CBT or Psychotherapy?
Questions and Answers
Q. Why does psychodynamic psychotherapy appear to lead to better results than Cognitive Behaviour Therapy
A. Researchers have analyzed hundreds of hours of taped therapy sessions and have identified seven features that are distinctive in psychodynamic psychotherapy. These are:
Exploration of Emotions
Psychodynamic psychotherapists encourage the exploration of the full range of emotions. By contrast, a CBT therapist might respond to the patient’s emotional difficulties with worksheets, or encourage the person to put aside ‘irrational’ thoughts.
Examining what might otherwise be avoided
Each person has his or her characteristic ways of avoiding issues or feelings, etc, that might be distressing. Psychodynamic psychotherapists encourage patients to examine why and how they avoid what they might find distressing.
Psychodynamic psychotherapists encourage patients to recognise and change self-defeating patterns.
The influence of past experiences on the present
Psychodynamic psychotherapists encourage patients to consider the influence of past experiences on the present. By contrast, CBT therapists focus on the present.
The focus on relationships
Psychological problems tend to be wound up in difficult relationship patterns. Psychodynamic psychotherapists encourage patients to recognise and change problematic ways of relating to others.
Psychodynamic psychotherapists encourage patient to speak about whatever is on their minds, without censoring out thoughts and feelings, etc that might otherwise seem difficult to express, Cognitive Behaviour Therapists tend to follow a pre-agreed agenda.
Examining the relationship between the patient and therapist
This is an important part of psychodynamic psychotherapy because patients’ emotional reactions to the therapist tend to reflect the patients’ emotional responses to others. For example, a person who feels a need to dominate and control others is likely to wish to feel dominant in the psychotherapy situation. Psychotherapists call this phenomenon ‘transference,’ because the patient’s characteristic ways of responding to others are transferred onto reactions to the psychotherapist. When psychotherapists help patients recognise their transference reactions it offers an opportunity for the patient to change habitual ways of responding to others. Cognitive Behaviour Therapists often consider patients’ transferences are a distraction from the work.
Q. Does this mean that everyone who could benefit from psychological treatment should seek psychodynamic psychotherapy, and not consider Cognitive Behaviour Therapy?
A. No. The choice of psychological therapist is a personal decision. For instance, some patients may prefer not to examine the influence of the past on the present, and may wish to focus on lessening present symptoms. Sometimes patients experience a specific problem like fear of heights, or spider phobia, for instance, and otherwise experience good psychological health and good relationships with others. Cognitive Behaviour Therapy would be a good choice for those patients.
Keep in mind that the relationship between the patient and the therapist (the therapeutic alliance) is an important part of the treatment. Psychodynamic psychotherapists pay particular attention to the therapeutic alliance, but many Cognitive Behaviour Therapists also recognise its importance. Here is another Shedler quote from American Psychologist.
‘Therapist adherence to the psychodynamic prototype predicted successful outcome in both psychodynamic and cognitive therapy.’
This means that when cognitive therapists use psychodynamic techniques the outcome for the patients is better than when the therapists do not waver from Cognitive Behaviour Therapy (CBT) techniques.
Q & A References:
Abbass, A. A., Hancock, J. T., Henderson, J., & Kisely, S. (2006). Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews, Issue 4, Article No. CD004687. doi: 10.1002/14651858.CD004687. pub3 PDF Download
Haby, M. M., Donnelly, M., Corry, J., & Vos, T. (2006). Cognitive behavioural therapy for depression, panic disorder and generalized anxiety disorder: A meta-regression of factors that may predict outcome. Australian and New Zealand Journal of Psychiatry, 40, 9-19 PDF Download
Shedler, J. (2010). The Efficacy of Psychodynamic Psychotherapy. American Psychologist, Feb - Mar, 98 - 109 PDF Download
Shedler, J. (2010). Getting to Know Me. Scientific American Mind, Nov- Dec, 52-57 PDF Download
How the two major kinds of therapy differ
Reproduced with permission from Scientific American Mind, November/December 2010, p. 56.
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