Cognitive Behavioral Therapy versus Psychodynamic Approaches to Counseling

Abstract
The purpose of the present study was to compare and contrast the two
therapeutic approaches, namely the cognitive behavioral therapy and the
psychodynamic approach. The cognitive behavioral therapy approach
focuses on thoughts and feelings of the client as the major cause of
psychological problems while the psychodynamic approach focuses on the
unconscious mind where deep feelings where the deep feelings that cause
psychological problems are sheltered. Most of the similarities between
CBT and the psychodynamic approach result from their basic principles
and their practical application. These similarities include the
dependence on therapeutic alliance, emphasis on the importance of
narrative, client empowerment and advocacy, and schemas. The differences
between the two approaches include the BT focus on belief and thoughts
while the psychodynamic approach focus on the expression of emotions,
the client-patient relationship is a focus of treatment under
psychodynamic approach, but not a focus under the CBT. Other differences
result from the basic principles, structure, and the duration of the
treatment process.
Key words: psychodynamic, cognitive therapy, post traumatic stress
disorder, traumatic conditions.
Cognitive Behavioral Therapy versus Psychodynamic Approaches to
Counseling
Psychotherapy is one of the therapeutic fields that have been gaining
significance in the modern world as a result of empirical evidence
supporting its effectiveness in treatment of psychological problems.
Different theories (such as cognitive behavioral therapy and
psychodynamic therapy) have been developed to help psychologists and
counselors in resolving psychological problems that vary in causes,
potential resolution, influence, and triggers. This field has been
developed from the standard to positive psychotherapy, which involves
the use of interventions that enhance positive engagement, meaning, and
emotion instead of targeting the symptoms in a direct way (Seligman,
Rashid & Parks, 2006). This process involves the treatment of
psychological conditions by talking with a professional who applies
theories of psychology to help the client learn about their feelings,
behavior, moods, and thoughts. Some of the theories applied in
psychotherapy have some similarities and differences. This paper will
compare and contrast the theory of cognitive behavioral therapy and the
theory of psychodynamic therapy. The cognitive behavioral therapy and
psychodynamic therapy have both the points of convergence and
divergence, which are based on their basic principles and practical
application.
Exposition of CBT and psychodynamic approaches
The theories of cognitive therapy (including CBT) emerged from the
disagreement with the initial views that human emotionality resulted
from unconscious conflicts. The theory took its modern dimension in the
1950s following the work of Albert Allis who realized that patients’
recovery was accelerated by the change of thinking patters from negative
to positive (Froggatt, 2006). Since then, theorists have focused on the
study of this cognitive perspective, especially in its effectiveness in
the treatment of trauma and post traumatic disorders. Currently,
psychologists and counselors who apply the CBT focus on three domains,
namely cognitive, psychology, and behavior (Lata, 2000). The aim of
applying the cognitive domain is to help clients in using cognitive
restructuring techniques in correcting the distorted thoughts that cause
depression. The behavioral domain focuses on training the clients on
social skills, activity scheduling, and training on assertiveness in
order to remediate deficits causing traumatic conditions. The
physiological domain help psychologist in applying mediation, imagery,
and relation approaches in calming the bodies of clients suffering from
trauma (Lata, 2000).
Psychodynamic therapy is a therapeutic technique that focuses the study
of unconscious processes in order to understand their manifestation in
the client’s present behavior. The primary goal of using psychodynamic
therapy is to enhance the self-awareness of the clients as well as their
understanding of the impact that the past makes on their present
(Miller, 2010). This approach emerged from the theory of psychoanalysis,
which encompasses four schools of thought, including Freudian, object
relations, ego psychology, and self psychology. Supporters of the
psychodynamic therapy assume that significant can take place within the
initial interventions, thus facilitating the subsequent healing without
the need for constant engagement with the professional therapist. This
process may take a long time because it involves helping the clients’
change of identity, integration of significant developmental learning,
and change of personality that was distorted at early stages of
development. This is achieved by addressing the intra-psychic as well as
the unconscious conflicts and their impact on human development.
