CBT and psychoanalysis:

When Devorah came to see me, she sat down quietly and looked around the room. There was a long pause, one of those silences that can feel heavy and uncomfortable.

Part of me wanted to jump in, make small talk, help her feel safe. But I stopped myself.

Not because I didn’t care, but because sometimes what happens in silence is powerful.

I smiled and said gently,

“Try saying whatever’s on your mind. It can feel awkward at first, but most people get used to the quiet pretty quickly. It helps us notice what’s coming up inside, what your unconscious wants to say.”

Eventually, Devorah broke the silence.

“I’ve been having anxiety,” she said. “And I really need tools.”

That moment captures something I often feel as a therapist:

Part of me wants to go deep, explore what’s underneath the anxiety.
Another part of me wants to give her quick, practical strategies—because CBT and exposure therapy work. They bring real relief.
And both matter.

For those of us struggling with anxiety or OCD, tools are lifesavers. Thought records, exposure hierarchies, reframing things…these are ways we take back control instead of letting our fears or compulsions control us.

But here’s the thing: tools aren’t usually enough on their own, and I also want my clients to experience the benefits of a therapy relationship with me.

Why? Because anxiety often isn’t just a “symptom to fix.” It’s a signal, pointing to something deeper, something that needs understanding, not just management.

Silence gives space for that deeper work. In the quiet, feelings or associations come up that words haven’t yet caught up with. It’s not about power or withholding. It’s about listening—really listening—to what a person might not even know they’re feeling.

Here’s what I’ve learned:

CBT challenges our fears and beliefs.
Insight and connection soothe and regulate us relationally.

I wish more therapists were open to integrating these two approaches. It took me a long time in my own work to get over my resistance to using CBT because I associated going out of my comfort zone with losing control. Later I learned to enjoy the mastery that brings.

So yes, if you come to me for therapy, we’ll absolutely use CBT and exposure if you need them. But we’ll also slow down enough to notice what your anxiety is trying to tell you. Because long-term freedom isn’t just about control. It’s about knowing yourself—and feeling safe enough to be you (including in the silences) in the presence of someone else.