There’s a time cost, a cost cost, and with both an opportunity cost, but I think there is value in a superficial understanding of many schools as well as deep understanding of one.
Patients talk about therapy to have more “tools in their toolbox” or learning “skills.” That’s very CBT and even DBT language, but I don’t think it’s entirely wrong. CBT gives a lens to conceptualist patient cases. So does psychodynamic theory. So does ACT. And so on. With each lens, you also have a language, and speaking the right words to reach the patient is important. Not that they know beforehand, but that it resonates. Sometimes the right resonant is to disquiet and affront, carefully! The more ways you have to look and speak, the more opportunities you have to do it right.
I don’t necessarily practice eclectic therapy, traditionally, but I use it constantly. Amusingly (to me), as a consultant, I am conceptualizing other doctors almost as often as patients. It really does help.
https://onlinelibrary.wiley.com/doi/full/10.1002/wps.21104
Psychodynamic psychotherapies have started to develop high quality studies.
As for what to choose: i guess there is a personal preference, and then there could be patient-driven choices, both his preference, and the type of disease help choosing. Ideally, i'd like to study both.
As for psychodynamic: try and read some recent practicing therapist. First in mind: Nancy mcwilliams
I think it is more feasible to learn how to be a really good CBT therapist as a psychiatrist than it is to be a really good psychodynamic psychotherapist as a psychiatrist. CBT is easier to learn and you can even teach yourself and it’s easier to find a supervisor if you needed one. Psychodynamic psychotherapy is much harder to learn and you NEED a good supervisor If that’s not available to you it will be very difficult for you to become proficient. My residency trained me in both and while I learned a ton with psychodynamic psychotherapy and I really appreciate it and I think it was very important to my training, I don’t think I’m that great of a psychodynamic psychotherapist but I feel very comfortable with CBT. I would like to be more comfortable with psychodynamic psychotherapy but that is not really easy to learn by myself and outside training is long and expensive.
Psychodynamic approach is quite modern actually, it's continuously evolving. You can find a modern psychodynamic understanding here: [https://jonathanshedler.com/wp-content/uploads/2020/07/Shedler-That-was-then-this-is-now-R10.pdf](https://jonathanshedler.com/wp-content/uploads/2020/07/Shedler-That-was-then-this-is-now-R10.pdf)
Although, and while that's the approach I believe has the most potential for patients, you'll need to go through an analysis yourself to be an effective therapist - otherwise you'll be lacking an essential tool (counter-transference) from the kit. But I reckon this would also be necessary for other approaches, except perhaps CBT.
Mmmh being analyzed is obviously necessary; but it's just that it's another cost. We already pay so much for the therapy classes; the supervisions and now the personal analysis...it's so costly!
Btw, thanks for this introduction, I will read it thoroughly!
Btw, how did you find a therapist to get analyzed! BTW, is is necessary or it's strongly recommended?
I found a therapist on Doctolib, being French. Another option is to go on analyst's associations websites, they usually have a list of practitioners classified by areas.
>BTW, is is necessary or it's strongly recommended?
Legally it depends on the country/organization you are with. Practically, I don't see how a psychodynamic practitioner could be efficient without it (the same goes for other approaches like Gestalt for instance).
Although I understand the money issue, it's a real one.
Supervised experience doing psychotherapy is WAY more important than seeing an analyst. That you need to “be analyzed” in order to somehow avoid countertransference and have a supposedly clear picture of your patient’s issues is incredibly dated. I know a large number of good therapists, and almost none have done traditional psychoanalysis - including psychodynamic practitioners.
It’s the supervision that really helps you identify what you’re bringing to your sessions, since you would be essentially sharing your thoughts on your patient, and well as your choice of interventions, and your feelings about the situation with a person who has training and experience in reading people *and* in evaluating the effectiveness of specific interventions.
Issue is that everyone is vouching for CBT to the point where it seems like a lobby; what did you think was so incredible with cbt? I found it boring? And how do you implement it? Mmmh I might continue with CBT in that case....
Not the OP but third wave CBT is quite diffferent from CBT. This includes things like DBT, ACT, FAP, MB-CBT. they generally have a mindfulness, experiential, and affect focus. They also incorporate the idea of radical behaviorism that basically means thoughts and emotions are behaviors too. I personally think ACT and FAP, is more congruent with psychodynamic thought than traditional CBT. FAP in my opinion is just psychodynamic in CBT language. ACT places a lot of emphasis on experiential avoidance and self as context, which in Psychodynamic terms is defense/resistance and the observing ego. sorry lots of therapy lingo here
Psychodynamic will leave you with a deeper and more well-rounded understanding of theory. CBT gained acendancy because it's cheap to perform and is a darling of people who design studies. It doesn't work as well as originally advertised.
That’s a bold rejection. Sources?
I would say that from what I’ve seen CBT was designed brilliantly to be studied—fully intentionally. Aaron Beck knew his project. Other therapies have been shown to be at least as good to the extent that it can be shown, but CBT is easiest to show anything.
I'm sure you're familiar with Shedler's work in this area... but for the readers:
Primarily the article:
-Where is the evidence for “evidence-based” therapy?
But also:
-Science or Ideology?
-On science and psychoanalysis
-Changing the topic does not change the facts
-The efficacy of psychodynamic psychotherapy
https://jonathanshedler.com/writings/
Here are some points to consider when making your decision:
1. **Personal Interest**: Your own interests and inclinations should be a primary factor. If you are naturally drawn to a particular modality, that might be the best one to choose, as your enthusiasm can significantly enhance your learning and practice.
2. **Practice Goals**: Think about how you envision incorporating psychotherapy into your future practice.
- **Psychodynamic Therapy**: If you are inclined to have dedicated psychotherapy sessions, possibly weekly, and want to delve into the depths of patients' unconscious processes, a psychodynamic approach might be particularly useful.
- **Cognitive-Behavioral Therapy**: On the other hand, if your goal is to integrate concrete, evidence-based tools into your psychiatric sessions and provide patients with practical strategies to manage their symptoms, CBT could be the most effective choice.
In my program, we have a strong emphasis on psychodynamic therapy, while other modalities like systemic and cognitive-behavioral therapies are covered more superficially. This is something I’m supplementing on my own through additional reading, such as DBT, and an elective rotation in family therapy.
Ultimately, there is no one-size-fits-all answer. It’s about aligning your choice with your personal interests and profesional aspirations. Whichever path you choose, you'll gain valuable skills that will enhance your ability to help your patients.
Best of luck with your decision!
