Xiaojie on Cognitive Behavior Therapy: A Therapist's Honest Take

I originally written this article in English. After obtaining the preliminary Chinese translation from Deepseek, I personally refined the content with localized adaptations to bridge cultural differences between Eastern and Western perspectives, and to accommodate varying levels of psychological knowledge among readers.

本文原文我用英文撰写，中文翻译经由Deepseek完成初译后，我基于中西方文化差异和读者心理学知识背景的不同，对译文进行了细致的本地化调整和内容优化。

Author: Xiaojie Qin 2025

作者：秦小杰2025

I first learned about black-and-white thinking in the early 2010s while studying psychology—and to my surprise, I realized it was how I’d been operating for years. That was just the beginning of discovering how many cognitive distortions I’d been blind to. If I admired a supervisor, I’d feel quite uncomfortable about any criticism of them, even when it made sense. In my 20s, my self-judgment swung between extremes: one day I was ‘brilliant,’ the next a ‘total loser.’ Life felt like sailing a shaky boat on an unpredictable ocean. I was at the mercy of the weather, never knowing when the next wave might wipe me out on bad days. I wish I’d known about this earlier; it could have spared me years of disorientation and fear.

2010年代初接触心理学时，我第一次认识到'非黑即白'的思维模式——震惊地发现这竟是我多年的心理惯性。而这只是觉察众多认知扭曲的开始。当我敬重某位前辈时，听到对他们的批评就像眼里进了沙子，明明知道该审视却总自然的抛之脑后；二十多岁时，我的自我评价总在沾沾自喜的'做得不错'和自惭形秽的'彻底搞砸了'之间剧烈摇摆。那时的生活就像乘着小舟漂在海上，晴雨无常。我对风浪毫无把握，每次天气带强风就害怕自己会被打翻，因为根本不知道该如何应对。要是能早点接触心理学或者是心理咨询，或许就不会在迷惘不安中度过最青春的那十年。

Discovering cognitive distortions introduced me to Cognitive Behavior Therapy (CBT) and gave me something revolutionary: a framework to analyze how my mind operates. That space let me observe, question my assumptions, and slowly change. When applying for my master's degree, I naturally favored programs that taught CBT as a core modality - which led me to choose Monash University's Master of Counselling. By the time I became a therapist, CBT felt like second nature. It was the cornerstone of my graduate training in counseling, and I’d also lived its transformative potential.

认知扭曲的发现，为我打开了认知行为疗法（CBT）的大门，更带来我成长的革命性的改变：一个解析自己思维运作的框架。这个视角让我能够观察自己的思维，质疑那些根深蒂固的思维模式，并逐步实现改变。申请硕士项目时，我本能地倾向以CBT为核心课程的院校——这最终指引我选择了蒙纳士大学的心理咨询硕士项目。当我开始作为心理咨询师接待来访时，CBT已如同我的第二本能。它不仅是我专业训练的根基，我亲身经历过它的蜕变力量。

CBT’s signature strength lies in its framework for understanding cognition. With therapy newcomers, I’d watch their faces light up when recognizing distortions like ‘mind-reading’ or ‘emotional reasoning’ for the first time—that moment of ‘Wait, just because I feel like a failure doesn’t mean I am one.’ Some of my clients have shared struggles, commonly with overwhelm, constant distraction, and deep frustration with their rumination. In our sessions, we worked on distinguishing between what feels urgent versus what’s truly important—a breakthrough realization. Our brains often confuse intensity with importance.

CBT helps us understand thinking in two ways: sideways and depth-wise. The "Cognitive Triad" looks at thoughts sideways across three gears—how we see Self ("I’m in danger"), World ("They want to hurt me"), and the Future ("I might not survive"). In real sessions, these aren’t dry concepts but vivid stories clients share through tears or fear, sometimes filling an entire session. Then there’s the depth view: thoughts stack like a staircase. At the top are automatic reactions ("They’ll reject me"), deeper down are life rules that drive actions ("Why try when I might fail?" pushing us to overwork or avoid), and at the bottom lie core beliefs ("I’m unworthy") that color everything.

