Are You Hitting a Wall With CBT?

Cognitive behavioral therapy (CBT) was developed by Aaron Beck, MD, in the 1960s as a means of treating a range of mental health conditions. At the time, there was a push to create treatments that were shorter and could be easily researched. Did you know that the founder of CBT was a psychoanalyst by training? Yes, that’s right, Dr. Beck first started out working as a psychoanalyst before he led the way in creating short-term treatment models.

CBT was developed as a short-term model to help reduce symptoms. The therapist works with the client to identify mechanisms of maladaptive behaviors or distorted thinking patterns. As a team, they then create a plan to one by one reduce negative symptoms. In CBT, the therapist assumes a teacher-like role, giving homework assignments and weekly tasks to complete between sessions.

Does CBT work?

CBT has strong efficacy for many mental health conditions, including depression, anxiety, obsessive-compulsive disorder, and posttraumatic stress disorder, among others. One issue, however, is that CBT was mainly intended to be used as a short-term model. It is often studied in controlled settings, such as a hospital, where treatment must remain short and limited. If you’re attempting to work on a greater problem or long-lasting condition, you may benefit more from a depth psychotherapy, such as psychodynamic psychotherapy.

Are there limitations with CBT?

As with any treatment, there are limitations. The results of CBT tend to decay more quickly than those for psychodynamic psychotherapy. The reason behind this appears to be that CBT mainly aims to reduce symptoms in the short term. By contrast, psychodynamic psychotherapy aims not only to reduce symptoms but also to develop psychological capacities and internal resources. As such, the outcomes for psychodynamic psychotherapy tend to be better at long-term follow-ups; that is, the results tend to last longer.

What’s behind CBT that really makes it work?

Researchers have attempted to study the main components that make CBT work. Shedler found that the “working alliance” between therapist and client was really what facilitated change in CBT, not homework assignments, advice, or guidance from the therapist. The working alliance is directly from the psychodynamic model.

Why does CBT feel superficial?

Psychodynamic psychotherapy is a more open-ended treatment, where the client leads the way and decides how they want to use their session. It allows them ample space to explore conflicts, relationship issues, and recurring patterns or themes from their past that to contribute to ongoing difficulties. In psychodynamic psychotherapy, clients often feel they are getting to a greater level of depth and understanding surrounding their issues.

How can I get started with psychodynamic psychotherapy?

If you’ve been hitting a wall in CBT and find it too superficial to address your complex issues, consider starting psychodynamic psychotherapy. Find a psychodynamic psychotherapist on the Upper West Side.