Psychodynamic Psychotherapy vs CBT: Which to Choose?
Psychodynamic Psychotherapy versus CBT (Cognitive Behavioural Therapy)
When it comes to thinking about different forms of therapy, the two most often referenced therapies are that of Cognitive Behavioural Therapy and Psychodynamic Psychotherapy. Cognitive behavioural therapy on the one hand has emerged more recently as a panacea of all things mental health, while psychodynamic psychotherapy has been pushed to the side lines (but still very much at the forefront of favoured therapy.) Proponents of psychodynamic psychotherapy have argued that for many mental health issues longer term work is required, while proponents of CBT favour briefer interventions. In part their popularity has centred on their demonstrations of effectiveness within research but the differences between them have often resulted in confusion. We try to clear up some of the confusion between these two dominant therapies highlighting their differences and weighting up their pros and cons. After reading about psychodynamic psychotherapy vs CBT, you should have a good idea of which one may better suit your needs and goals or, you may feel that another approach is more suitable.
Cognitive Behavioural Therapy
By combining the theory and techniques behind both cognitive and behavioural therapies, CBT sought to define an approach that focuses on the interaction between our thoughts, feelings, bodily responses and behaviour. In particular, the work of Aaron T. Beck and Albert Ellis in looking at how emotional responses result from our thoughts was combined with the work of behaviourists such as Ivan Pavlov, John Watson and B.F Skinner whose work looked at the reinforcing power of behaviour. Together, this fusion of theories sought to focus on how individuals were thinking about their lives and how these thoughts have an impact on the way you behave. By changing negative patterns of thinking or behaviour, CBT argues that you can change any negative emotions you might be feeling. Further unlike other forms of psychotherapy, CBT focuses specifically on the problems and difficulties in the present, rather than issues based in the past.
Key Features of CBT
- Its brief and time-limited
- Focuses on what’s happening in the present rather than the past
- Setting an agenda for each session means that its highly structured
- Relationship with the therapist in not a focus of the treatment
- Homework is a central element – work continues outside of the therapy room
- Collaborative in nature – you and the therapist work together to set goals
Pros of CBT
- Brief and goal focused
- More affordable (because it’s shorter in length)
- Empowering – by teaching practical techniques and homework – put techniques into use even once therapy has concluded.
- Strong scientific support for its effectiveness in a number of issues
- Collaborative - you and your therapist work as a team
Cons of CBT
- Can feel superficial – only addresses current issues and ignores issues from childhood
- Need to put in the hard work – your therapist can support you but you need to be doing the skills outside of the sessions
- Due to the highly structured nature it might not be suitable for those with complex mental health needs or learning disabilities
- Looks at the individuals need to change and ignores wider problems i.e. society or families
Psychodynamic Psychotherapy
Psychodynamic psychotherapy takes its roots in the theories and work of Sigmund Freud and his ideas regarding psychoanalysis (the long-term “talking cure”). Put briefly, this type of therapy stresses the significance of our early childhood experiences and how they continue to affect us during adulthood. It also argues that human behaviour arises from both conscious and unconscious motives and that the act itself of talking about problems can help people find ways of understanding how their past influences their present behaviour. To do this, psychodynamic psychotherapy relies heavily on the therapeutic relationship and its ability to highlight to both therapist and client the aspects of their experience which are impacting on their relationships. Major techniques used by psychodynamic therapists include free association, recognising resistance and transference, counter-transference, catharsis, and building a strong therapeutic alliance.
Key Features of Psychodynamic Psychotherapy
- Often longer in nature (ranging from a few months to years)
- Less Structured and typically without homework assignments
- The client, not the therapist sets the agenda for the session by talking about whatever is on their mind
- Focuses on the here and now, as well as personal history
- The relationship between the client and the therapist is included as a focus of therapy
- Less intense than Psychoanalysis
Pros of Psychodynamic Psychotherapy
- Addresses the root causes of psychological distress and the complexity of human behaviour
- One of the few therapies to focus on personality
- Benefits from therapy can increase over time
- Encourages free expression
- Looking at themes that arise in the therapeutic relationship may reveal useful information
- You direct what’s talked about
Cons of Psychodynamic Psychotherapy
- Less structured than CBT
- Longer term commitment required
- Can be expensive (due to length of therapy)
- Discusses childhood/personal history which some may not wish to do
- Requires interpretation from the therapist – lacks objectivity
- Relies on theoretical constructs that are difficult to prove – i.e. unconscious mind
- Difficult to test in an empirical manner
So there you have it… the two major therapies in use today reduced down to their bare essentials. What is key to remember is that despite these advantages and disadvantages getting the most out of therapy is not about going with the most popular but about finding a therapy that suits your needs and helps you to achieve what you want to. Several therapists will have been trained in both therapeutic schools, which means that by selecting an integrative therapist, you can have treatment tailored to your presenting concerns. Often therapists begin working with CBT techniques to help with symptom relief, and they move towards more dynamic work with the client over time. There are also different types of therapies outside of CBT and Psychodynamic Psychotherapy (see here for a glossary of therapy approaches) and there are many factors to take into account when looking at what type/s of therapy and which therapist might be a good choice for you.
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Tags: cbt, psychodynamic psychotherapy
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