It can be confusing, if not overwhelming, to understand what type of therapy might work best for you. Two of the best known are Psychotherapy and Cognitive Behavioral Therapy.  They are very distinct, although they do share the overall goal of helping someone deal with life’s distressing elements. In this article, I explain the basics of each and provide a simple comparison table for ease of reference.

What is Psychotherapy?

Psychotherapy, commonly referred to as “talk therapy” or just “therapy”, is an approach with a long history. It dates back over a hundred years to the time of psychoanalyst Sigmund Freud. At its simplest, psychotherapy involves talking with a psychiatrist, psychologist or other mental health provider. 

Psychotherapy is the treatment, through a therapeutic relationship, of how your thoughts, behaviors or emotions affect your moods. The goal is to address root causes of feelings and behavior and eliminate or minimize problem issues or symptoms. In some cases, talk therapy may need to be complemented with medicines. 

It’s not uncommon to experience intense emotions in psychotherapy. So you may cry, become upset or feel very angry as you process feelings and information. An important part of the therapy is to work through these feelings.

Mental health problems treated include:

• Anxiety
• Depression
• Insomnia
• Social phobias
• Mood disorders
• Substance use disorder
• Personality disorders
• Schizophrenia
• Grief due to the loss of a loved one, or to childhood trauma

Other issues that can be treated with psychotherapy include:

• Stress 
• Interpersonal conflicts
• Major life changes such as death, job loss or divorce
• Physical or sexual abuse
• Aggression
• Sexual problems
• Long-term health issues

There are many schools of thought, offering a wide range of styles, including:

• Psychodynamic psychotherapy (the most common form of psychotherapy)
• Integrative psychotherapy
• Interpersonal therapy
• Counseling 
• Psychosocial therapy
• Acceptance and commitment therapy
• Mindfulness-based therapy
• Eye movement desensitization and reprocessing therapy
• Supportive psychotherapy

The key element in most of these forms of therapy is the relationship between the therapist and patient. Talk therapy helps you learn and develop insight to take better control of your life. In doing so it enables you to meet challenging situations with adaptive coping skills. 

Which approach is best for you depends on your situation. And if it’s not working for you, talk with your therapist. Sometimes you may need to switch to a different therapist or try a different approach.

What is CBT?

Cognitive Behavioral Therapy is a combination of two approaches: cognitive therapy and behavioral therapy. The core idea is that what we think, how we behave and how others make us feel are closely related and affect our wellbeing.

CBT is helpful for anxiety, depression, eating disorders, substance abuse and trauma among other issues.

CBT is structured, problem-oriented, and goal-oriented. It’s focused on working through current problems and finding solutions for them. It helps you unlearn unwanted reactions and learn new ways of reacting. 

Different from psychotherapy, CBT doesn’t deal primarily with the past. It’s concerned with the here-and-now and distressing thoughts and behavioral patterns.

CBT also has an emphasis on helping you help yourself and within a short timeframe. The goal is that you should be able to cope with your life as soon as possible without therapy.

Several core principles about psychological issues shape CBT, partly based on:

• Unhelpful or problematic thinking patterns
• Learned patterns of unhelpful behavior
• Core beliefs which are problematic, including ideas about yourself and the world
• People can learn better ways of coping which relieves symptoms and improves emotional and mental health.

Unlike psychotherapy, CBT typically involves a limited number of sessions (10-16). The therapist uses a question-and-answer format to help you gain insight and perspective. 

Common practices of CBT include:

• Looking at and reevaluating negative thoughts
• Learning to relax the body and calm the mind at the same time
• Facing fears rather than continuously avoiding them 
• Evolving coping skills
• Forging strengthened self-confidence and self-esteem

Benefits of CBT can include:

• Establishing new habits
• Gaining helpful coping mechanisms
• Moving negative thinking patterns to positive ones
• Lowering stress or anxiety
• Developing new interpersonal skills
• Learning to appropriately express feelings

There are a variety of forms of CBT that share similarities, but each with different emphasis. One of the most well-known is Dialectical Behavior Therapy. DBT is a development of CBT that combines two apparent opposites: acceptance (that the patient’s experiences and behaviors are valid) and change (that the patient has to make positive changes to manage emotions and move forward).

Psychotherapy and CBT back-to-back

This table compares the two therapy approaches and share insights as to what to expect from each of them.

How to Know When to Choose CBT Over Psychotherapy?

If you are focused on addressing the following issues and within a shorter timeframe, CBT may be a good choice, with its emphasis on overcoming negative thoughts and setting appropriate goals:

• Anxiety
• Depression
• ADHD
• Phobias
• OCD
• PTSD
• Eating disorders
• Substance use disorder
• Personality disorders
• If combined with appropriate medication CBT can help with Bipolar disorder and Schizophrenia.

Psychotherapy can be appropriate for deeper work exploring childhood dynamics and traumas and root causes of issues. However, it usually lasts much longer than CBT.

The most important elements in successful therapy are your timeframe, your willingness to make change and do the hard work involved, and a trusting relationship with a therapist you’re comfortable with.

Sources

Cognitive Behavioral Therapy (CBT). 2022. Cleveland Clinic.

Bettino K. 2021. All About Cognitive Behavioral Therapy (CBT). PsychCentral.

What is CBT? This is Cognitive-Behavioral Therapy. National Association of Cognitive Behavioral Therapists

Darcy A. 2023. Psychodynamic Psychotherapy vs CBT: Which to Choose? Harley therapy