Initially trained in cognitive psychology, I now provide psychodynamic therapy to adult clients. I specialize in the treatment of chronic depression, treatment-resistant anxiety and fear, repeated relationship difficulty, childhood trauma, complicated and prolonged grief, narcissistic personality disorder (NPD), OCD, feeling of isolation, fear of aging, hypochondria and, emotional difficulties experienced by children of first generation immigrants. My approach to psychotherapy is psychodynamic, relational and collaborative. From time to time, I also use Cognitive Behavioral Therapy (CBT) tools, specifically when it is called upon for crisis management, including panic attacks, situational depression and episodic stress.
As someone with an academic background in cognitive psychology and who practices psychodynamic therapy, I have been frequently asked this question: What are the differences between Psychodynamic Psychotherapy and CBT? In the following, let’s first take a look at brief descriptions of the two types of therapy.
What is CBT?
Cognitive Behavioral Therapy (CBT) is based on Albert Ellis’ Rational Emotive Behavior Therapy developed in the 1950s and Cognitive Therapy developed by Aaron Beck in the 1960s. CBT therapists hold that our thoughts and core beliefs influence and are influenced by our behaviors and feelings. CBT focuses on the client’ symptoms, its triggers and, thoughts immediately before and after a behavior. The assumption is that we may become symptomatic when our schemata or automatic thoughts are distorted. Cognitive distortions often result in development and maintenance of maladaptive behaviors. Examples of cognitive distortions include overgeneralization, emotional reasoning, catastrophizing, discounting the positive and, jumping to conclusions.
CBT is highly structured and goal-oriented towards symptom reduction. In the beginning of the treatment, CBT therapists often use Functional Assessment to hypothesize the factors that precipitate and maintain target symptoms in cognitive and behavioral terms. To problem solve, CBT therapists use data gathering, goal setting, symptom monitoring and measuring, thought challenging, activity engagement and, behavioral rehearsal.
A central feature of CBT is skill building, using an educational model through question-and-answer, psychoeducation, feedback and, role-playing activities. The work continues after the session, often through homework, journaling, though records and bibliography. CBT therapists teach clients to evaluate, modify and, change their cognitive content by gathering data and through behavioral experiments. A relatively simple method of changing one’s behavior is through reinforcement in the form of reward and punishment. At a more complex level, some CBT methods, such as guided discovery, exposure therapy and mindfulness exercises, are essentially behavioral modification.
What is Psychodynamic Therapy?
Psychodynamic Psychotherapy is often referred to as Psychoanalytically Oriented Psychotherapy. Developed by Sigmund Freud at around the end of 19th century, it is the first form of talk therapy in the history of psychotherapy. It emphasizes unconscious processes, early childhood experiences, both innate and internal processes, as well as one’s environment. Psychodynamic Therapy is characterized by its focus on emotion, the unconscious processes, early history, interpersonal relationships and, a close therapeutic relationship between the client and the therapist. The client learns experientially about the self and others, their needs and wants and, what is standing in the way of living a more satisfying life or a life with less symptoms. For a brief description of psychodynamic treatment, see My Approach.
Differences Between Psychodynamic Psychotherapy and CBT
Insight Driven and Affect Focused vs Behavioral and Skill Based
A fundamental difference between these two approaches is that Psychodynamic Therapy is insight-driven, while CBT is skill based and emphasizes behavioral change. Both approaches investigate what happens in the here-and-now. The linearity inherent in CBT’s triad of thought, behavior and feeling makes it simple and clean. On the other hand, Psychodynamic Therapy aims to contextualize the here-and-now in clients’ early histories and salient experiences. Current materials are used to help access clients’ unconscious processes that are standing in the way of living a more satisfying life or a life with less symptoms. Psychodynamic Therapy taps significantly deeper into clients’ emotions, allowing client access to their potential capacity for a more satisfying life.
The Role of Introspection
The role of introspection is core to both CBT and Psychodynamic Therapy. Working with thoughts and beliefs, introspection in CBT tends to present itself as more forced, typically by the therapist’s questioning and the client’s answers to questions. However, intellectual understanding by itself does not help the client overcome mental suffering. Otherwise, we would see, for example, a lot less professors suffering from depression or anxiety than individuals in other professions. In contrast, in Psychodynamic Therapy, introspection is more likely to happen in context. It usually manifests naturally in the dialogue between the client and the therapist, in the client’s monologue or, through what is implicitly delivered and registered. The benefit of a more contextualized reflective practice is that it allows space for processing the deep and unconscious mind, bringing it to surface with feelings. An emotional insight is more likely to affect the client at a deeper level, bringing about greater opportunity for change and greater enjoyment in life.
