March 24, 2026
What is CBT and what actually happens in sessions? A Bristol trauma therapist explains how CBT works, what it feels like, and whether it might be right for you.
If you're looking into therapy, you've probably come across CBT. Maybe your GP mentioned it. Maybe you've seen it recommended online. And maybe you're sitting there thinking: What actually is it? Will it work for me? Do I have to talk about everything? What if I'm not good at it?
I get those questions. All the time.
So let me tell you what I tell my clients: CBT isn't about "thinking positive." It's not about ignoring the hard stuff. And it's definitely not about me sitting across from you handing out worksheets while you try to figure out the "right" answers.
At its best, CBT is collaborative. It's you and me sitting together, trying to make sense of what's going on. We look at the patterns you're stuck in, and we ask: Where did this come from? Why does it make sense that you think and feel this way? What would it take to create a bit more flexibility — so you can start living a life that actually feels like yours?
In this blog, I'll answer the questions people actually ask me about CBT. No jargon. No fluff. Just an honest conversation about what this therapy is, how it works, and whether it might be right for you.
CBT stands for Cognitive Behavioural Therapy. The name sounds technical, but the idea is simple: the way we think affects the way we feel, and the way we feel affects what we do.
Most of us have patterns we get stuck in without even noticing. A thought pops up — I can't do this — and suddenly we feel anxious, so we avoid the thing that triggered it. And that avoidance makes the thought feel even more true next time.
CBT helps you notice those patterns. Not to judge them. Just to see them. And once you can see them, you have more choice about what to do next.
This is what people really want to know. What does it actually feel like to sit in a room (or on a video call) with a therapist doing CBT?
Here's what it looks like when I work with someone.
We pick a recent moment that was difficult. Maybe something that triggered anxiety, or a moment where you felt stuck or overwhelmed.
We map it out together:
I might draw this out on a piece of paper. I'm that kind of therapist.
This helps us see the loop that's keeping you stuck. Not because you're doing something wrong, but because our brains are wired to repeat what's familiar.
Once we can see the surface pattern, I'll ask something like:
"Where have you felt this before?"
Or:
"What's the earliest time you remember feeling this way?"
Because here's what I've learned: the patterns we get stuck in now almost always have roots. They made sense once. They helped you survive something. And now they're running in the background, shaping how you see yourself, others, and the world.
We call these core beliefs. They're the deep, often unspoken assumptions we carry. Things like:
And then there are the rules we develop to cope with those beliefs. Things like:
Here's the thing: these rules probably helped you at some point. They might have been the only way you knew how to survive. But now? They might be keeping you exhausted, small, or stuck.
This is the part I love. This isn't me sitting across from you telling you what's wrong. I don't do that.
It's us, together, trying to understand. I might offer a thought or a pattern I've noticed, and you'll tell me if it lands. You're the expert on your own life. My job is to help you see what you might be too close to notice.
We'll ask questions like:
We're not trying to argue the belief away. That never works. We're trying to make space for a more flexible, more balanced view—one that lets you live in a way that actually matters to you.
I want to be honest with you. CBT isn't for everyone — and it's not for every stage of healing.
There's a difference between CBT and counselling. Counselling is often more open-ended. You talk about whatever comes up. The therapist listens, reflects, and holds space.
CBT is different. It's more structured. There's usually a focus — a pattern we're looking at, a goal we're working towards. I'll ask questions. I'll gently guide. I might draw diagrams or suggest things to try between sessions.
Some people love that structure. It helps them feel focused and safe. Other people find it frustrating. They want space to just talk, without a direction or a goal.
If you want unstructured talking, that's valid. It's just not what I offer. And it's better to know that upfront than to start therapy and feel like you're not getting what you need.
CBT is a doing therapy. That means the work doesn't just happen in the session. You'll be asked to notice patterns between sessions. You might try out new ways of responding. You'll bring back what you noticed, and we'll build on it.
If you're looking for something where you just show up and talk while the therapist does the work — CBT probably isn't the right fit. It requires active participation.
That doesn't mean it's hard work in the sense of being gruelling. But it does mean you're an active participant in your own healing. You're not a passenger.
A lot of people come to me saying: I tried CBT. It didn't help. The therapist just gave me worksheets and told me to think differently.
That's not real CBT. That's a shallow version of it. Real CBT — the kind that works — is collaborative, curious, and willing to go deep. It doesn't hand you a worksheet and expect you to figure it out alone.
If you've had that experience, I'd be curious to hear about it. And if you're wary, we can go slow. You don't have to trust the approach before you trust me.
Standard CBT often relies on abstract concepts, metaphors, and the idea that you can "change" thoughts by challenging them. That might not land for a neurodivergent brain.
CBT can be adapted — using concrete, literal language, written summaries, and a focus on behaviour as much as thoughts. But it needs to be done by someone who understands neurodivergence. If you've tried CBT before and it felt confusing or invalidating, that makes sense. It might not have been adapted for you. Read more here.
I want to be transparent about how I practice. I'm trained in CBT, but I also draw on ACT (Acceptance and Commitment Therapy) and CFT (Compassion-Focused Therapy) .
These are what we call third-wave CBT approaches. They move beyond just changing thoughts and ask bigger questions:
Because here's what I know: we can't eliminate difficult emotions. Life will always bring pain. But we can change our relationship to those thoughts and feelings. We can learn to notice them without being swallowed by them. We can make room for them — and still take steps towards a life that feels meaningful.
That's what I love about this work. It's not about getting rid of the hard stuff. It's about helping you build a life that's big enough to hold both the hard stuff and what matters to you.
Yes. CBT is one of the most researched talking therapies in the world. There's strong evidence it helps with anxiety, depression, trauma, OCD, and many other difficulties.
But research is about averages. What matters is whether it works for you.
If you've tried CBT before and it didn't help, I'd be curious about what actually happened. Often, it's not that CBT doesn't work. It's that the approach was too surface-level, or it wasn't adapted to you, or you didn't feel truly seen.
How long does CBT take?
It depends. Some people feel a shift in a few months. Others want to go deeper and stay longer. I don't work to a set number of sessions.
Do I have to talk about everything?
No. You're always in control of what we talk about and when. Good therapy doesn't push—it follows.
What if I don't know what I'm feeling?
That's incredibly common. We'll work with what you do notice—sensations in your body, urges, thoughts that loop. You don't need to have the perfect words.
Do I have to do homework?
CBT is a "doing" therapy—the work doesn't just happen in the session. You might notice patterns or try new ways of responding between sessions. But this isn't school. I'm not grading you. We'll find a pace that works for you.
Can CBT help with trauma?
Yes. Trauma-focused CBT is a recommended treatment for PTSD. But it needs to be done carefully, at your pace, with someone who knows how to work with trauma safely. You're always in the driver's seat.
Is CBT available on the NHS?
Yes, but NHS Talking Therapies often use a shorter, more manualised version. If you want to go deeper, private therapy gives us more flexibility.
What if I've tried CBT before and it didn't help?
I hear this a lot. Often it's because the approach was too surface-level, or it wasn't adapted to you. If you're wary, we can go slow. I'd be curious to hear what happened.
I'm a trauma therapist based in Bristol. I work with people who are tired of being stuck in the same patterns—the anxiety, the overwhelm, the voice that tells them they're not enough.
I use CBT, ACT, and CFT in a way that's collaborative, curious, and grounded. I'm not interested in surface-level work. I want to understand where your patterns came from, why they make sense, and how we can create more flexibility so you can start living a life that actually feels like yours.
If you're not sure whether CBT is right for you, that's okay. We can have a conversation about it. No pressure. Just an honest chat about what you're looking for.
If you're wondering whether therapy is for you — or if you've tried CBT before and want something deeper — I offer a free, no-pressure consultation.
We can talk about what's brought you here, what you're hoping for, and whether working together feels right.
Click here to book a free consultation or learn more about my work
Set up your appointment today, choosing between meeting in person or virtually.
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