From Left: Freud (psychodynamic), Beck (CBT), and Jung (a more spiritual-focused psychodynamic)
Nearly half of therapists who use both CBT and psychodynamic therapy get better results with one over the other
STUDY: Coyne AE et al, Psychotherapy 2026;63(1):70–78
STUDY TYPE: Individual participant data meta-analysis
FUNDING: Netherlands Organization for Scientific Research; American Psychoanalytic Association
Background
Cognitive-behavioral (CBT) and psychodynamic therapy draw on different skills. To simplify, CBT is more structured, rational, and directive. Psychodynamic focuses more on what’s happening in the room – the process, the therapeutic relationship, and the client’s fantasy life. In training, therapists are often drawn to one side or the other, but do some get better results with one than the other?
The Study
Researchers pooled raw patient-level data from five clinical trials comparing CBT and psychodynamic therapy for depression, focusing on the 30 therapists who delivered both treatments. This yielded 492 patients across the two conditions. Depression severity was measured at baseline and posttreatment using validated instruments across all five trials.
Overall, outcomes didn’t differ between CBT and psychodynamic therapy — consistent with the broader literature. But that average masked real therapist-level variation. Among the 47% of therapists with a meaningful treatment-specific edge (d ≥ 0.20), effect sizes ranged from 0.21 to 0.65. Of those, 79% performed better with CBT; only 21% did better with psychodynamic therapy.
Limitations: The sample was small — just 30 therapists — and three of five studies came from the same research team. Adherence wasn’t formally assessed in all trials.
Practice Implications
- If your CBT patients consistently do better than your psychodynamic patients — or vice versa — that’s information worth acting on.
- Lean into your strength when the clinical picture is flexible, and reserve your less effective approach for patients who specifically prefer it or are a better theoretical fit.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
