Why Clinicians Say They Hate CBT (And How to Change Their Minds)

Jacqueline Cohen
PhD, RPsych

I am passionate about my work. I get to lead a team that trains clinicians working in the public system in how to deliver evidence-based assessment and psychotherapy. The clinicians we train come from diverse training backgrounds and a variety of disciplines, yet they have one thing in common: They genuinely care about people, and they deliberately chose public mental health to serve the people who need it most.

Given that our team's mandate is to train clinicians in first- and second-line treatments for mental health problems, most of our trainings focus on cognitive and behavioural therapies (CBTs). Yet here's what perplexes me: Clinicians often walk into our trainings with negative views of CBT. When I dig deeper and ask what specifically they dislike, I discover that their understanding of CBT is fundamentally different from how I view and practice it.

This disconnect has taught me that we need to address these misconceptions head-on if we want to help trainees embrace evidence-based practice and CBTs. Here are the most common critiques I encounter:

“CBT is Anti-Emotion”

This misconception seems to stem from CBT's name itself – where’s "emotion" in "cognitive-behavioural therapy"? Many clinicians see CBT as focused solely on changing thoughts and actions, missing the emotional core entirely.

Yet emotions are central to the CBT I was taught. CBT is about how we live with our emotions – the cognitive and behavioural elements simply provide the methodology. Indeed, the behavioural components are fundamentally about learning to be with and tolerate our emotions, regulate them, and accept them. None of this emotional work can happen without first acknowledging emotions, experiencing them without suppressing or amplifying them, and understanding their function. CBT doesn't dismiss emotions; it provides concrete tools to experience and skilfully work with them.

"CBT Pathologizes the Individual"

This critique is more disconcerting to me. Some clinicians have learned a version of CBT that treats so-called "cognitive distortions" (a term I've always disliked) as inherent character flaws – as if the problem lies within the individual.

This couldn't be further from the CBT I learned and practice. Christine Padesky's groundbreaking 1989 paper transformed my entire therapeutic worldview. She argued that harmful thought patterns aren't internal defects – they’re learned responses to societal messages and environmental pressures. This perspective problematizes society and systems, not individual people.

When I work with clients, my stance is consistently: "Of course it makes sense that you think this way – look at what you were taught and what surrounds you." This approach feels profoundly more empathic and person-centred than models that locate problems in intrapsychic conflicts. It validates clients' experiences while empowering them to recognize that change is possible.

“CBT is Racist”

A related misconception is the idea that CBT is racist because of its focus on the individual rather than systems. While CBT did emerge from colonial intellectual traditions, this critique misunderstands what good CBT practice entails. CBT does not assume that real-world events are untrue or that pathology originates in problematic thinking. Rather, effective CBT helps us evaluate the systemic, discriminatory messages that society inculcates so we can recognize and reject them rather than internalize them. This approach situates racism, discrimination, and oppression as societal rather than personal problems. When we help clients identify and challenge internalized oppressive messages, we're not pathologizing their responses to real discrimination – we’re empowering them to resist harmful societal narratives while validating their lived experiences of systemic injustice.

"CBT is Too Simplistic"

This one stings. I once had a senior psychologist dismissively tell me, "Everyone can do CBT – it’s real therapy that requires skill." This critique suggests CBT lacks depth and fails to address root causes.

This misconception fundamentally misunderstands the sophistication required for effective CBT practice. Quality CBT is not formulaic – it demands an individualized, client-centred case conceptualization that flexibly adapts to individual and cultural differences. Each client brings unique experiences, values, beliefs, cultural contexts, and presenting concerns that require integration into treatment planning. Good CBT practitioners don't apply cookie-cutter interventions; they skilfully weave together assessment findings, cultural considerations, and individual strengths to create personalized treatment approaches. And the work isn’t superficial: Practitioners examine how experience shaped clients’ current beliefs and ways of being, and what needs to change so they can live the life they want.

Moreover, effective CBT is not didactic. Rather than lecturing clients, skilled practitioners use Socratic dialogue and guided discovery to help clients identify and act in accordance with their own values. This respects client autonomy while providing the structure needed for meaningful change. The therapist's role is to guide exploration, not to impose predetermined solutions.

What This Means for Training

If you're reading this, you're likely already a CBT practitioner who's encountered these same questions – either from within yourself or from skeptical colleagues and trainees. Whether we're working with graduate students, novice therapists, or veteran practitioners, people enter CBT trainings with preconceived notions about CBT that can interfere with learning.

Of course, questioning dominant schools of thought like CBT is not inherently problematic. Critical thinking and skepticism are valuable qualities, especially in this day and age, and critiques should be welcomed and thoughtfully evaluated. Our responsibility is to create space for these discussions while also carefully assessing where genuine concerns end and misconceptions begin. When we encounter critiques of CBT, we need to thoughtfully evaluate their merit rather than dismissing them outright, while also addressing misunderstandings that may be interfering with effective learning and practice.

Just as we do with any therapeutic target, we need to identify the beliefs at play, validate the concerns behind them, and then systematically address them. We can't assume that good training techniques alone will overcome deeply held misconceptions.

The clinicians we train are passionate about helping others – that’s why they chose this challenging field. Our job is to show them that CBT, properly described and practiced, aligns beautifully with their values of compassion, empowerment, and social justice. When we succeed in shifting these misconceptions, we open the door for evidence-based practice that truly serves the vulnerable populations we all care about.

Reference

Padeksy, C. A. (1989). Attaining and maintaining positive lesbian self-identity: A cognitive therapy approach. Women and Therapy, 8, 145-156.