Cognitive Behavioral Therapy and Time-Limited Dynamic Therapy are two commonly utilized approaches in clinical psychology. Although different in theory, both techniques are designed to help patients improve their mood and day-to-day functioning in an over all more effective manner. When comparing Levenson and Strupp’s Time-Limited Dynamic Therapy with Beck’s Cognitive Behavioral approach, it is abundantly clear that although similarities and differences are present, there is a constant overtone of benevolence coming from both. With this in mind, this article will systematically analyze each theory with special emphasis on congruent and discrepant characteristics between the two.
In general, Cognitive Behavioral theorists and psychoanalysts conceptually agree on the idea that it is important to focus therapy on core problems produced by the patient. They also agree that faulty conclusions have been made due to early negative experiences, which inevitably causes self-fulfilling prophecies via expectation and reactions. Where they differ is more complicated. First of all, psychoanalytic therapy is usually long-term and non-directive where as CBT tends to be time-limited and more directive. On a deeper differential level, Cognitive Behavioral theory rationalizes that underlying conflicts are largely accessible and can be modified by changing unrealistic thinking and maladaptive behaviors using a directive approach. Conversely, psychodynamic theory contends that these core assumptions are unconscious and not easily accessible to the patient. This disparity in theory causes the role of the therapist to veer off into vastly different directions. To illustrate this further, Beck’s cognitive behavioral approach will now be examined.
Cognitive Behavioral theory is based on the premise that thinking patterns are directly related to mood. Beck theorized that early on in life people have negative experiences. Based on these experiences, negative schemas (ideas and assumptions about the way things are) are formed. Eventually these schemas become stagnant and dictate a negative view of the self, others and the world in general. Ultimately, because all new experiences are filtered through these schemas, inaccurate and unrealistic assumptions are made which usually lead to poor mental health. Based on this theory, cognitive behavioral therapists focus intervention on thoughts distortions as the root of ineffective coping skills and disturbed daily functioning.
Beck’s cognitive behavioral approach has a few clear specifications for treatment. Foremost, it is crucial that the therapist formulate a case conceptualization early on so that a framework for understanding the patient’s maladaptive behavior and dysfunctional attitudes are present. This should not be kept a secret. On the contrary, it should be shared with the patient in order to provide guidance as to what experiences and negative underlying beliefs should be targeted.
Subsequently, an important part of the cognitive behavioral approach is identifying schemas. The therapist should use the data, which has been gathered via interviewing and therapy to extract the patient’s self-concept and rules by which they live. In other words, this means that the therapist must use their understanding of the patient in order to pick out their foremost assumptions about life and the effects this has. Specifically, the patient’s ideas about themselves, others and the world should be highlighted. In this way, the therapist now can pinpoint problem thoughts and their destructive patterns. Eventually these schemas will be confronted and challenged in a helpful manner, which begins the process of thought modification.
Next the therapist must help the patient to identify and prioritize underlying goals. Many people come into therapy with aspirations and expectations, but it the cognitive behavioral therapist’s job to help guide the patient into coming up with helpful and attainable goals. For instance, man patients often come into therapy wanting to be “cured” of all unhappiness. This is an unrealistic goal because even the healthiest and highest functioning people at times are unhappy. In this situation the therapist can help high light to the patient what an appropriate goal is by reflecting back what the patient’s needs are.
As a final point, emphasis on the therapist-patient relationship is key in Cognitive Behavioral Therapy. Instilling a sense of trust and collaboration has a huge impact on prognosis. CBT is directive in nature but this must go both ways. Outcome in therapy is directly related to whether or not the patient believes that they can get better with therapy. This is why it is just as important that the therapist believe that their patient can get better. This type of symbiotic relationship feeds off of itself, creating a therapeutic dynamic filled with motivation, hope and trust. Another reason why the therapeutic relationship is imperative is because it offers support. By using a directive style, the therapist allows the patient to feel supported, when in reality they are helping themselves via introspective change.
Levenson and Strupp’s Time-Limited Dynamic Therapy (TLDP) is meant to help patient’s get away from replicating unhealthy interpersonal relationship patterns. This is done in theory by facilitating new experiences and realizations within the context of the therapeutic environment. TLDP is based on major psychoanalytic concepts such as the importance of childhood experience, development, the unconscious mind, behavior, conflict and transference. Time-Limited Dynamic Therapy although does not focus on regression and dependency. Rather, the therapist is supposed to emphasize the patient’s strengths and keep the therapy reality-based. Also, as self-evident in the name, TLDP is time limited. This makes it by nature more focused, present-based and directive if necessary to stay on task which is oriented to interpersonal relationship pattern.
Most importantly, Time-Limited Dynamic Therapy is based on seven underlying premises. They are as follows: The patient needs interpersonal therapy because their problems come from interpersonal relationships; dysfunction styles of behavior were learned as a child and are being maintained presently; the patient reenacts interpersonal difficulties in therapy; the therapist is a participant observer; the therapist becomes caught up with reenacting difficulties, and finally there is one problematic relationship pattern which keeps playing itself over and over again.
Levenson and Strupp illustrate the two primary goals of TLDP. They are providing new relationship experience for the patient and providing a new understanding or interpretation for the patient. In this way, the patient can relearn and benefit from a healthy, more appropriate relationship, while discarding the maladaptive behavior patterns associated with early childhood experiences. This is based on affect. The new understanding gained from this experience is a cognitive one. In other words, it involves identification and comprehension of his or her dysfunctional patterns. Ultimately, as a way of facilitating these two goals, first and foremost, a case conceptualization is created. This is in order to formulate how these goals can be attained based on where the patient is coming from. Now the similarities and differences of Cognitive Behavioral Therapy and Time-Limited Dynamic Therapy will be discussed.
CBT and TLDT surprisingly share many commonalities. For instance, they both are time-limited in nature and both use this to their advantage creating focus and motivation. Furthermore, both rely heavily on an initial case conceptualization in order to formulate a starting ground for treatment. In other words, both types of therapy are very well organized in terms of gathering information and basing intervention on this. Also, these two therapies both emphasize the importance of affect and cognition. CBT and TLDT both recognize that early experience change our thoughts and emotions, which is where unhealthy behavior styles stem from. Also, they both rely on confrontation to challenge ideas. Most essentially though, CBT and TLDT both use support via the therapeutic relationship to help patients. Where they differ is clear. CBT tries to change the patient’s attitude by challenging and modifying thinking patterns. TLDT on the other hand strives to change the patient’s idea of relationships by creating a new healthy and reliable one within the therapeutic context. In essence, TLDT is interpersonally based which changes thinking, and CBT is thought oriented which changes interpersonal relationships. Ultimately, it seems that both types of therapy have the same goal but come from different starting points.
Beck’s Cognitive Behavioral Therapy and Levenson and Strupp’s Time-Limited Therapy are both interesting and effective forms of psychotherapy. Although they are rooted in different belief systems and intervention, both strive to change the quality of people’s lives by changing the patient’ s perspective. The one most important string that both therapies seem to play is support. Through the therapist’s support and belief, the patient can overcome many personal hurtles on their own because they no longer believe that they are alone. This is the most powerful tool that the mental health practitioner has.
To find out which type of therapy would fit best for you, call 561-460-1885 today or schedule an appointment online and mention this article.
Writen by: Blair H. Mor, Psy.D.
Licensed Clinical Psychologist
MorMindful Therapy & Psychiatry