How Do Couples Therapists Use Cognitive Behavioral Therapy?
Updated August 05, 2020
Medically Reviewed By: Elizabeth Strong
Cognitive behavioral therapy is a well-known method of creating change in thoughts, feelings and behaviors. While many people are aware of its use in individual therapy, CBT can also be used in couple’s therapy to help partners change their behavior in ways that are beneficial to the relationship. Couples therapists use this technique in special ways that apply specifically to couples.
What Is Cognitive Behavioral Therapy?
Cognitive behavioral therapy is a specialized treatment used to facilitate change by challenging thoughts we have that may be detrimental to our well-being. We tend to believe what we tell ourselves over and over and if we can change these sometimes unhealthy, untrue, or unproductive thoughts, we can often change the harmful behaviors and feelings that tend to follow.
What Problems Can Be Addressed With CBT?
Cognitive behavioral therapy can be used to deal with a variety of personal and relationship issues. It's often used to treat mood disorders, but it can also be used to help with any issue that is caused or affected by maladaptive thoughts.
CBT As One Part Of An Eclectic Approach
Some therapists use CBT as one of several therapies. In couples' therapy, it's often used alongside communication and assertiveness training. When a thought or behavior that is causing discord in the relationship comes up, the therapist can switch to cognitive behavioral therapy to help the couple make changes designed to set a healthier course for the relationship.
CBT As The Primary Therapy
Cognitive behavioral therapy may be used as the primary or only mode of therapy. The technique is versatile, as it can be used to solve a wide variety of problems. It's suitable for couples' therapy because many couples find they want or need to change their thoughts, behaviors, and feelings in order build a stronger relationship. CBT provides them with a systematic way of achieving that.
How Cognitive Behavioral Therapy Works To Create Change
If you've never experienced CBT before, the notion that it can create positive change may seem a bit like magic. After all, you feel the way you feel. How can a simple technique change those feelings that seem so real and permanent?
The truth is that you can change the way you feel, but you have to do it by changing your thoughts about your situation. Once you change your thoughts, new feelings often follow and new, healthier behaviors can be more easily implemented. Cognitive behavioral therapists use a systematic technique to help you create these changes.
Orientation To CBT
Before your therapist begins CBT, they'll likely spend some time orientating you to the process. You'll learn more about what cognitive behavioral therapy is, how your therapist uses it, and what procedures you'll use during therapy sessions.
Identifying What's Good
CBT starts with identifying current situations and thoughts, feelings, and behaviors related to those situations. Many therapists have found that the best way to create positive expectations of couples' therapy is to begin by identifying what partners appreciate about each other.
What do you like about them? What do they do that helps make the relationship work as well as it does? What are some pleasant memories you have of your partner? These types of questions can also help the therapist understand the basis of your relationship.
Identifying Problem Situations, Thoughts, Feelings, And Behaviors
Before you can change anything, you'll spend some time talking about the situations that are causing stress in the relationship. Some examples might be changes in employment, serious medical conditions, interference in the relationship by family members, or past traumas of one or both partners.
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You'll also describe your feelings about these situations as accurately as possible and talk about what seems to trigger those feelings. In the process, you'll get an opportunity to learn more about your partner's perceptions and feelings and notice how they're the same as or different from yours.
Once you cover the problem situations and the uncomfortable feelings surrounding them, your therapist will typically help you pinpoint how your behaviors contributed to or helped alleviate the situation. The goal here is to create an accurate and complete picture of what is happening in your relationship.
When you become more aware of the current state of your relationship and the feelings and behaviors that are a part of it, you can begin to uncover the thoughts that led you to that point. Only then can you use all this information to make plans for change.
Identifying Avoidance And Escape Behaviors
Often, rather than facing problems directly, people use avoidance and escape behaviors that temporarily keep them from having to deal with the situation. The problem is that when you avoid the situation for very long, the problems can mount up without you even realizing it.
While it might seem wonderful to escape problem situations completely, the risk is that by doing so, you reduce your chances of bonding and developing a closer relationship with your spouse. It might be great to avoid or escape a bad situation, but if you leave your partner to deal with it alone, they may have a very hard time surviving it, and they might come to resent you.
