Schools of Psychotherapy

CBT and Psychodynamic Psychotherapy – A Comparison Ch Jonathan Haverkampf

Cognitive Behavioural Therapy (CBT) and psychodynamic psychotherapy, the less intensive form of psychoanalysis, are arguably the most prominent and well-researched schools of psychotherapy (see Lambert and Bergin, 1994), apart from interpersonal therapy (IPT) models.

Essentially all psychotherapies go back to the revolutionary concept of the ‘talking cure’[1] in the late nineteenth century, the use of communication as an instrument of healing. CBT and psychodynamic psychotherapy as descendants from the same concept should be viewed as complimentary rather than as substitutes. Technical approaches from both can be helpful in individual situations.

The aim of psychotherapy is not merely to eliminate suffering (WHO, 1946), but to help patients develop as humans. The primary tool is communication, in CBT to provide information that generates change and in psychodynamic psychotherapy to reveal the information that brings about change.  There are synergistic effects from using both. Zipfel et al (2014) showed in a large sample of anorexic patients, that CBT was associated with weight gain, while psychodynamic psychotherapy with lower relapse rates at the 12-month follow-up. McFall and Wollersheim (1979) in an early study successfully used a combination of CBT and psychodynamic psychotherapy in anxiety[1]. Given the widely-perceived need for multimodal approaches[2], it is difficult to comprehend that this should not apply to the most important therapeutic models we have. In ancient Greece, knowing oneself (γνῶθι σεαυτόν, “know thyself”) and the process of the Socratic dialogue were inextricably linked. Psychodynamic psychotherapy and CBT should be viewed as complementary rather than substitutes.

[1] The objective was to “modify their unrealistic cognitive appraisals of threat” (cognitive), “test the validity of their fears” (behavioural), and “realize resources … for coping with uncertainty and anxiety” (psychodynamic).

[2] A multimodal approach with intensive psychotherapy, medication, and psychosocial rehabilitation has repeatedly been shown to yield superior outcomes (see, for example, Saxena et al, 2002, Greist et al, 2003).

[1] Breuer et al, 2000