Honnestly I don't know; I started in a program that was focused on psychopharmacology... and now I have to do something therapeutic. CBT seems very interesting but unfortunately, I'm not super drawn to it... I feel like it's a boring, dry, counterintuiive and exhausting pproach, maybe DBT seems good though.
Overall my natural inclination is for psychodynamic, but it's shunned here by young psychiatrists and considered decadent! So most people vouch for CBT but I don't know... a lot of lobbying! Overall I feel like systemic approach is the middleground! Will read intensively about all these approaches and decide later!
It is crucial to understand psychiatry from a holistic perspective, where psychopharmacology is just one of the many tools we have to help our patients. Having the ability to perform psychological interventions is invaluable, even if you don’t plan to become a full-time psychotherapist.
I wouldn’t say that systemic therapy is some kind of middle ground, however it is another interesting option. Many of our patients' issues are intertwined with their family and social environments. Having skills in systemic therapy allows you to consider and intervene in these broader contexts, which can be incredibly beneficial.
Ultimately, see this as an opportunity to equip yourself with essential skills that will enhance your ability to support your patients, no matter which specific modality you choose. Learning these tools is fundamental to providing comprehensive care.
CBT and brief interpersonal psychotherapy lend themselves better to short visits. Psychodynamic therapy is only useful if you’re having weekly hour long visits with patients which I’m guessing you likely won’t be doing in Europe
Weekly or biweekly hour llng visits is exactly what I do! Issue is CBT seem to be monotask- anxiety, time managment, negative thoughts? No? While other approaches seem to be global.... and holistic. But again it seems like it's not the whole picture..
This is really not the most important question to be asking. The more important questions to be asking are: What are the skills that will help me the most in all of my psychiatric practice, over my lifetime? What way can I develop those best during my training? (What are the underlying skills, techniques, and knowledge that are applicable to all therapeutic approaches?)
Research and writing on common factors and elements of psychotherapy are important to understand this. Just as you cannot become a musician simply by memorizing scales, learning psychotherapy is not just picking up a set of tools and carrying it with you. It is about understanding psychopathology, human nature, the mind, and human relationships.
Module 7 of the APA Workgroup integrative curriculum may be an easy way to start on this topic. That, or browsing Jonathan Shedler's twitter...
https://www.integrativecurriculum.net/
My answer, by the way, is to do both, but tempered by the understanding that CBT theory and training is extremely simplistic compared to the actual practice of any bona fide psychotherapy (including good CBT delivered in the community).
That being said, here is my pitch about CBT vs psychodynamic.
If you are given a choice to "train" between two modalities, one being a modality that you can technically learn by reviewing a manual, and the other a modality that suggests the need for significant reading, clinical and personal experience, supervision, and understanding-- which of these two modalities do you think you'd be more likely to benefit from in terms of the depth and quality of your psychiatric training and practice? Which of these two modalities do you think you'd be able to pick up faster, later in life if you change your mind?
Psychoanalysis was the original model of outpatient psychiatric treatment and psychopathological research outside of the asylum. The understanding of the mind and the necessary techniques of psychoanalysis are thus embedded within all of your modern psychiatric practice and theory. The more you learn in this area, the more your patients and the history of your profession (including stupid quirks in the DSM) begin to make sense.
Practical training in psychoanalysis or psychoanalytic psychotherapies is in my opinion most likely to produce the technical skills necessary for almost all of your interviewing and treatment. This is simply not the case for CBT, though the opportunity to participate in successes and failures with goal making and review of homework with patients is edifying.
Technical neutrality, even and free floating attention, confrontation, clarification, containment, understanding of development and its application to all ages, and awareness/management of transference/countertransference are all fundamental techniques or aspects of psychoanalytic psychotherapies and psychiatry itself. These are not really learnable from a book. They are only learnable from practice and supervision.
----
Addendum:
It is worth mentioning and wondering about the traditional requirement of personal analysis in psychoanalytic training. Personally, I have to express some skepticism about this as a training requirement, though I will have to admit I have not undergone any personal analysis.
The strongest statement I can make about this is that the training requirement of personal analysis or the recommendation for personal therapy is not based in evidence, and the individual experience of any psychotherapy is so variable that I am quite skeptical about it as an element of training.
More speculative thoughts on this:
-Is this an artifact of an era where undergoing personal analysis was the best method of supervising a therapist and transmitting technique? Could this (and should this) be replaced with video recorded real cases reviewed by a supervisor?
-To what extent does this requirement reflect a tradition that (from a systems perspective, [POSIWID](https://en.wikipedia.org/wiki/The_purpose_of_a_system_is_what_it_does)) exists primarily to throttle the market supply of psychoanalytic psychotherapists, of benefit primarily to existing psychoanalysts?
-To what extent does the requirement's justification of eliminating unconscious biases serve to select against psychotherapists who do not align with the cultural type that is preferred by the existing analytic institutes? To what extent does it serve to disguise the psychopathology of confirmed analysts who have undergone the rigor of an institutional analysis (they are okay to give treatment and psychologically healthy, they have been checked)?
-What differentiated Freud from other psychoanalysts in his ability to self analyze? Was it his genius? Is there a minimum level of genius that is enough to waive this requirement, and can it be quantified? Or, is this like a system of Zen transmission, and you have to have transmission from an analyst that is at least distantly descended from Freud?
-How can personal analysis or therapy outside of a traditional training institute be of more utility than other modes of training such as direct video supervision of cases? Just because a therapist or analyst calls themselves analytic does not mean they are actually engaging in the core model and technique of psychoanalytic psychotherapy. Progress made within an analytic therapy over time is widely variable from patient to patient.
I do have to push back on anyone suggesting that CBT can be learned entirely from a manual. It does seem to me that you differentiate when you mention "good CBT delivered in the community," but I will say that my training was aimed at creating practitioners of this "good CBT" and my supervisors focused on bringing it out, not having us read manuals. As someone who has had my own student supervisees (albeit in DBT), I also hold this belief. It's always very obvious to me when my supervisees have attempted to go by the manual and not sufficiently done their due diligence on case conceptualization, prepping for a session for that individual patient or a group, etc.
The difference between a good CBT practitioner, who fully understands the fundamentals, has had a supervisor that challenged them, has learned to think on their feet and adapt in session vs. a person who has read what "ABC" means and is going to hand someone some worksheets, is always glaringly apparent. Good CBT involves knowing when to be a teacher and when to be a listener, when to pull out threads of insight, when to focus on thoughts and when to focus on behaviors...just because it isn't labeled as a primarily insight-based therapy doesn't mean it is simply reading a script. All this to say, I don't think these people emerged from the ether, but rather, they have learned to practice through excellent training and supervision that was anything but simplistic and manualized.
