Psychodynamic Psychotherapy vs CBT: Which to Choose?

by Andrea M. Darcy

Two forms of talk therapy in particular stand out as popular. Not least as they are shown by research to produce results. But when it comes to psychodynamic psychotherapy.vs CBT, how can you know which one is right for you?

[To find cognitive behaviour therapists or psychotherapists available for online sessions worldwide, you can visit the harleytherapy.com platform.]

What is cognitive behavioural therapy?

Cognitive behavioural therapy , or “CBT” for short, is a newer entry to the world of therapy than its psychodynamic counterpart.  And from calming anxiety, to helping with depression and PTSD? It’s often hailed as a panacea for all things mental health.

As a form of brief therapy, you and your therapist will decide to meet between five to 20 meetings on average. There might possibly a few follow-up sessions after that.

How does CBT work?

CBT came into being when the theory and techniques behind both cognitive and behavioural therapies where combined. Aaron T. Beck and Albert Ellis were psychologists that examined how emotional responses result from our thoughts. Their work 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.

This created an approach that looks at the interaction between our thoughts, feelings, bodily responses and behaviour. In other words, the thoughts we have about our lives affect the way we act.

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.

Key Features of CBT

• brief and time-limited
• focuses on what’s happening in the present rather than the past
• highly structured- an agenda is set for each session
• the relationship with the therapist is 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 therapy (because it’s shorter in length)
• empowering – by teaching practical techniques that you can put 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 cognitive behavioural therapy

• only addresses current issues and ignores issues from childhood
• requires hard work as you need to be practicing the skills outside of the sessions
• its highly structured nature means it might not be suitable for those with complex mental health needs or learning disabilities
• the focus on your individual need to change ignores wider problems i.e. society or families.

What is psychodynamic psychotherapy?

Psychodynamic psychotherapy has been rather pushed to the side lines since the emergence and popularity of CBT. But it is still very much a favoured type of therapy.

A longer-term therapy, you and your therapist will usually work together until you agree that you are ready to end your work. Or, of course, if you decide that you are ready to end your therapy sessions.

Psychodynamic psychotherapy has its roots in the theories and work of Sigmund Freud, and his ideas regarding psychoanalysis.

How does psychodynamic talk therapy work?

This form 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 talk therapy relies heavily on the therapeutic relationship. This is the relationship that develops between the therapist and client. In therapy you will examine this relationship, and see how it reflects other relationships that you have (or had).

Techniques used by psychodynamic therapists

These include:

• free association
• recognising resistance
• noticing transference (unconsciously transferring feelings about a person or event in the past onto a person or event in the present)
• and also counter-transference (feelings evoked in the therapist by the client’s transference)
• catharsis (intense emotional release).

Key Features of Psychodynamic Psychotherapy

• longer in nature (ranging from a few months to years)
• less structured and typically without homework assignments
• the client and not the therapist sets the agenda for the session by talking about whatever is on their mind
• focuses on the here and now but also your personal history
• the relationship between the client and the therapist is included as a focus of therapy.

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

• 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.

Psychodynamic psychotherapy vs CBT

So to summarise psychodynamic psychotherapy vs CBT, we could say:

• longer term and open-ended vs short-term and contracted 
• looks often to the past to solve the present vs mostly present-focused
• the past creates your current issues vs your thoughts create a cycle that creates your issues 
• client led and open vs therapist led and structured
• session based vs also has homework and skills practice between sessions
• focus on the client-therapist relationship vs focus just on the individual. 

Can’t decide? The main thing to keep in mind

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. This 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, then move towards more psychodynamic work with the client over time.

There are of course many different types of therapies outside of CBT and psychodynamic P]psychotherapy (see here for a glossary of therapy approaches) So do not feel that if neither of these two types of therapy appeals it’s a lost cost. There are over fifty types of talk therapy to choose from, so there is bound to be one that is just right for you.

Ready to try CBT therapy or psychodynamic therapy? We connect you with some of London’s most highly trained and rated therapists. Or use our booking platform to find UK-wide talk therapists and online counsellors you can work with from the UK or overseas. 

Andrea M. Darcy is a mental health writer and a therapy consultant who found CBT life changing. Find her on instagram @am_darcy