Comparing Approaches

Psychodynamic therapy vs CBT

Two different ways of understanding why you're stuck - and what to do about it

The core difference

CBT asks how you can think differently. Psychodynamic therapy asks why you think this way at all.

Cognitive Behavioural Therapy treats your mind like software that needs debugging. Identify the faulty thought patterns, challenge them with evidence, replace them with more helpful ones. It's structured, practical, focused on what you can change right now.

Psychodynamic therapy treats your mind like a history that needs understanding. Those 'faulty' patterns didn't appear randomly - they developed for reasons, usually in childhood, usually as ways of surviving difficult circumstances. They made sense once. Understanding where they came from is how you stop being controlled by them.

CBT changes the story you tell yourself. Psychodynamic therapy changes the storyteller.

How they work differently

In CBT, sessions are structured. There's often an agenda, homework assignments, thought records to complete. The therapist teaches you techniques - challenging cognitive distortions, behavioural experiments, exposure hierarchies. Progress is tracked through questionnaires. Treatment is usually time-limited: 6-20 sessions for most problems.

In psychodynamic therapy, sessions are less structured. You talk about what's on your mind; the therapist listens for patterns you can't see yourself. There's no homework, no worksheets. Progress is measured by changes in how you relate, how you feel, what you're able to tolerate. Treatment is open-ended - typically months to years, not weeks.

CBT focuses on the present - current thoughts, current behaviours, current triggers. Psychodynamic therapy moves between past and present, understanding how your history shapes what's happening now.

CBT is directive - the therapist actively teaches and guides. Psychodynamic therapy is more exploratory - the therapist helps you discover what's already there but outside awareness.

What each is good for

CBT tends to work well for:

Specific phobias with clear triggers
Panic disorder
Mild to moderate depression (first episode)
Health anxiety
OCD (especially with exposure response prevention)
Problems you want practical tools to manage

Psychodynamic therapy tends to work well for:

Recurring relationship patterns
Chronic or treatment-resistant depression
Anxiety with unclear origins
Personality difficulties
Problems that keep coming back despite other treatment
Feeling stuck, hollow, or disconnected without knowing why
Identity questions and sense of self

There's overlap, of course. Both can help with depression and anxiety. The question is what kind of help you need - symptom management or deeper understanding.

What the research says

Both approaches have substantial evidence. CBT has more studies - it's been prioritised in research funding and is easier to study (structured, time-limited, measurable). This doesn't mean it's more effective, just more researched.

Key findings for psychodynamic therapy:

Meta-analyses show it's effective for depression, anxiety, personality disorders, and somatic symptoms
Benefits continue to grow after therapy ends (unlike CBT where gains sometimes fade)
The Tavistock Adult Depression Study found it outperformed CBT for treatment-resistant depression at two-year follow-up
Particularly effective for complex, long-standing problems rather than single-episode difficulties

The evidence question is often framed unfairly. 'Evidence-based' has come to mean 'lots of RCTs', which favours approaches designed for research. Psychodynamic therapy has strong evidence - it's just less publicised.

How to choose

CBT might suit you better if:

You have a specific problem with clear triggers
You want practical tools and homework
You prefer structure and measurable progress
You want shorter-term treatment
You're dealing with a first episode of depression or anxiety

Psychodynamic therapy might suit you better if:

You've tried CBT and it helped temporarily but patterns keep recurring
You want to understand yourself, not just manage symptoms
Your difficulties feel connected to your history
You're dealing with relationship patterns or identity questions
You're willing to invest time in deeper work
You've 'done the self-help' and something's still missing

Neither is universally better. They're different tools for different jobs. Sometimes the same person needs both - CBT for specific symptom management, psychodynamic work for the deeper patterns underneath.

Common questions

More specific comparisons for particular issues.

Which is better for anxiety?

It depends on the anxiety. CBT is often recommended first for specific anxieties with clear triggers - social anxiety, health anxiety, phobias. It gives you tools to challenge anxious thoughts and gradually face what you're avoiding. Psychodynamic therapy works better when the anxiety is more diffuse, when you don't know what you're anxious about, or when the anxiety keeps coming back despite having the tools to manage it. It asks what the anxiety is protecting you from, what you learned about safety early on, why your nervous system is on such high alert. If you've done CBT for anxiety and it helped but didn't stick, psychodynamic work might address what CBT couldn't reach.

Which is better for depression?

CBT is typically the NHS first-line treatment for depression. It can be effective, especially for first episodes of mild to moderate depression.

But for chronic, recurring, or treatment-resistant depression, psychodynamic therapy often has better outcomes. The Tavistock Adult Depression Study found psychodynamic therapy outperformed CBT at two-year follow-up for people whose depression hadn't responded to other treatments.

Psychodynamic therapy sees depression not as faulty thinking but as a meaningful response, often to loss, disappointment, or feelings that couldn't be felt. Understanding what the depression is about, rather than just challenging negative thoughts, can create more lasting change.

Why is CBT shorter than psychodynamic therapy?

CBT is designed to be time-limited - typically 6-20 sessions. This makes it cheaper to deliver, which is why the NHS prefers it. It's structured, manualised, focused on symptom reduction. You learn techniques, do homework, track progress on questionnaires. Psychodynamic therapy takes longer because it's doing something different. It's not trying to reduce symptoms as quickly as possible - it's trying to understand why those symptoms keep appearing. Patterns that developed over decades don't shift in twelve sessions. Shorter doesn't mean faster results. CBT can produce quicker symptom relief, but those gains sometimes fade, especially for complex problems. Psychodynamic therapy takes longer but the benefits tend to continue growing after therapy ends. The question isn't which finishes sooner but which creates lasting change.

Is CBT more scientific?

CBT has more research papers because it's easier to study. It's manualised, time-limited, and targets measurable symptoms. These features make it ideal for randomised controlled trials.

Psychodynamic therapy is harder to research. It's less structured, longer-term, and its effects are harder to capture in questionnaire scores. But 'harder to research' isn't the same as 'less effective.'

Meta-analyses show psychodynamic therapy is effective for depression, anxiety, personality difficulties, and relationship problems. The evidence is substantial, just less publicised. Neither approach has a monopoly on science.

What if CBT didn't work for me?

This is common, and it doesn't mean you're a therapy failure. CBT works well for some problems and some people. But if you've done the thought records, challenged your cognitive distortions, learned all the techniques, and the same patterns keep running your life - that's not a character flaw. It might mean the problem runs deeper than thinking patterns. Psychodynamic therapy asks different questions. Not 'what thoughts should you replace?' but 'why do these thoughts keep appearing?' Not 'how can you behave differently?' but 'what makes this behaviour so compelling?' When CBT hasn't worked, it's often because the roots of the problem are in places CBT doesn't go - in your history, your relationships, your unconscious. That's where psychodynamic therapy works.

Want to explore further?

I'm a psychodynamic therapist practising in Croydon, South London. I work with individuals who want to go beyond symptom management to understand why they're stuck.

If you're curious about what psychodynamic work involves, you can read more about what psychodynamic therapy is or how I work with individuals.

If CBT didn't give you what you needed, that's not failure - it might just mean you need a different approach. Get in touch if you'd like to talk about whether psychodynamic work might help.

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