As I’ve grown as a therapist, I now recognize recurring patterns much faster—when clients return with a same same but different story, I can pinpoint the roots of their struggle with increasing precision. It’s like the difference between a novice and expert physiotherapist: Where a junior might focus on the aching knee (the presenting symptom), an advanced practitioner traces the pain to an old foot injury (the core issue)—the real culprit behind the misaligned knee and strained pelvis (and yes—as a long-termyoga practitioner and teacher, I am fascinated by the human skeletal and muscular structure.). Treatment begins at the source. This sharpened vision lets me formulate cases and craft treatment plans not just increasingly more accurately, but efficiently.

认知行为疗法（CBT）最打动我的地方，是它总能带来那些"啊哈时刻"，这都基于疗法提供了认知理解的框架。——当来访者第一次意识到"原来我一直在读心术（揣测别人的想法）"，或者发现"我把情绪当事实"时，他们眼睛突然亮起来的那个瞬间，就像有人突然对你说："等等，觉得失败不代表真的失败啊！"很多来找我咨询的人都描述过类似的困扰：脑子里像有十个频道在同时播放，明明没做什么却累得像被掏空，总是控制不住反复想同一件事，越想越烦躁。在咨询室里，当我们一起练习分辨"看似紧急"和"真正重要"的区别时，总会有这样的神奇时刻——来访者突然意识到："原来我一直自动把情绪强烈的事情当作最重要的事"。我能清晰地看到，对面那个原本紧绷的身体渐渐舒展开来，眉头不再紧锁，呼吸也慢慢沉到了腹部。

认知行为疗法（CBT）从两个维度帮助我们理解思维：横向和纵向。"认知三角"横向审视我们对自我（"我很危险"）、世界（"他们想伤害我"）和未来（"我可能活不下去"）的看法。在实际咨询中，这些并非枯燥的理论，而是来访者含着眼泪或带着恐惧讲述的真实故事，有时候故事讲述会占据整个咨询时段。而纵向来看，思维就像层层堆叠的阶梯：最表层是自动反应（"他们会拒绝我"），更深层是驱动行为的生活准则及中间信念（"既然可能会失败，何必尝试？"这种念头让人过度工作或逃避），最底层则是影响一切的核心理念（"我不配"）。

随着咨询经验的积累，我现在能更快识别那些反复出现的模式——当来访者带着"相同却又不同"的故事回来时，像一个外科手术大夫一样，我能更精准定位问题的根源。这就像新手与资深理疗师的区别：新手可能只盯着疼痛的膝盖（表症），而行家却能追溯到陈年的足部旧伤（核心问题）——这才是导致膝关节错位和骨盆紧张的真正元凶（没错，我也是一个瑜伽习练者，每周都会教一节瑜伽课，我对人体骨骼肌肉结构有着执着的痴迷）。心理咨询必须从源头着手。这种日益敏锐的洞察力，让我制定的个案概念化和治疗方案不仅越来越精准，而且高效。

To me, this mirrors the psychoanalytic concept of consciousness and unconsciousness—just framed in CBT terms. The more I explore different therapy modalities, the more I notice their profound interconnections. What fascinates me most are these points of convergence, which vividly reaffirm the Daoist wisdom I've always embraced. But that’s a story for another chapter, on my increasingly integrated approach in my therapy practice.

对我而言，这恰似精神分析中"意识与潜意识"的概念——只是用CBT的术语重新诠释。当我越深入探索不同疗法流派，就越能发现它们之间深刻的共通之处。而最吸引我的正是这些交融点，它们再次印证了我一直认同的道家智慧。在之后的章节中，我会讲到，在我的咨询方式和技术上，我是如何逐渐向整合方式上转变的。

Zooming out from cognition, CBT’s full framework has a playful nickname: the ‘hot cross bun’ model. It maps the interplay between thoughts, behaviors, physical sensations, and emotions—often analyzed within a specific life situation or those seemingly inescapable, debilitating patterns we all know too well. Looking back, I now see CBT’s distinctly analytical flavor—something I couldn’t articulate when I barely knew other modalities as a newbie therapist. No wonder it resonated with me. My mind has always operated analytically: from excelling in math and science during my school years, to earning my first master's in Development Evaluation and Management at the University of Antwerp, to applying those skills as a monitoring and evaluation specialist in an international NGO. These experiences systematically sharpened my analytical abilities and problem-solving frameworks—both professionally and in life.

