CBT vs. Psychodynamic Therapy for Depression
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CBT vs. Psychodynamic Therapy for Depression
Depression is a chronic mental disorder that is often debilitating and challenging in the course of management. Different treatment modalities are explored to ensure the resolution of the condition. Proper management could explore both psychotherapeutic as well as the pharmacotherapeutic approach (Goldstone, 2017). In most cases, psychotherapy is often considered the first-line approach, and if it fails, medications are used to manage the presentation. The different types of depression that exist include major depressive disorder, persistent depression, and bipolar disorder.
In major depressive disorder, the patient has symptoms that last for more than two weeks. The condition is also associated with disabling presentations and affects one’s ability to work and interact with other people. The condition could be sudden or after the occurrence of a traumatic encounter. The persistent depressive disorder occurs after a previous episode that had been managed but recurred. It could be due to treatment failures or inability to comply with therapy. Bipolar disorder presents when the patient has extreme periods of highs and lows. The patient in BD has drastic changes in mood, and this makes it difficult to manage.
In other cases, the use of medications and psychotherapy can be combined, which would produce superior results (“APA PsycNet,” n.d.). This essay seeks to compare the use of cognitive-behavioral therapy as well, and psychodynamic therapy, options that are effective in the management of depression. The piece will also examine the efficacy and effectiveness of each treatment in alleviating the symptoms of depression.
CBT in the management of depression
CBT is a prevalent type of therapy in the management of several mental disorders, and depression is among the numerous conditions. It is even more effective than others, often scoring great outcomes. The therapy option is useful for either management of moderate or severe illnesses. In this approach, the therapist aims at imparting skills to the patient to enable them to manage the future presentations of the disease. The skills are among other coping strategies to give them the power to pull through both mild and severe presentations of the symptoms. In the therapy, the therapist would identify the negative or false presentations of the disease and then seek to establish positivity or realistic views that make the client able to wane off the disease. In an example, the patients would, at times, feel worthlessness, and this would expose them to adverse effects like suicidal ideations and some even go-ahead to commit suicide.
Unique to this therapy option, some sessions are organized between the therapist and the client. The therapy sessions are organized and conducted over some time, where the client is supposed to interact with the therapist. There is an understanding between the client and the therapist, where a therapeutic relationship is stricken, and sessions begin. During the therapy sessions, the client and therapist are allowed to interact freely and relay concerns as much as possible, to address the disorder. Over time, CBT has been considered as the first option in the management of mental disorders and has always demonstrated efficacy and superiority.
Psychodynamic therapy entails the approach where the therapist employs strategies that are meant to relieve one of the unnecessary tensions. In this therapy, it is believed the condition affecting the client is related to the internal conflicts from things that are unresolved. When used, the therapy helps the patient explore the complete range of emotions, including those they are aware of and those they are not aware of (Leibovich & Zilcha-Mano, 2017). Over time, the patient can understand how their mood and behaviors are affected by the issues that exist unresolved within them.
This therapy has been used in the management of several mental disorders, and depression is among them. In the management of depression using this therapy approach, the relationship between the patient and therapist is taken to be very important and therefore cultivated. To ensure an improved relationship between the therapist and the patient, the process of transference is implored. In transference, the patient is allowed to make assumptions about the therapist’s thoughts on the process. In return, the therapist watches the patient through and through as they make the assumptions and then relay proper information.
The full course of psychodynamic therapy in previous times required multiple weekly numbers of sessions, spread out over time, mainly months or years. However, the current provision requires that therapy occurs over a limited duration between 12 and 20 weeks (Leichsenring et al., 2019). Importantly, the patient is helped to develop insight into the unconscious issues as well as conflicts suspected to cause depression.
Comparison of CBT and Psychodynamic therapy
There are both points of convergence and divergence in the use of CBT and psychodynamic therapy. In as much as CBT and PDT are therapies with diverse styles and indications, there are some common grounds in the paradigms to warrant the comparison.
