Posted on 9th May 2025

Updated on 10th December 2025

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The Strengths and Limitations of Cognitive Behavioural Therapy (CBT)

And the case for Holistic Counselling and Therapy approaches…

By Jim Byrne, Doctor of Counselling

9th May 2025 and 21st November 2025

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Introduction

Most systems of counselling and therapy have

a cognitive (or thinking/perceiving/interpretation) component,
and an emotive component.

CBT also has a behavioural and habit-changing component.

But CBT does not sufficiently respect human emotions.

And it tends to blame the client for being upset by the problems of their daily lives. And it promotes “unconditional self-acceptance”, which is an amoral stance in life, and an open invitation to act immorally!

In this article, I want to outline the major theoretical strengths and weaknesses of cognitive behavioural therapy (CBT), and to suggest some emotive and lifestyle elements that need to be combined with CBT to make it more effective.

The theoretical strengths of CBT

Counselling research is poorly developed, in that there are no scientifically measurable features of the individual client which can be monitored objectively; and there are no reliable placebo control devices or processes. And to improve counselling research, to include empirically verifiable objective measurements, would cost millions of pounds or dollars; and nobody with such investment capital has any interest in investing in counselling research. (From my unpublished PhD proposal to the University of Leeds. See brief extract – the draft budget – here🙂

So we have to make judgements about various studies based on the statistical manipulation of subjective reports, which are of questionable value. One major view is that all the systems of counselling and therapy which have been compared with each other are broadly equivalent in terms of the benefits gained by the clients. (The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work, By Bruce E. Wampold).

Beyond that perspective, there is a split between two camps, one of which believes that CBT is the “cat’s pyjamas”, and one of which believes that it’s “the work of the Devil”. (See: Against and for CBT: Towards a Constructive Dialogue? Edited by Richard House and Del Loewenthal.)

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Theoretically, we could argue that CBT has the following potential strengths:

(1) It seems to encourage the client to think about their problems, which can engage their Adult ego state, and lift them out of feeling like a helpless victim of negative emotions.

(a) Afterthought: My second thoughts are often better than my first; and, upon reflection, it now seems to me that it is highly likely that the positive effects produced by CBT and REBT therapists are produced as a result of the therapist soothing the emotional arousal of the client, by their statements and non-verbal rejections of the client’s overly aroused affects. In other words, it seems highly likely – thought not currently provable – that CBT therapists achieve their positive outcomes in ways which are comparable to Affect Regulation therapists!

(2) CBT (and REBT) can teach individuals how to change behavioural habits, using rewards and penalties.

(a) This is essentially a behaviour therapy strategy, and not necessarily claimable as a “cognitive therapy” strategy or effect.

(3) CBT (and REBT) can teach some empowering perspectives, from Buddhism and Stoicism, including this one: “There are certain things you can control, but certain things are beyond your control. To avoid distressing frustrations, give up trying to control what is clearly beyond your control.”

(a) Is this “cognitive restructuring”? Or “affect regulation”? Or “behavioural advice”? Does it work because we change our thinking; or our feelings; or out expectations?

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I think it is important to bear in mind that, with all systems of therapy, it seems to be more the singer than the song that helps the client to heal themselves! The relationship between therapist and client is very important. (See: The Therapeutic Relationship in Counselling and Psychotherapy (Essential Issues in Counselling and Psychotherapy – Andrew Reeves)

And the client does most of the work! So good, diligent clients produce better results than procrastinating or unengaged clients, no matter whether their therapist uses CBT, person centred counselling, affect regulation therapy, or any one of the more than 400 different systems of counselling and therapy currently in use around the world! (This is the case, in so far as we have any evidence at all about what goes on in counselling and therapy sessions! The research funds are not forthcoming!)

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CBT is supposed to be “manualized”, which is supposed to “standardize” the treatment, but nobody inspects what goes on in CBT counselling sessions; and many of today’s “CBT therapists” are “Bishops of Bray”, going along with the flavour of the moment, until the winds change.

