Your doctor just told you to find a therapist who does CBT. Maybe your insurance company listed it as a “covered treatment.” Or you Googled “best therapy for anxiety” and CBT dominated the results.
Everyone agrees: CBT is the gold standard. Evidence-based. Scientifically proven. Modern and effective.
Here’s what they’re not telling you: The research shows multiple therapy approaches work equally well. So why does everyone push CBT?
After 15 years as a clinical psychologist, I can tell you exactly why—and what you actually need to know before choosing a therapist.
What CBT Actually Is
Cognitive Behavioral Therapy focuses on the connection between thoughts, feelings, and behaviors. The core idea is simple: our thoughts influence our emotions and actions, so by changing thought patterns, we can improve our emotional well-being and behavior.
CBT emerged in the 1960s when psychologists Aaron Beck and Albert Ellis challenged the dominant psychoanalytic approach. Instead of exploring childhood experiences and unconscious motivations, CBT focuses on present-day thoughts and practical coping strategies.
The approach is structured and goal-oriented. Therapists help clients identify unhelpful thought patterns, test whether these thoughts are accurate, and develop more balanced perspectives. Since the 1960s, variations have emerged—Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), and Mindfulness-Based Cognitive Therapy (MCBT) all build on CBT’s foundation.
Why Everyone Recommends CBT
If you’re wondering why CBT seems to be the only therapy anyone talks about, there are specific reasons—and they have more to do with insurance companies and marketing than with superior effectiveness.
Insurance Companies Love CBT
CBT is typically short-term and time-limited, which makes it cost-effective for insurance companies. Twelve to sixteen sessions is far cheaper to cover than open-ended therapy. When insurance companies create their “approved” treatment lists, CBT tops the list not because it’s more effective, but because it’s easier to budget.
It Fits the Medical Model
Physicians are trained in the medical model: identify the problem, prescribe the treatment, measure the outcome. CBT fits this framework perfectly. It uses symptom checklists, treatment protocols, and measurable goals. This makes doctors comfortable recommending it—it feels like prescribing medication for diabetes.
Other therapy approaches—psychodynamic therapy, relational therapy, humanistic approaches—don’t fit this neat model. They’re harder to explain in a fifteen-minute medical appointment. So doctors default to what they can explain quickly: CBT.
The Marketing Has Been Successful
The movement for “empirically supported treatments” has spent decades positioning CBT as the scientific, evidence-based choice. This marketing campaign has been remarkably effective. CBT advocates have successfully framed the conversation as “science-based CBT versus outdated approaches,” even though this framing misrepresents the actual research.
What the Research Actually Shows
Here’s where things get interesting. When you actually look at the research comparing different therapy approaches, a clear pattern emerges: multiple established approaches produce equivalent outcomes.
Head-to-head studies comparing CBT to psychodynamic therapy, interpersonal therapy, and other legitimate approaches consistently show no significant difference in effectiveness for most mental health conditions. This isn’t a secret in the research community—it’s been documented for decades.
The Limits of Randomized Controlled Trials
The push for “empirically supported treatments” relies heavily on randomized controlled trials (RCTs), which work well for testing medications. Give half the group a pill, give the other half a placebo, measure the difference. Clean and simple.
But therapy isn’t a pill. Therapists can’t be blinded to what approach they’re using. Clients know whether they’re talking about their childhood or completing thought records. The relationship between therapist and client introduces variables that don’t exist in drug trials.
This doesn’t mean RCTs are useless for therapy research—they provide valuable information. But insisting that only manualized treatments tested in RCTs count as “evidence-based” ignores a wealth of other research showing that multiple approaches work.
Why “Evidence-Based” Doesn’t Mean “Only Evidence-Based”
CBT has strong research support. But here’s what the CBT fundamentalists don’t mention: psychodynamic therapy, interpersonal therapy, emotion-focused therapy, and other approaches also have strong research support showing they work.
The problem isn’t that CBT lacks evidence. The problem is the marketing campaign claiming it’s the only approach with evidence, while dismissing equally effective approaches as “unscientific.” This is dogma, not science.
I’ve watched this play out in countless consultations. A parent calls and says, “My daughter’s pediatrician said she needs CBT for her anxiety.” When I ask what the anxiety looks like, I often learn that the real issue is family conflict, school stress, or a response to trauma—situations where other approaches might be more appropriate.
But the parent heard “CBT” from a doctor, so that’s what they think they need.
What Actually Matters More Than Technique
Here’s what decades of psychotherapy research consistently demonstrates: the therapeutic relationship predicts outcomes better than the specific technique used.
This finding has been replicated so many times it’s no longer controversial in the research community. The quality of the connection between therapist and client matters more than whether the therapist uses CBT, psychodynamic therapy, or another established approach.
