CBT

How does the loop work?

A thought turns up, often too fast to notice. Nobody here wants me around. That thought produces a decision: leave early, say nothing, do not call. The decision then produces evidence, because you left early and nobody stopped you.

So the thought gets confirmed by your own response to it, and next time it arrives with more authority.

So you tell me to think positive?

No, and I would not blame you for expecting that. Slapping a cheerful sentence over an accurate one is insulting and it does not hold.

What we do is check the thought against the evidence the way you would check anything else. Sometimes it turns out to be true, and then the work is what to do about a real problem. Often it turns out to be one interpretation among several that you had stopped considering.

Where does the behavior half come in?

Behavior is usually the faster lever. Changing what you do this week changes the evidence available to you, and the thinking follows.

That means small, specific experiments: making the call, going to the thing, saying the sentence. Sized so they are achievable, and reviewed honestly afterwards, including when they go badly.

How does it sit with DBT?

DBT grew out of this tradition, so they fit together naturally. CBT is strong on examining a thought. DBT adds the acceptance half: you are doing the best you can, and you can do better.

In practice I move between them depending on what is in front of us, rather than running a fixed protocol.

Ready when you are.

Therapy starts with a conversation. Send a short message and tell me what is going on, in your own words. We meet in person in Omaha, and online across Nebraska and Rhode Island.