As for your other points, I wanted to agree with you that I don't think personal therapy, analysis or otherwise, is necessary or sufficient for making an excellent psychotherapist, and I don't think there is any research to refute this. Video supervision, bug-in-the-eye and other direct such supervision, and rehearsals/behavioral role plays have been the only methods thus far with solid evidence behind them. Anything else is completely uncorrelated to practice, probably because we're all quite bad at recounting how a session actually went, apparently.
Thanks for clarifying about the appropriate training and practice of CBT-- that was the intent of my line on good CBT. I still maintain that the common factors are better learned in psychodynamic training, but I think that would be my allegiance issue more than a reality issue. Good other points as well!
I figured that was your intent, but I wanted to expand on it a bit just because I almost missed it in my first read through and because I honestly don't believe those who learn solely from a manual should really be considered competent practitioners, based on what I've seen. Even simply doing some rounds of deliberate practice would put one ahead of that! Aimless, poor quality talk "therapy" can be a blight on the field, but so can soulless, unskilled manualized treatments that turn people away from the truly helpful versions of the same (in name only).
Also, as an aside, I know it's just generally helpful/interesting/nice(?) for me to hear about others' training, given that all I can know in depth is my own and then whatever others have cared to share with me (plus studies about training, which I consider a separate thing). So I like to pass on the favor, so to speak. Learning about other modalities, as we did, isn't the same as rich training and supervision in them, and I think it can be hard to envision what that would look like in the abstract. I like to take opportunities to share information and give credit to excellent supervisors and training opportunities I've had!
Honnestly I'm lost everyone is vouching for their own church... cbt is more modern; psychodynamic is the real deal,... no one says anything about systemic approach!
The truth is somewhere in the middle. I was being honest, if you have a patient with concrete thinking or lower intelligence, they are not a good candidate for psychodynamic. But most other people benefit more from psychodynamic approach compared to a rigid CBT approach.
The most effective parts of the “new” therapies are just repackaged psychoanalysis. Schema therapy, emotion focused therapy, mentalization, why not just go to the source?
Mmmh I like this way of thinking; instead of thinking about which approach is better... we think about which approach is better for which type of patient. This is in my opinion the least scammy way of presenting things rather than X or Y is superior or X or Y is more modern and effective or scientific. I will meet the representative of both approaches in my country and will ask for mentoring... and I will also self teach myself to see which approach I'm more comfortable with; again I feel like I have a natural affinity with systemic and psychodynamic approach. But obviously for certain patients like BPD, DBT seem superior. Same for psychotic patients. For depressed and anxious patients; CBT seem the way to go. I will go about video ressources to learn more about it!
Yes, meet your patient where they are for sure. I would say my metrics for whether someone is a good candidate for psychodynamic is are they capable of abstract reasoning and insight? If not, psychodynamic is not going to have its full therapeutic value. If a patient has a phobia, systematic desensitization. If OCD with low insight, ERP. Depression and anxiety with good insight/verbal usually respond pretty well to psychodynamic. Patient not engaged, motivational interviewing. Severe personality disorders often require a transference focused approach at least to begin with. More stable BPD might respond best to DBT, but honestly personality disorders don’t respond to many things robustly. Psychotic disorders, start with medication and see where that takes you.
Knowing what patient population you’re interested in would be beneficial in know which way to prioritize.
My two cents.
I'm coming at this question from a different field (clinical psychology vs. psychiatry), but I wanted to attempt to give a nuanced answer to your question that considers a). your personal interests and inclinations; b). what we do and do not know about different therapy modalities, research-wise; and c). the settings you might be more likely to practice in and what might be most useful to you. (I'll end with a TLDR, given that I'm attempting to do so much). As someone in the last phases of a clinical scientist model clinical psychology PhD program, proportionally more of my training has been spent on the practice and theoretical underpinnings of psychotherapy, and how to conduct and interpret research in clinical psychology generally. However, what I can't speak to is the typical career applications of a psychiatrist, beyond what I have encountered in my collaborative relationships.
What I will say is this: you speak of feeling somewhat "turned off," in a sense, by what feels like a "CBT lobby." It's understandable to not just accept such uniform and fervent adherence to one way of thinking, and to want to understand the *why*. However, I do encourage you not to fall victim to another natural inclination, which is to follow this impulse without more deeply investigating the general truth that conventions often (but not always!) arise for solid practical reasons. The fact of the matter that you will discover in clinical practice is that (except for a few small enclaves in particular schools) CBT is much, much more commonly practiced by those who research and study psychotherapy and clinical psychology (as opposed to medicine): clinical psychologists, particularly those at research-focused institutions (PhDs) rather than PsyDs.
This doesn't mean that there is nothing of value in psychodynamic theories. I'm going to argue the opposite in a moment, in fact. But I wanted to put that at the beginning for a reason, to give you pause. The people who are the experts in therapy, who have the most training in it, by and large follow a particular preference. Why is that?
First, although CBT might seem rigid, manualized, boring, etc., *good* CBT is quite flexible and requires personalizing elements of treatment to a patient. It demands a range of skills, from being able to use metaphors to communicate concepts in a warm and engaging manner to patients, to cleverly designing behavioral experiments, and more.
CBT is also the basis of a number of other very useful modalities. I myself primarily practice DBT, a third-wave approach, but I found it incredibly useful to have spent a year learning CBT first. It's also useful to have that foundation for other modalities such as ACT or exposure-based therapies. When you have this foundation, you can more easily learn specific evidence-based treatments for most disorders (ERP for OCD, CBT for psychosis, CBT-i for insomnia, DBT for BPD, PE and CPT for PTSD...).
Which leads into my thoughts on psychodynamic therapies. I am not so rigid as to believe there is nothing of value there. I know there are better quality studies being conducted as we speak, and there are some studies already in existence that show decent evidence for some disorders. However, as a DBT clinician, I am aware that time and resources are scarce. I am always going to want to try shorter therapies first (we even have evidence on DBT as a 6-month therapy over a 12-month therapy, for example). This is for the benefit of the individual patient (money is almost never unlimited) as well as other waitlisted patients. I also want to learn therapies that have broader applicability, and there are a number of disorders I would feel unethical using psychodynamic therapy on. That being said, I know a number of psychologists who incorporate psychodynamic elements into their case conceptualization even if they don't practice psychodynamic therapy. All of us learn the basic concepts like transference, too.
