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WHAT IS COGNITIVE-BEHAVIORAL THERAPY (CBT)?
Cognitive behavioral therapy (CBT) recognizes that thoughts (or cognitions), feelings (or emotions), and behaviors influence one another. For example, the thought, “Today is going to be a lousy day,” can lead to a feeling like frustration, which can then lead to a behavior like staying at home rather than going out to meet a friend or take a walk. Staying at home can then ‘fulfill’ the expectation that the day was ‘lousy’ and this association can contribute to more negative thoughts and feelings, along with behaviors that perpetuate them. Thoughts, behaviors, and feelings can cluster into patterns that contribute to common mental health challenges like depression and anxiety. The goal of CBT is to help individuals to understand their own patterns of thought, feelings, and behavior and support them in making changes and improving wellbeing. CBT can be helpful for treating a wide range of challenges.
CBT uses a variety of tools. For example, asking “Socratic questions” is a core component of CBT. Socrates taught by asking questions that evoked the answer from the student. Similarly, in CBT, the psychotherapist asks the individual questions to explore and sometimes challenge patterns of thinking and behaving. In the above example, the psychotherapist might ask what leads the individual to have the thought that the day is going to be ‘lousy’ and also what kind of day the individual thinks he or she might have if he or she made plans to meet with a friend instead of staying home. Another widely used tool in CBT is a thought record that encourages individuals to track their first thoughts in problematic situations to identify thoughts that are so habitual they are practically invisible. This tool then allows for the creation of alternative thoughts and behaviors and provides a framework for practicing changes and monitoring their effects.
CBT usually involves homework between sessions to help individuals develop and practice new ways of thinking and behaving to improve wellbeing. For example, someone struggling with depression might work on an activity to improve mood, such as starting an exercise program or taking a class. This activity would be broken down into steps and the individual would tackle one step at a time with the help of the psychotherapist, exploring obstacles to the goal and celebrating successes.
WHAT IS PSYCHODYNAMIC PSYCHOTHERAPY?
Psychodynamic therapy is concerned with relationships between the individual and anyone or anything of importance to the individual. This includes other people, such as family members, friends, and work colleagues, as well as the individual’s relationship with him- or herself and the relationship between the individual and the psychotherapist. It also includes such things as love, work, and money. A key concept in psychodynamic psychotherapy is that the past influences the present and that this influence is often not obvious (e.g., in the conscious awareness of the individual). Part of psychodynamic treatment thus involves exploring the role of past experience on current problems. To illustrate, a traumatic childhood experience like the death of a parent, can interfere with the individual’s present day love relationships. People interpret childhood events through their understanding at the time; this is carried on into adulthood, partly or wholly forgotten, and yet taken to be ‘true’. For example, a child might interpret a parent’s death as meaning that others whom they love will also leave them. Depending on his or her personality, as the individual grows older, he or she might then go on to ‘cling tightly’ to someone he or she falls in love with for fear of losing that person. Alternatively, he or she might endeavor not to ‘risk’ losing someone and so work to hold him- or herself back from falling in love at all. Through exploration of the past in relation to present day problems, individuals can gain life-changing awareness of why they think and feel as they do. Through the safety and trust of the therapeutic relationship, they have the opportunity to grow and change habits and patterns that have caused them distress, such as being unable to experience a fulfilling love relationship.
Psychodynamic therapy has a long history in psychotherapy and is subdivided into many different schools of thought and theoretical frameworks that guide treatment. Examples of different frameworks include self psychology, object relations theory, and attachment theory. Psychodynamic therapy also naturally allows the inclusion of the spiritual in psychotherapy, since this involves any number of relationships (e.g., to God, the natural world, organized religion, a personal spiritual practice, and so forth).
THE COMBINATION OF CBT AND PSYCHODYNAMIC PSYCHOTHERAPY
CBT and psychodynamic psychotherapy complement one another and can be combined in a single session or across different phases of treatment. For example, an individual seeking help with anxiety might receive assistance in a session with recognizing the role that his or her thoughts play in making him or her feel anxious (the contribution of CBT). Another part of the session might focus on the individual’s relationship with significant people, such as parents, and the role these relationships may have played in raising his or her anxiety and establishing patterns of anxious thinking (the contribution of psychodynamic therapy). Since change and healing is the goal of psychotherapy, it is vital that the treatment itself be flexible and adaptable as a person’s needs change.
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