Psychodynamic Therapy vs CBT

Searching for a therapist means coming across terms that might be new to you, such as “cognitive behavioral therapy” – isn’t therapy just, well, therapy? Not quite. While many forms of therapy focus on covering a groundswell of mental health and emotional problems plaguing clients, such as treating PTSD or marriage counseling, there are two major schools of thought in the field of therapy. 

Cognitive Behavior Therapy and Psychodynamic Therapy are both examples of talking therapy types that are very effective when helping recover from a potential disorder, but for different reasons. So, which one is right for you? Let’s get into the differences between these two types of talk therapy, what they offer to patients, and what else you might need to know so you can decide which form of therapy – and which type of therapist – suits your current needs best.

How CBT Works

Cognitive Behavioral Therapy, also known as CBT, is a generally short-term therapeutic relationship that encourages patients to disrupt thinking or behavioral patterns in order to change feelings and behaviors. If a patient is thinking consistently negative thoughts, for instance, CBT catches those negative thoughts in the moment and changes them to rational thinking. CBT focused therapists focus on finding practical solutions to present problems that can arise with any mental health condition. They will teach behavioral skills like examining responses to anxiety with concrete skills that challenge that thinking and feeling. 

Instead of looking for the root of the issue, CBT uses other clinical psychology tools to help patients confront what is going on in their lives. Sessions often include homework assignments or “action plans' ' such as journaling (especially about negative thoughts that arise during the day), practicing positive reinforcements, visualization techniques, meditation, and breathing exercises. Other times, sessions might focus solely on facing a fear instead of avoidance, role-playing to prepare for future interactions, or learning ways to calm and relax the mind and body in anxiety-provoking situations. 

Let's say a patient is rejected by a love interest or goes through a breakup. They may be saying, “I will never find a partner again!” or “No one will ever love me!” A CBT therapist would ask patients, “what else could be true?” in an effort to help them develop thoughts beyond the negative, like: “You and your partner are no longer together, but that does not mean you will never be with another person again.”

Clinical trials have found CBT is extremely effective for many mental health issues, including anything and everything from schizophrenia and addiction or substance abuse issues to generalized social anxiety and depression or chronic insomnia. It’s also only supposed to be two to three months, on average, and some therapists use a rigid CBT practice during sessions, while others might play around with elements of other interpersonal therapy treatments.

Regardless, repetition and practice are integral to successful rounds of CBT. Patients are encouraged to address rational concerns and go up against those irrational beliefs, ruminations, or catastrophizing thoughts, which is done best by repeatedly challenging them. CBT is going to be the most effective when the patient and therapist work together to find as many solutions as possible to the present problem.

How Psychodynamic Therapy Works

Psychodynamic theory and/or psychoanalytic therapy is more a long-term therapeutic approach, where the therapist works through complex emotions getting in the way of thoughts and behaviors. The goal of the psychodynamic approach is to work with feelings that will lead to internal changes. Think of it as looking back on your past to understand where and why you're in the present. 

Sessions might look like examining relationship and attachment styles, exploring how your relationship with your parents affected you, how you and your siblings interacted, and any other insights your early life and childhood may have impacted your adult self. Interpersonal struggles, your personality as a whole, emotional development, and patterns in work, relationships, and life are all up for investigation. 

Let’s go back to the patient going through a breakup. During this session, a therapist might ask for more about what it means that the patient is not in a relationship. The idea is to look for emotional themes and patterns in a patient’s life. An emotional narrative will usually begin to form with time – in this case, perhaps the patient sabotages relationships in an effort to avoid commitment – allowing the therapist to return to why a specific feeling keeps a patient in a negative state of mind, or why a patient has trouble changing behaviors. 

The overall goal of psychodynamic therapy is to improve self-awareness, and by proxy, self-empowerment in the patient. A greater understanding of the self – both now and in the past – is what the patient and therapist aim to reach so that the patient can heal emotional wounds and shift from unhealthy cognitive and relationship patterns to healthier ones. It’s also fairly effective, and definitely works better for “persistent and complex problems,” according to a study from Jonathan Shedler published by the American Psychological Association. Often this form of therapy leads to transformative moments and major changes, even after the end of treatment. So while presenting behaviors may continue, it has the capacity to shift in the long term. 

Unlike other forms of therapy like CBT, psychodynamic therapy doesn’t have a set end date. It can last from months to years, depending on the issues presented. It may take a while for patients to start changing behaviors, but it’s usually used to treat mental health issues such as long-term depression, anxiety disorders, adjustment disorders, eating disorders, various phobias, and so on. However, you don’t need to have a specific mental health diagnosis to benefit from psychodynamic therapy. In fact, many patients undergo it just to explore, learn, and walk away with a better understanding of themselves.

Which to Choose: CBT or Psychodynamic Therapy? 

Many patients come into therapy with an issue that is currently making their lives harder to manage, so CBT makes the most sense to help alleviate symptoms. Others start with psychodynamic therapy to heal their suffering around emotions, or do it after doing CBT, or find that it works best when they’re done in tandem. 

Patients might walk away saying they’ve learned a lot about themselves in psychodynamic therapy because the process is more experiential and insightful, while CBT uses skill-based work to pinpoint the root of issues and reverse them. It’s really up to the patient, the work they want to do, and how they wish to understand themselves. 

For some patients, the fact that CBT is often short-term and low commitment is a plus. It’s also helpful for very specific instances, like taking on a new role at work that’s leading to a lot of stress. Other patients prefer the work of psychodynamic and psychoanalytic therapy because it’s focused on feelings, relationships, and the current state of emotions. CBT can be seen as too intellectually focused or rigid, while psychodynamic therapy sessions can be seen as too time-consuming and far less structured. One route many people take for a less-committed treatment is online therapy, since an online therapist makes it easier for many people to be able to attend therapy sessions. While online therapy can be good for those looking for less of a commitment, there are many pros and cons of online counseling.

Remember, CBT and psychodynamic therapy are not the only forms of therapy! They’re just two of the most common. EMDR, brainspotting, and more may be more useful to you. That said, most therapists use some kind of combination of approaches. Patients can look for “integrative therapists” if they want to try both CBT and psychodynamic therapy together, or can talk to their therapists about how to incorporate more of one or the other form of therapy into sessions together. At the end of the day, therapists will always work with the patient to find the best solutions to their issues. If a therapy career seems like the right fit for you, contact us today to help get yourself started on your path to becoming a mental health professional.