Cognitive Behavioral Therapy
You can usually see the thought is irrational, and you think it anyway.
For people who can already argue against their own anxious thoughts and still lose. We use CBT as something you practice, not something you understand.
What It Is
In plain language
Almost everyone who arrives asking for CBT has already done a version of it on their own. You have read the list of cognitive distortions. You can name catastrophizing while it is happening. You can explain, calmly and accurately, why the email you sent at 4pm was fine. And then you lie there at midnight anyway with your jaw tight, running it again.
That gap is the actual problem, and it is not a sign that CBT does not work for you. It is a sign that the version you have been doing lives entirely in your head. Thoughts that were built by years of evidence do not fall over because you disagree with them once. They change when you collect different evidence, on purpose, in your real life, and when your body gets a vote.
Cognitive behavioral therapy works from a simple observation: what you think, what you feel, and what you do are wired together, and you can enter that loop from any of the three doors. Most anxiety loops are self-sealing. You predict something will go badly, you avoid it or over-prepare for it, nothing bad happens, and you credit the avoidance rather than the prediction being wrong. The belief survives untested.
Think of an anxious belief as a rumor that never gets fact-checked. Every time you avoid the thing, the rumor gets treated as confirmed and passed along again. CBT is the fact-check. Not an argument about whether the rumor is fair, but a plain look at what actually happens when you stop acting as though it were true.
In practice that means two kinds of work. Cognitive work: catching the specific sentence your mind produces, in the words it actually uses, and testing it against what you can observe. Behavioral work: doing the small thing you have been routing around, deliberately, and watching what your nervous system does. The second one is where the change usually lives. Insight tells you the rumor is probably false. Experience is what finally retires it.
At a Glance
- Shelley Davidescu, LMFT, 17 years in practice
- In person in Bankers Hill, San Diego
- Telehealth Monday through Friday across California
- Free 15-minute consultation
Individual sessions are $210, or $325 for 90 minutes. Couples sessions are $225, or $345 for 90 minutes.
All of my methodsIn a Session
What this actually involves
Step through it. This is the shape of the work, not a script we follow line by line.
Not the theme, the sentence. People say they have low confidence. What they are thinking at 9:40 in the morning is closer to: if I ask this question they will realize I have been guessing for two years. We work with that one, because that is the one running.
Fit
Best for, and not for
Worth knowing before you book, so neither of us spends four sessions finding out.
Best For
- People who want something concrete to do this week, not only something to understand
- Anxiety that shows up around performance, health worry, decisions, or specific avoided situations
- Anyone who has read the self-help and can explain the concept but cannot get it to move the feeling
- People who like structure, homework that is short, and a clear sense of whether it is working
Not For
- If you need crisis or inpatient-level care, structured weekly therapy is not the right first step, and I will help you find the right level of care instead
- If the distress comes mostly from an unprocessed memory rather than a present-day prediction, EMDR is usually the better place to start and we would say so early
If you are in crisis, call or text 988. If I am not the right clinician for what you are carrying, I will say so and help you find someone who is.
How I Use It
Where this sits in the rest of the work
I rarely use CBT alone, because pure thought work asks a body to calm down by being reasoned with, and bodies do not take instruction well. So the cognitive piece usually runs alongside something physical: a breath pattern that actually lengthens the exhale, a way to notice where the tension sits before it becomes a full spike, a short grounding sequence for the drive home. When the body has a way down, the thought work has somewhere to land.
It also folds into everything else I do. In couples work, the thought that your partner's silence means contempt is exactly the kind of prediction worth testing out loud. In trauma work, CBT is often what holds the week steady while we do slower processing. I am direct about what is working: if six weeks of thought records have not shifted anything, we stop doing them and look at what we are missing rather than asking you to try harder.
Questions
Answered plainly
Anything not covered here is worth asking on the free 15-minute consult.
Related Reading
Is CBT just positive thinking?
No. Positive thinking asks you to believe something nicer. CBT asks what is actually true, which sometimes lands on a harder answer than the anxious one and sometimes on a plainer one. The point is accuracy, not cheerfulness.
Do I have to do homework?
There is usually something small between sessions, because the change happens in your week rather than in my office. If it does not fit your life, tell me and we will make it smaller. I would rather you do a ninety-second version five times than a thorough version never.
How long does CBT take?
It depends on what you are bringing and how long it has been running. Some people notice their week feels different within a couple of months, others are working on something older. I do not make any guarantees about timelines, and we check in regularly about whether this is going somewhere.
Can we combine CBT with the deeper work?
That is usually how it goes. Skills first, so your week is livable, then the slower look at where the belief was learned. Many people do CBT and EMDR in the same course of therapy, in that order.
Do you do CBT over telehealth?
Yes. It works well remotely because so much of it is collaborative writing and planning, and we can look at the same thought record on screen. Telehealth is available Monday through Friday anywhere in California.
Free 15-Minute Consult
Fifteen minutes to find out whether this is the right work.
Tell me what is actually going on. I will tell you honestly how I would approach it, and whether I am the right person for it.
In person in San Diego, and by telehealth across California.