Similarities between CBT and psychodynamic approaches
The two approaches of psychotherapy are perceived to be different in
many respects, but there are a few similarities that can be seen in
their practical application. First, the effectiveness of the two
therapeutic approaches depends on the strength of the therapeutic
alliance between the client and the therapist. Therapeutic alliance
refers to the connection existing between the client and the patient and
helps them work in a way that enables the patient to get the insight
into experiences of life that are difficult to think or talk about. Kar
(2011) investigated the effectiveness of the use of CBT in the treatment
of post traumatic conditions and documented findings indicating that CBT
is effective for both chronic and acute PTSD. Most importantly, the
researcher identified that the participants were more satisfied at the
therapeutic alliance rate of 87.5 %. In a similar study Leichsenring et
al. (2010) identified that the therapists who use psychodynamic therapy
rely on positive alliances with clients to ensure the success of the
entire therapeutic process. This means that the users of both approaches
should enhance a positive therapeutic alliance with clients.
Secondly, the two approaches emphasis on the importance of narrative in
achieving the best therapeutic outcome. The narrative model that is
integrated into the CBT helps in the process of transforming the
personal narrative of the client (Yanos, Roe & Lysaker, 2011). This is
because most of the psychological problems (such as trauma) result from
the lack of ability of individuals to narrate their evolving stories.
The main role of the therapist in the narrative approach is to provide
the client with an opportunity to narrate about issues that are wrong,
those that are not wrong, losses, hopes, and what should be done.
Similarly, supporters of psychodynamic approach hold that life narrative
has the capacity to enhance a strong bond between the therapist and the
client as well as enhancing the speed at which the client gets relieved
from traumatic symptoms (Viederman, 1983). In both approaches, the
therapists reflect on the clients’ narration and encourage them to
elaborate on the key dimensions of the story.
Third, users of the two approaches (CBT and psychodynamic) emphasize on
the philosophy of client advocacy and empowerment. According to Lata
(2000) the primary orientation of CBT is patient empowerment, which
involves the provision of clients with basic skills to help them offset
their traumatic conditions. This is achieved by facilitating the use of
therapeutic techniques that are applicable outside the client-patient
contact sessions, thus empowering the client to develop a positive
spiral of emotions by implementing some therapeutic strategies on their
own. Similarly, supporters of the psychodynamic approach belief that
client empowerment creates an atmosphere needed for the patient to
review their present and what they might perceive to be of value in the
future. This means that client empowerment acts as a motivation for
change, which can only be elicited from the patient and not from
preconditions. The therapists using either of the two approaches aim at
empowering the client to take control of their psychological conditions
on their even when they are away from psychologists.
Fourth, there exists some point of convergence between the unconscious
fantasy in psychodynamic therapy and the theory CBT. According to
Shedler (2010) schemas are the cognitive structures that arise from the
CBT literature and develop as a result of experiences that one undergoes
in early life. These structures are maintained by the consequent
distortions occurring in one’s perception. The persistence of these
distortions is considered to be the essence of the psychodynamic
therapy. This means that the formulation of psychoanalytic theory is
based on the schema model that conceptualizes the key traumatic
conditions that results in specific symptoms. In addition, symptoms
result from the unconscious and pathogenic beliefs that are deductions
about traumatic scenarios. The schema structure or traumatic scenario
results determine the subsequent thoughts, perceptions, and feelings.
These facts support the idea that the schema-based therapy is both
ideational and cognitive.
Differences between CBT and psychodynamic approaches
Although the two therapeutic approaches have some similarities, there
are significant differences that are evidenced from their basic
principles and practical application. First, the psychodynamic approach
focuses more on the expression of emotion while the cognitive behavioral
therapy approach focuses on beliefs and thoughts (Shedler, 2010). The
therapist using the psychodynamic approach aims at encouraging the
clients to describe their contradictory, troubling, and other feelings
that the patient may not be in a position to acknowledge. The therapists
applying the CBT approach, on the other hand, encourage clients to give
their self-critical, pessimistic as well as their global negative
thought (Seligman, Rashid & Parks, 2006). This gives an opportunity for
the therapists to help the client in the determination of how negative
thinking causes and sustain depression. This focus on thought
distinguishes the CBT approach from psychodynamic approach.