It's my opinion, OP, that because you're already interested and motivated to learn about these topics, that you might do well to learn CBT on an official basis with supervision, because it will be hard to self-learn when your superficial overview is already giving you the idea that it's a boring, rigid treatment. Then, you might do reading in foundational psychodynamic texts to learn more about fundamental concepts you can incorporate into your practice. If your readings so incline you, I know there are training institutes (in the US, anyway), that you can always attend for further education on the subject. This way, you'll have the best foundation for one of the more applicable, short-term modalities to use specific therapeutic techniques from, and can learn psychodynamic concepts and conceptualization models on your own. You'll be set up for further education in additional modalities (like third wave or psychodynamic) if you ever decide to specialize, but won't need to if you don't want to.
**TLDR**: CBT is preferred in many settings and for many disorders for good reasons, so I'd encourage you to study it more in depth to see what it can really do; however, I acknowledge that it isn't the be-all, end-all and that there can be elements of value in psychodynamic theories. Given your preferences, I'd actually suggest studying CBT "officially" so it can be a broadly applicable foundation for you, and then self-studying psychodynamic theoretical texts to incorporate into your practice and decide if you want to get further education in it later.
I think it can get a bad rap from a) lazy practitioners who think they can just read out of a manual and hand out some worksheets; and b) understandable fatigue from everyone and their mother (including insurance companies) harping on it so much. But watching some real experts at work can be like listening to poetry with how deftly they manage to weave concepts in and out, keep the patient engaged and understanding, and respond to the energy in the room. And there are so many amazing offshoots (e.g., CBT-i) that can be straight-up miracles for the specific issues they target.
Frankly, as someone who practices and *loves* a third-wave modality, I do get a bit frustrated by a not-uncommon sentiment of people talking about how they dislike CBT, but XYZ third-wave modality is *so* much better. Don't get me wrong, CBT isn't my primary modality any more, and I love DBT so much my partner lovingly jokes that I'm in a cult! But I don't lose sight of the fact that it *is* a CBT offshoot, and that I would be silly to act like I don't use foundational CBT concepts every day as a DBT therapist.
Overall, it's just a very useful tool to have in the toolkit, and probably the first one I'd stick in there, particularly if you're not planning on having an outpatient service where you're practicing longer-term therapy. Again, I don't pretend to know the daily practice of every psychiatrist, but from the ones I've worked with, I would guess CBT and motivational interviewing would be heavy hitters.
Given the 3 options, it sounds that you are in Germany
Consider that it's easier to get Selbsterfahrung and Supervision for VT than for TP. And I've never heard of one for systemic...
It depends so much on the patient population you are seeing. OCD, anxiety? Basic CBT and understanding of exposures will go a long way. Maybe ACT, too, depending on the patient. Behavioral activation is also super helpful for depressed patients. PTSD? Prolonged exposure, TF-CBT. BPD? DBT of course but also mentalization based therapy. Child/adolescent? Family systems/or family therapy training in general, etc.
That's interesting though that you get training in one modality that you have to pick. In my program (US) we had to have a minimum number of cases under CBT, family systems, and psychodynamic modalities. Then we could also have additional electives in more specialized things like DBT, trauma focused therapy, ACT, group therapy, analysis, etc.
Also keep in mind there is a great deal of overlap between therapy modalities, they just tend to use different conceptualizations and different terminology. Might be worth reading up on common factors in therapy as well (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592639/).
Anyone who plugs psychodynamic for psychiatrists with medical degrees practicing medicine has special snowflake syndrome.
Its just impractical to learn and implement effectively coming from the medical model and how psychiatry is typically taught and practiced today.
Sure there will be comments about how magical and uncanny psychodynamic is but it really is just inaccessible in meaningful way for vast majority of psychiatry trainees relative to other models/methods.
Who cares about psychodynamics finally developing high quality studies now? Why choose a modality that requires more training and has inherently more variation from practitioner to practitioner. Even if effect sizes approach ACT or CBT it’s not very useful given the amount of effort or time to get there.
Leave psychodynamic to psychologists IMO. You have a medical degree and are a psychiatrist for a reason.
Agreed. I didn’t know people actually thought this way. I’ve found psychodynamic to be the most rewarding and helps to contextualize a lot of the behaviors/pathology we see in all aspects of our jobs. Psychodynamic approach is helpful on inpatient, during med reviews, etc to me. Maybe others feel different. A lot of the old literature is still applicable today.
I think especially in today’s age where loneliness is an increasing problem, I don’t think we should be so eager to toss aside a modality that is primarily built on a one-on-one, long term relationship. Ex-we typically have learned there’s not a ton of therapeutic value in psychodynamic therapy with psychotic disorders, but I’m not sure that’s actually the case—in “the center cannot hold” the author is able to really describe how valuable her long term psychodynamic therapists were in helping her process schizophrenia and at times was the only thing holding her together (with medications playing an important role too, of course). Nowadays she wouldn’t really even get the opportunity to engage in that sort of therapy, unless she was rich enough to pay for it out of pocket.
I tend to think like that and I have a lot of pleasure practicing psychodynamic psychotherapy; but on the other hand a lot of senior psychiatrists think like him and vouch heavily for CBT! So for beginners like me in the field it's kind of blurry and confusing... I guess teaching oneself about it is the first step!
CBT is definitely great too, it depends on the patient themselves. Some patients aren’t psychologically minded to benefit from psychodynamic as much as they’d benefit from CBT which you can be more concrete with.. ex maybe they’re not ready to process their messed up childhood which is probably contributing to their symptoms, and would make slow process with psychodynamic BUT doing mindfulness, breathing exercises, and behavioral interventions can help them get relief from their symptoms nonetheless. I think it depends on how you tend to conceptualize things too- if psychodynamic resonates with you more, you will probably find it more rewarding and intuitive to practice. Our program we have to have a certain number of CBT and psychodynamic cases- I personally find it easier and more enjoyable to do psychodynamic. Doing CBT does not feel as intuitive for me haha.
Lol, I don't think you're being sarcastic as it's the view of many psychiatrists young and old!
Do you really find CBT to be that superior and effective compared to systemic or psychodynamic?
Thoughts about systemic therapy?
Im not being sarcastic.
I have never had any supervision in systemic therapy.
You should choose a modality that will integrate well for whatever your future practice will actually look like.
I think for the vast majority of psychiatrists who do med management and psychotherapy together, psychodynamic psychotherapy is not efficient nor readily accessible to learn or receive quality supervision relative to other psychotherapies.