Identifying Automatic Thoughts
One of the basic tenets of cognitive behavioral therapy is that everyone has automatic thoughts: the thoughts or images that come up in response to a trigger. You don't actively try to think about them; they come up without prompting. You may or may not even be aware of them.
For an example of an automatic thought, consider a situation in which you think your spouse is angry with you. There could be several feelings that immediately surface in regards to that thought. The thoughts and feelings that arise may then lead you to act a certain way toward him or her. You might not be consciously aware of these thoughts, but there they are influencing how you feel and respond.
Only when you identify automatic thoughts can you discover whether they're accurate or not and decide if you want to change them. When you recognize all the images, thoughts, associations, and assumptions surrounding your feelings, your therapist can guide you in the work of changing them.
Identifying Shared and Different Core Beliefs
Core beliefs go a lot deeper than automatic thoughts. Your core beliefs are beliefs about yourself, the people around you, the way the world works, and what will happen in the future. These core beliefs are so strong that they are typically a part of who you are as a person and usually develop over a long period of time. They're often very rigid and inflexible beliefs that influence much of what we think, feel, and do.
Core beliefs can be changed, but the process is much more difficult and may take much longer than with more transitory thoughts. People commonly look for evidence to support their core beliefs, but in CBT, the goal can be to challenge these beliefs if they're unhelpful.
In couples therapy, you need to be very aware of your and your partner's core beliefs as well as your own. You might spend some time investigating each of your core beliefs and seeing whether they match up, work well with your partner's core beliefs, or cause discord between you. At that point, core beliefs can be addressed in the same way as other thoughts.
Setting Goals For Change
Just as cognitive behavioral therapy is a systematic method, setting goals for CBT is a systematic process. First, you need to settle on broad categories of change you want to work on. Then, you can narrow down to specific behaviors that you want to change.
Goals for CBT need to include three factors; they need to be observable, measurable, and achievable. Ideally, the change is carried out in small increments so that you can enjoy success as early as possible. Then, you can set new, narrowly-defined goals that contribute to your broad overall goals.
After you change your thoughts about a situation, your feelings may begin to change, too. You may also be ready to change your behaviors so that they mesh more closely with your new thoughts about your situation. This will increase your positive feelings, and at the same time, you'll choose behaviors that are more adapted to improving your relationship.
The Importance Of Homework
You're typically only in therapy for a limited amount of time. If you're going to make real changes, you'll need to practice new behaviors more frequently than you can in a therapy session. What's more, you and your partner may be on their best behavior during therapy sessions. For these reasons, your therapist may assign you homework to do alone or with your spouse between sessions.
Your therapist might give you information to read, exercises to do alone or together, and of course, specific behaviors from your list of behavioral goals to practice. It's important to take the time to do these exercises if you want to get the most out of therapy and create the changes you want for your relationship.
The Setup For Cognitive Behavioral Therapy For Couples
Cognitive behavioral therapy for couples is a bit different than for individuals. The setup is based on the fact that you and your partners are both distinct individuals and together make up a couple. This means that these three distinct entities need to be considered throughout the therapeutic process. The therapist facilitates the interactions between the two of you during sessions.
The Couple As Two Distinct Individuals
Even though you're in a relationship, you're still two distinct individuals. You'll need to work together as a couple, but you'll also need to identify your issues that contribute to the problems you face together.
The Couple As A Unique Entity
Many people have trouble wrapping their minds around what it means to consider a couple as a unique entity. What you need to remember is that you and your partner have characteristics and interactions as a couple that you may or may not have as two individuals.
For example, each of you might be very career-minded. On the other hand, when you're functioning as a couple, you might be more fun-oriented. Or, you might work together to advance a shared business. Either way, the couple made up of you and your partner can easily be different in type or degree from each of you as individuals.
You may speak in therapy as a part of a couple, or you might speak regarding your individuality. You might work together to change unhelpful patterns of behavior the two of you have developed. You might also do homework on your own to address your behaviors so that you're not contributing to problems between you. Regardless, each entity will need to put in the work for quantifiable changes to be made.
