Comparisons of Psychodynamic and Cognitive Behavioural Therapy

The origins and development of psychoanalysis, the foundation on which psychodynamic therapy is built were established by Sigmund Freud in his writing and therapeutic endeavours with his patients in the late 1800’s and early 1900’s (Freud, 1910).  Based on his observations, Freud proposed that all human behaviour and feelings are driven by unconscious motives. Comparable to an iceberg analogy, psychodynamic theory proposes that the greatest influence on behaviour is out of conscious awareness of the patient and lies waiting for an opportunity to be uncovered. Derived from childhood experiences, unconscious beliefs about oneself are developed over time and directly influence feelings, behaviour and how an individual believes they fit into the world (Weiss, 1990). Conversely, other modalities such as Cognitive Behavioural Therapy (CBT) propose different basic theoretical assumptions, in that maladaptive behaviour is driven by negative cognitions and core beliefs.

Psychodynamic therapy is considered to be long term, consisting of many months, often years, of weekly or twice weekly sessions (Milton, 2003), compared with shorter term CBT consisting of ten to twenty session of problem solving interventions (Milton, 2003). CBT places less emphasis on ensuring a regular, identical weekly setting for therapy. CBT generally takes place in the therapist’s professional rooms but may move to other locations for the purpose of social experiments such as exposure therapy to treat social anxiety or phobia disorders. In contrast, psychodynamic therapy will strive at all times to remain in the same location, on the same day, and at the same time for the duration of the sessions. This maintenance of a consistent and predictable presence is an important part of the therapy frame and is vital to establish boundaries and define appropriate and expected behaviour both of the patient and the therapist (Cabaniss et al., 2011). The length of a psychodynamic session is generally fifty minutes and remains the same each for each session, similar to that of CBT sessions.

An additional difference between CBT and psychodynamic therapies is the way in which a patient’s thoughts are identified and challenged. CBT strategies are used to identify and challenge automatic negative thoughts and cognitive distortions through collaborative evidence testing of unhelpful thoughts and teaching alternative thinking to improve patient symptoms of depression or anxiety. Salient focus is on the therapist’s psychoeducation, teaching of coping strategies and giving homework tasks, to assist the patient to access a newly learned repertoire of skills to build positive changes in their lives (Hilsenroth et al., 2005). In contrast, a psychodynamic therapist will avoid making suggestions to ‘fix’ things, will not assign homework tasks or recommend readings, or direct the patient to undertake tasks of any kind (Moorey, 2010). The removal of a formal ‘structure’ that these types of activities provide in the cognitive behavioural setting, lead to a focus on the here and now interaction between the patient and the therapist in the psychodynamic setting. 

Remaining neutral and non-directive enables the therapist to provide a safe container in which the patient can play out any transference. Differences are therefore evident in the therapeutic interaction and attitudes of therapists from the two modalities of CBT and psychodynamic therapy.

Cabaniss, D. L., Cherry, S., Dougla, C. J., & Schwartz, A. (2011). Setting the frame and establishing boundaries. In psychodynamic psychotherapy: A clinical manual (pp. 72– 81). John Wiley & Sons.

Freud, S. (1910). The origin and development of psychoanalysis. The American Journal of Psychology, 21(2), 181–218.

Hilsenroth, M. J., Bonge, D. R., Blagys, M. D., Ackerman, S. J., & Blais, M. A. (2005).

Measuring psychodynamic-interpersonal and cognitive-behavioral techniques: Development of the Comparative Psychotherapy Process Scale. Psychotherapy, 42(3), 340–356. https://doi.org/10.1037/0033-3204.42.3.340

Milton, J. (2003). Psychoanalysis and cognitive behaviour therapy - Rival paradigms or common ground? The International Journal of Psychoanalysis, 82(3), 431–447. https://doi.org/10.1516/0020757011600957

Moorey, S. (2010). Cognitive behaviour therapy and psychoanalysis. In A. Lemma & M. Patrick (Eds.), Off the Couch: Contemporary Psychoanalytic Applications (pp. 194– 211). Routledge.

Weiss, J. (1990). The nature of the patient’s problems and how in psychoanalysis the individual works to solve them. Psychoanalytic Psychology, 7(1), 105–113. https://doi.org/10.1037/h0079148