When I became a therapist, I defaulted to what I knew best: giving people concrete elements to examine, reflect on, and change. There’s comfort in that tangibility—in a framework that makes the abstract feel ‘usable.’

认知在CBT的框架中，只是其中的一个模块。当我们用无人机般的全景视角来观察CBT时，会发现其完整框架包含四个基本模块：思想、行为、躯体感受和情绪——这个组合有个可爱的昵称，叫"热十字面包"模型（在西方文化中，"热十字面包"（hot cross bun）是复活节传统食品，面包表面的十字象征基督教信仰；而在CBT中，这个十字形象地分割出四个相互作用的心理模块。）更重要的是，我们要关注这些模块之间动态的相互作用关系。常常会发现，当我们"头脑发热"时，其实是特定生活情境激活了我们早已形成、却未被觉察的那些令人疲惫的顽固模式。回望过去，如今我能清晰辨识CBT鲜明的分析特质——而当年作为一个新手咨询师，对别的流派了解很少的我是审视不到的。难怪它如此契合我的思维模式：学生时代数理成绩名列前茅，第一个硕士在安特卫普大学攻读发展与评估。随后，归国后多年在国际发展组织从事项目监测和评估的工作，大量参与系统构建分析与数据剖析的工作，这些精力又进一步加强了我这样的认知偏好和能力。

因此当我成为心理咨询师时，很自然地选择了自己最熟悉的工作方式：为来访者提供具体的认知要素供他们检验、反思和改变。当抽象的心理活动信息被装进清晰的框架里，改变就变得触手可及，至少在理论层面。

(I look at this with pride indeed. full score on ‘working with data’. I was nerdy, and still I am. 我第一个硕士学位的成绩单，只要跟数据相关的成绩，都拿了高分，包括‘和数据工作’的这个单元拿了💯，骄傲不骄傲)

CBT comes with ‘homework’. Unless there’s a good reason not to, I almost always assign it. Some homework is experimental—like gathering data for our next session. Others focus on practicing new skills, or working toward concrete goals (e.g., ‘stop working after 8pm’ for a recovering ‘workaholic’). It could be journaling, organizing therapy notes into a resource list, watching a documentary that I recommend to them, or even taking a walk in the evening 3 times a week without the phone.

Of course, assigning homework isn't as straightforward as it seems. There's real art to it - how specific should the task be? What type actually fits this particular client? How do we frame the discussion around it? What happens when a client wants to focus on one thing, but I believe something else would serve them better? And how do we handle it when homework doesn't get done? Even what we call it matters - 'homework' might work for some clients, while others respond better to 'between-session exercises'.

At its core though, when done right, these between-session tasks become the engine that moves therapy forward - even though our relationship exists almost entirely within those four walls of the therapy room, well, or on the four corners of our computer screen.

One brilliant teen client adored their journaling homework that unpacks triggering moments. She’d return with detailed ‘hot-cross-bun’ style entries, eager to read them aloud before I could even ask. I’d probe for missing details, highlight patterns, and eventually we named her ‘protective parts’ (this is not a CBT term, but commonly used in Internal Family System, which I’ll explain in my other chapters)—like Iron Curtain and White Tiger, each with their own strengths and purposes. Through these discoveries, we could work directly with The Iron Curtain, that descends like a mute barrier, and the White Tiger, all claws and no softness.

