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Cognitive-behavioural therapy or CBT, is an approach that explores the way we interpret situations. CBT supports unhelpful negative or unrealistic ideas or perspectives about ourselves and the world around us, which impact on our mood and cause anxiety or critical thoughts.


If you choose to attend CBT sessions, you will find it is structured in its response to your experiences. I will ask questions as a way of gathering information to clarify and understand your experience. I will also work with you to look for evidence concerning your thoughts and encourage you to reflect on whether there is any reality to the way you choose to react or think.



What will happen in the session?


CBT is a collaborative way of working, you are responsible for the direction and the change you make. I may offer guidance in developing the strategies involved in working with CBT and we will share observations. You may be asked to carry out small tasks outside the sessions, such as self monitoring of your thoughts and reactions. We will then explore what you bring back to the session and examine possible alternative thoughts, behaviour and perspectives. This way of working puts you at the centre of your life and offers "tools" or coping strategies to be your own counsellor beyond the sessions.


Why choose CBT?


The National Institute for Clinical Excellence (NICE) recommends CBT as an effective option for depression, anxiety and trauma.


Do you use any other approaches?


My approach to working with you will always include my committment to respecting and valuing your experience. I may also work with a Mindfulness approach, which is a meditation and awareness practice often used with CBT. It offers ways to become more engaged in the present moment rather than dwelling in the past or thinking about the future, which is often not in your control. It supports ways of understanding the relationship between your thoughts, behaviour and feelings through observng without reaction or judgement.


An example of unhelpful thinking


Carole is a teacher, she has just finished teaching a challenging class. She walks down the corridor to the staff room and sees her head teacher ahead of her, when they pass she appears to ignore her. How might you react; here are some possible thoughts that might go through your mind:




Unhelpful thinking and reaction: My head has just ignored me – have I done something wrong, maybe she is annoyed with me, was it because I got those marks in late, maybe she doesnt like me, or I must be so useless she can't even be bothered to say hello.


Emotional Feelings


Unhelpful:  I feel low, worthless and rejected.

Helpful:  I feel concerned for my head teacher, perhaps she is having a bad day?


Physical Symptoms


acid in my stomach

feeling a sense of panic

feeling low in mood which impacts on my motivation


Helpful:  None – feel comfortable or concerned




reaction or behaviour


Unhelpful: go home and avoid friends and family

dread seeing your head teacher and going into school

reconfirms your past feeling that you she doesn't like you

and you need to avoid her


Helpful:  Get in touch to make sure they’re OK.


More helpful thinking and reactions:  He/she looks preoccupied, she must have so much to deal with, I wonder if she is okay, or if she is under pressure, perhaps she has had a bad day, maybe she is in a rush and didn't see me?


If we were to work together, a CBT approach could support you to challenge the cycle of unhelpful thinking, feelings and behaviour. We would then work with observing when these reactions arise and identify patterns around this, looking at alternative thinking and reactions. When you stand back and give yourself space to see the sequence of events more clearly, you can change the way you feel.










































© 2013 Ebb & Flow Counselling, Ann Rapstoff, all rights reserved








leads to changes in mood

or uncomfortable feelings

behaviour such as isolate yourself,  are snappy with partner, don't want to go back into work

initial thoughts 

bodily sensations such as

anxiety, sweating, panic

situation or event 

Cognitive Behavioural Therapy or CBT



“Life is like the river, sometimes it sweeps you gently along and sometimes the rapids come out of nowhere.”


Emma Smith

Ann Rapstoff, Individual & Couples Counselling,

Psychotherapy, Mindfulness & CBT

T: 07703 182 186 E:

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