Cognitive Behavioural Therapy: What it gets wrong
(and what still works)
CBT has become the McDonald’s of therapy: fast, standardised, and everywhere. If you’ve seen a psychologist in the last twenty years, odds are you’ve tasted its special sauce—identify the thought, challenge it, replace it, repeat until “better.”
But here’s the uncomfortable truth: while CBT has done enormous good, it also has blind spots big enough to drive a busload of burnt-out clients through.
The logic trap
CBT assumes that thoughts create feelings, so if you change your thoughts, your feelings follow. It’s neat, rational, and makes sense to a spreadsheet.
The problem? Humans aren’t spreadsheets. Many emotional storms have roots in attachment wounds, nervous system dysregulation, or trauma that bypasses language entirely. You can’t “think” your way out of a body that still believes it’s in danger. Try telling your amygdala to “reframe its cognition” mid-panic attack. Good luck.
The invalidation problem
CBT often starts with “Let’s look at your distorted thinking.” For someone who’s been gaslit, dismissed, or chronically misunderstood, that can sound like, “You’re overreacting again.”
The therapist may mean well, but the message lands as: Your emotions are wrong, and logic will fix you. That’s not therapy, that’s a correctional program.
The behavioural bias
CBT loves homework—thought logs, exposure exercises, daily goals. Great for anxiety or phobias, less so for existential despair or identity collapse.
Some people don’t need another worksheet; they need someone to sit with them in the dark without trying to turn on the bloody light straight away.
Culture and neurodiversity blind spots
CBT grew out of Western, individualist, neurotypical soil. It expects linear thinking, verbal precision, and self-analysis.
That’s not how everyone’s mind works. A neurodivergent client may process laterally, visually, or intuitively. A collectivist-culture client may prioritise relationships over personal autonomy. Telling them to “focus on your own thoughts” can miss the cultural and neurological forest for the cognitive trees.
The time pressure myth
Insurance systems love CBT because it’s measurable and short—six to twelve sessions and you’re meant to be fixed. Except some people need time to build trust, unpack decades of patterning, and safely feel emotions that have been exiled since childhood.
You can’t microwave human growth, no matter how strong your manualised protocol.
The overload effect
For clients with ADHD, depression, or trauma, CBT’s self-monitoring tasks can feel like extra work on top of already-limited executive functioning. “Track your thoughts” quickly turns into “I forgot the notebook again.” Shame piles on top of struggle.
The truth under the rubble
CBT still has value—enormous value—when used as part of a larger framework. Its structure can anchor chaos. Its logic can challenge catastrophising. But like any good tool, it depends who’s holding it, and why.
For people who’ve already developed emotional awareness and safety, CBT can fine-tune the machinery. But for those still learning how to trust themselves, the first task isn’t thought correction — it’s self-connection.
References
Beck, A. T. (1979). Cognitive therapy of depression. Guilford Press.
Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35(4).
Wikipedia: Cognitive behavioral therapy
Linehan, M. M. (2014). DBT Skills Training Manual (2nd ed.). Guilford Press.