CBT会布置"作业"。除非特殊情况，我基本都会安排。这些作业可能是：记录情绪为下次咨询准备素材，练习新学的技巧，或是完成具体目标（比如让工作狂"晚上8点后不工作"）。也可能是写日记、整理咨询笔记、看我推荐的纪录片，或者每周三次不带手机散步。

当然，布置作业可没那么简单。这里头很有讲究：任务要具体到什么程度？哪种类型最适合这位来访？怎么讨论作业内容？当来访想练A，我却觉得B更有效时怎么办？作业没完成又该如何处理？就连称呼也有门道——有人适合叫"作业"，有人更喜欢"心理练习"。

说到底，只要安排得当，这些课后任务就能成为推动咨询进展的"发动机"——尽管我们的咨访关系基本只存在于咨询室的四壁之间，或是2020年代的电脑屏幕的方寸之地。

总有那么几个来访特别喜欢作业，我有一个就读北京某国际学校的青少年来访者，格外钟情于日记作业，记录下自己心情点被触发时的事情和心里活动过。她总会带着详实的「热十字面包」式的记录来到咨询室，还没等我开口就迫不及待地朗读。我会引导她补充遗漏的细节，梳理其中的模式，后来我们甚至为她的「防御部分」命名(此处使用的"部分(parts)"概念虽非CBT术语，而是内在家庭系统疗法(IFS)的核心理念，关于这套体系我将在后续章节详细展开)——比如「铁幕」象征突然的沉默屏障，「白虎」代表只有锋芒没有柔情的状态。

Beyond its proven effectiveness, CBT’s popularity stems from its short-term, cost-efficient structure—making it a preferred choice for governments and healthcare systems worldwide. National programs like the UK’s NHS Talking Therapies and Canada’s Ontario Structured Psychotherapy Program actively promote CBT for mild-to-moderate conditions, citing its rapid symptom relief and high return on investment. Employers and insurers also favor it: Employee Assistance Programs (EAPs) typically cover only 3–18 sessions per year, and hospitals under national health plans or premium insurance often reimburse just brief therapy. (reviewed and heavily edited with evidence by DeepSeek) Over coffee in Beijing, a friend who runs a counseling company for Chinese students abroad mentioned she strongly prefers working with CBT-trained therapists over psychoanalytic practitioners—primarily because of CBT’s short-term effectiveness.

认知行为治疗在国际上的通用程度很高，在国内的应用程度也越来越广。除实证疗效外，CBT的流行还得益于其短程、经济的特点——这使其成为全球医疗体系的首选方案。英国"NHS谈话疗法"、加拿大"安大略结构化心理治疗项目"等国家级计划都积极推广CBT用于轻中度症状，正是看中其见效快、投入产出比高的优势。雇主与保险公司也青睐这种模式：员工援助计划（EAP）通常每年只覆盖3-18次咨询，而医保体系下的医院或高端保险也倾向报销短程治疗。（这个部分我的原文经DeepSeek核查证据并深度编辑）在北京，有次我和一位朋友喝咖啡时聊到——她经营着一家为海外中国留学生提供心理咨询服务的公司——她说自己更倾向与接受过CBT培训的咨询师合作，而非精神分析流派的治疗师，正是因为CBT短期就能见效的特点。

While CBT has helped many clients, I quickly discovered its limitations - and my own growing edges as a therapist. That's the beautiful challenge of our work: you never know which approach will resonate with each unique person who walks through your door.

I first became aware of CBT’s distinctive style when several clients—particularly Chinese clients—commented on how much more structured my sessions felt compared to their previous therapy experiences, which seem to be primarily psychoanalytic or person-centered. The responses to my CBT-oriented approach varied dramatically. Some clients flourished with the clear framework, experiencing breakthroughs in self-awareness and meaningful change. Others found it constricting - I remember sessions where the tension was palpable as we struggled between my instinct to be guided by the structure and their need for open exploration.

CBT确实帮到了不少来访者，但我也很快发现了它的局限——以及我自己作为心理咨询师需要成长空间。这份工作的美妙之处就在于此：你永远不知道下一个推门进来的独特个体，会更适合哪种咨询手法。

最早让我意识到CBT特质的，是来访者的反馈。我会不定期的跟来访探讨我们咨询的方向、节奏和方式，这能让我更好的及时调整咨询方案、达到最佳效果。在我咨询的初期，好些来访，特别是部分中国来访，不约而同提到，我的咨询比起他们之前的咨询体验"框架感强得多"，经过一些简单的了解，我大致的推论是之前的咨询师多为精神分析或者是人本主义疗法方向的。

