Over the last 70 years, psychologists have been developing two main schools of thought: the psychodynamic / psychoanalysis approach, and the cognitive-behavioural approach. This paper will try to point out the main differences between these theories, and their implementation in therapy and look into research-based evidence for both theories.

The core difference is the value of the unconscious part of the psyche. Freud (1923), the father of psychoanalysis argued that the unconscious plays a big role in a human’s personality, mostly an uncontrollable part influences behaviour, thoughts and feelings. Unconsciousness can be revealed through dreams, which have been a big focus for Jung (1995) in his analysis; slips of the tongue and patterns of speech, lately have been more researched as the main focus in Lacanian therapy (Bailly, 2009). The main focus of PDT is to bring a patient to awareness of the existence of the inner conflict, caused by opposing forces in the unconscious (Freud, 1933). Such states as anxiety, depression, etc., are viewed as symptoms and indicators of a deeper problem within oneself. By addressing and resolving the root of the problem, which is lying in childhood experience, symptoms will disappear (Pilecki, et al., 2015).

 In contrast, CBT doesn’t provide that much value and attention to the unknown parts of the patient’s psyche. History is taken into account but isn’t the main focus (Kihlstrom, 1990). CBT therapists focus on symptoms and current conditions to determine patient treatment goals and target issues which are preventing individuals from living a full life (Skinner, 1953). 

Another big difference is the length of the therapy. PDT is a long-term treatment and requires 4-5 sessions a week while CBT can be in a short form and medium form and requires 2-3 sessions a week. Which makes CBT more accessible to people. 

It is important to mention that due to the analytical, individual approach to each patient PDT incorporates social-cultural differences in the process of working with clients. For example, the Adlerian approach focuses on providing a feeling of equality, and social belonging and increases self-value (Feltham, 2017). Meanwhile, CBT focuses on altering behaviour, and addressing maladaptive thoughts without going deep into a person’s history and differences, thus social-cultural aspects could be not addressed (Dozois 2019).

However, the effectiveness of CBT therapy is easier to measure, because it’s shorter and more structured. When PDT sessions are usually unstructured, the client could lead the topic of conversation and have complete freedom. 

For instance, Hoffman et al., (2012) showed results of 269 meta-analyses of CBT as highly effective in the treatment of stress disorder, anger control, bulimia and anxiety. Nevertheless, after decades of criticism of PDT as a non-evidence-based theory, Fonagy et al., (2015) provided long-term data collection research where they were able to show the effectiveness of PDT over a long period. Moreover, research showed that after therapy patients continue to improve on their own (Feltham, 2017).
In conclusion, both theories are fundamental for the therapeutic world and despite their weaknesses are still being broadly used and new research appears.

References

Bailly, L. (2009) Lacan: A Beginner’s Guide. Oxford: One World.

Dozois, D. J. A., Dobson, K. S., & Rnic, K. (2019). Historical and philosophical bases of cognitive-behavioural therapies. In K. S. Dobson & D. J. A. Dozois (Eds.), Handbook of cognitive-behavioural therapies (pp. 3–31). The Guilford Press. https://core.ac.uk/download/pdf/344776995.pdf

Feltham, C., Hanley, T., Hanley, T., & Winter, L. A. (Eds.). (2017). Part V: Theory and Approaches. In The SAGE handbook of counselling and psychotherapy. Sage.

Fonagy P., Rost F., Carlyle J.A., McPherson S., Thomas R., Pasco Fearon R.M., Goldberg D., Taylor D. (2015). Pragmatic randomized controlled trial of long-term psychoanalytic psychotherapy for treatment-resistant depression: the Tavistock Adult Depression Study (TADS). World Psychiatry, 14(3), 312-21. doi: 10.1002/wps.20267. 

Freud, (1923). The Ego and the Id. General Press. https://books.google.rs/books?id=gRbNDwAAQBAJ&lpg=PP1&pg=PT6#v=onepage&q&f=false

Freud, S. (1933). New introductory lectures on psychoanalysis. New York: Norton. rb.gy/q8qhuq

Jung, C. G. (1995). Memories, dreams, reflections (R. Winston & C. Winston, Trans.). Fontana Press.

Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioural therapy: A review of meta-analyses. Cognitive Therapy and Research, 36, 427–440. http://dx.doi.org/10.1007/s10608-012-9476-1

Kihlstrom, J. (1990). The psychological unconscious. In L. Pervin (Ed.), Handbook of personality: Theory and research (pp. 445-464). New York: Guilford. https://www.ocf.berkeley.edu/~jfkihlstrom/Pervin3.htm

Pilecki, B., Thoma, N., McKay, D. (2015). Cognitive Behavioral and Psychodynamic Therapies: Points of Intersection and Divergence, Psychodynamic Psychiatry, 43(3) 463–490. DOI: 10.1521/pdps.2015.43.3.463 

Skinner, B. F. (1953). Science and human behaviour. New York: Appleton-Century-Kroft. https://www.bfskinner.org/newtestsite/wp-content/uploads/2014/02/ScienceHumanBehavior.pdf