The role of the unconscious and insight
CBT
In CBT, the role played by the unconscious is not significant enough to help conceptualize mental illness. The cognitive theory bears recognition that many processes occur in mind and hence do so below one’s conscious awareness. However, there is no emphasis on the discovery of what is unknown to the patient. In CBT, the focus is laid on identifying the factors that are currently accelerating the symptoms. In the concept, the symptoms are grouped, and targeted therapeutic intervention is netted to provide a targeted treatment. Also, the behavioral responses focus on inquiring from the patients and challenging them to try new things in the daily routines and environment.
The cognitive interventions also give focus on the direct thought process and patterns and then highlight some of the maladaptive behaviors that contribute to the occurrence of symptoms. In as much as insight is likely to develop over time, it is not considered part of the therapy. The CBT therapists do not get into the intricacies of determining the history of patients, and an assumption is made that once the patient is aware of their condition, they can live a fulfilling life. The therapists also go beyond the insight and then ask the patients to consider what they would do differently.
PDT
In this therapy, there is a great emphasis laid on the role of unconscious processes and hence contribute to the mental disorder. This therapy, therefore, follows the Freud theory of the mind where it is said that the mind is divided into several parts. The aspect of the unconscious explores the elements that are outside the patient’s awareness, thoughts, behaviors, and feelings. Psychodynamic therefore considers the conflicts that occur in the patient’s mind amidst the competing interests. The manifestations of the symptoms are consequently taken as evidence of the existing conflicts.
PDT has an aim to address the unconscious content by the use of procedures through identification and then integration of the aspects of the unconscious mind. In the therapy also, there is the principle of free association, and the patient is then asked to give themselves a chance to converse freely without limitations in thoughts. With time, this makes it possible for the patients to stumble on their insights or connection with what they previously were unaware of.
The therapy sessions’ structure is that the patients may be guided through the topic of discussion in a manner that would shed light on the various aspects of the unconscious mind. The moment the insight by the patient is achieved and the contents of the unconscious brought into awareness of the patient, and they are then encouraged to integrate the information into the comprehension of their conditions. The symptoms have been shown to resolve in many instances once the patients can unearth any existing conflicts.
Maladaptive Thoughts and Defense Mechanisms
CBT
In another consideration, the guidelines, as well as heuristics, are essential to orient the therapists regardless of the theoretical perceptions of crucial procedures and therapy tasks. In an example of such principles, defense mechanisms are considered in PDT, while the maladaptive thoughts are found in CBT. The defense mechanisms are considered the unconscious mechanisms of coping, which the individuals explore to avoid impulses and anxiety presentations. Contrary to the coping strategies in the conscious approach, the defense mechanisms are individualized behaviors, patterns, or habits outside the patient’s awareness. Also, the presence of higher-order defense mechanisms includes less pathological processes, and an example is intellectualizing or talking about feelings instead of directly feeling them.
PDT
In this option, there is also repression, which means using the unconscious processes to prevent threatening thoughts from getting to conscious awareness. On another aspect, rationalization considers the process of intervening or setting reasons to explain the behavior which allows an individual to repress the real motivations. Besides, the defense mechanisms differ in the degree with which the intervention can produce an effect on the condition and minimize the occurrence of negative symptoms to individuals. In the long run, the PDT therapists are trained to consider several defense mechanisms, and when they are adequately determined. The therapists also work in helping individuals to be more aware of the different patterns that exist. In furtherance, being aware of the defense mechanisms would help orient the therapist in identifying the unconscious content that the patient is not aware of or trying to deny, suppress, or avoid.
Just like the PDT, the CBT therapists comply with the guidelines or the heuristics that then give directions to the interventions. In this venture, the aspect of cognitive restructuring is implored. It aims at helping the patients to identify specific thoughts or the beliefs used in evaluating the veracity and believability of the thought process rather than coming up with effective alternatives that can be depended on or reinforced. Further, the patients are expected to have a record of their thoughts daily and then carry the files to the therapy sessions.
In the beginning, the therapists would help the patient by identifying specific thinking errors, which could lead to the occurrence and exaggeration of the symptoms. Logically, this approach to therapy helps the individuals determine and then replace the distorted forms of behaviors and unhelpful beliefs that would be suspect for the occurrence of symptoms. The most common focus of the therapists in CBT’s maladaptive thinking process that the patient is aware of is that cognitive restructuring involves considering the ideas or the beliefs, which then operate below levels of patient awareness. In different cases, the therapists give facilitation in identifying the beliefs or assumptions which have not been stated and what the psychodynamic therapists consider at the unconscious level.