I have supervised and trained American CBT/REBT MA graduates who simply could not grasp the simple ABC model of REBT/CBT; and therefore what they did in the name of CBT/REBT was just whatever idea happened to come into their mind while talking to their client! (They may have owned The Manual, but the manual was not running the sessions!)

I know of so-called CBT therapists, or therapists who “also” offer CBT, but whose core model of therapy is the APET model from the Human Givens approach, which directly contradicts the ABC model of CBT. I know of person-centred counsellors who “also” offer CBT, but who are committed in heart and soul to being “non-directive”, while CBT is supposed to be actively directive.

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More on “the myth of manualization”!

It seems to me that Cognitive Behavioural Therapy (CBT) is on thin ice when it comes to being in contradiction with some major theories of human personality. For example, would it be fair to say that for CBT therapists, all counselling and therapy clients are “thinking types”, who cause their upsets by their distorted thinking? But is it not the case that the Myers Briggs (and Keirsey Bates) personality systems categorize humans into four types: the Thinking; the Feeling; the Sensing; and the Judging types?

So I checked this intuition of mine with Copilot, and this is what I got back:

“The tension arises because CBT fundamentally focuses on the role of thoughts in shaping emotions and behaviours, which can seem at odds with personality frameworks that highlight other dominant traits, such as feeling or sensing. However, CBT does not claim that everyone is exclusively a “thinking type.” Rather, it recognizes that while people may differ in how they process experiences—some relying more on emotions, others on intuition or judgment—distorted thinking patterns can still influence emotional distress across all personality types. Thus, CBT techniques can be adapted to fit clients with various personality preferences, working not just with thoughts but also with feelings and sensory experiences to promote psychological well-being.”

But is this eclectic approach not a contradiction of the simple ABC model of REBT/CBT?

Copilot writes: “While the ABC model in Rational Emotive Behaviour Therapy (REBT) and CBT emphasizes that emotional consequences (C) stem from beliefs (B) about activating events (A), the model is flexible enough to accommodate an eclectic approach. The ABC framework does not restrict therapists to addressing only thoughts; it allows for the integration of feelings and sensory experiences as part of the belief system. In practice, therapists may work with clients to explore how emotions, sensations, and judgments interact with thoughts, thereby enriching the process without contradicting the core principles of the ABC model. This adaptability supports the notion that CBT can be tailored to individual personality types while maintaining its foundational structure.”

But if CBT can be tailored to individual personality types – and feelings and sensory experience can be integrated with thinking, as part of the “belief system” – then CBT is not a Manualized Form of Therapy! It can be modified by the individual CBT therapist, who can ignore the rigour of the “B causes C” model, or indeed anything else which gets in the way of their intuitive assessment of the client’s situation. And, therefore, CBT is no different in principle or practice from other “non-manualized” approaches to counselling and therapy.

And thereby, one of the main defences of CBT is discarded into the dustbins of history!

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The front cover of "A Major Critique of REBT" by Dr Jim Byrne And I have personally written a critique of the many errors and flaws in the original form of CBT, which is entitled, “A Major Critique of REBT”.

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In my opinion, the single biggest problem with Cognitive Behavioural Therapy (CBT) is that it tends to focus too narrowly on changing thought patterns and behaviours, potentially overlooking deeper, underlying emotional or relational issues. While CBT seems to be highly effective for many individuals, its structured approach may not address the complexity of certain individuals’ experiences, which can limit its applicability for those who need a more holistic or personalized therapeutic approach. And, let us face it, most systems of counselling and therapy – which have been evaluated by the theorists of the Common Factors school of therapy – seem to be broadly equivalent in terms of outcomes. (But, as I mentioned above, we currently do not have a scientific means of assessing counselling and therapy systems. And we cannot come up with a convincing placebo for counselling, to be used in research projects!)

