, which is Webster University in St. Louis. It was a very, very applied program, meaning that it was something that you did not some not some theoretical thing we were taught. And so we did a lot, a lot, a lot of role plays. And people would say all the time in classes, well, I'm really self conscious about doing roleplay. And I'm like, what that makes no sense to me. I was completely 100%, desensitized to that, because I'd been doing it now for almost a decade. And so that never, that that was never something that I was intimidated by actually being in the room with another person and doing the therapy. So for me when I went to graduate school, and I was indoctrinated with this knowledge that was so far above what I had gotten when I was an undergraduate. For me, it was like I said, it just opened up a whole new universe. And in particular, rational emotive therapy, because the cognitive therapies, and we're going to talk more about this during this episode, but the the cognitive therapies for me, are different than the motivational therapy. So the motivational therapies are like psychodynamic, and they tell you how people get sick. The cognitive behavioral therapies are more like a book for doing interventions, they don't necessarily tell you how people get sick, but they tell you how to fix them. And so that, for me was really, really powerful. And especially when I was first starting out to give me a whole spectrum of skill sets to just go out and apply doing therapy,

Unknown Speaker 8:31

one on one, but sometimes that has the effect of a blunt hammer, you slapping somebody upside the head in saying, hey, look at this. And philosophically, you're approaching it, I think, from two different ends, the psychodynamic end is to say, Are you a victim of a script that was written for you? Are these things that happen in your life that you can't emotionally regulate yourself around? Or that you can't change your memories of abuse or shame or whatever? So how do you treat that? If that's what you are? How do I help you live your life better? How do I help you feel better about yourself, feel more empowered, the rational emotive or cognitive behavioral stuff says that this is all about man's ability to reason this is about your ability to logic your way out of this problem. And I think the true answer is somewhere in between. I don't think there's a right answer, to to invest in either way. But I think you take elements from the different theories, because you have to begin wherever the client is, the client comes in, and they present themselves and I say, this is what's going on. I have to attend to them, I have to watch their nonverbals I have to listen to their story. I have to remember their story. And I have to watch for patterns of repetition. And then I try to bring the knowledge base that I have acquired to that individuals story and see whatever I see and reflect that back to them. Or when yalom says you have to do accurate reflection, and that that's the best thing thing that you can do. Clinical, that's the best therapeutic school that you can have is accurate empathic reflection. So I don't know where that fits on the spectrum for you between the psychodynamic and the cognitive, but to me, that's where I try to stand every day. Well, and

Dr. Mike Mohan 10:15

at some point very soon, we're gonna have to do an episode on Irvin yalom. I know he's somebody that you really respect a lot and have taught a lot. I remember you, having us read loves executioner and in class. But I think that probably the way that cognitive behavior therapy started with Albert Ellis was exactly based on what you just said that he was really decided he was trained psychoanalyst, right, he was dissatisfied with the speed with which that he saw therapy progress. And we're doing practicing psychoanalysis where you were in therapy virtually every day for seven years. And he said, there has to be a better way. And he came up with the original cognitive therapy called

Unknown Speaker 10:58

the pattern of repetition, you hear someone say, I was talking to a kid the other day, a young man who said, I couldn't ask a girl out, she's way above my level. And so that is his self script. And that limits him in terms of opportunities that might be in front of him. And I was trying to encourage him, if you think you want to ask her out, go ask her out, the worst thing that can happen is she can say no, you know, I'm sure you laugh and say, You're ridiculous. Get out my face. But she might say yes. And you and that was even one of Albert Ellis, thank you, I think Albert Ellis assignments and he would give his patients assignments to do outside of the therapy room. And one of the ones that may be somebody said, You know, I can never get a woman to make love to me, he said, Go stand on the street corner and ask the first 50 women that walk by, if they'll make love to, you want to say yes. And you may get slapped 49 times, or you may get the police call, or whatever you just explained, I'm in therapy, and this is an exercise, I'm not really a pervert, and you have to deal with it, you have to work your way out of it. But that kind of experimentation is what you're talking about challenge. The mental blocks that have been imposed are occur in someone's life that prevent them from taking an opportunity or taking power over their choices.

Dr. Mike Mohan 12:17

And so in 1962 Ls wrote a book called reason and emotion in psychotherapy, which actually is on the bookshelf here in the site with Mike library. I don't know exactly where it is on what shelf, but I know that I have a copy of it here. And I read that book in graduate school. And it really changed my life. And and because it was based on exactly what you're talking about these principles that you could reason your way out of these mental ruts that you were in. And it was based on a very, very simple model called the ABCDE. f model, right. And I'll put a slide up for that. But a was the activating event. B was the belief that you engaged in C was the behavioral consequence, D was a disputation II was the effect that the disputation had. And then F was the new feeling that that elicited in the person. And so that's a really, really simple conceptual framework for a really, really dynamic process. That is the foundation of psychotherapy.