The Clinical Stances
The clinical stances in CBT and Psychodynamic Therapy are also fundamentally different. CBT therapists play an active and usually directive role. Their focus is on observable or quantifiable behaviors and on meeting specific goals for symptom reduction. On the other hand, Psychodynamic therapists usually do not predetermine the materials to cover in session. Furthermore, they usually do not lead the conversation or coach the client. The intent is for the therapist to open and hold a space for the client to speak freely and bring up whatever comes to their mind. When the client becomes used to speaking freely and uninhibitedly, we may get a glimpse of the client’s desires, hopes, fears and fantasies. These can be used to facilitate the client’s understanding of self and others, patterns of their interaction, including avoidance and expectation. Psychodynamic therapists hold that sustainable changes and a potential for a more satisfying life come from within an individual, an individual who understands who they were, who they have become and, how they interact with others.
Treatment Length
CBT is a time-limited therapy with a duration of 5 to 15 sessions. Psychodynamic Psychotherapy usually is a once or twice a week treatment. It lasts from months to a few years, which can be expensive. Long-term work in a less structured format coupled with a more reflective nature requires strong commitment and dedication from both the clients and therapists.
CBT or Psychodynamic Therapy?
CBT unarguably is an intuitive, affordable and popular style of therapy. It is appropriate for people of all ages, including children and young adults. CBT is not only used by therapists, but also by teachers at school and parents at home. We know that to look at “the glass that is half full” makes us feel more positive than seeing the glass half empty. We all have extensive personal experience of how positive and negative reinforcements have shaped our habits. In addition, because CBT views behaviors in a quantifiable way, it is not surprising that CBT enjoys extensive research on its efficacy in treatment for many common mental health conditions. They include stress, depression, addiction, eating disorders, PTSD, and anxiety disorders, especially specific phobia and panic attacks. CBT can also be used to cope with physical health issues, such as chronic pain, tinnitus and irritable bowel syndrome.
However, some people turn to insight driven therapy after going through rounds of CBT or other types of brief therapy. Some people new to psychotherapy are drawn towards Psychodynamic Therapy because they are interested in gaining an in-depth understanding about themselves and their emotions. Individuals who aim to understand what drives their mental health suffering may benefit from Psychodynamic Psychotherapy. Psychodynamic Psychotherapy has the longest history of all schools of psychotherapy. Although nowadays few psychoanalytic therapists practice in strict accordance with Freudian theory, the concepts of the unconscious, self-awareness and self-understanding remain very relevant to modern day being. Psychodynamic Therapy is often used in treatment of persistent emotional struggles or prolonged dissatisfaction, such as chronic depression, treatment-resistant anxiety, repeated unsatisfying relationships, low self-esteem, childhood trauma, prolonged and disabling grief, narcissistic personality disorder (NPD) and, psychosomatic conditions.
Stress Management – A Self Help Tool Based on a CBT model
Many clients ask about self-help tools. There are countless resources, including many hundreds of how-to books, TED talks and YouTube postings. Which resource may be most helpful depends on the nature of your symptoms, lifestyle, reading habits and personal style preference. A few years ago, I myself provided stress management training at a college’s professional development seminar. If you are interested, here is a link to the presentation where I listed techniques for preventing stress from evolving into an anxiety disorder or a mood disorder, such as depression.
Telehealth and In-person Appointments
During the COVID-19 pandemic, I am providing therapy mainly through a confidential HIPAA compliant video platform. Occasionally, in-person sessions can be arranged. My office is located in downtown Chicago. For fees, insurance coverage and other information, please consult my Psychology Today profile, or refer to Blue Cross Blue Shield’s Provider Finder Page to verify if I am in network with a specific BCBS plan. I am also in network with UnitedHealthcare (UHC).
You can either call (or text) 773-614-0536 or email jane@jc-therapy.com if you have a question or would like to schedule an appointment.