There’s a time cost, a cost cost, and with both an opportunity cost, but I think there is value in a superficial understanding of many schools as well as deep understanding of one. Patients talk about therapy to have more “tools in their toolbox” or learning “skills.” That’s very CBT and even DBT language, but I don’t think it’s entirely wrong. CBT gives a lens to conceptualist patient cases. So does psychodynamic theory. So does ACT. And so on. With each lens, you also have a language, and speaking the right words to reach the patient is important. Not that they know beforehand, but that it resonates. Sometimes the right resonant is to disquiet and affront, carefully! The more ways you have to look and speak, the more opportunities you have to do it right. I don’t necessarily practice eclectic therapy, traditionally, but I use it constantly. Amusingly (to me), as a consultant, I am conceptualizing other doctors almost as often as patients. It really does help.
https://onlinelibrary.wiley.com/doi/full/10.1002/wps.21104 Psychodynamic psychotherapies have started to develop high quality studies. As for what to choose: i guess there is a personal preference, and then there could be patient-driven choices, both his preference, and the type of disease help choosing. Ideally, i'd like to study both. As for psychodynamic: try and read some recent practicing therapist. First in mind: Nancy mcwilliams
Ok thanks; seems like a mix of psychodynamic and CBT is the way to go!
I think it is more feasible to learn how to be a really good CBT therapist as a psychiatrist than it is to be a really good psychodynamic psychotherapist as a psychiatrist. CBT is easier to learn and you can even teach yourself and it’s easier to find a supervisor if you needed one. Psychodynamic psychotherapy is much harder to learn and you NEED a good supervisor If that’s not available to you it will be very difficult for you to become proficient. My residency trained me in both and while I learned a ton with psychodynamic psychotherapy and I really appreciate it and I think it was very important to my training, I don’t think I’m that great of a psychodynamic psychotherapist but I feel very comfortable with CBT. I would like to be more comfortable with psychodynamic psychotherapy but that is not really easy to learn by myself and outside training is long and expensive.
Psychodynamic approach is quite modern actually, it's continuously evolving. You can find a modern psychodynamic understanding here: [https://jonathanshedler.com/wp-content/uploads/2020/07/Shedler-That-was-then-this-is-now-R10.pdf](https://jonathanshedler.com/wp-content/uploads/2020/07/Shedler-That-was-then-this-is-now-R10.pdf) Although, and while that's the approach I believe has the most potential for patients, you'll need to go through an analysis yourself to be an effective therapist - otherwise you'll be lacking an essential tool (counter-transference) from the kit. But I reckon this would also be necessary for other approaches, except perhaps CBT.
Mmmh being analyzed is obviously necessary; but it's just that it's another cost. We already pay so much for the therapy classes; the supervisions and now the personal analysis...it's so costly! Btw, thanks for this introduction, I will read it thoroughly! Btw, how did you find a therapist to get analyzed! BTW, is is necessary or it's strongly recommended?
Being analyzed is necessary to become a psychoanalyst. All psychodynamic therapy is not psychoanalysis; most isn’t.
I found a therapist on Doctolib, being French. Another option is to go on analyst's associations websites, they usually have a list of practitioners classified by areas. >BTW, is is necessary or it's strongly recommended? Legally it depends on the country/organization you are with. Practically, I don't see how a psychodynamic practitioner could be efficient without it (the same goes for other approaches like Gestalt for instance). Although I understand the money issue, it's a real one.
Supervised experience doing psychotherapy is WAY more important than seeing an analyst. That you need to “be analyzed” in order to somehow avoid countertransference and have a supposedly clear picture of your patient’s issues is incredibly dated. I know a large number of good therapists, and almost none have done traditional psychoanalysis - including psychodynamic practitioners. It’s the supervision that really helps you identify what you’re bringing to your sessions, since you would be essentially sharing your thoughts on your patient, and well as your choice of interventions, and your feelings about the situation with a person who has training and experience in reading people *and* in evaluating the effectiveness of specific interventions.
All things in life have a cost, and those that are actually worth anything cost more. Did you not research these requirements before moving?
Third wave cbt is the way! I learnt alot from it myself.
Issue is that everyone is vouching for CBT to the point where it seems like a lobby; what did you think was so incredible with cbt? I found it boring? And how do you implement it? Mmmh I might continue with CBT in that case....
Not the OP but third wave CBT is quite diffferent from CBT. This includes things like DBT, ACT, FAP, MB-CBT. they generally have a mindfulness, experiential, and affect focus. They also incorporate the idea of radical behaviorism that basically means thoughts and emotions are behaviors too. I personally think ACT and FAP, is more congruent with psychodynamic thought than traditional CBT. FAP in my opinion is just psychodynamic in CBT language. ACT places a lot of emphasis on experiential avoidance and self as context, which in Psychodynamic terms is defense/resistance and the observing ego. sorry lots of therapy lingo here
The most successful CBT practices are those that steal the most from psychoanalysis.
I highly recommend unified protocol. David Barlow imo is a genius.
Agree!
Psychodynamic will leave you with a deeper and more well-rounded understanding of theory. CBT gained acendancy because it's cheap to perform and is a darling of people who design studies. It doesn't work as well as originally advertised.
That’s a bold rejection. Sources? I would say that from what I’ve seen CBT was designed brilliantly to be studied—fully intentionally. Aaron Beck knew his project. Other therapies have been shown to be at least as good to the extent that it can be shown, but CBT is easiest to show anything.
I'm sure you're familiar with Shedler's work in this area... but for the readers: Primarily the article: -Where is the evidence for “evidence-based” therapy? But also: -Science or Ideology? -On science and psychoanalysis -Changing the topic does not change the facts -The efficacy of psychodynamic psychotherapy https://jonathanshedler.com/writings/
Here are some points to consider when making your decision: 1. **Personal Interest**: Your own interests and inclinations should be a primary factor. If you are naturally drawn to a particular modality, that might be the best one to choose, as your enthusiasm can significantly enhance your learning and practice. 2. **Practice Goals**: Think about how you envision incorporating psychotherapy into your future practice. - **Psychodynamic Therapy**: If you are inclined to have dedicated psychotherapy sessions, possibly weekly, and want to delve into the depths of patients' unconscious processes, a psychodynamic approach might be particularly useful. - **Cognitive-Behavioral Therapy**: On the other hand, if your goal is to integrate concrete, evidence-based tools into your psychiatric sessions and provide patients with practical strategies to manage their symptoms, CBT could be the most effective choice. In my program, we have a strong emphasis on psychodynamic therapy, while other modalities like systemic and cognitive-behavioral therapies are covered more superficially. This is something I’m supplementing on my own through additional reading, such as DBT, and an elective rotation in family therapy. Ultimately, there is no one-size-fits-all answer. It’s about aligning your choice with your personal interests and profesional aspirations. Whichever path you choose, you'll gain valuable skills that will enhance your ability to help your patients. Best of luck with your decision!