Unknown Speaker 13:22

Well, I, I do a lot of consulting, or have done a lot of consulting for companies and things. And now you're what I'm alone retired, oh, you're retired, of semi retired

Dr. Mike Mohan 13:32

love being retired, although you work harder being retired person, because anybody I know,

Unknown Speaker 13:37

now I get to do all the things I wanted to get right enough the things I have to do. But I do a lot of consulting and part of what I would say to people who, especially professionals who hate meetings, I hate to go to meetings, meetings are always stupid waste of my time, blah, blah, blah. And my approach is, I've never been in a meeting that I didn't know, wasn't my meeting. I don't care who called it, I don't care what my status is, I have an agenda. And whatever that might not, my agenda may be to keep you from satisfying your agenda. My agenda may be to present myself as a witty, delightful fellow, my agenda may be do accomplish a contract or whatever it might be. But I never go into a meeting with the attitude of I hate meetings. Because they're a waste of my time, they're always an opportunity to opportunity to learn. There's an opportunity to maneuver manipulate, accomplish, whatever it might be. So so you need to think your way through. What's my agenda here? What am I doing here? So Because ultimately, we're all self employed, right? I mean, even if you're a contract employee for a company, you're self employed, because you have to manage yourself and your contributions. So

Dr. Mike Mohan 14:35

So there are two things that I would would respond. So the first one is that that's a cognitive mindset. Yes. And so that is you created this cognitive mindset for yourself, because you never wanted to have the experience where you went into a meeting and you said, Oh, my gosh, I hate being in this meeting. When I was working at the hospital, I would go into these situations. Where there would be a violent patient, and you would have to physically restrain them, right. And I would have nurses say to me all the time, I'm just so scared to come to work. And I would say, I can't understand that the first time that I'm ever scared to come to my place of employment is the last day I've ever come into my place of employment. And I would never allow myself to have that kind of sense of being scared. I mean, I just bet that was

Unknown Speaker 15:29

my mind. But then they would look at you and say, You're a man, you're strong, you're physical, you have less reason to be scared than I do, especially with dealing with violent patient in potentially violent patient, you're extending that argument to other situations, you know, I'm not gonna be afraid to lose my job, I'm not going to be afraid to be verbally assaulted, I'm not gonna be afraid to be manipulated and power spectrum. Because I always have the ability to walk away, protect myself here. When the day walk away. Women will say, you know what you're talking about, right? You're not a woman, you don't understand where we come from.

Dr. Mike Mohan 16:00

So the the idea of that mindset is the first thing and then the second thing is, I've been in how many meetings with you, I mean, more than, dude, every one of us or three could ever count. And while you say that you always went in with an agenda, which is absolutely 100% true, because I know you and I know that that is absolutely true. But the way that you presented that was never obtrusive. It was never stomping on somebody else's throat. It was never overt. You're ability to project that agenda was done tactfully. It was done respectfully. So if you're going to do that, if you're going to have this mindset, I don't ever want to be in a meeting that I don't own. You also have to have you know, we've talked recently about narcissism, you have to have a mindset that you're going to be in, tell me, I'm a narcissist, no, I'm telling you, you're not okay. Because I think you say that a lot. And I don't think it's true. Yeah. And because a narcissist would go into that meeting and would stomp on other people.

Unknown Speaker 17:01

Oh, yeah. If that was the best move. Yeah. Yeah. But But I think the best move, sometimes my agenda for the meeting is survive this meeting without loss of face or status. So keep stay in the background, let people talk about what are they want to talk about, get out of the meeting. I mean, sometimes it's as simple as that. It's not always to come out as president of the committee, or the acknowledged expert on something. I mean, you have to really know yourself and know what your goals are, which is part of the whole rational control your emotions approach of understanding, and making good choices as things come up.

Dr. Mike Mohan 17:37

And we're obviously using this as an analogy for people who are out there in the audience saying, These are how we dealt with this very specific situation. And hopefully, they can generalize this information and apply it to their situation. And one of the ways in which that I think that this is very apt is because we worked together for a long time in this group practice. And the person that was in charge of that group practice was, was somebody that could be challenging to work with. Fair, very fair, yeah. And I have been in meetings, where you were being where things were being said to you that were very challenging. And even in those meetings, what you didn't do is you didn't fall apart and start crying. And and, you know, try and elicit sympathy or, you know, be compensate to the point where you were unintelligible. You still had an agenda to attack someone else? Yeah. Take the heat off me. Yeah, you still had an agenda where you would say I disagree with the interpretation that you are presenting, I disagree with maybe some of the facts that you

Unknown Speaker 18:43

are present, or you're paying attention in those meetings. I always paid attention to you. All right. My wife says that people don't like to be in meetings with me, because I'm frightening. Because I will always say there's an elephant in the room. Let's talk about it. And then, you know, what do we need to do because it's here. And she said, People don't like the risk of having that stripped away from them, you know, to pretend it's not going on, and we don't know somebody's upset, or somebody is being abusive or inappropriate. And you'll always say, me, it looks to me like this is happening. Am I saying that? Right? And she said that people don't like that.

