If you’re an integrative counsellor in private practice, CBT can sometimes feel like this:
- You explain the model well.
- The client understands themselves better.
- You have “good sessions.”
- …and yet the change is slower than you expected.
When people say “CBT doesn’t work” in private practice, it’s usually not CBT failing. It’s one of these three implementation problems.
1) Sessions stay in “insight mode” instead of “change mode”
What it looks like
- Lots of talking, processing, understanding.
- The same themes repeat every week.
- The client feels validated, but life outside the room doesn’t shift much.
Why this blocks CBT
CBT is a learning model. It works best when you create new experiences (behavioural change) that update threat predictions and beliefs. If sessions don’t include a clear intervention step, progress becomes vague.
What to do instead
Use this rule:
One target. One intervention. One practice step.
In every session, decide:
- Target: avoidance? reassurance? rumination? low activity? safety behaviours?
- Intervention: experiment? exposure/ERP? behavioural activation? problem-solving? cognitive technique?
- Practice: one tiny between-session step
Pivot line you can use in-session (non-robotic):
“This is really useful insight. Let’s turn it into one small experiment for this week so we can test something in real life.”
2) Homework doesn’t happen (or it’s too big / too vague)
What it looks like
- Homework is agreed, then not done.
- Next session becomes: “What got in the way?” → new homework → repeat.
- You start feeling like CBT is “homework therapy,” and the client starts feeling judged.
Why this blocks CBT
Between-session practice is where most learning happens, but homework fails when it isn’t:
- small
- specific
- scheduled
- reviewable
- …and when it doesn’t have a plan for barriers.
What to do instead
Make homework “bad-day doable.”
A simple system:
- Shrink it until confidence is 7/10 or more
- Schedule it (day/time/place)
- Add an If–Then plan for the obstacle you already know will happen
Homework line that keeps rapport:
“This isn’t a test. It’s practice data. Even if it doesn’t happen, we learn exactly what to adjust.”
Better examples
- Vague: “Try to challenge your thoughts.”
- Specific: “When worry starts, write one line in the worry log and postpone it to a 20-minute worry window at 7pm (3 times this week).”
3) The therapist gets pulled into reassurance, rumination, and safety behaviours
What it looks like
- Clients ask for certainty: “Do you think I’m okay?”
- Sessions become “worry content debates” (especially with GAD/health anxiety).
- You unintentionally become part of the safety system: reassuring, checking, analysing endlessly.
Why this blocks CBT
Reassurance and rumination reduce anxiety short-term, but strengthen threat beliefs long-term. The client feels calmer in the session, but the cycle gets reinforced between sessions.
What to do instead
Shift from content → process:
- Don’t try to “solve” the worry.
- Work on the worry habit, uncertainty tolerance, and safety behaviour reduction.
Warm boundary script (works well):
“I can’t give certainty because it feeds the cycle. What I can do is help you practise responding differently to uncertainty.”
Rumination redirect:
“That’s another ‘what if’. Let’s look at the pattern: when that worry shows up, what do you do next?”
Then choose one action:
- IU experiment (uncertainty practice)
- response prevention plan (reduce checking/reassurance)
- behavioural experiment
- exposure step
A quick “CBT is working when…” checklist
CBT usually starts moving when you can see:
- a clear maintaining cycle
- one target per session (not 5)
- one active intervention (not just discussion)
- one small scheduled practice step
- a trend in measures or behaviour (even small)
- reduced avoidance/safety behaviours over time
If those elements are missing, CBT often feels ineffective even when everyone is trying hard.
A practical takeaway for private practice
If you’re shopping for CBT CPD, don’t only ask “Is it evidence-based?”
Ask: Will it help me execute CBT in the room next week?
The most useful resources for private practice usually include:
- session structure (agenda → intervention → homework)
- templates that reduce prep time
- scripts for stuck moments
- quick decision guides (“what to do next”)
Free resource (optional, non-salesy)
If you’d like a practical starting point, offer a free download here:
15-minute pre-session checklist + session agenda template
(Insert link)