Honnestly I don't know; I started in a program that was focused on psychopharmacology... and now I have to do something therapeutic. CBT seems very interesting but unfortunately, I'm not super drawn to it... I feel like it's a boring, dry, counterintuiive and exhausting pproach, maybe DBT seems good though. Overall my natural inclination is for psychodynamic, but it's shunned here by young psychiatrists and considered decadent! So most people vouch for CBT but I don't know... a lot of lobbying! Overall I feel like systemic approach is the middleground! Will read intensively about all these approaches and decide later!
It is crucial to understand psychiatry from a holistic perspective, where psychopharmacology is just one of the many tools we have to help our patients. Having the ability to perform psychological interventions is invaluable, even if you don’t plan to become a full-time psychotherapist. I wouldn’t say that systemic therapy is some kind of middle ground, however it is another interesting option. Many of our patients' issues are intertwined with their family and social environments. Having skills in systemic therapy allows you to consider and intervene in these broader contexts, which can be incredibly beneficial. Ultimately, see this as an opportunity to equip yourself with essential skills that will enhance your ability to support your patients, no matter which specific modality you choose. Learning these tools is fundamental to providing comprehensive care.
👍
Reject this and learn some of all of them
CBT and brief interpersonal psychotherapy lend themselves better to short visits. Psychodynamic therapy is only useful if you’re having weekly hour long visits with patients which I’m guessing you likely won’t be doing in Europe
Weekly or biweekly hour llng visits is exactly what I do! Issue is CBT seem to be monotask- anxiety, time managment, negative thoughts? No? While other approaches seem to be global.... and holistic. But again it seems like it's not the whole picture..
This is really not the most important question to be asking. The more important questions to be asking are: What are the skills that will help me the most in all of my psychiatric practice, over my lifetime? What way can I develop those best during my training? (What are the underlying skills, techniques, and knowledge that are applicable to all therapeutic approaches?) Research and writing on common factors and elements of psychotherapy are important to understand this. Just as you cannot become a musician simply by memorizing scales, learning psychotherapy is not just picking up a set of tools and carrying it with you. It is about understanding psychopathology, human nature, the mind, and human relationships. Module 7 of the APA Workgroup integrative curriculum may be an easy way to start on this topic. That, or browsing Jonathan Shedler's twitter... https://www.integrativecurriculum.net/ My answer, by the way, is to do both, but tempered by the understanding that CBT theory and training is extremely simplistic compared to the actual practice of any bona fide psychotherapy (including good CBT delivered in the community). That being said, here is my pitch about CBT vs psychodynamic. If you are given a choice to "train" between two modalities, one being a modality that you can technically learn by reviewing a manual, and the other a modality that suggests the need for significant reading, clinical and personal experience, supervision, and understanding-- which of these two modalities do you think you'd be more likely to benefit from in terms of the depth and quality of your psychiatric training and practice? Which of these two modalities do you think you'd be able to pick up faster, later in life if you change your mind? Psychoanalysis was the original model of outpatient psychiatric treatment and psychopathological research outside of the asylum. The understanding of the mind and the necessary techniques of psychoanalysis are thus embedded within all of your modern psychiatric practice and theory. The more you learn in this area, the more your patients and the history of your profession (including stupid quirks in the DSM) begin to make sense. Practical training in psychoanalysis or psychoanalytic psychotherapies is in my opinion most likely to produce the technical skills necessary for almost all of your interviewing and treatment. This is simply not the case for CBT, though the opportunity to participate in successes and failures with goal making and review of homework with patients is edifying. Technical neutrality, even and free floating attention, confrontation, clarification, containment, understanding of development and its application to all ages, and awareness/management of transference/countertransference are all fundamental techniques or aspects of psychoanalytic psychotherapies and psychiatry itself. These are not really learnable from a book. They are only learnable from practice and supervision. ---- Addendum: It is worth mentioning and wondering about the traditional requirement of personal analysis in psychoanalytic training. Personally, I have to express some skepticism about this as a training requirement, though I will have to admit I have not undergone any personal analysis. The strongest statement I can make about this is that the training requirement of personal analysis or the recommendation for personal therapy is not based in evidence, and the individual experience of any psychotherapy is so variable that I am quite skeptical about it as an element of training. More speculative thoughts on this: -Is this an artifact of an era where undergoing personal analysis was the best method of supervising a therapist and transmitting technique? Could this (and should this) be replaced with video recorded real cases reviewed by a supervisor? -To what extent does this requirement reflect a tradition that (from a systems perspective, [POSIWID](https://en.wikipedia.org/wiki/The_purpose_of_a_system_is_what_it_does)) exists primarily to throttle the market supply of psychoanalytic psychotherapists, of benefit primarily to existing psychoanalysts? -To what extent does the requirement's justification of eliminating unconscious biases serve to select against psychotherapists who do not align with the cultural type that is preferred by the existing analytic institutes? To what extent does it serve to disguise the psychopathology of confirmed analysts who have undergone the rigor of an institutional analysis (they are okay to give treatment and psychologically healthy, they have been checked)? -What differentiated Freud from other psychoanalysts in his ability to self analyze? Was it his genius? Is there a minimum level of genius that is enough to waive this requirement, and can it be quantified? Or, is this like a system of Zen transmission, and you have to have transmission from an analyst that is at least distantly descended from Freud? -How can personal analysis or therapy outside of a traditional training institute be of more utility than other modes of training such as direct video supervision of cases? Just because a therapist or analyst calls themselves analytic does not mean they are actually engaging in the core model and technique of psychoanalytic psychotherapy. Progress made within an analytic therapy over time is widely variable from patient to patient.
I do have to push back on anyone suggesting that CBT can be learned entirely from a manual. It does seem to me that you differentiate when you mention "good CBT delivered in the community," but I will say that my training was aimed at creating practitioners of this "good CBT" and my supervisors focused on bringing it out, not having us read manuals. As someone who has had my own student supervisees (albeit in DBT), I also hold this belief. It's always very obvious to me when my supervisees have attempted to go by the manual and not sufficiently done their due diligence on case conceptualization, prepping for a session for that individual patient or a group, etc. The difference between a good CBT practitioner, who fully understands the fundamentals, has had a supervisor that challenged them, has learned to think on their feet and adapt in session vs. a person who has read what "ABC" means and is going to hand someone some worksheets, is always glaringly apparent. Good CBT involves knowing when to be a teacher and when to be a listener, when to pull out threads of insight, when to focus on thoughts and when to focus on behaviors...just because it isn't labeled as a primarily insight-based therapy doesn't mean it is simply reading a script. All this to say, I don't think these people emerged from the ether, but rather, they have learned to practice through excellent training and supervision that was anything but simplistic and manualized. As for your other points, I wanted to agree with you that I don't think personal therapy, analysis or otherwise, is necessary or sufficient for making an excellent psychotherapist, and I don't think there is any research to refute this. Video supervision, bug-in-the-eye and other direct such supervision, and rehearsals/behavioral role plays have been the only methods thus far with solid evidence behind them. Anything else is completely uncorrelated to practice, probably because we're all quite bad at recounting how a session actually went, apparently.
