Cognitive Behavioral Therapy (CBT) and psychodynamic psychotherapy differ mainly in what they focus on and in how the work is carried out. CBT is a structured, goal-oriented approach that focuses on the cycles of thought and behavior that maintain present-day difficulties. Psychodynamic psychotherapy, on the other hand, gives more room to emotions, relationship patterns and the effect of past experiences on the present; the flow of the session is freer.
This article is not meant to say which approach is “better”; it explains where the two approaches differ and where they come closer to each other. For the general framework of psychotherapy, see What Is Psychotherapy?.
What are CBT and psychodynamic psychotherapy, in brief?
Cognitive Behavioral Therapy is a structured psychotherapy approach that focuses on how thoughts, emotions, bodily reactions and behaviors affect one another. The process is usually collaborative; the person and the therapist examine the patterns that maintain the difficulty together and develop skills in line with the goals that have been set. For detailed information, see What Is Cognitive Behavioral Therapy (CBT)?.
Psychodynamic psychotherapy is based on psychodynamic theory, which comes from the psychoanalytic tradition. It aims to understand a person’s emotions, relationship patterns and how past experiences shape present-day experience; it also makes room for processes that the person is not always aware of. For detailed information, see What Is Psychodynamic Psychotherapy?.
What are the main differences between CBT and psychodynamic psychotherapy?
The table below summarizes the general tendencies of the two approaches.
| Criterion | CBT | Psychodynamic psychotherapy |
|---|---|---|
| Focus | Cycles of thought, emotion and behavior that maintain present-day difficulties | Emotions, relationship patterns and the effect of past experiences on the present |
| Session flow | More structured; the session agenda and goals are usually set together | More flexible; the person’s free expression of whatever comes to mind guides the process |
| Therapist’s role | A role in which goals are set together with the person, techniques are explained and practice is supported | A role aimed at understanding the person; generally not giving advice or proposing an action plan |
| Techniques | Techniques such as thought records, behavioral experiments and gradually approaching avoided situations | Free expression; working with transference, resistance and defenses |
| Work between sessions | Often used; e.g., practicing exercises, keeping records | Structured homework is generally not given |
| Therapeutic relationship | The working alliance is important; the relationship forms the ground for applying techniques together | The relationship itself is part of the work; the person’s relationship patterns may also become visible in the therapeutic relationship |
| Duration | Usually shorter and more limited; the NHS often mentions 5–15 sessions, depending on what is being addressed | Brief forms exist; longer-term work can take a year or more |
| Aim | Easing specific difficulties and developing coping skills | Going beyond symptoms, a deeper understanding of oneself and one’s recurring patterns |
This comparison reflects general tendencies; practice may vary according to the therapist’s training, the way an institution works and the person’s needs.
How does a session proceed in the two approaches?
In CBT, a session usually begins with a brief check-in and with agreeing together on the topics to be addressed that day. Starting from a situation the person finds difficult, the thoughts that came to mind, the emotions felt, the bodily reactions and the behaviors in that situation are examined together. At the end of the session, an exercise that can be tried before the next meeting may be planned.
In psychodynamic psychotherapy, the person is invited to express whatever comes to mind as freely as possible. The therapist tries to understand what is being said and pays attention not only to events but also to how the person experiences those events, which emotions come to the fore and which topics recur. Over time, the person’s relationship patterns may also become visible in the therapeutic relationship; these are made sense of together.
How can the same difficulty be addressed in the two approaches?
The example below is entirely fictional; it does not reflect a real person or client and is prepared only to give a general idea of how the two approaches work. Imagine a person who avoids voicing their opinion in meetings and cannot quite understand why.
In CBT, the work usually begins by examining a concrete moment in a meeting: the thought that came to mind at that moment (“What I say will be seen as worthless.”), the anxiety and bodily reactions, and the avoidance behavior are addressed together. How realistic and useful the thought is gets evaluated, small steps toward speaking up are planned, and these are tried out before the next session.
In psychodynamic psychotherapy, on the other hand, the person is invited to say whatever comes to mind about their reticence in meetings. When this reticence began, in which relationships it has been experienced in a similar way, which past experiences it may be connected with, and whether similar feelings also show up in the therapy relationship are explored and made sense of together.
Both approaches deal with the same difficulty; what differs is where the work starts and which tools it moves forward with. In reality, processes can be more flexible than this example, and elements of both approaches can be used together.
What do the two approaches have in common?
Alongside the differences, the two approaches also have much in common:
- The importance of the therapy relationship: The Beck Institute states that a sound therapeutic relationship is necessary for CBT; the Greater Manchester Mental Health NHS Foundation Trust says that psychodynamic psychotherapy is built on a safe and trusting relationship.
- Sessions with a framework: Both are talking therapies that are generally carried out within a defined framework and at regular intervals.
- Attention to thoughts, feelings, behavior and relationships: One addresses these areas through present-day cycles, the other through relationship patterns and past experiences.
- The person’s active participation: In both, how the process works depends on the person sharing their own experience and working on it.
Are CBT and psychodynamic psychotherapy opposites?
No. Although the two approaches start from different points, they deal with the same human experience: a person’s thoughts, emotions, behaviors and relationships are not independent of one another. CBT can also address past experiences when needed, and psychodynamic psychotherapy also focuses on present-day symptoms and current relationships. In practice, the boundaries are not always sharp; some clinicians work within an integrative framework that draws on both theories according to the person’s needs.
