Short-Term Psychodynamic Psychotherapy and Cognitive Behaviour Therapy: Common and Specific Elements.

Journal of Psychiatry Reform vol. 11 #6, June 7, 2024

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Author

Alan Eppel MB, MRCPsych, FRCPC

Author disclosures: Dr. Eppel receives royalties from sales of Short-Term Psychodynamic Psychotherapy.

Reviewed by I. Milosevic PhD and K. Rowa PhD.

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Two of the most well-established psychotherapies are short-term psychodynamic psychotherapy, STPP, and cognitive behavioural therapy, CBT. The purpose of this article is to describe the therapeutic interventions that are used in these therapies. The article identifies those interventions which are common to both of these therapies and those that are specific. This should assist in orientating students who are training in both of these modalities.

There is a long-standing debate in the psychotherapy literature as to whether the therapeutic benefits derive from the common elements or the specific elements. Each of these two therapies have a somewhat different focus on psychological processes and are are based on different theoretical conceptualizations. Both of these practices have evolved over decades and there has been some convergence in some specific areas of therapy practice.

Key Processes

The focus in STPP is on emotional processing and interpersonal relations. STPP is synonymous with  EDT, Experiential Dynamic Psychotherapy and Supportive Expressive Psychodynamic Psychotherapy.  It includes Intensive Short-Term Dynamic Psychotherapy and Accelerated Experiential Dynamic Psychotherapy.

The principle strategy in STPP is to facilitate the experiencing and processing of core affects by the patient within the context of a secure therapeutic relationship.

CBT  is skill-based with the goal of teaching the patient the skills needed to become their own therapist. Guided discovery using Socratic dialogue is one of the hallmarks in terms of therapist style and process of delivering the treatment

 

Interventions

#	Therapy Process	STPP	CBT
1	therapeutic alliance.	yes	yes
2	explains rationale for process and method of therapy	yes	yes
3	agreement on goals and process of therapy	yes	yes
4	verbal or written treatment contract	yes	yes
5	fixed number of sessions	yes	yes
6	non-judgemental, respectful empathic stance.	yes	yes
7	comprehensive assessment & diagnosis	yes	yes
8	focus on developmental origins and relationships throughout life.	yes	no
9	Identifies attachment style.	yes	no
10	utilizes moment to moment tracking.	yes	no
11	deepens emotions and helps the patient to access associated memories.	yes	no
12	explores nonverbal communication	yes	no
13	works on defense mechanisms	yes	no
14	works with unconscious feelings and memories; works with transference & countertransference	yes	no
15	interpretation	yes	no
16	identifies recurrent interpersonal themes  related to past and present relationships	yes	no
17	encourages patient to try new ways of relating	yes	yes
18	processes meaning and emotions related to termination	yes	no
19	focuses on automatic thoughts &maladaptive behaviours	no	yes
20	sessions are structured and guided by an agenda	no	yes
21	uses thought records	no	yes
22	uses exposures to feared situations & response prevention	no	yes
23	between-session practice and behavioural experiments	no	yes
24	works on core beliefs	no	yes
25	use of rating scales & outcome measures	yes	yes
26	discusses discharge summary with patient	yes	yes
27	gives written discharge summary to patient	yes	no
28	relapse prevention & maintenance of gains at  end of treatment	no	yes

 

 

 

                                                      fig 1. Venn Diagram STPP and CBT

 

 

 

Conclusion

Identification of common and divergent therapeutic processes in STPP and CBT should be of assistance to trainees who are learning both methods of psychotherapy. This may also be of assistance to researchers in identifying which interventions and processes result in the best therapeutic impacts.

Bibliography

Ablon JS, A. Levy RA, Katzenstein T. Beyond brand names of psychotherapy: identifying empirically supported change processes. Psychotherapy: Theory, Research, Practice, Training; 2006, V 43,  216 –231

Eppel A. Short-Term Psychodynamic Psychotherapy. Springer International 2018.

Leichsenring F, Ablon S ,  Barber JP. Developing a prototype for short-term psychodynamic (supportive expressive) therapy: An empirical study with the psychotherapy process Q-set. Psychotherapy Research, 2016 Vol. 26, No. 4, 500–510, http://dx.doi.org/10.1080/10503307.2015.1051160

McCarthy KS, Barber JP. The Multitheoretical list of therapeutic interventions (MULTI): initial report. Psychotherapy Research, January 2009; 19(1): 96113. DOI: 10.1080/10503300802524343.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Venn Diagram