Although the effectiveness of treatment outcome is affected by the
therapeutic relationship between the patient and the client in both
approaches (CBT and psychodynamic), the relationship is considered as a
focus of treatment in psychodynamic while in CBT it is not a focus of
treatment. According to Shedler (2010) the therapist using the
psychodynamic approach perceives their relationship with clients to be
interpersonal and it can be emotionally charged. The intimacy of this
relationship is enhanced by repetitive themes, manner of interaction in
the context of a person’s relationship. The repetition of
interpersonal themes in the psychodynamic therapy helps the two parties
(client and therapist) to explore and amend the themes in vivo. This
enhances flexibility in the relationship between the two parties, thus
increasing their capacity to address interpersonal needs. The therapists
using the CBT approach, on the other hand, emphasize on the need for
sound therapeutic relationship, but not as the main focus of treatment
because they believe that the patient change depending on their ability
to think differently and take the necessary actions on the basis of what
they learned.
The third difference between the two approaches arises from the basic
principles on which they are based. The CBT approach is based on the
notion that the way people interpret feelings and thoughts is the major
cause of psychological problems. Consequently, CBT therapists focus
their attention on these causes with the objective of helping their
clients in adopting different behavior and ways of feeling. This leads
to the fulfillment of the primary objective of CBT therapy, which is to
leave the patient with the freedom of selecting their lifestyle,
behavior, and emotions (Froggatt, 2006). The psychodynamic therapy, on
the other hand is based on the different factors that have the capacity
to cause affect a person’s symptoms. Some of these factors may include
childhood experiences and current relationships (Shedler, 2010). These
factors affect the unconscious mind that shelters the thoughts,
feelings, and urges that cannot be looked at directly.
Fourth, CBT is a directive and highly structured approach in which the
therapist divides the treatment process into sessions and specific
agendas prepared for each session (Shedler, 2010). The clients are
taught different techniques in each session where the treatment focuses
on client determined goals. The approach is directive given the fact
that the therapist aims at helping the patient in behaving and thinking
in ways that help them attain the goals they have set. The psychodynamic
approach, on the other hand, is less structured and encourages patients
to speak out their minds freely. Consequently, patients can generate a
wide range of issues, including fears, dreams, fantasies, and daydreams
because they the treatment process is not structured to restrict them on
what they should talk about. This is a resourceful approach that helps
the therapist in understanding how the clients view their self and
interpret experiences.
Fifth, CBT is a brief therapeutic process that because it is results
oriented compared to psychodynamic therapy that can go for years. The
instructive nature and structure of CBT approach briefer compared to
psychodynamic therapy. The CBT therapist gives home assignments to
clients to be accomplished in every session. This means that the client
is informed that there will come a time when the formal therapy process
will end. However, the termination of the formal therapy process is
decided by the therapist and the client. The psychodynamic approach does
not use homework assignment. Although the psychodynamic process can be
short, it takes six or more months in most cases.
Conclusion
The cognitive behavioral therapy and psychodynamic therapy have both the
points of convergence and divergence, which are based on their basic
principles and practical application. The CBT approach is based on the
notion that psychological problems (such as trauma and PTSD) result from
thought and feelings and these problems are also resolved by changing
the clients feeling and thought patterns. The psychodynamic therapy is
based on the notion that psychological problems and solutions can be
solved by addressing the unconscious processes. The similarities between
the two approaches include the importance of the therapeutic alliance,
emphasis on narration, and client empowerment. These points of
convergence between the two approaches enhance their application in
addressing similar challenges, although their outcomes may vary. The
differences in outcome of the two therapeutic approaches may result from
several differences between them. The major differences that impact
therapeutic outcomes include the differences in duration of therapy, the
therapist-client relationship, and the basic principles on which the two
approaches are founded.
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