Not CBT (Cognitive Behavioral Therapy)

I want to start off by letting those who are fans of, or actively participating in CBT that they are not wrong, bad or deserving of judgement. If you're have a positive experience, godspeed. Keep it up. I'll also call out what I think CBT is best for — an introduction to therapy for those who are extremely resistant to begin. It is better to be in CBT than nothing at all. (Well, most of the time. More on that later.)

That being said, (very, very) often falls short for people with trauma (and in 2026 who among us are free from this designation?), complex relational issues or a need to understand the root causes of their behavior (which many would argue is essential). It can feel invalidating or overly simplistic since it largely ignores your past or dismisses your emotional reality as what can be over-simplistically referred to as "faulty thinking." Here are some of my specific beefs with this modality.

• Dismissal of Past Experiences: CBT focuses heavily on the present, which means it rarely explores why you feel or behave a certain way. Amazing for coping in the immediate, largely useless for addressing issues long term. Beyond being a simple band aid, it often sells clients short of their most impactful and developmentally relevant experiences by skipping over how childhood, past relationships, or upbringing impact your current distress.

• Reinforcement of Self Doubt & Negative Self Talk: Because CBT challenges negative thoughts and teaches you to do the same, it can 'accidentally' enforce a sort of auto-gaslighting of self. If your thoughts reflect a real, objectively difficult situation or systemic oppression (which happens. sometimes often.), trying to reframe them can feel like minimizing your valid struggles. This can lead to a diminishing of self, confusion, an increase in anxiety, feelings of inferiority and imposter syndrome.

• Doesn't Address Trauma: CBT can be deeply harmful to trauma survivors. I mentioned this earlier but the overlap between people who have experienced zero trauma and the people who are interested in pursuing therapy is almost impossibly small. During a traumatic event, the brain's fear system overrides the logical, thinking centers. Asking a trauma survivor to challenge their immediate irrational fears can be too demanding and invalidating. It also denies an opportunity to engage with what many professionals would recognize to be the 'meatiest' bits to dig into with a therapist.

• Requires High Motivation: CBT is an active process that requires you to do a lot of "homework" and consistently challenge your mental habits. If you are experiencing severe depression, exhaustion, or executive dysfunction, it can be incredibly difficult to keep up with the rigorous exercises. If you identify as being anywhere on the neurodivergent spectrum, this becomes that much more difficult.

• Easy to Circumvent Progress: I can't tell you how many people I've talked to, who know they would benefit from therapy, have early experiences with CBT and explain that it went nowhere. When I press for more info, 95% of the time the reasoning comes down to their ability to basically talk their way out of anything difficult. They omit what would be most painful to engage with, over explain their reasoning/actions, over intellectualize emotions vs experiencing them and subconsciously dance around what they know on some level they came to therapy for. CBT makes all of that much, much easier than any other modality does.
  
  Overuse by Insurance Companies: Due to its short-term and structured nature, CBT is frequently pushed by insurance companies as a one-size-fits-all solution. This can lead to rushed or ineffective treatment if a patient actually needs a more exploratory, long-term approach. Honestly this is probably the worst part overall because of the absurd number of people it affects (nearly every single person who needs therapy, doesn't have a platinum PPO and can't afford to pay out of pocket).