There are many different approaches to psychotherapy, and it can be difficult to understand what distinguishes one from another. Three approaches that are commonly encountered are Cognitive Behavioural Therapy (CBT), Dialectical Behaviour Therapy (DBT), and psychoanalytic therapy.
Although there is some overlap between them, they differ considerably in what they focus on and in how the therapist works.
CBT tends to focus on the relationship between thoughts, feelings and behaviours. It is usually structured and goal-focused, helping people identify patterns of thinking and behaviour that may be contributing to their difficulties and experiment with ways of changing them.
DBT developed from the cognitive-behavioural tradition but places particular emphasis on emotional regulation. Originally developed by Marsha Linehan for people experiencing severe emotional dysregulation and chronic suicidality, it combines behavioural approaches with mindfulness, validation and the idea of holding two apparently opposing truths at once. A central principle is the balance between acceptance and change: accepting the reality of one’s present experience while also working towards change.
Psychoanalytic psychotherapy approaches psychological difficulties rather differently. Rather than primarily trying to modify thoughts or behaviours, it is interested in the unconscious meanings and relational patterns underlying them. The relationship that develops between patient and therapist becomes an important part of the work, providing an opportunity for longstanding ways of relating, defending against difficult experience, and understanding oneself and others to emerge and be thought about.
A very simplified way of describing the different emphases might therefore be:
DBT — Acceptance + Change
CBT — Challenge + Change
Psychoanalytic Therapy — Insight + Transformation
These are necessarily broad distinctions. Contemporary practitioners within each tradition work in varied and sophisticated ways, and no short comparison can capture the full complexity of any of them. Nor is one approach inherently “better” than another: what is helpful depends on the person, their difficulties, what they want from therapy, and sometimes where they are at a particular point in their lives.
I have put together a short comparison chart looking at DBT, CBT and psychoanalytic therapy side by side, including their aims, therapeutic stance, use of the therapeutic relationship, and typical ways of working.