Psychodynamic Psychotherapy vs CBT: Which to Choose?

Psychodynamic Psychotherapy vs CBT

Psychodynamic Psychotherapy versus CBT (Cognitive Behavioural Therapy)

When it comes to thinking about different forms of therapy, the two therapies that come up most often are  Cognitive Behavioural Therapy and Psychodynamic Psychotherapy.

Both of these forms of therapy are popular because research has demonstrated their effectiveness. Cognitive behavioural therapy  has emerged more recently and is often seen as a panacea of all things mental health, while psychodynamic psychotherapy although pushed to the side lines is still very much a favoured type of therapy. Supporters of psychodynamic psychotherapy argue that for many mental health issues, longer term work is required, while supporters of CBT favour briefer interventions.

So the length of the therapeutic process is one main difference. But that aside there is still a lot of confusion around these two types of popular therapy. This article weighs up the differences as well as the pros and cons so that you can have a better idea of which one might suit your needs or goals, or if you need another type of therapy entirely.

Cognitive Behavioural Therapy

CBT argues that you can change any negative emotions you might be feeling by changing negative patterns of thinking or behaviour. Unlike other forms of psychotherapy, CBT focuses specifically on the problems and difficulties in the present, rather than issues based in the past.

CBT came into being when the theory and techniques behind both cognitive and behavioural therapies where combined to create an approach that looks at the interaction between our thoughts, feelings, bodily responses and behaviour. The focus was  also on how on we as individuals think about our lives, and how these thoughts about our lives have an impact on the way we behave.  The work of Aaron T. Beck and Albert Ellis that examines 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.

Key Features of CBT

  • It’s brief and time-limited
  • Focuses on what’s happening in the present rather than the past
  • It’s highly structured- an agenda is set for each session
  • The 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 it’s 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 individual’s 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 of talking about problems itself 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-  – the relationship that develops between the therapist and client. It provides an opportunity to examine this relationship in a safe arena and see how it reflects other relationships that we have (or had). And it works to make this relationship between therapist and client a strong one.

Major techniques used by psychodynamic therapists include free association, recognising resistance and transference (unconsciously transferring feelings about a person or event in the past onto a person or event in the present), counter-transference (feelings evoked in the therapist by the client’s transference), and catharsis (intense emotional release).

 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 kind, but about finding a therapy that suits your needs and helps you to achieve what you want to.

Many therapists train in both therapeutic schools, which means that by selecting what is known as an ‘integrative therapist’ you can have your treatment tailored to your concerns. Often therapists begin working with CBT techniques to help with symptom relief, and they move towards more psychodynamic work with the client over time.

There are of course many 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.

Do you have any further questions? Or would you like to share your own experiences about psychodynamic psychotherapy vs CBT? Share in the comment box below, we love hearing from you. 

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