Typical Psychodynamic vs CBT session.

Hi all. I would appreciate anyone who could give me some insight regarding what Psychodynamic therapy is like. I currently see a CBT specialist for anxiety although I have depression and ruminate a lot. I was hoping someone who has experienced both types of approaches could tell me how a Psychodynamic session would be different. I have read its as much about the relationship you establish with the T as your particular issue(s) you are in therapy for.

Thanks.

I see two psychodynamic ones. They asked a lot about my childhood.

Psychodynamic focuses more on childhood, unconscious, relationships, defense mechanisms, etc. Yes, you are right, the relationship with your therapist (e.g. transference) matters quite a bit. So it's more important to have a good match with your T there.

Good news is that it's certainly less homework than CBT.

Thanks for the reply. May I ask if you done both, and if you feel you have been helped more with one or the other?

I have only experienced CBT in two ways: in a group setting and as someone being trained to use it. I know also a fair amount about what it does, and what it's good for, and also how well it works. What can I say, it is the treatment of choice, today, especially with the things that you list.

I have experienced various forms of "psychodynamic," though most would be called by different schools of psychoanalytic. My current therapist is also an analyst, meaning he had extra training in this area, had to do about 5 years of every day analysis on himself, and also so test cases with a supervising analyst.

What I like is that hardly any of that shows, except it is clear to me that he has worked on himself to a very fine tuned extent. That's is one thing that helps me trust him more; that he has been through a process way more intensive and deep and personal and difficult than what I am doing most of the time, and has come out seeming very resilient, optimistic, at the same time sensitive and emotional.

I guess in terms of what I would say for going more with a psychoanalytically-informed type of therapy, you have to know what you want and who you are to some extent before it can serve you well. The goals in general are different. Basically some sort of transformation, whether it be the situation at hand or the whole character structure, but something that shifts everything else. Whereas other treatments that are more behavioral are focused primarily on symptoms and reducing them. There is schema work in CBT so it goes into a deeper area, but the approach is not the same.

The two psychologolies are essentially divided on some fundamental things so you have to decide where you stand or what would be more useful to you. CBT assumes if you modify behavior (and thoughts too) that mood, emotions, attitude, all of that will change and improve.

Psychoanalytic (though there are so many different forms and many are really opposed to each other at this point) basically says emotions are primary, primal even, and stem from very early patterns that tend to repeat. So analyzing those repetitions and patterns and even origins give you another way to dismantle stuff that is troubling.

One puts cognitive/behavior first and says that emotions/moods are caused by that. The other says the opposite, that emotions/moods, even primal reactions happen first, and thoughts and behaviors grow outside and after that.

The relationship with the therapist is also valued in some forms of psychoanalytic but I hear not so much in CBT although I have also heard that people are trying to change that since the relationship has been proven to have one of the biggest impacts.

Some people talk about CBT as skill based though I would say that DBT is more clearly skills based. I think skills are really important. I think also that psychoanalytically informed therapists also value skills of distress tolerance and other things that are actually part of a lively literature. It just doesn't get marked so heavily or stands out as much so people don't really see it.

The truth is that both have been proven effective. So it is really up to the way that the client approaches it and the way the therapeutic relationship goes that determines the most of the outcome.

You're welcome.

Yes I've had both kind of therapy. I will answer you but before I do, just want to emphasize that whether a kind of therapy helps also depends on the problem itself and your own personality and your views. For instance, I think CBT works exceptionally well for phobias.

So in terms of what worked for me, I would say I found psychodynamic therapy to be more to my liking than CBT, but that CBT probably helped me more than psychodynamic therapy.

A good thing CBT got going for it is that it is quite structured, it has homework, it focuses on your present experience and how to manage your emotions, how to think clearly about things. It has immediate application.

Like the other day I went to a new store and the cashier seemed very short with me (I accidentally took my cart behind, instead of in front of her). Though I smiled at her and said sorry, she just stared at me and said how much to pay. Yet she was pleasant and laughing with the person before and after me. As I was standing there I started to sweat profusely and got very panicky and hot and afraid of some serious illness or me dying and all these additional fears that were overwhelming me but it passed within a minute or two.

In the past it would linger for hours! I had learned to immediately make a list of how I felt, the emotions and the symptoms, looked at alternative explanation for them, looked at the various cognitive errors I was making, and that stuff, when repeated, becomes automatic and no pen or paper ready. After PTSD (when my sister was suicidal and psychotic and hospitalized and I got traumatized) a lot of things really trigger me and that, combined with my social anxiety, can be a recipe for disaster. I can now think about these things in more logical way, and despite the rush of emotions, I'm using CBT regularly and I'm in quite a better place than I was before. I even now take the bus, and I'm able to live on my own. I used to stay home 24/7. Small steps but certainly an improvement.

I know you are familiar with CBT but I just wanted to mention it to tell you what I mean when I say it's been helpful. The psychodynamic part deals with something else, something from my childhood. It's that I have a mother with borderline personality traits. A lot of times I either felt really afraid of her or felt sorry for her or wanted to rescue her. I really enjoyed it when she was being loving towards me, her love seemed boundless. Unfortunately, so did her anger and her fear and her sadness. Psychodynamic therapy made me more aware of this.

It doesn't matter if the cashier was racist or sexist or was having a bad day or did not like me because of the way I look or whatever. What matters is that something about her just staring at me deadpan with no emotions kind of frightened and angered me at the same time. I had told her sorry (about the cart) but no reaction. I had tried to smile but no reaction. I had felt hated or rejected or ignored.

