In my clinical training, I received an interesting blend of Relational-Cultural Theory (RCT) during our deeper discussion courses, and the “gold standard” of mental health treatment, Cognitive Behavioral Therapy (CBT). While RCT aligned with my values and inspired me, CBT felt solid. As a young therapist, a book full of CBT worksheets to “fix” my clients felt essential to my work. I learned the scripts, created charts for measurable change, and encouraged clients to track their quantifiable progress. I came prepared!
Throughout these efforts, my first supervisor met my enthusiastic charts with questions about the therapeutic relationship, about my own connections with clients, and about the experience we were co-creating. For a while, I tried to hold both RCT and CBT equally. But with more experience, I heard things like, “yeah, duh, I know that, I just can’t feel it.” While there are fantastic mental hygiene skills offered in the annals of CBT, hearing something is different from integrating it.
What’s CBT got to offer?
When someone calls for a therapy appointment, particularly if they’ve been consulting Dr. Internet, or an insurance company website, they frequently ask if we have anyone who specializes in CBT. A quick search will demonstrate that CBT is one of the most researched approaches to mental health. CBT offers clients tools for reality-checking their thoughts, as well as some exploration of the interplay between beliefs, actions, and thinking. Clients might take home a list of prompts as reminders in between sessions.
These prompts can help build insight and reduce suffering, especially when used skillfully and collaboratively. But when worksheets become the main event—detached from relationship, context, and culture—they can inadvertently reinforce the very disconnection that many clients come to therapy to heal. The challenge is, what are we measuring? How do we know we’re successful?
The difference between knowing, and experiencing
From a Relational-Cultural Therapy perspective, this is where we pause.
RCT reminds us that symptoms—whether anxious thoughts, depressive beliefs, or painful behaviors—don’t float in isolation. They emerge from a person’s relational and cultural history. Sometimes a so-called “distortion” is actually a survival strategy. Sometimes a thought isn’t irrational—it’s a learned truth from a world that hasn’t always been safe. There are several RCT concepts that fit here– Strategies of Disconnection/Survival is just one.
When a client says, “People will leave me if I ask for too much,” CBT might ask for the evidence.
An RCT therapist might ask, “Where did you learn that? What’s the story behind this belief?”
Then they might wonder aloud, “Have you ever been in a relationship that showed you something different?”
There’s power in naming, and CBT has given us useful tools for noticing how our thoughts shape our experiences. But growth doesn’t always come from replacing thoughts with “more rational” ones. (Come. on. Do you even Star Trek?) It often comes from being seen in the places those thoughts came from—held with compassion, not corrected with logic. Healing comes from integrating the thinking, the sensations, the experience, the emotions, the belonging, all held in a growth-fostering relationship.
CBT worksheets aren’t the problem. But using them without relationship, without curiosity, without honoring the wisdom beneath someone’s coping strategies? That’s where the work risks becoming shallow, even shaming.