The graduate school I went to, the Derner Institute at Adelphi University, is a professional school that teaches psychoanalytic, psychodynamic psychotherapy. It wasn't until my first post-doctoral job that I learned about cognitive behavioral therapy (CBT) and whole new approach to helping people opened up to me. I was very fortunate to get my CBT training from Dr. Arthur Freeman, who studied under Drs. Albert Ellis and Aaron Beck, the grand-daddy and daddy of CBT. Having in-depth education in both these modalities is like having a nice, deep bench for your basketball team. I can adapt easily to whatever my patient needs even if those needs change in the process of therapy.
My father was a Neo-Freudian psychoanalyst so the psychodynamic approach was super familiar to me. Discovering CBT was like discovering a whole new color in the spectrum. Awesome!
Basically and very simply put, CBT focuses on what is happening here and now to shape our thoughts which in turn influences our mood. Psychodynamic therapy uses the exploration of past experiences and relationships, internal and external, past and present to provide insight and change in the patient.
Both approaches have a place in treating depression, anxiety and other mood and personality disorders. Here I share a few things I love about CBT in particular:
1) It allows both patient and therapist to be creative. I wrote this one first because it's my favorite. At a workshop for seasoned therapists, there to hone their CBT skills, the workshop leader invited us to trust our professional instincts to find unique solutions to our patients' problems. With that encouragement, my patients and I have come up with some imaginative, non-traditional ideas to help them reinforce the work we do in the therapy hour.
Here's an example: I often use a white board to illustrate take-away concepts to fight anxiety or depression, an idea I borrowed from Tim Russert. My patients can then take a photo of the board with their phone camera and voila! An instant CBT cheat sheet they can look at any time, as needed.
And Skype: CBT therapy provided by phone, or better yet, using Skype, is another illustration of creativity that works! I provide services to people wherever they are, stateside or abroad. With Skype we can talk as easily as if we were in my brick and mortar office, whether you are in California or Chile, Toronto or London.
2) CBT reinforces common sense. A lot of good therapy is just common sense and CBT delivers. For example, if someone I'm seeing is highly anxious about calling their psychiatrist about the side effects of a new medication I suggest they call the psychiatrist right there in session. Doesn't that make sense? We use the call as an exercise to review CBT techniques with me right by their side, coaching them through their nerves. By the end of the hour we have an answer from the psychiatrist, a reduction in anxiety and learned techniques that can be applied on their own.
Also in the common sense CBT spirit, when my patients ask me a question I answer as directly as possible, without defensiveness, validating their right to ask and letting them know that I am human, too. Rarely is a question inappropriate or needing redirection.
3) It emphasizes what is healthy in the patient. In CBT if it ain't broke you don't fix it. You use what does work to challenge the depression and anxiety. CBT is founded on the belief that when dealing with depression and anxiety, even when our emotions and moods overcome us, we maintain the ability to think. We just need some help reconnecting with and empowering our reasonable mind.
Another part of CBT is taking inventory of internal and external resources available to the patient and calling them into action. It is such a good feeling to witness the joy when someone rediscovers an interest, talent, skill even a relationship, they forgot they had.
4) It's accessible. There is no mystery to CBT. Its basic principle, that our mood is largely influenced by how we think, is simple. It's the application to our lives when we are mired in mood disorder that can be difficult. That's where the CBT therapist comes in, to point us in the right direction, sort of like calling in a guide when we're lost in the woods.
In CBT we bring any and all tools available to us to support the talking therapy: homework exercises, taking notes during sessions, journaling, bringing in family members, spouses, reading books, blogs, websites, articles, using Skype and telephone sessions, all can be part of making therapy available to suit our lifestyles.
5) It promotes self-reliance. One of the first things I tell my patients is that it's my job to see that they know as much as I do. The point of CBT isn't to have them become dependent on the process or on me. It's to obtain the insight, knowledge and skill that will help them maintain resilient self-esteem and independence.
6) It works. Study after study demonstrates the effectiveness of CBT in treating mood disorders, but the best proof I have that CBT works is the feedback from my former patients who 'graduate' from therapy feeling satisfied they have the tools to manage what life brings them, the hardships and the joys and everything in between.
To be honest, I love psychodynamic psychotherapy too, in fact, it was my first love, and you know how it is with first love! In combination, both modalities are dynamite! Psychodynamic Therapy vs CBT Smackdown for Anxiety
To learn more about CBT read: In Depth: Cognitive Behavioral Therapy
Photo courtesy of define23 via Flickr