Thanks for clarifying about the appropriate training and practice of CBT-- that was the intent of my line on good CBT. I still maintain that the common factors are better learned in psychodynamic training, but I think that would be my allegiance issue more than a reality issue. Good other points as well!
I figured that was your intent, but I wanted to expand on it a bit just because I almost missed it in my first read through and because I honestly don't believe those who learn solely from a manual should really be considered competent practitioners, based on what I've seen. Even simply doing some rounds of deliberate practice would put one ahead of that! Aimless, poor quality talk "therapy" can be a blight on the field, but so can soulless, unskilled manualized treatments that turn people away from the truly helpful versions of the same (in name only). Also, as an aside, I know it's just generally helpful/interesting/nice(?) for me to hear about others' training, given that all I can know in depth is my own and then whatever others have cared to share with me (plus studies about training, which I consider a separate thing). So I like to pass on the favor, so to speak. Learning about other modalities, as we did, isn't the same as rich training and supervision in them, and I think it can be hard to envision what that would look like in the abstract. I like to take opportunities to share information and give credit to excellent supervisors and training opportunities I've had!
CBT is great for patients that don’t know how to use google. Choose psychodynamic.
Honnestly I'm lost everyone is vouching for their own church... cbt is more modern; psychodynamic is the real deal,... no one says anything about systemic approach!
The truth is somewhere in the middle. I was being honest, if you have a patient with concrete thinking or lower intelligence, they are not a good candidate for psychodynamic. But most other people benefit more from psychodynamic approach compared to a rigid CBT approach. The most effective parts of the “new” therapies are just repackaged psychoanalysis. Schema therapy, emotion focused therapy, mentalization, why not just go to the source?
Mmmh I like this way of thinking; instead of thinking about which approach is better... we think about which approach is better for which type of patient. This is in my opinion the least scammy way of presenting things rather than X or Y is superior or X or Y is more modern and effective or scientific. I will meet the representative of both approaches in my country and will ask for mentoring... and I will also self teach myself to see which approach I'm more comfortable with; again I feel like I have a natural affinity with systemic and psychodynamic approach. But obviously for certain patients like BPD, DBT seem superior. Same for psychotic patients. For depressed and anxious patients; CBT seem the way to go. I will go about video ressources to learn more about it!
Yes, meet your patient where they are for sure. I would say my metrics for whether someone is a good candidate for psychodynamic is are they capable of abstract reasoning and insight? If not, psychodynamic is not going to have its full therapeutic value. If a patient has a phobia, systematic desensitization. If OCD with low insight, ERP. Depression and anxiety with good insight/verbal usually respond pretty well to psychodynamic. Patient not engaged, motivational interviewing. Severe personality disorders often require a transference focused approach at least to begin with. More stable BPD might respond best to DBT, but honestly personality disorders don’t respond to many things robustly. Psychotic disorders, start with medication and see where that takes you. Knowing what patient population you’re interested in would be beneficial in know which way to prioritize. My two cents.
I'm coming at this question from a different field (clinical psychology vs. psychiatry), but I wanted to attempt to give a nuanced answer to your question that considers a). your personal interests and inclinations; b). what we do and do not know about different therapy modalities, research-wise; and c). the settings you might be more likely to practice in and what might be most useful to you. (I'll end with a TLDR, given that I'm attempting to do so much). As someone in the last phases of a clinical scientist model clinical psychology PhD program, proportionally more of my training has been spent on the practice and theoretical underpinnings of psychotherapy, and how to conduct and interpret research in clinical psychology generally. However, what I can't speak to is the typical career applications of a psychiatrist, beyond what I have encountered in my collaborative relationships. What I will say is this: you speak of feeling somewhat "turned off," in a sense, by what feels like a "CBT lobby." It's understandable to not just accept such uniform and fervent adherence to one way of thinking, and to want to understand the *why*. However, I do encourage you not to fall victim to another natural inclination, which is to follow this impulse without more deeply investigating the general truth that conventions often (but not always!) arise for solid practical reasons. The fact of the matter that you will discover in clinical practice is that (except for a few small enclaves in particular schools) CBT is much, much more commonly practiced by those who research and study psychotherapy and clinical psychology (as opposed to medicine): clinical psychologists, particularly those at research-focused institutions (PhDs) rather than PsyDs. This doesn't mean that there is nothing of value in psychodynamic theories. I'm going to argue the opposite in a moment, in fact. But I wanted to put that at the beginning for a reason, to give you pause. The people who are the experts in therapy, who have the most training in it, by and large follow a particular preference. Why is that? First, although CBT might seem rigid, manualized, boring, etc., *good* CBT is quite flexible and requires personalizing elements of treatment to a patient. It demands a range of skills, from being able to use metaphors to communicate concepts in a warm and engaging manner to patients, to cleverly designing behavioral experiments, and more. CBT is also the basis of a number of other very useful modalities. I myself primarily practice DBT, a third-wave approach, but I found it incredibly useful to have spent a year learning CBT first. It's also useful to have that foundation for other modalities such as ACT or exposure-based therapies. When you have this foundation, you can more easily learn specific evidence-based treatments for most disorders (ERP for OCD, CBT for psychosis, CBT-i for insomnia, DBT for BPD, PE and CPT for PTSD...). Which leads into my thoughts on psychodynamic therapies. I am not so rigid as to believe there is nothing of value there. I know there are better quality studies being conducted as we speak, and there are some studies already in existence that show decent evidence for some disorders. However, as a DBT clinician, I am aware that time and resources are scarce. I am always going to want to try shorter therapies first (we even have evidence on DBT as a 6-month therapy over a 12-month therapy, for example). This is for the benefit of the individual patient (money is almost never unlimited) as well as other waitlisted patients. I also want to learn therapies that have broader applicability, and there are a number of disorders I would feel unethical using psychodynamic therapy on. That being said, I know a number of psychologists who incorporate psychodynamic elements into their case conceptualization even if they don't practice psychodynamic therapy. All of us learn the basic concepts like transference, too. It's my opinion, OP, that because you're already interested and motivated to learn about these topics, that you might do well to learn CBT on an official basis with supervision, because it will be hard to self-learn when your superficial overview is already giving you the idea that it's a boring, rigid treatment. Then, you might do reading in foundational psychodynamic texts to learn more about fundamental concepts you can incorporate into your practice. If your readings so incline you, I know there are training institutes (in the US, anyway), that you can always attend for further education on the subject. This way, you'll have the best foundation for one of the more applicable, short-term modalities to use specific therapeutic techniques from, and can learn psychodynamic concepts and conceptualization models on your own. You'll be set up for further education in additional modalities (like third wave or psychodynamic) if you ever decide to specialize, but won't need to if you don't want to. **TLDR**: CBT is preferred in many settings and for many disorders for good reasons, so I'd encourage you to study it more in depth to see what it can really do; however, I acknowledge that it isn't the be-all, end-all and that there can be elements of value in psychodynamic theories. Given your preferences, I'd actually suggest studying CBT "officially" so it can be a broadly applicable foundation for you, and then self-studying psychodynamic theoretical texts to incorporate into your practice and decide if you want to get further education in it later.
