Behavior Therapy vs. Psychoanalysis: Which One is Best for You?
The decision to begin mental health therapy is often a difficult one. However, it may be one of the best lifetime choices you have ever made. Know that you are not alone. According to “2022: The State of Mental Health in America,” in 2019 almost 20% of the adult population (nearly 50 million people) in the United States experienced mental illness. It’s particularly unfortunate that more than half of them did not receive treatment.
Choosing the type of therapy that works best for you can be challenging, to say the least. There are numerous therapeutic approaches that have been supported by scientific research. What’s most important, however, is that it is the right fit for your personal and unique needs.
This article describes several key components of two major forms of mental health treatment: behavioral therapy, and psychoanalytic therapy. Similarities and differences will also be summarized.
Psychoanalytic Therapy Defined
Psychoanalytic theory posits that thoughts, feelings, and desires are deeply rooted in the unconscious. Through psychoanalysis, the patient and therapist work together to bring the unconscious into the conscious mind. There is often extensive discussion of past experiences (particularly of childhood) and how they might have an effect on events, situations, and relationships of the present. Over time, through psychoanalytic techniques such as free association and dream analysis (further discussed below), the patient’s personal narrative is uncovered.
It should be noted that the term, “psychodynamic psychotherapy’ is often used interchangeably with psychoanalytic psychotherapy. The main difference is in the frequency of sessions. Psychodynamic therapy sessions typically occur once per week, while psychoanalytic therapy sessions may occur at least three times per week. Both psychoanalysis and psychodynamic psychotherapy share a belief in the unconscious process, the primacy of developmental history, and in the influence of one’s personality traits.
A Brief History
Although psychoanalysis is widely attributed to Austrian neurologist Sigmund Freud, a great many other clinicians and researchers have made lasting contributions and expanded upon Freud’s initial theoretical concepts. One of these researchers was Freud’s daughter, Anna Freud, who developed play therapy for engaging young children.
Later in the 20th century, the neo-Freudians began to emerge, most notably Alfred Adler, Erik Erikson, Carl Jung, and Karen Horney. Although they generally agreed with Sigmund Freud regarding the importance of childhood experiences, they decreased emphasis on Freud’s focus on sexual drive and repressed emotions. Instead, greater attention was placed on the social environment and how present culture can affect one’s personality.
Key Concepts
A core belief of psychoanalytic theory is that most of our action plans (that is, the ways in which we meet our needs) are developed unconsciously. They have been deeply automatized by way of family upbringing, social environment, and culture. Action plans are necessary to help us meet the needs and challenges we face in our world.
When people suffer mental disorders, such as anxiety, phobia, or depression, it is an indication that their subconscious action plans are somehow impaired. This is because they cannot effectively meet certain innate human needs such as safety, love, or self-esteem.
The psychoanalytic therapist then, helps the patient to bring those impaired action plans from the unconscious mind into conscious awareness. The psychoanalytic psychotherapist may use a number of different approaches:
Free association
Analysis of dreams and fantasies
Exploration of the patient’s full range of emotions.
These strategies serve to facilitate the ability of the patient to connect present feelings and perceptions to past experiences. The therapist and patient work together to identify recurring themes and patterns in the patient’s actions, thoughts, and emotions which may be self-defeating. The gaining of these insights is key to unshackling the bonds of past experience and living instead in the present moment.
ADDITIONAL RESOURCE: More information on psychoanalytic psychotherapy.
Both Therapist and Patient as Active Participants
Contemporary psychoanalysis practice strongly emphasizes the importance of the patient/therapist relationship. It is in itself an important interpersonal relationship. A psychoanalyst who is skilled at facilitating a positive therapeutic relationship offers an opportunity for the patient to explore and rework problematic interpersonal relationships in the patient’s daily life.16
The “dyad” (from the Greek, “pair”), is a term initially recognized in relational sociology. It refers to the smallest group, that is, of two people.17 In psychology, it can refer to a committed, two-person relationship, including between therapist and patient.
This is much different than classical psychoanalysis as advocated by Sigmund Freud, in which the therapist is an authority figure. In contrast, psychodynamic psychotherapy (including contemporary psychoanalysis), advocates for the highest respect for the patient as a partner in the therapeutic process.
When therapist and patient can explore issues with an easy, flowing, and unstructured dialogue that reveals insights on how the patient can make progress, this is an indication of “dyadic fit.” It can be an excellent vehicle for gaining insight and self-discovery, thus leading to more effective treatment.
Behavior Therapy Defined
Behavior therapy is based on the contention that humans learn from their environment. If a certain behavior is maladaptive or problematic, then new learning strategies are used to extinguish it. Subsequently, positive reinforcement, or “rewards” are used to encourage more positive action. Behavioral therapy sessions are action-based and highly focused.