Many of the beliefs of the CBT may, at times, be unraveled via the repetitive inquest and then dialogue that may look similar to the approaches in PDT and encourage the underlying materials. In the CBT, the intermediate and conditionals beliefs are essential to conceptualize the way patients look at their problems and hence come up with effective interventions. The patient may be challenged to engage in activities that remind them of the need to determine solutions for their problems.
Symptom substitution and symptom reduction
CBT
In this aspect, CBT focuses and capitalizes on the reduction of the symptoms. In this case, therefore, the outcome is easily measured, and this is done through a certain level of reduction of the symptoms. Later, this facilitates the research and determination of the efficacy and effectiveness of the therapy. The focus on reducing symptoms also makes alignment of the desire to demand accountability from the care provided. There should also be a demonstration of the billable treatment as being effective and worthy of consideration for reimbursement. From the clinical point of view, the CBT therapists take the symptoms to be the center of focus for the sessions and then make collaboration about the needs of the patients in the course of treatment. The therapy option is often vital for patients who have long lists of problems that keep arising from time to time. Using the symptom-based intervention allows the therapists to formulate a structure that would help the therapists focus on one problem at a time.
PDT
On the converse, the focus of PDT is to focus on helping patients be more aware of the different phases of their psyche, which were previously concealed in their unconscious. The therapists’ curiosity drives them into the encounters and processes that would make the clients more susceptible to the symptoms. The therapy, therefore, considers substitution of the symptoms and presume that addressing the symptoms would be limited and superficial, leading to the manifestation of newer or worse symptoms. In the first place, the therapists would be interested in managing the unresolved conflicts, which are the basis for the symptoms.
Therapeutic alliance and transference
CBT
The relationship between the patient and the therapist is also another aspect that is considered to bring out the difference between CBT and PDT. The building of a proper therapeutic alliance between the therapist and the patient is deemed to be cardinal in determining the kind of treatment outcome of any patient. The alliance is always a common feature in PDT, and it is increasingly becoming standard practice when exercising CBT.
Regarding CBT, the therapeutic relationship cultivated is more collaborative and similar to an approach used by teachers or coaches. The therapist and the patients form part of organizing the therapy sessions and then designing the homework exercises. At the end of the therapy, the therapist uses feedback from the client after the session and utilizes the information in coming up with monitoring the treatment course. Transparency is also considered one of the crucial aspects of the therapy. The patient is made to understand the basis of every strategy and takes the responsibility of addressing the problem. It is also hoped that at the end of the therapy, the patient understands the principles of therapy to independently manage the condition later on.
PDT
In contrast, the psychodynamic concept of therapy emphasizes the potential for the patients to reproduce some essential relationship elements with the therapist, considered under transference. Based on the psychoanalytic point of view, the therapists will aim at minimization of contamination of the transference and after that creation of situations where the intentional withholding is necessary social behavior and personality characteristics. The development of sufficient transference responses makes it possible to identify and correct the relational encounters that may contribute to the conflicts with the therapeutic relationship’s help.
Similarities between CBT and PDT
Both CBT and PDT consider the therapeutic relationship between the patient and therapist is crucial for an effective treatment. Similarly, both the therapy options are meant to ensure the patient is capable of conducting their daily activities without interruptions of the disorder, depression in this case.
The Use of Homework and the length of therapy
CBT
The use of the homework assignments has also been used as the most established features that can be relied upon in distinguishing between PDT and CBT. In CBT, there is homework assigned to the patients after one session, and at the beginning of the net session, time is spent reviewing the previous homework. The use of the homework is taken as an assessment to determine the patient’s cooperation and the implementation of the solutions to the problems to increase self-awareness. The therapy is mainly short term and focused on specific goals. The total number of sessions would be between 5 to 20 sessions.
PDT
On the other hand, not much emphasis is made on the use of assignments, and psychologists have rated the usefulness of assignments are somewhat or of moderate importance. In current practice, therapy sessions are based on client-based, emotion-oriented, interpersonal, family, and psychodynamic approaches. Psychodynamic therapies can take as long as years with a frequency of sessions occurring up to 5 times a week.
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