What jumps out at me is that, as far as I know, CBT training focuses on having the therapist provide cognitive tools to reduce awful automatic thoughts and emotions. The therapist empowers the client. Some therapists bring from their own prior experience the ability to manage anxiety, shame, and guilt by leading the conversation, but others approach their work like computer programmers -- for them the task is to get the code in there. If you have ever seen a talented salesperson alternate pushing and withdrawal as they manage the prospect's anxiety and vanity while bringing them to a purchase, you have seen the element that is present in some CBT, but not part of the official training. Without that management by the therapist, the client may feel worse in sessions, and might come away with the sense that CBT is belittling. An irony here is that the greater respect of empowering the client may feel like less respect.