What Makes a Good Therapist
The best therapists—and some really are better than others—share certain qualities that transcend their training in specific techniques:
- Strong interpersonal skills: They can build genuine rapport with diverse clients
- Flexibility: They adapt their approach to each person’s needs rather than forcing everyone into the same protocol
- Genuine humility: They’re honest about what they don’t know and when a client might benefit from a different approach
- Empathy and presence: They’re genuinely engaged with the client’s experience
These qualities matter far more than whether a therapist completed a CBT training program.
The Relationship Isn’t Soft Science
Some people hear “the relationship matters most” and think this is touchy-feely nonsense—the opposite of rigorous, scientific treatment. This couldn’t be more wrong.
The therapeutic relationship is a dynamic process involving attunement, emotional regulation, pattern recognition, and skilled intervention. It requires empathy, yes, but also keen observation, clinical judgment, and the ability to challenge clients productively.
This is sophisticated clinical work. It just doesn’t fit neatly into a treatment manual.
When CBT Is (and Isn’t) the Right Choice
I’m not arguing against CBT. I’m arguing against the idea that it’s the only legitimate approach or that you must find a CBT therapist because your doctor said so.
When CBT Often Works Well
CBT can be particularly effective for:
- Specific phobias (fear of flying, fear of dogs, etc.)
- Panic disorder
- Obsessive-compulsive disorder (especially when using Exposure and Response Prevention)
- Certain anxiety disorders where thought patterns are central to the problem
- Situations where a structured, skills-focused approach appeals to the client
When Other Approaches Might Be Better
For many people, other approaches offer distinct advantages:
- Relationship patterns: Psychodynamic therapy excels at helping people understand recurring patterns in relationships
- Identity and meaning: Existential or humanistic approaches address questions about purpose and values that CBT often bypasses
- Family dynamics: Systems-based approaches address the family patterns that maintain problems
- Trauma: Trauma-focused approaches designed specifically for processing traumatic experiences often work better than generic CBT
The Real Question
The question isn’t “Should I do CBT?” The question is “Will this particular therapist understand my situation and build a collaborative relationship with me?”
A skilled therapist will draw from multiple approaches—including CBT techniques when they’re useful—while tailoring the work to your specific needs.
How to Actually Choose a Therapist
Instead of searching specifically for CBT, here’s a better approach:
1. Look for Licensed Professionals with Real Training
Psychologists, licensed clinical social workers, licensed professional counselors—these credentials ensure someone has completed rigorous training and passed licensing exams. Be cautious about unlicensed practitioners offering “coaching” or “consulting” instead of therapy.
2. Ask About Their Approach to Your Specific Concern
When you call for a consultation, describe your situation and ask how they typically work with this kind of concern. Listen for:
- Do they ask questions to understand your situation, or do they immediately prescribe an approach?
- Do they explain their thinking, or just list their credentials?
- Do they sound like they’re following a script, or responding to you as an individual?
3. Prioritize the Relationship
Most therapists offer a brief consultation before starting. Use this to assess whether you feel heard and understood. Ask yourself:
- Can I imagine being vulnerable with this person?
- Do they seem genuinely interested in my situation?
- Do I feel talked at or talked with?
Trust your gut. The best technique in the world won’t help if you can’t build a working relationship with the therapist.
4. Don’t Be Afraid to Ask Direct Questions
- “My doctor recommended CBT. Do you think that’s the best approach for my situation?”
- “What other approaches do you use, and when?”
- “How will we know if therapy is working?”
Good therapists welcome these questions. Defensive or evasive responses are red flags.
The Insurance Reality
Here’s something else your doctor probably didn’t mention: many excellent therapists don’t take insurance specifically because insurance companies prioritize short-term CBT over other approaches.
This doesn’t mean you can’t use insurance. Many therapists are “out-of-network” providers who will give you documentation for insurance reimbursement. Depending on your plan, you may get 50-80% reimbursement.
For some people, paying out-of-pocket for the right therapist is worth it. For others, finding a good in-network provider is essential. There’s no right answer—just trade-offs to consider.
At Kingsbury, we’re an out-of-network provider specifically because we want the freedom to provide the approach each client needs, not what an insurance company will pay for. We provide documentation for reimbursement and offer a sliding scale based on income to make quality care accessible.
Bottom Line: You Don’t Need CBT—You Need a Good Therapist
When someone calls Kingsbury asking if we do CBT, the answer is yes. But the follow-up is always: “Let’s talk more and see if that’s what you need most right now.”
Because the truth is more nuanced than “CBT works” or “CBT doesn’t work.” CBT is one useful approach among several. The technique matters far less than:
- Whether the therapist can build a genuine relationship with you
- Whether they can adapt their approach to your specific needs
- Whether they have the clinical skill to know when what they’re doing isn’t working
Your doctor recommended CBT because it’s what they’ve heard about, what insurance covers easily, and what fits the medical model they understand. That doesn’t make it wrong—but it doesn’t make it the only choice either.
The best therapy for you is the one delivered by a skilled therapist who can connect with you as a person, not a diagnosis. Start there, and the specific techniques will follow.