Psychodynamic therapy vs CBT: what's the difference?

The short answer

Psychodynamic therapy looks for the roots of current problems in unconscious patterns, early relationships and feelings you'd rather not have, often by exploring how those patterns show up with the therapist (hello, transference). Cognitive behavioral therapy, or CBT, focuses on the present: identifying unhelpful thoughts and behaviors and practicing new ones. One is archaeology. The other is a gym membership.

CBT in one breath

CBT grew out of Aaron Beck's cognitive therapy in the 1960s, alongside Albert Ellis's rational emotive behavior therapy. It's structured and time-limited, often around 12 to 20 sessions, with an agenda each session and homework in between: tracking thoughts, testing predictions, gradually facing feared situations. It is, in the best sense, therapy with a syllabus.

Psychodynamic in one breath

Psychodynamic therapy descends from psychoanalysis but usually meets once or twice a week, face to face. Sessions are less structured; you talk, the therapist listens for patterns, and together you notice what keeps repeating. It tends to be open-ended, though short-term versions exist. Worksheets are rare. Silences are not.

Which one works?

Both have research support for depression, and CBT has an especially large evidence base for anxiety disorders. How well you and your therapist work together, the “therapeutic alliance,” is one of the strongest predictors of success across therapy types. So the best therapy is often the one with a therapist you'll actually keep showing up for.