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An Introduction to Common Psychotherapy Approaches:
Cognitive Behavioral Therapy and Short-term Psychodynamic Therapy
 
by London Butterfield, M.A. 1, Abimbola Farinde, PharmD 2., M.S. and Ernest J. Bordini, Ph.D. 1
 
1Clinical Psychology Associates of North Central Florida, 2121 NW 40th Terrace Ste. B, Gainesville, FL 32605  (352) 336-2888   WWW.CPANCF.COM
 
2 Walden University, Minneapolis, MN
published 1/7/13 Clinical Psychology e-magazine Jan-March Issue all rights reserved Clinical Psychology Associates of North Central Florida
Introduction:
 
When people are faced with psychiatric illness, difficult life events, or intense struggles that they are unable to resolve on their own, licensed psychologists can assist by applying a variety of psychotherapeutic approaches. Much of the origins of modern psychotherapy evolved from what was described as the “talking cure”. While in practice, many therapists combine approaches to suit the individual and the problem at hand, cognitive-behavioral therapy (CBT) and short-term psychodynamic therapies are two of the most common frameworks for psychotherapeutic treatment.  These approaches are used to address and treat adjustment difficulties, behavioral issues, addictions, insomnia, mood disorders such as depression or anxiety, obsessive-compulsive disorder, major psychiatric disorders, and interpersonal difficulties or conflicts.  Both approaches aim to address and improve psychological conflicts, dysfunctional emotions, and problematic behaviors.  These can also address problems with self-concept, or problematic thought patterns.
 
While the ultimate goal of both therapies is to help alleviate current psychological dysfunction, there are fundamental differences in the two approaches.  Simply put, short-term psychodynamic therapy provides an approach in which change is achieved through exploration and working-through of emotions, thoughts and patterns of behaviors.  The psychodynamic approach often focuses on exploring and developing an understanding of connections between past experiences and present patterns of behavior, coping mechanisms or defenses, and personality dynamics.  It has roots in psychoanalytic theory involving concepts that unconscious impulses or conflicts contribute to maladaptive patterns and psychiatric disorder and that making conflicts and historical roots of symptoms conscious, garnering insight, and integrating insights leads to resolution and improved functioning.  Cognitive-behavioral therapy often focuses on helping to identify maladaptive beliefs and thought patterns and applies behavioral and cognitive principals to change maladaptive and self-defeating thoughts and behaviors into more adaptive ones, leading to observable changes in their behavior. In real practice, there are certainly overlaps between the two approaches.
 
Short-Term Psychodynamic Therapy
Psychodynamic approaches place emphasis on an interactive process in which emotions, reactions, and interpersonal or other patterns are identified, explored, integrated, and resolved through insight.  In short-term psychodynamic therapy, the therapist primarily attempts to bring unresolved unconscious conflicts into awareness (Abbass, 2006). A positive therapeutic relationship based on confidentiality and developed trust assists in overcoming anxiety and resistance to exploring and resolving feelings and emotional experiences about the past and present.  Through a supportive-interpretative approach, the therapist helps enhance level of insight about how repetitive conflicts are keeping current problems alive (Leichsenring et al., 2006). The therapeutic relationship and timing of interpretations is often considered important in managing anxiety that might result from this process (Svartber et al., 2004). Central concepts involve uncovering, reducing resistance, examining psychological defenses, and raising unconscious or preconscious conflicts into conscious awareness.
 
The emphasis on the therapeutic relationship is one of the distinguishing factors between short-term psychodynamic therapy and CBT (Leichsenring et al., 2006).  There is an assumption that patterns and reactions to others are in part repeated with the therapist.  This is classically referred to as transference. Transference is the redirection, or projection, of feelings, reactions and ways of interacting from the past onto current relationships.  It is assumed that the repetitive nature of emotions and behaviors from past relationships or traumas may have a negative effect on present interpersonal relationships, and the lack of conscious awareness of these patterns impedes resolution, adaptation and change.
 