Transcending the limitations of CBT

To achieve a more holistic approach to counselling and psychotherapy, it is crucial to integrate techniques that acknowledge and validate the client’s emotional experiences. This can include methods from humanistic therapies that emphasize empathy and greater self-acceptance and positive regard, as well as elements from emotion-focused therapy, which encourages clients to explore and make sense of their emotional responses.

By combining these emotive techniques with the structured framework of CBT, therapists can better support clients in addressing not only their thoughts and behaviours but also their underlying emotional states, leading to more comprehensive and sustainable mental health outcomes.

Additionally, incorporating mindfulness practices can further enhance the therapeutic process. Mindfulness helps clients develop greater awareness and acceptance of their present-moment experiences, including their thoughts, feelings, and bodily sensations. This can reduce reactivity and increase self-regulation, providing clients with valuable tools to manage stress and emotional challenges.

When integrated with CBT, and/or emotive/affective systems of counselling and therapy, mindfulness can deepen clients’ understanding of their cognitive and emotive patterns, making it easier to identify and challenge maladaptive thoughts, perceptions and interpretations; and “racket emotions”.

Attachment issues

Another valuable addition to a holistic therapeutic approach is the incorporation of attachment theory. Attachment theory emphasizes the importance of early relationships and their impact on emotional development. Understanding a client’s attachment patterns can provide insight into their interpersonal dynamics and emotional regulation. By addressing attachment-related issues, therapists can help clients build healthier relationships and develop a secure sense of self.

Helping clients to manage their emotional affects

Affect regulation theory, which focuses on the processes by which individuals manage their emotional experiences, is also crucial. Techniques derived from affect regulation theory can assist clients in identifying, understanding, and modulating their emotions. This can lead to improved emotional resilience and stability, enabling clients to navigate life’s challenges more effectively.

Taking childhood personality adaptations into account

Additionally, personality adaptations theory offers a framework for understanding how individuals develop coping mechanisms and behavioural patterns based on their adaptations to their parents in early childhood. By recognizing these adaptations, therapists can tailor their interventions to align with the client’s acquired strengths and vulnerabilities, fostering more personalized and effective therapeutic outcomes.

Holistic counselling and therapy

Integrating these theories can enhance the therapeutic process by providing a more comprehensive understanding of the client’s emotional landscape and equipping them with tools to manage their emotions and relationships. Ultimately, a multifaceted approach that combines cognitive, emotive, and behavioural techniques with insights from attachment theory, affect regulation theory, and personality adaptations theory can lead to more profound and lasting improvements in mental health and well-being.

But that is not all…

Lifestyle factors coaching

Furthermore, lifestyle factors such as diet, exercise, and sleep play a significant role in a client’s mental health functioning. A balanced diet rich in essential nutrients can positively impact brain health, mood stability, and overall well-being. Regular physical activity has been shown to reduce symptoms of anxiety and depression, enhance cognitive function, and promote better sleep quality.

Sleep, in particular, is crucial for mental health. Adequate sleep supports emotional regulation, cognitive performance, and resilience to stress. Poor sleep patterns can exacerbate mental health issues and hinder the therapeutic process. Encouraging clients to adopt healthy lifestyle habits can complement therapeutic interventions and enhance their effectiveness.

And nutrition is foundational. Our brains need a broad range of nutrients, interacting with out neurotransmitters, in order to work properly.

Therapists can incorporate lifestyle recommendations into their treatment plans by educating clients about the importance of nutrition, exercise, and sleep hygiene. By addressing these fundamental aspects of well-being, therapists can support clients in achieving a more balanced and holistic state of mental health.

And then there is the need to learn how to relax, in order to overcome tension and anxiety problems.

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Recommended books:

The following books should be of help to therapists who want to broaden their practice into a more holistic mode:

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Lifestyle Counselling and Coaching for the Whole Person

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Neglect Your Sleep, Wreck Your Health and Happiness

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How to control your anger, anxiety and depression, using nutrition and physical activity.

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Relax Your Way to a Better Life…