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Mental Health Matters

CBT or Psychodynamic Therapy

CBT or Psychodynamic Therapy

CBT or Psychodynamic Therapy

Which is better?  I hear this question a lot, and the ultimate answer is: it depends.

Cognitive Behavioral therapy (CBT) is a short term (often 12 session) approach to treatment that encourages changing your thinking, in order to change your feelings and behaviors.  The therapist often helps you identify catastrophic and negative thoughts running through your head and can give you “homework” to catch and change those thoughts to more rational and realistic ones.

For example, if you get rejected for a job, and you get depressed, saying, “I am never going to find work!” the CBT clinician might ask, “What else could be true?”  The therapist might help you develop other thoughts, such as, “You didn’t get this job, but it doesn’t mean you won’t get the next one,” and “I didn’t get this job, but I will do better in the next interview.”

Often CBT clinicians will also teach behavioral skills that you might not have learned before, for example, examining your responses to anxiety-producing situations.  Studies have shown that after three months, many of the presenting symptoms have abated, although there is debate on how long those results last (Cornelius, 2014, Shedler, 2010, 2015).

Psychodynamic Therapy Addresses More Complex Emotions

Psychodynamic and psychoanalytic therapy is usually longer term work, as it is based on more than just the stated symptoms someone walks into treatment with.  The therapist makes the assumption that the symptoms are an indicator of a more complex set of emotions that are getting in your way, and that working with feelings will lead to changes in thoughts and behaviors.

For example, if you walk in and report feeling depressed over job prospects, the dynamic therapist might ask you to say more about what it means to not find a job, looking for themes in your emotional life.  Over time, you might look at patterns in your life where these themes recur:  are there patterns of self-sabotage, working hard in situations that don’t work, etc.  With enough time, an emotional narrative begins to take shape, and the therapist begins to make a hypothesis about why certain feelings keep bothering you and don’t seem to change.

Psychodynamic Therapy Can Feel Like Psychoeducation

The psychodynamic approach can often feel like psychoeducation in the end, as people who are struggling emotionally start saying, “I learned such and such about myself in therapy.” The process involves a more experiential process and insight than the direct education of CBT and skills based work.  Often the therapist uses the relationship between therapist and the person the therapist is helping to understand more about the problem and to facilitate change. Many studies have shown that although symptom reduction at the start is slow, a change in how the person is doing things leads to transformation, and that benefits continue even after treatment ends (Cornelius, 2014).  Some studies have shown that psychodynamic therapy works better for persistent and complex problems (Shedler, 2010).

CBT Clinicians Take Note – Symptoms Can Be Deceiving

One of the hallmarks of psychodynamic work is the understanding that sometimes symptoms can be deceiving.  Recently I read a paper by Tessier (2016) in which he presents two elementary-school-aged children.  One can’t sit still, runs, and presents with a typical ADHD diagnosis.  The other can sit still and talk, but her words are pressured and full of anxiety.  Working psychodynamically, he finds that both need to be “contained,” held in a way, through validation and help with putting their symptoms into words that help them function better day to day. Although the presenting behaviors are very different, both symptoms convey the same cause – feeling out of control.  With both children, the therapist then works on that feeling to help the symptoms, as opposed to teaching one child to sit still and the other to breathe, for instance.

Some people who are struggling emotionally like that CBT is short term and low commitment beyond doing your homework.  Although they sometimes complain it is intellectual and overly rigid and structured.

Others like that psychodynamic work seems more focused on relationships and feelings in the here-and-now.  However, they sometimes complain that it is long-term and sometimes not structured enough.

Many people start with CBT to help alleviate their daily symptoms.  If a round of CBT resolves them without continuously having to return to treatment, this may be a good choice.  Other people work in CBT while also engaging in finding a therapist to do the long-term work of understanding themselves and their patterns. Some people turn to psychodynamic therapy after a number of rounds of CBT have not healed their suffering.  Many others begin with psychodynamic therapy because they have a deep interest in understanding their complex emotions and their repetitive suffering.


Author: William Sharp, Psya.D.

William Sharp is on the faculty of BGSP and the Director of the Mental Health Counseling program.  In addition, he is an assistant teaching professor  at Northeastern University and adjuncts at various schools in Boston where he encourages psychoanalytic research and thinking. Dr Sharp consults with schools and teachers in the Boston area helping them reach children that are often hard to reach due to emotional blocks to learning.

 

References

Cornelius, J. T. . (2014, October 7). The Case for Psychoanalysis (v4) [Video File]. Retrieved from https://www.youtube.com/watch?v=IQBx5TONHac

Shedler, J. (2010) . The Efficacy of Psychodynamic Psychotherapy. American Psychologist. Vol. 65, No. 2, 98 –109 DOI: 10.1037/a0018378

Shedler J. (2015). Where is the evidence for “evidence-based” therapy? Journal of Psychological Therapies in Primary Care. 4:47–59.

Tessier, J. (2016). Modern psychoanalysis applied in school-based therapy. Modern Psychoanalysis, 41(2). pp 168-185.


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