Dr. Mike Mohan 19:17

Right? Well, because I think it's very threatening to them. So really, what we're, what we're focusing on here right now, is the be part of this. So the belief, so what is the belief that you have, so if you're in a difficult meeting, and your belief is I'm incompetent, other people don't like me something along those lines, then you're in a difficult meeting, which is the activating event. So the A, so you have an activating event, which is a difficult meeting, your belief B is people don't like me, I'm not somebody that people respect, then the see the consequences going to be that you're going to fall apart, right? But if the activating event is exactly the same, so you're in a difficult meeting, but your belief is I'm in control. I'm in charge. Me, I have an agenda, I can present this agenda appropriately, respectfully, then the consequences is going to be that you're going to present that agenda. And you may not agree with the other person and the other person may not agree with you, but it's not going to be a decompensation and emotional decal.

Unknown Speaker 20:16

Absolutely. And part of it, is this the ability to say, No, I need to revisit my thought process here, I came in thinking that the meeting was going to be about this. And now it shifted over to this. How do I want to respond to that, to survive to fight another day, is a choice that I can make. So I don't have to win in the moment at all costs, I have to be fluid, I have to be able to dance, I have to be able to go back and forth, and get myself out of there without losing status or face. I mean, that's my goal at the end of the day, and over time to accumulate enough of that, that I can get where I want to go.

Dr. Mike Mohan 20:55

So then let's assume that our be our belief is Oh, my gosh, I'm horrible. People don't like me, I'm incompetent. Then what we want to try and do in therapy is through D, the disputation is to say, to challenge that belief, so why are you incompetent? What is the evidence that you have that you could present? Just like when you were talking earlier about this guy said to you, oh, I can ask that girl out. She's out of my league. And what you want to say is, well, why is she out of your league? What evidence do you have that proves that she's out of your league? Right? And then you work through that until you get to a place where you can get the person to engage in some kind of different behavior? Well, why don't you go and ask her out and challenge that hypothesis? And see if it's a lot

Unknown Speaker 21:44

of angles, you can take a you know, further question, why would you be overly response? Because my car's a piece of crap. Okay, so what you're telling me then, is that the only kind of woman that would attract you is a woman that would require you to have a really beautiful car,

Dr. Mike Mohan 22:00

which is a very superficial thing. Absolutely. Is that the person you

Unknown Speaker 22:02

want to be working? You want to be hooked to for the rest of your life? Or wired? Why do you want to go out with her? Is it just a slap in dash? Or is it a relationship? But But you challenge the thought processes that make themselves evident in the things that the people say? So are you realize that's what you're saying? You know, that you're looking for a woman in your life? Who is preoccupied and driven by ephemeral and surface level things? You want somebody that can see us? Is that you your relation, reflection, your car, right? And it makes them stop and think in a different way? Wait a minute, is that what I'm saying? Is that what I want? Right? And very frequently, it comes in waves? because initially, they'll say, No, that's not what I'm saying. Okay, let's, let's continue talking and see if we see more examples of this,

Dr. Mike Mohan 22:44

right? Because they'll come up. And so for me, one of the most gratifying things that can happen in therapy is when my clients come back in and say, you know, I had this problem this week, and then I could hear you in my head saying, Okay, what, and I'm sure that you've had that experience as well. And my hope is, is that what that little voice in their head is, is this growing idea of disputing these negative, defeating self talk delays,

Unknown Speaker 23:11

I teach in class all the time to therapists in training, they will initially not be able to hear anything except the voice of their abuser in their head, then a progress gets made, they will be able to hear your voice at that juncture where something needs to happen. And then it progress continues to be made, they will hear their voice, and that's the goal now, you know, so you need to be needed for a while to stabilize and redirect, but then they need to let you go and own their own progress.

Dr. Mike Mohan 23:41

And that's a perfect place to wrap. Okay, so thank you for that. I hope that this was helpful for somebody out there again, you know, click the icon in the bottom right hand corner, and subscribe to the show. And all of the music that appears inside with Mike is produced and performed by Mr. Benjamin NYCLU. And for Brett and I, if it's Friday, it's cycle.

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