CHOOSING AN APPROACH
Psychoanalysis or CBT: what is the difference?
When you are looking for therapy, the names of different approaches do not always tell you what actually happens in a session. Should you explore your history or focus on a current difficulty? Talk freely or try exercises? These are reasonable questions, but they are not simply a choice between understanding and taking action.
Psychoanalysis and cognitive behavioural therapy have different frameworks and methods. Understanding them can help you express what you hope for, without having to decide on the “right” therapy alone before you have even met a practitioner.
What is psychoanalysis?
Psychoanalysis explores psychological life, personal history and patterns that may repeat without our fully understanding why. Talking offers a way to explore relationships, desires, inner conflicts and ways of protecting ourselves.
The unconscious has a central place in this approach: some of what motivates us may lie beyond our immediate awareness. You might, for example, want a close relationship yet pull away as soon as it becomes important. This contrast raises questions about what closeness means to you and the fears it brings up.
The aim is not to find a single explanation in childhood. The past is explored in relation to what is happening now, including within the therapeutic relationship. Defences and patterns are not seen as faults to eliminate, but as ways of coping whose meaning and limits can be explored.
To learn more about the work offered at the practice, visit the page on psychoanalytic support in Strasbourg.
What is CBT?
Cognitive behavioural therapy looks at the connections between thoughts, emotions, physical sensations and behaviour. It particularly seeks to understand the mechanisms that maintain a difficulty in current situations.
If you fear being judged, you may anticipate the worst, feel very tense and avoid speaking up. Avoidance brings immediate relief but can leave the fear of judgement unchanged. The work involves describing this sequence and exploring other ways of responding.
Specific goals are agreed together. Depending on the situation, observation, exercises or behavioural experiments may be suggested. They help examine what actually happens rather than impose a particular way of thinking. You can find more information on the CBT therapist in Strasbourg page.
What is the main difference between psychoanalysis and CBT?
The main difference lies in the starting point and how the work is organised. Psychoanalysis emphasises the exploration of personal history, inner conflicts and repetitions, with attention to their unconscious aspects. CBT places more emphasis on current mechanisms and practical changes that can be observed in daily life.
This distinction is useful, but it does not mean that CBT ignores personal history or that psychoanalysis disregards the present. Both can address emotions, relationships and ways of responding, drawing on different theoretical frameworks.
For example, if you repeatedly feel rejected in relationships, analytic work may explore how this pattern connects with your history and expectations. CBT may examine a recent situation, the interpretations that arose and the reactions that followed. The starting points differ, but they can illuminate different aspects of the same experience.
Does psychoanalysis always take a long time?
Classical psychoanalysis generally involves in-depth work over an extended period. There are also psychoanalytically oriented psychotherapies whose arrangements, frequency and duration may differ. These forms of work are not interchangeable.
It would be inaccurate to say that every analytically informed therapy necessarily lasts for years. Duration depends on the kind of work undertaken, what brings you and the arrangements agreed. You should be able to discuss these points with the practitioner, without being promised the same timetable as everyone else.
Is CBT simply a quick method?
CBT is often structured around goals and may include regular reviews. This does not mean that it amounts to a few tips or that every difficulty can be resolved quickly.
Understanding a reaction is not always enough to change it. New experiences can require time, adjustments and work on deeply held beliefs. The complexity of the situation, how long difficulties have been present and the goals matter more than the label of “short-term” therapy.
CBT can also consider relationships, emotions and the history that has shaped certain expectations. Its structure offers guidance; it does not replace attention to the individual person.
Can psychoanalysis and CBT be combined?
An integrative or flexible approach can bring an understanding of history and recurring patterns together with practical tools where appropriate. For example, exploring the significance of a fear of rejection may be accompanied by work on expressing a request in a particular situation.
This combination is not automatic. It requires a coherent framework, appropriate skills and discussion of the purpose of what is being proposed. Classical psychoanalysis and integrative therapy are not the same undertaking.
Nor is the aim to add exercises at any cost. What matters is being able to understand why something is suggested and how it relates to your concerns. You can read about me and my way of working to learn more about my approach.
How can I choose an approach that suits me?
Your difficulties, goals and relationship to therapy all matter. These questions may offer a starting point:
- What is troubling me most at the moment?
- Do I want to work on a specific situation, understand a recurring pattern, or both?
- Would I find explicit goals and suggested exercises helpful?
- Would I like a more open space to talk about my history and relationships?
- What would help me feel safe enough to speak about my difficulties?
These preferences provide useful information, but they do not determine the approach on their own. The nature of the difficulties, the approaches recommended for them and the practitioner’s skills also need to be considered. A referral may be suggested if a different setting would better meet your needs.
What if I do not know what would suit me?
You do not need to arrive having chosen a method. A first consultation helps clarify what brings you, what you have already tried and what you would like to understand or change.
You can ask practical questions: what happens in sessions? What role do exercises play? How is progress reviewed? Is the approach suited to my situation? The proposal is discussed with you and can be reassessed.
Consultations at the practice are currently offered by video, in French or English. The other articles on the Resources page may also help you prepare your questions.
Frequently asked questions
What is the difference between psychoanalysis and CBT?
Psychoanalysis explores personal history, unconscious conflicts and recurring patterns. CBT focuses more on current mechanisms and practical changes. This distinction does not capture the full diversity of either approach.
Is CBT faster than psychoanalysis?
CBT may be organised around specific goals, but its duration varies. Meaningful comparisons need to take account of the person’s concerns and the precise form of therapy being offered.
Can I use both approaches?
They can be brought together within a coherent framework where this suits your situation. This is discussed with the practitioner rather than applied automatically.
How do I know which therapy to choose?
A first conversation allows you to explore your difficulties, expectations and preferences. You can ask the practitioner to explain the proposed approach and its limits.
Further reading
Additional NHS information on psychoanalytic and psychodynamic psychotherapy and cognitive behavioural therapy.
CLARIFYING WHAT YOU NEED
A first conversation,
to find your bearings.
Unsure which approach to choose? We can begin by talking about what brings you and considering what kind of support might suit you.
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