Communicating Without Cognitive Distortions
In couple therapy, you and your partner will work on issues such as communication, infidelity, or trust. In CBT couple therapy, the partner's relationship is looked at as a unit. The two partners are creating a positive pair where each person doesn't make assumptions about the other one. In individual therapy, you only need to worry about your outlook and needs. In couple therapy, you have two people who need to work together and form a healthy bond. Cognitive distortions can impact the way a couple communicates. For example, if you assume your partner is thinking something, that's the cognitive distortion of "mind-reading." Cognitive distortions can lead to negative behaviors. What you want to address in couple therapy is to encourage positive behaviors. In CBT couple therapy, partners are going to learn how to communicate effectively and curb cognitive distortions. You and your partner will learn cognitive restructuring. That's a way of unpacking negative or maladaptive thoughts and reframing them to positive ones. That way, you and your partner are engaging in positive behaviors toward each other. Your therapist will start with behavioral observation. They will see if you and your partner are using cognitive distortions when you communicate. You learn a lot by watching a couple interact. In couple therapy, the mental health provider will watch behavioral interactions between you and your partner and give you insight into what they see. The couples learn they are communicating negatively, and how to reframe those dialogues. The therapist will help work through the couple's distress.
How Cognitive Distortions Hurt Us
Cognitive distortions are detrimental to the way that people think. These ideas revolve around negative thinking and discourage positive behaviors. That's why cognitive restructuring is so important for individuals and partners in couple therapy. For example, if a couple is engaging in black and white thinking, they aren't going to feel good about each other. The partners make assumptions like "we're always fighting." or "you never listen to me." These all or nothing statements discourage positive behaviors and contribute to distressed couples. Cognitive restructuring can help people learn to stop making assumptions, relying on distorted thinking, and couples learn how to communicate with kindness. In couple therapy, the therapist will teach the partners how to effectively express how they feel without using cognitive distortions.
Stop Jumping to Conclusions
When two partners enter couple therapy, the relationship may be damaged. The people are experiencing "couple distress." That means that each partner is uneasy about the relationship. "Couple distress" happens when the partners feel insecure in the relationship. Maybe one person is assuming the other is cheating. That would be the cognitive distortion of "jumping to conclusions. "Couple distress" should be addressed in a therapeutic setting. Distressed couples can benefit a great deal from CBT couple therapy. The people are unaware, but they assume their partner thinks and feels a certain way without proof. Couples experience a variety of emotions when they start therapy. The two people may be excited to get better at communicating. One partner may be defensive or angry. Another person might be sad about where the relationship is headed. One thing that happens a lot in couple therapy is that people are jumping to conclusions about how the other person feels. It's important that the therapist works on cognitive restructuring with the couple. That the partners aren't assuming that their loved one is up to no good. A therapy assessment can help the provider identify what the couple wants to focus on treatment. After that, the therapist can start teaching cognitive structuring, so the couple can learn positive thinking and stay away from maladaptive behaviors. Couple therapy can be life changing when people learn how to love one another without being negative toward each other. Therapy can provide clarity on how your partner's behavior impacts you and vice versa. The therapist will observe the couple interactions and provide insight into what's working and what isn't. Sometimes people are used to being cruel to each other. The resentment builds up over time, and you can't stop fighting. The couple interactions show how healthy the connection is, and what needs to change. There are cognitive techniques that a couple therapist can show the pair to help their communication improve. There is also couple therapy for depression where one partner has clinical depression and impacts the relationships. Whatever the couple interactions are, CBT couple therapy can help teach people how to communicate effectively with one another without being judgemental.
Assume the Best in Your Partner
Satisfied couples aren't worried about their partner cheating. When you watch some "couple interactions," you can tell if the partners are secure with each other. Satisfied couples have worked through these insecurities in therapy, or by talking with their significant other about trust. The strength of a couple's relationship is based on how much the pair trusts each other. That's why it's important to develop that bond. When you assume the best about your partner, that makes them want to do the same for you. It's important to keep your couple therapy current. Don't go to counseling with your partner one time and think the problems are going to be gone. Counseling can take months or years to be effective. Some couples experience the benefits of therapy immediately, while for others, it could take time. Whatever the case may be, it's crucial to keep seeing your therapist with your partner. Keep learning to assume the best about your significant other, and you will find they do the same for you.