对这种结构化的工作方式，来访者的反应天差地别：有人在这种清晰的框架下如鱼得水，获得了觉察和改变；也有些来访者会感到被束缚——我清楚地记得那些充满张力的时刻：当来访者沉浸在漫无目的的叙述中，而我的结构化咨询框架要求我温和地引导他们聚焦或转换话题时，有些人的挫败感会瞬间爆发。这种干预有时会引发强烈的情绪反应，甚至暂时动摇我们的治疗联盟，曾经也有人再也没有回来咨询。

Those moments forced me to reflect: Was this CBT’s limitation, or mine? The truth is, while CBT provides invaluable structure, rigidly adhering to it (or any modality) risks missing the person in front of you. It’s a therapist’s trap—one I am learning to navigate by balancing frameworks with attunement, and it’s a long life process.

A more profound limitation emerged: cognitive insight alone doesn’t guarantee behavior change. Like a surgeon, I learned that even the sharpest tools have their limits. Early in my career, I’d watch clients master CBT’s ‘mental anatomy’—mapping thoughts, emotions, and behaviors with precision—yet still struggle to act differently.

Therapy, like surgery, demands the right tool for each layer of the work. A scalpel (CBT) might expose the problem, but sometimes you need forceps (EMDR) to lift emotional blockages, or sutures (IFS) to mend deeper patterns. No single instrument does it all. Those plateaus push me to learn other modalities, and taught me to adapt—switching tools even mid-session when the mind’s ‘tissue’ required a different approach.

这些咨询实战的困难让我不断思考：问题到底出在CBT本身，还是我的使用方式？虽然CBT的结构化框架很有价值，但如果死板地套用（不管什么疗法），反而会让咨询师和来访者之间失去联结感——就像两个人明明面对面坐着，却像隔着一堵玻璃墙在交流。这是很多咨询师都会遇到的职业挑战，而我的日积月累的咨询经验，让我平衡好两个相互牵拉的力量：既要保持专业框架，又要保持对来访当下状态和需求的敏感，这需要终身的修炼。

随着咨询经验增加，我逐渐认识到CBT更深层的局限：认知上的领悟并不必然带来行为改变。就像外科医生最锋利的手术刀也有力所不及之时，我目睹过太多来访者进阶到可以精准分析自己的"心理构造"——理清想法、情绪和行为之间的关联，却依然难以真正改变行动模式。

心理咨询和外科手术有些雷同，需要针对不同"心理层面"选择合适的工具。认知行为疗法（CBT）如同手术刀，能精准剖析问题；但有时需要眼动治疗（EMDR）这样的镊子，才能移除情绪淤堵；或者需要内在家庭系统疗法（IFS）这样的缝合线，来修复深层的行为模式。没有任何一种工具能解决所有问题——正是这些咨询瓶颈促使我学习其他咨询流派，教会我灵活转换疗法，当来访者的"心理组织"需要不同干预方式时，及时调整心理咨询方案和策略。

What might be the hardest challenge for any therapist: defining a therapy modality simply yet accurately. I turned to Deepseek for help distilling CBT’s essence—

对任何咨询师来说，最棘手的挑战莫过于：如何既简洁又准确地定义一种疗法。于是我向Deepseek求助，希望它能帮我提炼CBT的精髓——

Disclaimer: 

1. I worked with Deepseek for three purposes: 1) editorial role: to refine this article - improving grammar, clarifying ideas, and smoothing the flow - while carefully preserving my personal voice, therapeutic perspective, and original intent. All therapeutic insights and opinions remain my own. 2). to double check facts regarding CBT’s application in the world 3) translate my writing from English to Chinese.

2. Case examples in this work are either generically described scenarios without representing any single client, or real client case shared with their consent. These reflections represent generalized therapeutic observations.

   
   

特别声明：

1. 这篇文章在撰写过程中，使用了Deepseek，仅限于三个层面：1）编辑润色：对文章进行语法优化、观点澄清及行文流畅性调整，但严格保留我的个人风格、专业理念与核心观点。所有心理咨询见解与立场均出自本人；2）核实CBT在全球应用情况的相关事实；3）完成英文至中文的文本初步翻译。

2. 文中案例均为去标识化处理后的通用共性描述，内容仅代表普遍性心理咨询实操反思，或来访以授权于我的真实案例分享。