Goal setting is an important part of making progress in behavioral therapy. Ideally, goals are clearly defined and require agreement between the patient as well as the therapist. An example might be in the case of substance abuse. The patient would need to agree to a goal of attending Narcotics Anonymous for four consecutive weeks.
In short, the overall emphasis in behavioral therapy is on targeting the problem behavior(s), not on establishing the underlying cause or the analysis of past experience.
A Brief History
Behavior therapy emerged in the early part of the 20th century and became recognized as a dominant therapeutic intervention in the 1950s and 1960s. The first inkling of the benefits of behavioral therapy was accidental. Ivan Pavlov was studying the digestive systems of dogs when he realized that the sound of a bell caused dogs to salivate even when the stimulus (meat) was not present. This has since been referred to as classical conditioning.
John Watson further advanced behavioral theory. He argued that all behaviors are the result of learning. B.F. Skinner coined the term operant conditioning, illustrating that the more a behavior was reinforced, the more likely the specific behavior would occur in the future.
Key Concepts
A primary assumption in behavior therapy is that previous learning leads to the development of a mental health problem. Therefore, new learning is necessary to extinguish maladaptive behavior. If new learning is successful, then the patient will be able to engage in more adaptive and positive behaviors.
The task of the behavioral therapist then, is to work with the patient on learning new ways to participate in positive actions: those that are productive, healthy, and appropriate for the environment and culture.25
Basic principles of behavior therapy include classical conditioning, which is the act of pairing stimuli to illicit a certain response; and operant conditioning, the establishment of positive and negative reinforcement to help modify behaviors. Research and expansion of these principles gave rise to numerous behavioral techniques:
Cognitive-Behavioral Therapy (CBT): Adds a cognitive component to classical behavioral and operant conditioning, thus allowing for analysis of the thoughts behind the behaviors.
Dialectical Behavior therapy (DBT): a form of CBT that uses emotional regulation, mindfulness training, and distress tolerance to help patients live more in the moment and manage daily stressors. It was originally developed to help those with borderline personality disorder. DBT is also used in cases of post-traumatic stress disorder, anxiety, and depression.
Systematic desensitization therapy is used often when dealing with phobias and fears. Beginning with the least fear-inducing stimulus and progressing to the most fear-inducing stimulus, the patient exposes him/herself under the guidance of the behavior therapist.
Behavior Modeling: This considers the social environment. Modeling allows individuals to learn new skills by observing others.
Differences and Similarities
The most striking differences between behavior therapy and psychoanalysis involve the acknowledgement of unconscious motivations and desires. In psychoanalytic therapy (as well as the very similar psychodynamic therapy), bringing the unconscious into conscious awareness is paramount. Free association is the springboard for open, unstructured dialog between the therapist and patient. The analysis of dreams and fantasies provides a window to a unique, personal narrative. When the patient gains insight into his/her patterns of behavior, it is then that transformation can occur.
Behavioral therapy goes seemingly in the opposite direction. Only actions and behaviors that are observable have credence. Therapeutic interventions are targeted to meet specific goals. Therapy sessions are much more structured than psychoanalytic therapy.
One might think it impossible for psychoanalysis and behavior therapy to enjoy any kind of shared platform. However, there are similarities that increase the potential for some integration. The development of cognitive-behavioral therapy indeed merges the states of outward behavior and inner thought. Both modes of treatment look at recurring themes and patterns of behavior that could be maladaptive or self-defeating.
Most interestingly (and fortunately), a clinical study comparing the effectiveness of psychoanalytic versus long-term cognitive-behavioral therapy for chronically depressed patients revealed that both types of therapy are equally effective.
Key Points to Remember
So, when it comes to making the choice between behavior therapy or psychoanalysis, consider the following key points:
A major goal of psychoanalytic therapy is to bring unconscious thoughts into conscious awareness. So, when it comes to making the choice between behavior therapy or psychoanalysis, consider the following key points:
The main focus of behavioral therapy is behavior change, not mental awareness.
Psychoanalytic therapy uses concepts of free association, dream analysis, open-ended questions and unstructured dialogue. The insights achieved through this interplay between therapist and patient is what creates transformation.
Behavioral therapy utilizes tools and techniques based on classical and operant conditioning to change maladaptive behavior.
Do you have more questions about the difference between behavior therapy and psychoanalysis? Contact Nicholas Samstag, Ph.D., clinical psychologist and psychoanalyst living and working in New York City. Nick offers online virtual therapy in addition to in-person treatment. He’ll help you make the choice that helps you flourish.