The Therapist as Facilitator
A CBT couples' therapist has a unique job. They're not there to tell you what to think, do, or feel. Rather than directly leading the sessions, they'll make it easier for you to discover what you want, understand how to set goals, and accomplish the changes you want to make.
You can rely on your therapist to keep the conversation between you flowing in a helpful direction. They can also provide you with information and guidance on certain issues and techniques. However, the two of you are in charge - both separately and together - of making all the decisions involved in your couple’s cognitive behavioral therapy.
Finding Out What Is Negotiable And What Isn't
If you've never been in therapy before, you might assume that the therapist will tell you what you have to change. Guess what. They won't. While they might help you understand the consequences of changing or not changing, only you will decide what you will change.
In fact, one of the most important parts of setting CBT goals in couples' therapy is to identify what each partner is willing to change. If you or your partner says that a thought or core belief is non-negotiable, then the other has to learn to accept their partner having that thought or core belief as well as the natural consequences of it. Otherwise, you can't make much progress in therapy.
If you and your partner are ready to start therapy, waiting for an appointment can cause you to lose your momentum and commitment to that goal. Fortunately, you can begin online therapy right away with ReGain. The therapists are licensed counselors who work with couples to help them achieve their goals for a closer, more satisfying relationship.
Frequently Asked Questions (FAQs)
What does cognitive behavioral therapy involve?
Cognitive-behavioral therapy or CBT is a form of treatment that focuses on establishing more productive ways of thinking. In cognitive behavioral therapy, you will work through negative thinking patterns and learn positive ways to navigate negative feelings. Cognitive behavioral therapy can help people with a variety of different mental health conditions such as depression, anxiety, posttraumatic stress disorder, OCD or obsessive-compulsive disorder, eating disorders, and panic disorder. Generally, cognitive behavioral therapy CBT is a short-term form of talk therapy, but it's highly beneficial for many people, and it can benefit you for the rest of your life by providing coping skills and strategies to use long-term outside of therapy. Cognitive behavioral therapy will most often involve you sitting with a therapist about once a week so that you can talk about what's going on with you. In those therapy sessions, you'll work on identifying cognitive distortions, learn about how to implement strategies that help you face negative thinking patterns, develop confidence in your problem-solving skills, and more. You'll work toward new ways of thinking and behaviors that are more adaptive.
What is an example of cognitive behavioral therapy?
A lot of the time, people receive cognitive behavioral therapy for specific problems. Let's say that someone is getting cognitive behavioral therapy for anxiety, and this person has a tendency to catastrophize or believe that the worst is going to happen to the extent that it impacts their quality of life and mental health on a regular basis. In this example, during a session, an individual might open up to their therapist about how they feel and what they're thinking. They might say something to the effect of, "I'm so nervous. I want to be able to socialize and make friends, but I feel like no one will ever like me" or "I'm a failure; I'll never be successful." Both of these things could be identified as cognitive distortions. Rationally, it's probably not true that no one in this world will ever like you or that you won't be successful in any of your endeavors. In cognitive behavioral therapy cbt, you would challenge those thoughts by saying something like, "I can't predict what people will think of me. I have good qualities, and I can make friends." It can be hard to change your thought patterns at first, but when you use techniques from cognitive behavioral therapy regularly, your thoughts start to become more positive. You start being able to challenge automatic negative thoughts more easily over time, and you will be able to rationalize any negative thoughts that come your way. We all get down on ourselves from time to time, but these skills can help us think in a way that will benefit us more in our lives, whether that's in our careers, in social situations, or in romantic relationships.
Can you do CBT on yourself?
Technically, therapy needs to be conducted by a licensed mental health provider. However, you can use cognitive behavioral therapy skills on your own as a mode of self-help, and doing so is beneficial for a lot of people. You can ask a mental health professional for CBT worksheets and read books about CBT that can help you understand cognitive behavioral therapy cbt techniques and apply them yourself. There are workbooks, information books, and a lot of free resources on the Internet that can help you understand CBT. Don't be afraid to reach out for mental health support from a professional. Although you can learn a lot from working on CBT skills or mental health on your own, there is no replacement for a mental health professional who can support you and help you work through any sticking points. The ultimate goal of CBT is that you'll be able to use CBT skills on your own, so remember that you don't have to stay in therapy forever and that a mental health provider is there to help you get to a better place.
