What to Expect from Cognitive Behvioural Therapy (CBT) and Compassion Focused Therapy (CFT)?
This guide explains both approaches, what sessions are like, and how they can complement each other.
What is Cognitive Behavioural Therapy?
Cognitive Behavioural Therapy (CBT) is a practical, structured therapy based on the idea that our thoughts, feelings, body sensations and behaviours are closely connected. When we're struggling, unhelpful patterns can develop and keep difficulties going. For example, worrying thoughts can lead to avoidance, which brings short-term relief but strengthens the anxiety over time.
CBT helps you notice these patterns, understand how they work, and try different ways of responding. It's recommended by NICE for a range of difficulties, including depression, anxiety disorders, OCD and PTSD.
What happens in CBT sessions?
CBT is collaborative. We work as a team, and you're an active partner in the process.
• Setting goals. We agree what you want to change and how we'll know it's working.
• Building a shared understanding. Together we map out how your difficulties developed and what keeps them going. This is sometimes called a formulation.
• Structured sessions. Each session usually has an agenda, so we use the time well. We review how things have been, work on a focus for the day, and agree what to try before next time.
• Trying things out. Between sessions, you might practise a new skill, keep a short record of your thoughts and moods, or run a "behavioural experiment" to test a worry in real life.
• Looking at thoughts. You'll learn to spot unhelpful thinking patterns and consider more balanced alternatives. This isn't about "thinking positive". It's about thinking accurately and flexibly.
Many people find CBT is time-limited, often somewhere between 6 and 20 sessions depending on what you're working on, though this varies.
What is Compassion-Focused Therapy?
Compassion-Focused Therapy (CFT) was developed by Professor Paul Gilbert. It was created particularly for people who struggle with shame and harsh self-criticism, and who may find that knowing something logically ("I know I'm not a bad person") doesn't change how they feel.
CFT draws on evolutionary psychology and neuroscience. It describes three broad emotion systems in all of us:
• The threat system: detects danger and brings anxiety, anger or disgust
• The drive system: motivates us to seek, achieve and acquire
• The soothing system: linked to calm, safety, connection and care
For many people who've been through difficult experiences, the threat system is overactive and the soothing system is underdeveloped. CFT aims to help rebalance these, so you can feel safer and more settled in yourself and in relationships.
What happens in CFT sessions?
CFT is gentle and paced to suit you. You might explore:
• Understanding your mind. Learning how your brain and body evolved to protect you, and that many of your struggles aren't your fault
• Compassionate mind training. Practising skills such as soothing rhythm breathing, mindful attention and developing a kind, steady inner voice
• Imagery. Imagining a compassionate figure or place that feels safe and supportive
• Working with your inner critic. Understanding where self-criticism comes from, what it's trying to do, and how to respond with more encouragement
• Compassionate letter writing and reflection. Using writing to support yourself through difficult feelings
Some people find the idea of self-compassion uncomfortable at first, especially if kindness felt unsafe or unfamiliar growing up. That's very common, and we'd go slowly.
How do they work together?
CBT and CFT can complement each other well. CBT offers clear tools to change unhelpful patterns, while CFT helps create the warmth and safety that make change feel possible. If self-criticism or shame gets in the way of CBT techniques (for example, "I should be able to do this by now"), bringing in compassion can make a real difference.
A therapist trained in both can tailor the balance to you, using more structure in some sessions and more compassion-based work in others.
Is it right for me?
Both approaches can help with a wide range of difficulties, including anxiety, low mood, stress, trauma and low self-esteem. Whether they're the best fit depends on your needs, preferences and goals. In an initial conversation, we can talk through the options honestly, including whether another approach would suit you better.
Taking the first step
You don't need to have it all figured out to begin. If you're curious about whether CBT or CFT could help, I offer a free 15-minute consultation. You can contact me using the Contact button above.
This article is for general information and isn't a substitute for professional advice or treatment. If you're in crisis, please contact your GP, call NHS 111, call Samaritans on 116 123, or dial 999 in an emergency.