Which type of psychotherapy works best? There’s no simple answer. Just as people respond differently to different drugs, you might do better with one type of therapy than with another. Many people find that a blended approach — one that draws on elements of different schools of psychotherapy — suits them best. There are many forms of psychotherapy, but the two most popular forms are psychodynamic therapy and cognitive behavioral therapy.

Psychodynamic therapy

Psychodynamic therapy focuses on how life events, desires, and past and current relationships affect your feelings and the choices you make. In this type of therapy, you and your therapist identify the compromises you’ve made to defend yourself against painful thoughts or emotions, sometimes without even knowing it. For example, someone with an overbearing parent may unconsciously find it difficult to risk developing intimate relationships, out of fear that all close relationships will involve a domineering partner. By becoming aware of links like this, you may find it easier to overcome such obstacles.

The process of psychoanalysis developed by Sigmund Freud may be the most familiar form of psychodynamic therapy, but it’s not the most common. Psychoanalysis is designed to uncover the unconscious roots of your symptoms and help you apply this understanding to your current life. Classic psychoanalysis is time-consuming (it requires meeting several times a week, possibly for many years) and not widely used today. However, it’s still influential in the thinking behind much psychodynamic therapy, which can be short- or long-term, and may focus broadly or more narrowly on a particular issue or symptom.

Another common focus of psychodynamic therapy is an individual’s interaction with other people. Psychodynamic therapy can help you identify what you seek in a relationship (your needs), the healthy and unhealthy ways of meeting those needs, and ways to improve your ability to communicate. Such therapy can help people cope with the loss of a relationship, conflicts within relationships, or the demands of shifting roles (such as retirement or caring for a parent). One system of therapy with this emphasis, called interpersonal therapy, combines elements of psychodynamic therapy, cognitive behavioral therapy, and other techniques. Therapy is limited to three or four months and focuses on psychological difficulties sparked by recent conflicts or transitions.

The cognitive behavioral approach

Cognitive behavioral therapy (CBT) is less focused on the underpinnings of feelings and instead emphasizes how to change the ingrained patterns of thoughts and behaviors that are causing problems. CBT can be used to alter difficult behaviors, such as smoking, procrastination, or phobias, and can also help address conditions such as depression and anxiety.

Cognitive behavioral therapists believe that you can change your feelings by changing your thoughts and actions. For example, you may have patterns of distorted thinking — excessive self-criticism or guilt (“I always mess up“ or “It’s all my fault”), always anticipating the worst (“I’ll never get this right”), attributing untoward motives to others (“Everyone dislikes me”) — that make you vulnerable to feeling bad. CBT teaches you to recognize these patterns as they emerge and alter them. During CBT, the therapist may ask you to judge the truth behind these statements, to work to transform such automatic thoughts, and to recognize events that are beyond your control. The “behavior” part refers to learning more productive responses to distressing circumstances or feelings — such as relaxing and breathing deeply instead of hyperventilating when in an anxiety-provoking situation.

Selected resources

American Psychiatric Association
703-907-7300
http://www.psych.org/

American Psychological Association
800-374-2721 (toll free)
http://www.apa.org/

National Mental Health Association Resource Center
800-969-6642 (toll free)
http://www.nmha.org/