Through psychodynamic therapy, through my feelings about the therapist (transference) and me thinking she was judging me or hated me and me needing more reassurance and me trying to make her love me, through discussion of dynamics between mom and I and my childhood, I have learned how I may repeat certain patterns in other relationships.

She may not remember me now if I ever saw her again. But I remember the bones in her jaw, her large somewhat bulging eyes and the darker skin under (very little makeup), her small and thin body, her black shirt, her big forehead. I remember her uninhibited laugh at some joke the guy behind me told her when dropped his change. She almost changed into a person completely different.

Was she my mom in that moment? Was I a little boy saying sorry mom I made a mistake and can you still love me or not be mad at me and I'm sorry? When she threatened to kill me, to abandon me? When she threatened to tell dad that I was a bad boy and he'd come home with his belt and threaten to beat me to death? Was I a powerless little boy in that moment, desperately looking for approval, desperately looking for a way to connect with her, to feel acknowledged, wanting to hear anything from her, all familiar with silent treatment, with getting ignored...

Anyhow, man that stuff is as anxiety provoking to write as it to feel, but I hope these more personal stories I've shared with you, give you an idea of the various ways you can be helped by each kind of therapy. I still like the idea of psychodynamic therapy as more appealing. CBT can feel bit robotic and lifeless. But when I look at how I have been helped, all in all I would give the edge to CBT. It helps me here and now with my present problems.

Good luck with your therapy.

Yours and Partless answers to my question has been so helpful to me I can't express my gratitude enough. I can't begin to tell you how thankful I am for you sharing this with me.
I wish you the best. KL

I've been engaged in both types of therapy, but I don't think I could effectively compare 2 sessions as it's been awhile since I've been in CBT. So, if you don't mind, I'll compare and contrast the 2 a bit here...

Psychodynamic therapy is more about feeling than thinking, in my experience. I agree with you it's more about the relationship than 'doing things'.

Comparison: PD therapy targets character change, where alleviation of symptoms follow. CBT focuses on symptoms, where change is supposed to follow. Sort of the inverse of one another. This is just the way I see it....

Two concepts often explain how our sense of self and behaviors are derived: character and temperment. Character is the part of your personality that was learnt from your primary caregivers + your environment. Temperment is your born traits. The interaction of these form your personality--how you relate to yourself, others, and the world.

I think CBT focuses on the behaviors of your personality, where PD therapy focuses on your sense of self--accepting, understanding, finding and becoming who you really are underneath it all. Personality change. It incorporates a strong element of freedom--a freedom from neurosis (for lack of a better term). Freedom to be yourself and be content with your self. Depending on your issues, PD can take a loooong time.

About the relationship: since you learn about yourself/your personality is formed from interacting with your primary caregivers, those who didn't have good enough parents have deficiencies and distortions in personality and self. The relationship with the therapist is the medium for corrective emotional experiences and learning that allow you to shape a healthier sense of self.

A big part of this is exploring unconsciousness, but also feeling instead of thinking/filtering/processing thoughts. Unconscious defense mechanisms distort reality, so addressing them is a big part of the work. When the defense are relinquished, you are sort of forced to feel how things really are/were. This is key in re-discovering the truth of your life and your sense of self.

Maybe not the most articulate synthesis right now, but I hope that helps a bit. Good luck.

I am so very grateful that you shared this personal story with me. I can relate in so many ways to what you said about past experiences. Regarding CBT I feel that it is a bit to structured but I also have to admit (especially to myself) that I have not put in the necessary work to give it a fair chance. ( I am always looking for the silver bullet/magic answer to my problems).
IMHO your answer comparing the two approaches is better than anything I have read on line on sites that are dedicated to explaining therapy and the different types. Many thanks.

KL

Great responses above! Not sure if I can add much but I see both types of T's.

I don't feel I could have handled CBT without doing the "deeper" work of psychodynamic. Both have been useful to me in different ways.

Psychodynamic does focus on childhood, relationships and past trauma as well as the therapy relationship. Very deep and healing for me.

CBT has been more helpful for practical changes like my driving phobia, health management etc. I know people sometimes think it is too patronizing and simplistic and there is a hint of truth to it. However, I am kind of a disorganized messy and probably too-emotional person so I find CBT useful in breaking down tasks into manageable steps. Yes, it can seem insulting because these steps seem like common sense. But for someone like me , the structure is helpful. I believe for all my flaws I'm at least highly intelligent, and I can see how CBT may come off as insulting. Once I got over my pride and just followed the suggestions given, I've made a lot of headway.

I often put it this way;psychodynamic is "deeper" but you run the risk of all talk and no action. CBT will get you where you want to be faster, but deeper issues are often neglected as a result.

I wish you well whatever path you choose.

Oh you're being too kind Angst guy, but thank you very much for the appreciation, you made my day. I was actually worried if I had written too much (as usual). Sometimes I feel like sharing my views or my story means little to people. But then you replied this way and it makes me happy. Thank you.
And I totally understand looking for that magical solution to problems. CBT is so much work! Heck, therapy itself is so much work. The hours I've spent in therapy, the hours thought about my problems, I think I could have done a college degree with all that energy and time!
Hopefully you can find a therapy that works for you and you can get your problems under control. It really is doable, just requires patience and persistence.

p.s. I'm glad others also responded, I think Skies, Growlycat, and Archipelago make insightful comparisons between two therapies and I was going to quote relevant paragraph but I see you have been reading those posts, so hopefully these different views give you something with a more personal touch, to balance out any readings you've done on the subject (and there are a lot of stuff on the two therapies online).