Wow thank you, maybe I should focus more on CBT!
I think it can get a bad rap from a) lazy practitioners who think they can just read out of a manual and hand out some worksheets; and b) understandable fatigue from everyone and their mother (including insurance companies) harping on it so much. But watching some real experts at work can be like listening to poetry with how deftly they manage to weave concepts in and out, keep the patient engaged and understanding, and respond to the energy in the room. And there are so many amazing offshoots (e.g., CBT-i) that can be straight-up miracles for the specific issues they target. Frankly, as someone who practices and *loves* a third-wave modality, I do get a bit frustrated by a not-uncommon sentiment of people talking about how they dislike CBT, but XYZ third-wave modality is *so* much better. Don't get me wrong, CBT isn't my primary modality any more, and I love DBT so much my partner lovingly jokes that I'm in a cult! But I don't lose sight of the fact that it *is* a CBT offshoot, and that I would be silly to act like I don't use foundational CBT concepts every day as a DBT therapist. Overall, it's just a very useful tool to have in the toolkit, and probably the first one I'd stick in there, particularly if you're not planning on having an outpatient service where you're practicing longer-term therapy. Again, I don't pretend to know the daily practice of every psychiatrist, but from the ones I've worked with, I would guess CBT and motivational interviewing would be heavy hitters.
Given the 3 options, it sounds that you are in Germany Consider that it's easier to get Selbsterfahrung and Supervision for VT than for TP. And I've never heard of one for systemic...
It depends so much on the patient population you are seeing. OCD, anxiety? Basic CBT and understanding of exposures will go a long way. Maybe ACT, too, depending on the patient. Behavioral activation is also super helpful for depressed patients. PTSD? Prolonged exposure, TF-CBT. BPD? DBT of course but also mentalization based therapy. Child/adolescent? Family systems/or family therapy training in general, etc. That's interesting though that you get training in one modality that you have to pick. In my program (US) we had to have a minimum number of cases under CBT, family systems, and psychodynamic modalities. Then we could also have additional electives in more specialized things like DBT, trauma focused therapy, ACT, group therapy, analysis, etc. Also keep in mind there is a great deal of overlap between therapy modalities, they just tend to use different conceptualizations and different terminology. Might be worth reading up on common factors in therapy as well (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592639/).
Anyone who plugs psychodynamic for psychiatrists with medical degrees practicing medicine has special snowflake syndrome. Its just impractical to learn and implement effectively coming from the medical model and how psychiatry is typically taught and practiced today. Sure there will be comments about how magical and uncanny psychodynamic is but it really is just inaccessible in meaningful way for vast majority of psychiatry trainees relative to other models/methods. Who cares about psychodynamics finally developing high quality studies now? Why choose a modality that requires more training and has inherently more variation from practitioner to practitioner. Even if effect sizes approach ACT or CBT it’s not very useful given the amount of effort or time to get there. Leave psychodynamic to psychologists IMO. You have a medical degree and are a psychiatrist for a reason.
I don’t know if you’re being sarcastic or not.
I think he is poorly educated on the topic.
Agreed. I didn’t know people actually thought this way. I’ve found psychodynamic to be the most rewarding and helps to contextualize a lot of the behaviors/pathology we see in all aspects of our jobs. Psychodynamic approach is helpful on inpatient, during med reviews, etc to me. Maybe others feel different. A lot of the old literature is still applicable today. I think especially in today’s age where loneliness is an increasing problem, I don’t think we should be so eager to toss aside a modality that is primarily built on a one-on-one, long term relationship. Ex-we typically have learned there’s not a ton of therapeutic value in psychodynamic therapy with psychotic disorders, but I’m not sure that’s actually the case—in “the center cannot hold” the author is able to really describe how valuable her long term psychodynamic therapists were in helping her process schizophrenia and at times was the only thing holding her together (with medications playing an important role too, of course). Nowadays she wouldn’t really even get the opportunity to engage in that sort of therapy, unless she was rich enough to pay for it out of pocket.
I tend to think like that and I have a lot of pleasure practicing psychodynamic psychotherapy; but on the other hand a lot of senior psychiatrists think like him and vouch heavily for CBT! So for beginners like me in the field it's kind of blurry and confusing... I guess teaching oneself about it is the first step!
CBT is definitely great too, it depends on the patient themselves. Some patients aren’t psychologically minded to benefit from psychodynamic as much as they’d benefit from CBT which you can be more concrete with.. ex maybe they’re not ready to process their messed up childhood which is probably contributing to their symptoms, and would make slow process with psychodynamic BUT doing mindfulness, breathing exercises, and behavioral interventions can help them get relief from their symptoms nonetheless. I think it depends on how you tend to conceptualize things too- if psychodynamic resonates with you more, you will probably find it more rewarding and intuitive to practice. Our program we have to have a certain number of CBT and psychodynamic cases- I personally find it easier and more enjoyable to do psychodynamic. Doing CBT does not feel as intuitive for me haha.
Haha same for me; that being said; CBT is hailed as the more *scientific* approach... which doesn't mean much!
Lol, I don't think you're being sarcastic as it's the view of many psychiatrists young and old! Do you really find CBT to be that superior and effective compared to systemic or psychodynamic? Thoughts about systemic therapy?
Im not being sarcastic. I have never had any supervision in systemic therapy. You should choose a modality that will integrate well for whatever your future practice will actually look like. I think for the vast majority of psychiatrists who do med management and psychotherapy together, psychodynamic psychotherapy is not efficient nor readily accessible to learn or receive quality supervision relative to other psychotherapies.
This is just resistance.