What do studies show when the two approaches are compared?
A 2017 meta-analysis by Steinert and colleagues (American Journal of Psychiatry) examined 23 randomized controlled trials (2,751 patients in total) that compared manual-guided psychodynamic psychotherapy with treatments already shown to be effective for the same problem, and reported equivalence for target symptoms both at the end of treatment and at follow-up. The research was carried out through a collaboration of researchers representing psychodynamic psychotherapy and CBT. The finding is equivalence; it does not mean that one approach is superior to the other.
A 2018 meta-analysis by Flückiger and colleagues (295 studies, more than 30,000 patients) found a positive association between the therapeutic alliance and therapy outcome (r = 0.278); the association was also seen across different therapy approaches. This is an association and does not by itself show causation. Both studies are based on group averages; individual responses may vary with the problem, the person and the process.
Which approach is better?
There is no single answer to this question that applies to everyone. There are research findings for both CBT and psychodynamic psychotherapy in a range of difficulties; however, this does not mean that one approach is more suitable for everyone. Suitability varies according to the person’s reason for seeking support, goals, life circumstances and preferences about the way of working.
NHS sources also point to some characteristics of each approach:
- CBT: Applying what is learned between sessions is regarded as important for the process to work.
- Psychodynamic psychotherapy: It may require a long-term commitment, may be emotionally intense, and progress may be slower than an immediate relief of symptoms. It is also noted that it may not be the first choice for people who prefer more structure or direction.
For this reason, rather than “which is better?”, the more helpful question is “which is more suitable for this person, this difficulty and this period?” The answer usually takes shape in the first assessment sessions, together with what the person shares. For detailed information, see How Is the Suitable Way of Working Assessed? and Which Approaches Can Be Used in the Psychotherapy Process?.
What questions can be asked when choosing an approach?
Questions similar to those NIMH notes can be asked of a professional can also be a useful guide when choosing between the two approaches. A person might ask, for example:
- How does this approach address the difficulty being experienced, and what are its rationale and evidence base?
- How are sessions structured, and is work expected between sessions?
- What are the recommended number and frequency of sessions, and how is progress evaluated?
- Does more structure or a more freely flowing conversation feel more suitable for the person?
- How is the way of working reviewed if there is no progress?
Expert note
Knowing the difference between the two approaches helps build a realistic expectation of what the process will look like, rather than preparing a “shopping list”. For some people, structured steps and exercises offer a clearer ground; for others, being able to talk freely and noticing their own patterns over time may be more meaningful.
From a perspective that draws on both cognitive behavioral and psychodynamic theory, thoughts, feelings, behavior and relationship patterns are considered together. Which approach, or which combination of approaches, is suitable usually becomes clear only after an assessment; the information in this article does not replace that assessment.
Clinical Psychologist Özgün Emre Yaylacı
Frequently asked questions
Is CBT or psychodynamic psychotherapy more effective?
It cannot be said that a single approach is more effective for everyone. A 2017 meta-analysis reported that, for target symptoms, psychodynamic psychotherapy was equivalent to treatments already shown to be effective; the quality of the therapeutic relationship has also been found to be associated with outcome. Effectiveness varies according to the difficulty the person is experiencing, their goals and their participation in the process.
Is there a difference in duration between CBT and psychodynamic psychotherapy?
CBT is usually planned with a shorter and more limited number of sessions; the NHS often mentions 5–15 sessions, depending on what is being addressed. Although brief forms exist in psychodynamic psychotherapy, longer-term work can take a year or more. In every case, the duration varies according to the person’s needs and the form of the work.
In which approach is work done between sessions?
In CBT, work such as practicing exercises and keeping records between sessions is often part of the process. In psychodynamic psychotherapy, structured homework is generally not given; the work mainly proceeds through conversation and sense-making within the session.
Can CBT and psychodynamic psychotherapy be applied together?
Some clinicians work within an integrative framework that draws on both theories. The NHS also notes that, depending on need, another type of therapy may be recommended during the course of CBT. Whether a way of working is suitable, and changing it if necessary, is evaluated together with the therapist in line with the person’s needs.
How is it decided which approach is suitable?
This decision is usually made in an assessment process, taking into account together the person’s reason for seeking support, goals, life story and preferences about the way of working. Whether more structured steps or a more freely flowing conversation feels suitable can also be one of the topics of that meeting.
Sources
This article was prepared for general information; the following sources were used in preparing it (in English):
- NHS (UK National Health Service): Cognitive behavioural therapy (CBT)
- NHS London Waiting Room: Psychodynamic psychotherapy
- Greater Manchester Mental Health NHS Foundation Trust: Psychodynamic Psychotherapy
- Beck Institute for Cognitive Behavior Therapy: Understanding CBT
- Steinert et al. (2017), American Journal of Psychiatry: Psychodynamic Therapy: As Efficacious as Other Empirically Supported Treatments? A Meta-Analysis Testing Equivalence of Outcomes
- Flückiger et al. (2018), Psychotherapy: The alliance in adult psychotherapy: A meta-analytic synthesis
This article was prepared by Clinical Psychologist Özgün Emre Yaylacı. Last updated: October 23, 2026. The content is for general information only and does not constitute diagnosis, treatment or personal guidance.
