Psychodynamic/Psychoanalytic therapy vs. CBT/DBT

Over the past year I learned how ineffective psychodynamic therapy was for me in comparison to CBT/DBT, or at least the way that psychodynamic therapy was done for me. I specifically was doing transference-focused psychotherapy for BPD, and that ended me up in the hospital for the first time, followed by a period of time going in and out of the hospital for a few months, my last hospitalization being after a (*TW*) nearly successful suicide attempt. After that hospitalization, I started with CBT again and I haven’t had a hospital admission in 5 months now. (*TW*) Also, I have only self-harmed once in the last 5 months, as opposed to nearly every day before. It has made a world of difference for me.

I was curious to hear other people’s experience with the different modalities of therapy and what was more effective for you.

The only use I found for the therapist was to have them sit there while I vented about my sick then dying then dead loved one.
The tiny bit of CBT that was tried was actually actively harmful to me - I will never go near CBT again.
I never understood what was happening with psychodynamic. It never made any sense to me and I could never figure out what was supposed to be happening or how what was happening was supposed to be useful for that which I wanted help.

Psychoanalysis works perfect for me. CBT was a waste of my time.

CBT was completely useless to me and boring too. Psychodynamic therapy is at least interesting to me. But it's a long process with many ups and downs, lots of pain and conflict, and, well, high risk of adverse side effects.

Both work for different things for me. CBT helps with my anxiety and obsessive thoughts, psychodynamic seems to help more in overcoming issues mostly coming from my past.

I don't think either of the two would work on their own for me, since just talking doesn't help me develop coping skills, but CBT doesn't help me understand where my issues are coming from or what I can change about myself so that the same issues won't happen again in the future.

For me, psychodynamic is just deeper. CBT tries to change quickly problematic behaviour and psychodynamic tries to understand these behaviours, find a source of this and in consequence these behaviours, thinking, symptoms etc. disappears.
It takes A LOT of time and money - but for me, it's worth it.

For example - I used to have panic attacks in traffic.
As I understood, CBT is more focused on working with thoughts (that nothing bad will happen in this situation) or with desensitization (try to do this anyway, and finally you will use to traffics).
But after psychodynamic, where I can talk about my feeling, family, relationships - panic attacks disappear anyway (without trying and changing thoughts or being in this situation more often). I believe that then when I work through other important stuff my mind doesn't have to create other symptoms (like panic attacks, depression, insomnia, addictions).

I have used cognitive techniques related to CBT, mindfulness and NLP as coping strategies since my teens (although didn't always use those terms for them). They work to the extent that they enable me to get by most days and stay in work/life. But they do not go any further than that or deal with the affective and dysfunctional attachment based core of my problems. For that a more psychotherapeutic approach works better.

However I would not see this as an either/or thing, and also there are actually more treatment modalities than cognitive vs psychodynamic/psychoanalytic anyway. There are numerous psychotherapeutic approaches, the psychodynamic tradition itself has many strands and more recently has started to move closer to a more scientific understanding of the role of attachment and affect dysregulation so we are starting to see approaches emerging that are more science based and uniting developmental neuroscience with therapy (and there are also techniques like EMDR that tap more into the neuroscience part but less the psychodynamic part). Alongside these there are also humanistic approaches that tend to focus on the therapeutic relationship but more in the here and now and discourage transference and the formation of dependency relationships. Last but not least there are activity and creativity/drama based approaches that I find particularly helpful as there is much more to therapy and healing than words alone can accomplish.

Thanks guys, maybe someday psychodynamic might have applications for me if it’s done properly. The problem might have been that my therapist was fresh out of grad school and didn’t know what the hell she was doing. She would bring up stuff from my past/uncover repressed memories and then just leave me to wallow in them without actually helping me work through them in any way. She also didn’t give me any help or solutions to deal with my symptoms between sessions, instead she just had me coming in more and more for therapy...eventually I was seeing her 3x a week. It just didn’t work out for me. I’m at a time in my life where I need a more solutions-focused approach because of the rigors school, dredging through old stuff just doesn’t seem useful to me in any way now. Instead I need to be able to cope in the moment, I guess. I do think CBT does work on the root cause if the therapist is doing it right. Right now my T focuses a lot on core beliefs, how I developed those core beliefs, and what I can do to work through those negative core beliefs to build a better tomorrow. Seems more useful than making me feel emotions and then bro helping me with those emotions, but that’s just me personally I guess.