What are three of the goals of cognitive behavioral therapy?
CBT is a goal oriented therapy modality. Therapy goals will vary from person to person, but there are three main areas that cognitive behavioral therapy works to improve. The three goals of cognitive behavioral therapy are to modify thoughts to make them more productive, to develop and implement coping skills or strategies, and to get to an overall better state of mental health with decreased symptoms. Often, at the start of therapy, you and the mental health professional you see will outline goals that are specific to the mental illness or other concern you are in cognitive behavioral therapy for. As time progresses, you will revisit these goals with your mental health provider, see the progress you've made, and reassess your therapeutic needs.
What types of disorders are best treated by CBT?
Cognitive behavioral therapy is highly beneficial for a wide range of mental health disorders. Some of the forms of mental illness that are best treated by cognitive behavioral therapy are panic disorder, obsessive compulsive disorder (OCD), eating disorders, post traumatic stress disorder ptsd, and mood disorders such as bipolar disorder or depression. The American psychological association also asserts that CBT can benefit those with other concerns like substance use disorder and marital problems. If you believe that you may have a mental illness such as an anxiety disorder and would like to get an evaluation, it's important to see a psychiatrist or general doctor who can provide you with a proper diagnosis. A mental health diagnosis doesn't change who you are as a person; instead, it allows you to name the issues you're facing and get the help you need. According to the American psychological association, almost 30% of those in the United States who are 18 or older will struggle with an anxiety disorder in their lifetime, so remember that you aren't alone.
How long does it take for cognitive behavioral therapy to work?
Since CBT is generally a short-term form of treatment, it does not take as long as some other forms of therapy in many cases. The American Psychological Association states that CBT usually lasts for around 12 to 16 sessions. However, some experts say that cognitive behavioral therapy can start helping someone after only a couple of sessions. Generally, your length of treatment will depend on what you are there to treat, how much you have to work through, and what you find helpful. The length of a single session with a mental health provider for CBT will usually be around one hour. Since CBT is highly effective as a short term therapy, many people decide to use it to work through any number of specific problems they have, whether that is a mental illness or life issues such as those related to confidence, stress, relationships, or something else. Cognitive behavioral therapy is generally conducted on a one on one basis, but you can also go to CBT groups. The American Psychological Association has information regarding group therapy that can help you determine if it is a good fit for you.
What is CBT not good for?
CBT is beneficial for a wide variety of people and conditions, but in some cases, other forms of treatment may be more suitable. For those who have cognitive conditions or diagnoses that cause them to struggle with learning, CBT might not be a good fit. Additionally, those with severe psychological conditions may need to prioritize other forms of treatment. Everyone is different, and there are many different types of therapy to consider for those who don't benefit from CBT or cannot engage in cognitive behavioral therapy cbt.
What techniques are used in cognitive behavioral therapy?
One of the best things about cognitive behavioral therapy is that it is an accessible form of treatment in the sense that you can use a lot of cognitive behavioral therapy techniques at home. When you find a therapist that offers cognitive behavioral therapy, you will have skills that you can utilize even when you no longer attend therapy or simply aren't in a therapy session at that moment. Some common cognitive behavioral therapy techniques are cognitive restructuring and reframing, which allows you to look at your thought patterns to make them more adaptive and productive, mindfulness, keeping thought records, behavior activation, and role-playing. Therapists that practice CBT may also give you homework such as journaling assignments or worksheets if it's something that you are interested in, although that's not always the case. Oftentimes, you can find CBT assignments or exercises like this online when you aren't able to reach out to a therapist. You may also engage in exposure therapy or guided discovery with a therapist who practices CBT. CBT gives you what you need to solve many of your problems independently long-term, though there is always more to learn. Some people go to therapy for a little while and come back later, so know that if you ever need to return to therapy for any reason or feel like you might benefit from getting CBT again, you certainly can.
Is CBT good for anxiety?
