We come to therapy because something isn't moving. We're stuck on a decision, trying to break a pattern, trying to feel different. For most of us, the first place we're directed is CBT—and it's a reasonable starting point. But if you've been there and it hasn't quite done what you hoped, this might explain why.
A few years back, I was going through a difficult period. I'd just come out of an emotionally draining breakup and had basically stopped sleeping more than three hours a night, and something in me had gone offline.
I was referred to an EAP therapist through work for six sessions. She was lovely—she'd ask how work was going, send me worksheets, help me schedule downtime. On paper, it was the right support.
We focused on my stress and anxiety. At the same time, there was a client at work who was steamrolling everyone around him. I was on a secondment wearing my lawyer hat and had spent years being the person in the room who could hold a boundary. But I couldn't hold one here. I couldn't protect my own peace, and I genuinely couldn't understand why.
The therapist didn't notice anything out of the ordinary. I just needed to start going for walks again, and once my workload reduced, it would be okay.
What I felt in those sessions wasn't the feeling of being held—it felt like I was holding her. They felt like another work meeting, one more thing to get through. I didn't know it then, but what was missing wasn't a technique or a worksheet. It was a nervous system that could meet mine.
What CBT does well, and what it doesn't reach
CBT is one of the most widely recommended forms of therapy in the world, and for good reason. It's structured, it's evidence-based, and it works for a lot of things. It teaches us to notice when we're catastrophising, when our internal narrative has drifted somewhere untethered from reality. For decision-making, the advice usually sounds like this: examine the evidence for and against your thoughts, challenge the fears underneath your hesitation, clarify your values. Reasonable, useful, and for many people, exactly right.
But so many of us are already living in our heads. We've read Kahneman and done the worksheets. We've mapped our values and tried to make decisions from a place of logic and self-knowledge. We understand our cognitive distortions and we know why our patterns formed—and still, when it comes to the decisions that truly matter, we can't find our way forward.
That's not a failure. It's what happens when we work exclusively from the top down, starting with thought and trying to analyse our way into clarity.
"When thinking is already where we live, more frameworks for thinking don't actually move us."
What's needed is something different—not a better way to analyse, but a way back into the body.
The gap between understanding and knowing
Think about a time you watched someone you care about stay stuck in something that clearly wasn't working—a job that was hollowing them out, a dynamic they kept returning to. You could see it, and they could see it too. And still, nothing moved.
Not because they lacked insight. They had plenty. It was that something else was holding them in place, something beneath the level of thought—a familiar ache they'd learned to call home, a fear that the other side might not actually be better, years of almost-deciding that had worn a groove so deep it felt like the only path. One day they might do something sudden, not because they found clarity, but because staying stuck finally became unbearable.
"Understanding and knowing are different things. Most of us have lived in that gap without ever naming it."
I've sat with people who can explain everything about their patterns. They've done the values work and read the books on nervous system regulation and they understand the theory. But there's a vast territory between naming what's happening and actually being able to move through it.
Why the body holds what the mind keeps missing
Neuroscientist Antonio Damasio spent years studying patients who had lost the ability to feel emotions due to brain damage, and what he found was striking: without access to their physical and emotional responses, they couldn't make decisions—not bad ones, but no decisions at all. They could analyse endlessly and remain completely paralysed.
He called these responses somatic markers, the physical signals your body sends in response to a choice. The tightness that comes with anxiety, the nausea when something is deeply wrong, the quiet settling when something feels aligned. These signals have been arriving your whole life, and most of us have simply spent a long time learning to talk over them.
Approaches like Somatic Experiencing, Sensorimotor Psychotherapy, and family constellations all work from this premise—that the body holds information the thinking mind can't reach. My own practice is rooted in constellations, somatic awareness, and a human-centred approach.
What happens in your chest when you picture yourself walking away from something? What shifts when you imagine staying another year? The body already has a response—the work isn't more analysis, it's learning to hear what's already there.
When stress has been running the show
There's a quieting that happens when we've been carrying pressure for too long. Not a peaceful quiet, but a going silent kind of quiet—what happens when something in us has been bracing for so long it stops signalling altogether.
Under chronic stress, the prefrontal cortex—the part responsible for nuanced thinking—doesn't just underperform, it gets bypassed entirely. The brain shifts to faster, more reactive patterns, the ones that evolved to keep us alive in danger. This is why cognitive strategies can feel hollow when we're already deep in it: we're being asked to think our way through a decision using the very part of ourselves that stress has switched off. It's not a willpower problem—it's a nervous system one.
Body-based work doesn't try to change our thinking. It works with the signals directly, the tightness, the breath, the cues the body has been sending all along. And when the body begins to feel safe, the prefrontal cortex comes back online on its own. The stories we've been trying to restructure lose their charge—not because we challenged them, but because the ground beneath them shifted.
"When the body begins to feel safe, a different kind of choosing becomes possible."
Not what's safest? but what do I actually want? What feels aligned, not just tolerable? What am I choosing from, rather than reacting to?
Why the relationship is the work
Your nervous system doesn't regulate on its own—it regulates in relationship. This is one of the central findings from polyvagal theory: we need the presence of another calm, regulated nervous system to help ours come back online. Co-regulation isn't an added extra; it's the mechanism.
That's what was missing in those EAP sessions. It wasn't the worksheets that failed—it was that I needed a nervous system that could hold mine while I found my way back.
In body-based counselling, the therapeutic relationship isn't just a container where techniques are delivered. It's where we learn, through direct experience, that it's safe to stop bracing. And from that safety, something shifts. The answer that was always there becomes obvious, and moving forward stops being a decision we're forcing and becomes the only path that makes sense.
"We find our way back to ourselves through the steady presence of others."
What this means for you
CBT is valuable—if you want structured tools to manage anxious thought patterns, if you need something evidence-based and grounded, it's a strong place to start.
But if you've done the cognitive work and you're still stuck, if you understand everything intellectually but find yourself circling the same questions, the issue probably isn't your thinking. It's that your body hasn't yet felt safe enough to let you hear what it already knows.
The decisions we've been agonising over aren't waiting for better analysis. They're waiting for us to arrive—present, grounded, finally able to listen.