Psychodynamic Therapy in the Treatment of PTSD

How Psychodynamic Therapy Compares to CBT

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A number of treatments, including cognitive behavioral therapy and psychodynamic therapy, have been developed to help people cope with and recover from post-traumatic stress disorder (PTSD). If you're seeking treatment for PTSD symptoms, it's important to understand the difference between the two forms of therapy. Get the facts on both with this review.

Cognitive Behavioral Therapy for PTSD

Cognitive behavioral therapies for PTSD are based on the idea that problems arise as a result of the way people interpret or evaluate situations, thoughts, and feelings, as well as the problematic ways these evaluations cause people to act (for example, through avoidance).

Examples of cognitive behavioral therapies for PTSD include:

Cognitive behavioral therapy has been found to be successful in reducing the symptoms of PTSD.

Psychodynamic Psychotherapy for PTSD

Psychodynamic approaches to PTSD focus on a number of different factors that may influence or cause PTSD symptoms, such as:

  • Early childhood experiences (particularly our level of attachment to our parents)
  • Current relationships
  • Unconscious coping mechanisms people use to protect themselves from upsetting thoughts and feelings that are the result of experiencing a traumatic event

Unlike cognitive behavioral therapy, psychodynamic psychotherapy emphasizes the unconscious mind, where upsetting feelings, urges, and thoughts that are too painful for us to directly look at are housed.

Even though these painful feelings, urges, and thoughts are outside of our awareness, they still influence our behavior. For example, unconscious feelings may make you avoid starting a new relationship with someone because of the potential for the relationship to bring up those painful feelings. This is an example of where thoughts and feelings connect with behavior.

Just as with cognitive behavioral therapy, psychodynamic therapy also wants to bring about changes in behavior. It is just that the road it takes to get there is different.

How Psychodynamic Therapy Works

Bringing about a change in symptoms or behavior requires getting in touch with and "working through" those painful unconscious feelings. To do this, the psychodynamic therapist will assist the patient in recognizing the defense mechanisms being used, what they are being used for (to avoid painful feelings in the unconscious mind stemming from a traumatic experience), and connecting with and appropriately releasing those feelings and thoughts that were previously being avoided.

For example, over several sessions, a psychodynamic therapist may notice one of the following defense mechanisms:

  • Disavowal: When a patient is denying the extent to which a traumatic event has impacted their life. This common defense mechanism people use to protect themselves from something that they don't have the ability to cope with.
  • Displacement: When a patient is expressing anger and putting blame on family members even though they haven't done anything to deserve it. In this case, the therapist may interpret this behavior as a sign that the patient is actually upset with and blaming themselves for the traumatic event but since this anger and guilt is too difficult to cope with, it is expressed toward others.

In both of these cases, the therapist would interpret the patient's behavior and share this interpretation with the patient.

The therapist and patient can begin to break down these unhealthy defense mechanisms and bring insight to the underlying problem. Through this insight, the patient can then begin to work through those painful feelings in a healthier and more appropriate manner.

Effectiveness of Psychodynamic Therapy

Psychodynamic psychotherapy for PTSD has not been studied as extensively as cognitive behavioral therapy for PTSD. Of the studies that have been conducted, though, it has been shown that psychodynamic psychotherapy can have a number of benefits.

For example, studies of psychodynamic therapy for PTSD have shown that after therapy, people report improvement in the following:

  • Interpersonal relationships
  • Fewer feelings of hostility and inadequacy
  • More confidence and assertiveness
  • Reductions in PTSD symptoms and depression

Which Type of Therapy Should You Use?

The answer to this question is really based on your personal preference. Both cognitive behavioral therapy and psychodynamic psychotherapy can have benefits for someone with PTSD.

Cognitive behavioral and psychodynamic therapists, however, take different approaches to the treatment of PTSD, and some people may prefer one approach to the other.

Therapy is going to be the most effective if you trust the approach and have a good relationship with your therapist. So it is important to shop around and find the best fit for you. You can find PTSD treatment providers in your area through resources like UCompare HealthCare as well as the Anxiety Disorder Association of America.

4 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Kar N. Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: A reviewNDT. 2011;7(1):167-181. doi:10.2147/NDT.S10389

  3. Levi O, Bar-Haim Y, Kreiss Y, Fruchter E. Cognitive-behavioural therapy and psychodynamic psychotherapy in the treatment of combat-related post-traumatic stress disorder: A comparative effectiveness study: CBGT and PDT in PTSDClin Psychol Psychother. 2016;23(4):298-307. doi:10.1002/cpp.1969

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Additional Reading

By Matthew Tull, PhD
Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder.