Why CBT Therapists Don’t Challenge Clients’ Cognitions—And Why It Matters

Judith S. Beck, PhD, President, Beck Institute for Cognitive Behavior Therapy

As I teach mental health professionals around the world, I frequently discover that they believe it is important to challenge clients’ cognitions—their automatic thoughts and intermediate and core beliefs. I have also encountered a widely circulated narrative among both clinicians and the general public that CBT works by telling clients that their thinking is “wrong.” This myth harms the perception of CBT—potentially causing individuals who could benefit from CBT to seek treatment in another modality without a robust evidence-base. And it’s simply not true! Challenging clients’ cognitions violates a fundamental principle of CBT, that of collaborative empiricism.

and by examining the evidence. This collaborative process allows clients to actively engage in their own treatment, fostering a sense of empowerment.

As therapists, we often don’t know in advance the degree to which a client’s cognitions are distorted. For example, a client might think, “I’m going to run out of money” or “My partner is cheating on me.” These thoughts may be 100% true. And even if we are fairly certain that a client’s cognitions are not true (e.g. a client expresses the thought “No one cares about me,” but the therapist is aware that the client has a supportive daughter and several close friends) simply telling the client that they are wrong is unlikely to change their mind. A direct challenge may also impair the therapeutic relationship. Being told their thoughts are incorrect or distorted can lead clients to feel invalidated and they may conclude that their therapist is not empathic or trustworthy. A strong therapeutic alliance is necessary for therapy to be effective.

Instead, the therapist and client should examine the client’s cognitions together in a supportive and collaborative way. Here’s what I said to the client when I had significant evidence that her family and friends cared about her despite her conviction that no one cared.

Therapist: So, Brenda*, did I get this right? When you realized this morning that no one had called you over the weekend, you thought, “No one cares about me,” and you felt quite sad.

Brenda: Yes, that’s what happened.

Therapist: And how much do you believe that right now?

Brenda: A lot. If anyone cared, they would have called me.

Therapist: It would be really important for us to find out whether that thought is 100% true, or 0% true, or some place in between. Is it okay if we take a look at it?

Brenda: Okay.

Therapist: I know your daughter usually calls you over the weekend. It’s possible that she doesn’t care. But is there another explanation for why she didn’t call?

Brenda: I know she’s got this big project due this week. I guess she could have been working.

Therapist: So, what do you think? She didn’t call because she was busy, or she didn’t call because she doesn’t care about you?

Brenda: I’m not sure.

Therapist: Well, do you have any evidence that she does care about you? I remember you told me that she usually visits you on Sunday afternoons and that the two of you enjoy window shopping.

Brenda: That’s true.

Therapist: And didn’t she organize a big party for you last month for your birthday?

Brenda: Yes. [thinks] Maybe she does care.

Therapist: I have another question. At our last session, we had decided it would be optional for you to make social plans for the weekend. Had you been able to do that?

Brenda: I tried. I called Gail and Janet, but Gail was away and Janet’s son and grandchildren were visiting her.

Therapist: I wonder, did you feel lonely this weekend?

Brenda: Yes, I did.

Therapist: I wonder whether you were in a sad frame of mind and that’s why you had the thought “Nobody cares.” What do you think about that now?

Brenda: I guess that’s really not true. I would have seen my daughter and Janet if they hadn’t been busy.

Therapist: I’m glad you see it differently now. Would you like to write down something about this for the next time you get lonely?

Helping the client test the validity and/or utility of their thoughts and beliefs and developing a more adaptive response can improve their ability to think critically. When clients actively question their cognitions themselves, they are more likely to accept alternative, more accurate or helpful ways of viewing situations. And they may then be more motivated to make important changes in their lives. It’s important to empower clients to come to their own conclusions rather than imposing your perspective.

Teaching clients how to evaluate their thinking equips them with a lifetime skill which contributes to resilience and relapse prevention. They will be better able to respond effectively to future distorted or unhelpful cognitions. Self-discovery promotes a more empowering therapeutic experience that encourages long-term growth and effective coping strategies.

*Client’s name and identifying details have been changed to protect confidentiality.