Thursday, February 4, 2016

CBT Therapists prefer Psychodynamic for themselves

Last summer a professional colleague quoted a research finding, that CBT therapists, if they had to choose a style of therapy for themselves personally, preferred psychodynamic therapy.  I haven't been able to locate the exact source of  this finding-- perhaps it was a survey at a conference. 

Here, by "psychodynamic" I mean an open style of therapy, which is based on empathy, exploration, reflection, consideration of interpersonal patterns, consideration of existential issues, building insight, and particularly on attending to the relationship between therapist and patient or client.  Psychodynamic therapy is much less focused on symptom questionnaires, "psychoeducation,"  prescription of exercises, reviewing worksheets, etc.

During a subsequent discussion I had with a leading CBT specialist, this theme recurred--about how  meaningful and helpful it was for that person to have had a long-term personal experience with psychodynamic therapy.

CBT is a very much more "data-driven" style.  Psychodynamic styles are less so.   While I find CBT approaches extremely important, it is also true that because they are "data-driven" it will be naturally much easier to generate certain types of data from trials of CBT.  There would be a built-in bias favouring CBT in research.  Those therapists who are very inclined towards "data gathering" would likely be much more inclined towards CBT, and in turn would probably be more inclined to spend time publishing in research journals.  Psychodynamic therapists, on average, are simply less interested in publishing research papers. 

Those studies comparing CBT with other styles of therapy sometimes show advantages of CBT -- but many do not.   And most comparative studies are very brief in duration.

The meaningful, positive elements of psychodynamic styles of therapy are likely to require longer periods of time to evaluate.  Such long time periods are more difficult to measure in a study, due to technical limitations.

The inefficiencies of psychodynamic therapies, as manifest in some of the research, have often stemmed from applying old-fashioned psychoanalytic ideas in a dogmatic or highly passive way, and from offering long-term psychodynamic therapies to all patients, without any attention to shorter-term CBT-style work.  A "blended model" could involve attending to CBT ideas with most patients, but also offering longer-term psychodynamic therapies at the same time, according to patient wishes.    This type of blending is already a natural part of the approach of most therapists on both sides of the "CBT vs. psychodynamic spectrum."  The key feature which is required, in any case, is for the therapist to be kind, patient, empathic, engaging, and available.  

Another related factor, emerging in society in general, is that much of CBT is simply psychoeducational.  Ideas about basic psychological self-care tactics are a major part of every formal CBT course or manual.  The thing is, it is becoming much more prevalent now that people are already educated about CBT ideas.

Therefore, to offer only CBT would be, more commonly, to offer educational material that more and more people are already well-versed and experienced in.

I completely support the idea of increasing the availability of CBT, and of fostering education about self care based on these ideas, starting in childhood.  A lot of CBT could be "taught" as a university or high-school style course.  The manuals for them are similar in size to the workbooks for a typical 3 month course.

But the role of psychodynamic styles is likely to become even more important with time, since more people will already have been well-versed in CBT. 

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