Another fundamental difference between psychodynamic and CBT approaches involves the concept of allowing the individual receiving therapy wide latitude in discussing topics and concerns as opposed to a more structured approach in cognitive-behavioral therapy where there is more emphasis on step-by-step approaches to developing skills, confronting and “correcting” cognitions, and engaging in behavioral exercises or “homework”.  This has roots in the psychoanalytic technique of “free association”.  By allowing free exploration of emotions, feelings or thoughts without much restriction or direction, psychodynamic approaches facilitate disclosure, recognition, and resolution of experiences and conflicts.  Resolution of maladaptive patterns, reduction of maladaptive inhibitions, and reduction of “acting-out” of conflicts or destructive emotions is considered a by-product of achieved insight as opposed to behavioral targets of intervention. The ability to form a therapeutic bond, and cognitive ability to achieve and integrate verbal insights are normally considered important factors in the prospects for achieving therapeutic success (Leichsenring et al., 2006).  
 
Cognitive-Behavioral Therapy
While short-term psychodynamic psychotherapy is often characterized as more focused on the exploration of the past and its relation to the present, CBT is often characterized as focusing on the “here and now". CBT often involves combination of behavioral interventions (behavior therapy) and cognitive restructuring (cognitive therapy) techniques (Horrell, 2008). CBT is often associated with measurement of specific behavioral outcomes or goals.  It has been used for a wide variety of psychological disorders and symptoms, including depression, anxiety disorders, eating disorders, pain management, and phobias (Horrell, 2008).  CBT often focuses on the recognition of automatic negative or false thoughts, cognitive distortions, and core beliefs that have a negative impact on emotional well-being and behavior. These maladaptive thought patterns are then challenged and restructured into more adaptive ways of thinking and behaving.
 
Cognitive interventions in CBT, while less focused on “making the unconscious conscious”, still emphasize the ability to establish insight.  Learning to recognize common distortions or false beliefs, exploring how beliefs or thoughts impact on behavior, emotions, and reactions, and methods of practicing, role-playing or substituting more adaptive thought patterns and behavior are considered primary mechanisms of change in CBT (Leichsenring et al., 2006). The therapeutic relationship in cognitive-behavior therapy is often seen as a mechanism to more directly encourage or reinforce effective change (Svartberg et al., 2004). While in psychodynamic therapy, the therapist’s role is considered to be more neutral, cognitive-behavioral therapists typically more deliberately strive to produce a robust, rewarding and directive relationship that can shape the outcome of the therapeutic process (Kramer et al., 2009). A strong therapeutic alliance is considered important in establishing a collaborative effort in which positive reinforcement, relaxation techniques, stress management, cognitive restructuring, corrective imagery and problem-solving are implemented (Ryum et al., 2010). 
 
References
 
Abbass, A. (2006). Intensive short-term psychodynamic psychotherapy of treatment-resistant depression: A pilot study. Depression & Anxiety, 23(7), 449-452.
      
Horrell, S. C. (2008). Effectiveness of cognitive-behavioral therapy with adult ethnic minority clients: Review. Professional Psychology, Research & Practice, 39(2), 160-168.
 
Kramer, U., De Roten, Y., Bretta, V., Michel, L., & Despland, J. (2009). Alliance patterns over the course of short-term psychodynamic psychotherapy: The shape of productive relationships. Psychotherapy Research, 19(6), 699-706.
 
Leichsenring, F., Hiller, W., Weissberg, M., & Leibing, E. (2006). Cognitive-behavioral therapy and psychodynamic psychotherapy: Techniques, efficacy, and indications.  American Journal of Psychotherapy, 60(3), 233-259.
 
Newman, M. G., Castonguay, L. G., Borkovec, T. D., Fisher, A. J., Boswell, J. F., Szkodny, L. E., & Nordberg, S. S. (2011). A randomized controlled trial of cognitive-behavioral therapy for generalized anxiety disorder with integrated techniques from emotion-focused and interpersonal therapies. Journal of Consulting and Clinical Psychology, 79(2), 171-181.
 
Ryum, T., Stiles, T. C., Svartberg, M., & McCullough, L. (2010). The role of transference work, the therapeutic alliance, and their interaction in reducing interpersonal problems among psychotherapy patients with Cluster C personality disorders. Psychotherapy: Theory, Research, Practice, Training, 47(4), 442-453.
 
Svartberg, M., Stiles, T. C., & Seltzer, M. H. (2004). Randomized, controlled trial of the effectiveness of short-term psychodynamic psychotherapy and cognitive therapy for cluster c personality disorders. American Journal of Psychiatry, 161(5), 810-817.
 
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