Practical tools for the patterns running your day.
Written by Gerry McNamara, LMFTLast reviewed May 2026
CBT and DBT are the practical, day-to-day half of how I work. Both give you skills you can actually use — to interrupt the loops that aren't serving you and to build new ones that do.
Request a free 15-min consultation →Specific skills, not just understanding.
CBT and DBT both belong to the practical-skills end of therapy. They give you specific, repeatable tools you can use between sessions, not just insights to take home.
Cognitive behavioral therapy works with the loops between your thoughts, feelings, body sensations, and behaviors. Those loops are what keep anxiety running, what makes depression heavy, and what makes certain patterns unbreakable on willpower alone. CBT gives you concrete places to interrupt them.
Dialectical behavior therapy was developed when CBT alone wasn't enough, especially around emotion regulation and distress tolerance. DBT isn't as widely known as CBT, but it's genuinely useful and one I reach for often. The two are cousins; in practice I pull from whichever fits the moment.
None of this is "think your way out of feelings." It's closer to: notice the loop, find the leverage point, and practice a different move until it becomes available without effort.
Skills today, insight alongside.
CBT and DBT skills are half of how I work. The other half — exploring deeper childhood and relationship patterns — happens alongside, not after.
I work on two levels at once: building practical skills you can use today, while exploring deeper childhood and relationship patterns. CBT and DBT are the day-to-day tools. The psychodynamic work happens in the same sessions, often in the same conversations.
For some clients, the skills come first and the deeper work follows. For others it's the opposite. The order depends on what your nervous system can hold and what you most need traction on. We talk about it explicitly.
Questions I get asked about CBT and DBT.
What's the difference between CBT and DBT?
Both are practical, skills-based approaches in the same family. CBT (cognitive behavioral therapy) focuses on identifying and interrupting unhelpful thought-feeling-behavior loops — the patterns that keep anxiety, depression, or stuck behaviors running. DBT (dialectical behavior therapy) was developed for situations where CBT alone wasn't enough, especially around big emotion regulation and distress tolerance. In practice, the two overlap a lot. I pull from whichever fits the moment.Is CBT just thinking yourself out of feelings?
No. That's the cartoon version. Real CBT looks at how thoughts, feelings, body sensations, and behaviors loop into each other — and gives you specific places to interrupt the loop. Sometimes that's a thought-level shift. Sometimes it's behavior-level. Sometimes the loop has trauma underneath it and we need slower work before CBT will land. The skill is matching the intervention to what's actually happening, not forcing every problem into a thought-record.How long does CBT or DBT-based therapy take?
It depends. For specific, situational problems — a phobia, a clear anxiety loop, a distress-tolerance crisis — CBT and DBT skills can produce noticeable change in 8 to 16 sessions. For patterns that are older or more woven in, the practical skills work alongside slower psychodynamic and trauma-informed work. We talk realistically about that at the consult.Will I get homework?
Sometimes. CBT and DBT both work better when you practice the skills between sessions, so I might suggest a worksheet, a behavior to try, or a way to track a pattern. None of it is required, and none of it gets graded. The point is to make the work portable — what we do in session has to live in your week, not just your hour.
The rest of how I work.
Psychodynamic work
The depth half of the work. Understanding the patterns that have been running you, often since childhood.
Read moreTrauma-informed approach
Pacing the work safely. Trauma-informed isn't a separate modality; it's a posture I bring to everything.
Read moreAnxiety therapy
Where CBT and DBT show up most. Practical, multi-modal anxiety therapy for adults across Oregon.
Read more
Ready to talk it through? Let's see if we're a fit.
Send a message, or set up a free 15-minute phone consult. You can reach me by email, call, or text. I'll get back to you within two business days.