CBT · How I work

What Is CBT Like in an Actual Counseling Session?

By Andrew Yeaton, MA, LPC

Andrew Yeaton explains a practical CBT process: observe thoughts, feelings, and behaviors, then choose a truthful and useful intervention.

“Change your thoughts” sounds simple until a thought feels completely true. In a counseling session, Cognitive Behavioral Therapy is less like receiving a slogan and more like slowing a real moment down enough to see what happened. We work with your actual words and circumstances, not an idealized example.

First, observe the pattern

I often begin with three connected parts: thoughts, feelings, and behaviors. We might write down three thoughts that showed up in a difficult moment, three feelings and their intensity from 1 to 10, and three things you did or wanted to do. Did you withdraw, seek reassurance, over-prepare, argue, avoid, or move toward someone?

Observation matters because the first interpretation often feels like the whole story. “I disappointed them” may arrive alongside shame and an urge to disappear. Once we can see those pieces together, we have more room to choose a response.

Then, choose an intervention

There are several ways into the pattern. For thoughts, we can practice what I call talk-backs. Edit the thought toward what is actually true. Encourage yourself by remembering real strengths and resources. Balance the picture with a helpful truth, gratitude, or perspective. If you want faith included, ask what God might say about the thought in light of Scripture and the character of Christ.

For feelings, a short mindfulness practice may help you notice a sensation without immediately fighting or obeying it. That could mean breathing slowly or spending a few minutes picturing a place where you feel grounded. For behaviors, we can choose an opposite action when the automatic move is unhelpful: a small honest conversation instead of withdrawal, or the next valued task instead of another round of checking.

Practice beyond the room

We do not expect one insight to erase an old pattern. We look for a manageable experiment during the week and learn from what happens. The point is to become more flexible and intentional, not to eliminate every painful feeling.

For Christian clients, I sometimes describe this as both defense and offense for spiritual life. Defense means noticing an incoming distortion or temptation before it directs us. Offense means practicing truth and habits that support future growth. This is a metaphor for intentional practice, never a suggestion that anxiety or depression indicates weak faith.

CBT can be adapted to the person and concern. If you would like to see how it might fit your situation, send a brief inquiry. For a general description of CBT, see the American Psychological Association’s overview.