There’s More Than One Winner on This Racetrack, Psychotherapy Masters Conclude

“When I’m with a patient, I don’t care too much about theory,” said Glen Gabbard, M.D. (center), whose name has become synonymous with psychodynamic therapy. “I want to help the patient. It’s much better to take a flexible approach.”

And Aaron Beck, M.D. (right), the father of cognitive-behavior therapy (CBT), said, “Research can help us know which therapies work best for which patient. … People need to understand themselves, but if they have a few techniques and tools [to deal with their lives], so much the better.”

The exchange took place when the two psychotherapy masters sat down together for an informal and friendly conversation during the Opening Session of APA’s 2012 annual meeting in Philadelphia in May titled “Cognitive Therapy and Psychodynamic Therapy: More Alike Than Different?”

A psychoanalyst who eschews theory in favor of a “flexible approach” and a master of CBT who acknowledges patients’ need for meaning and understanding—it was an exchange that would seem to underscore the commonalities between the two therapies, rather than their differences. Moderated by outgoing APA President John Oldham, M.D. (left), Beck and Gabbard agreed that published research on psychotherapy has increasingly demonstrated its effectiveness as an evidence-based treatment for many psychiatric disorders, in categories ranging from mood and anxiety disorders to personality disorders.

But psychotherapy, even “manualized,” standardized psychotherapy, comes in many varieties, and not uncommonly, adherents to one form of psychotherapy or another advocate for its unique effectiveness, as if the field is a racetrack where there is only one winner. In this spirit, the most frequent “either/or” comparison is between cognitive therapy and psychodynamic therapy, often viewed as very different treatment approaches.

Different in theoretical and practical approach, the two therapies nevertheless both work to alter neurochemistry and hence human understanding and behavior. “Neuropsychiatric research has demonstrated that psychotherapy changes the brain,” Gabbard said. “This legitimizes the treatment for skeptics.”