Research indicates that CBT is highly beneficial to those who have anxiety disorders. More than 60% of people with an anxiety disorder who get cognitive behavioral therapy cbt benefit from it and are able to better manage their symptoms. The American psychological association states that CBT sometimes surpasses medication in terms of efficacy, which is great news for anyone who chooses to seek it. Often, CBT is the first line of treatment for people with anxiety disorders because of its efficacy and the substantial research that supports the modality.
How do I practice CBT for anxiety?
The best way to truly practice cognitive behavioral therapy for anxiety is to see a mental health provider who uses cognitive behavioral therapy as a modality in their work. To find a therapist who works with anxiety and uses CBT, you can search the web for "cognitive behavior therapy for anxiety near me" or check with your health insurance provider to see what they cover in terms of mental health services. You can call your health insurance company or visit their website to see a directory of therapists in your area. Another option is online therapy. Online therapy is generally more affordable than traditional in-person therapy is without insurance, and you can receive quality cognitive behavioral therapy remotely. Whether you see a mental health provider in person or online, you deserve to get the mental health support you need.
What is cognitive behavioral couples therapy?
Cognitive behavioral couples therapy is a focused therapy that deals with both the thinking processes and the behaviors that these processes put out. It shows couples a contextual approach to dealing with the tensions or problems in their relationship. Then, it also seeks to apply an enhanced cognitive behavioral therapy in order to promote better behavior in the relationship through better thinking about the relationship and partner.
In short, cognitive behavioral couples therapy is a form of cognitive therapy that is tweaked to accommodate two people in one relationship. This means that the bulk of cognitive behavioral couples therapy focuses on changing the thoughts, thought processes, and behaviors of both individuals in a marriage or relationship. The focus of cognitive behavioral couples therapy is changing thought patterns and behavior patterns in both partners in order to improve the relationship as a whole. It’s basically taking the foundations of cognitive behavior therapy and applying it to two people at the same time, with the specific goal of improving their relationship. Since cognitive behavioral couples therapy focuses on improving the cognition and behavior of two individuals as well as the relationship between them, it is sometimes called integrative behavioral couple therapy.
In terms of clinical psychology, cognitive therapy for couples is also a great way to address any mental health issues that may be causing some underlying problems in the relationship. Cognitive therapy is a safe space to process how you think and why you think that way. Through cognitive therapy, this approach to clinical psychology is a surefire way to mitigate any problems that may be caused by one individual’s thought or behavior patterns. Then, both partners can benefit from this cognitive therapy!
Can CBT help with relationships?
In a word, yes! Cognitive behavioral couple therapy has been shown to help couples improve their relationships, especially when they take the couple therapy seriously. When a couple prioritizes marriage and family therapy, they often see great results from cognitive behavioral couples therapy. This is because cognitive behavioral couples therapy can help with skill building that can really help the marriage or relationship to thrive. These skills include communication skills, problem solving skills, and conflict resolution skills.
Cognitive behavioral couple therapy is also a great way to work through personality disorders, mental health problems, or any other clinical psychology issue that may be holding the relationship back or causing problems in the relationship. Working with a couple and family therapist through cognitive behavioral couples therapy is a surefire way to address these issues that may be underlying a lot of the problems in the relationship.
What is the success rate of cognitive behavioral therapy?
On the whole, cognitive behavioral couple therapy has a pretty impressive success rate. In fact, most people seeking family therapy or cognitive therapy who choose cognitive behavioral couples therapy report improvement in their relationship. However, a lot of this success also depends on the couple’s commitment to the enhanced cognitive behavioral therapy. Basically, if the couple puts in the time and effort and does their best in family therapy, then cognitive behavioral couples therapy has a pretty good chance of helping them to improve their marriage or relationship.
That’s why cognitive behavioral couple therapy is a method four couples therapy that is espoused and promoted by the Institute for Cognitive Therapy and the department of psychology at most major research institutes, as well as the Society of Clinical Psychologists. The psychology topics covered in cognitive behavioral couples therapy is truly extensive; there’s nothing that doesn’t get addressed or covered in cognitive behavioral couples therapy in terms of you, your partner, and your marriage or relationship. On the whole, clinical psychology approves the use of cognitive behavioral couples therapy.
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