OK - Sounds like the problem was more to do with an inexperienced therapist than the actual approach.

btw Affect is not 'emotions' and 'core beliefs' are not even close to being root causes.

Core beliefs are developed due to the root causes, and by examining core beliefs and what led to them, without dwelling on it longer than needed, but rather on how to fix them and heal what led to them, it can be very helpful. And I’m fully aware that affect and emotions aren’t the same thing.

What works best for me is a humanistic approach combined with art and somatic experiencing plus mindfulness and grounding. I can't stand CBT at all, it triggers a very negative reaction in me. I guess it's because I am a naturally logically thinking person and a realist by nature, so this approach has little to offer me. It is also triggering because of some of my childhood experiences.

I have only been in Psychodynamic Therapy but it has helped me SO much. I think things vary from person to person, what has worked for me might well be unhelpful to someone else. Find what works for you, and I strongly feel that a person will get the best results by finding as many "tools" as you can to work with. Meds, Therapy, Peer Support Groups, friends, family and of course PC just to name a few.

I think for me an eclectic, tailored to actual problems/needs approach is best. It is also more in line with my general views and life philosophy, a belief that there isn't really one universal truth and theory of everything when it comes to mental health and life experience, I have never been a follower of just one thing long and like to create my own mix of philosophies and "programming" in almost everything. Both of my therapists used a primarily psychodynamic approach with me, and it comes naturally for me theoretically as I love to explore the deeper meanings and motives behind everything, and am also very interested in how awareness works, etc. I never allowed the Ts to have much power over my mental processes and thinking though, only as much as I considered acceptable for me at a time.

CBT I have never done with a T but I did find some techniques useful on my own when I was dealing with addiction. Practical, cognitive control over impulses and self-defeating behavior etc. I never felt I would have needed another person to lead me and teach me those things though as it's not hard for me to see how it works, the challenge was to apply in the critical moments, which therapy sessions would have had little help with anyway as the critical moments never occurred there and I had no problems seeing clearly, much more with inhibiting certain behaviors and with discipline.

DBT I find interesting and I do believe that the awareness and skills it is meant to teach can be very helpful for certain conditions. I never tried for myself because I don't think I have the relevant issues, I already use most of those skills naturally... if anything, I actually tend to over-regulate my emotions.

I also found other approaches interesting and helpful, e.g. existential and schema theory but, again, I never felt I needed a T to dive into them. Especially existentialism, which I was very interested in when young and identified with strongly, and kinda grew out over time. Schema theory I like a lot for the relatively simple but meaningful patterns it describes and can easily relate part of it to some of my biggest problems. But what I need more than anything is constructive, steady practical action in everyday reality, so I don't think more theoretical investigations these types of systems provide would help me more than it already has, so no interest in hiring a T for them. Theory and discussion is what I habitually tend to escape into, by default, and still nothing or little happens to actually make things better.

The kind of stuff I have never explored much are the more body- and action-in-the-moment oriented approaches such as some techniques in gestalt, psychodrama, or even art therapy with other people. I know that they would make me at least somewhat uncomfortable as I am not used to them and probably would feel self-conscious. But maybe that's why they would help exactly, in new ways? Don't know. Just talking I do very easily and can talk and analyze issues all day everyday and still engage in self-destructive behavior when I am so inclined, I think talk therapy one-on-one is limited for me because of this. I don't feel that I need therapy now, but perhaps in the future if I do, will try some of these, and maybe in a group format.

DBT therapy is the best for me hands down. I started it because of BPD and the skills I'm learning are a game changer for my life. I'm learning how to cope with my emotions. Its changing my perspective.