CBT Vs. Psychotherapy: Understanding the Differences

What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is considered a brief therapy treatment modality that focuses on changing a person’s thought patterns, in order to alter mood and behaviors that are causing distress. This approach was created by Aaron Beck in the 1960s, and was initially developed for people with depression; since its inception, it has been extensively studied and applied to many different mental health diagnoses.¹

Some common different versions of CBT are:

• Mindfulness-based cognitive therapy (MBCT): MBCT is a time-limited approach to therapy that focuses on noticing and accepting cognitive distortions instead of focusing on challenging or changing those thought patterns.
• Dialectical behavior therapy (DBT): DBT focuses on identifying and tolerating emotional distress by increasing a client’s awareness of their current behaviors and maladaptive coping and replacing those with healthier and more helpful coping behaviors.²
• Acceptance and commitment therapy (ACT): The primary goal of ACT is to help people understand themselves better through the identification of personal values and beliefs and to draw mindfulness to whether a person’s thoughts and behaviors are congruent with these deeper values and beliefs they hold. By drawing mindfulness to how things are misaligned, a person is able to understand their distress and behaviors better and make more intentional decisions.
• Rational emotive behavior therapy (REBT): REBT is a form of CBT that takes a more active-practice approach to challenging dysfunctional thoughts and behaviors, such as through using role-playing, rational analysis, and exposure-based practices to help clients practice for stressful situations before they happen.

Therapeutic Techniques of CBT

CBT has several components that are important for the long-term management of symptoms and relief. The three overarching elements of CBT treatment include educating the client about their diagnoses and symptoms, identifying and addressing unhelpful thought processes and elements that contribute to these, as well as learning new behaviors to help cope with life’s stressors.

• Psychoeducation: Psychoeducation is the process of providing knowledge, information, and resources on the “why” behind different things that may be happening for a client. Psychoeducation is important because it helps normalize, validate, and provide an understanding of the pain a client may be experiencing, which helps a client to stay engaged in the process throughout treatment.³
• Cognitive restructuring: Cognitive restructuring is the clinical term for noticing unhelpful thoughts and replacing them with something more realistic and helpful. This includes identifying automatic thoughts, examining how these might be distorted, and learning how to replace these with thoughts based in rationality.
• Identifying underlying beliefs: Underlying beliefs shape our perception of ourselves and the world, and they’re the foundation for the rules and cognitive distortions that we feed our minds. If there are dysfunctional beliefs that underlie cognitive distortions (such as “I am unlovable” and “I am a failure”), it is imperative that these are addressed in therapy to make treatment successful.
• Coping Skills: Developing healthy coping skills is important for a client in order to be able to tolerate the discomfort that inevitably comes with being in therapy. A lack of healthy coping skills can fuel dysfunctional underlying beliefs and cognitive distortions, which makes them a crucial piece of successful therapy treatment.

What to Expect in a CBT Session

Traditional CBT sessions tend to have more structure within them than other therapeutic approaches (such as psychotherapy). A CBT therapist is usually able to outline the process clearly at the beginning of treatment because classic CBT follows a clear protocol from beginning to end with little deviation.

A typical CBT session will involve:

• Structure: CBT sessions stay focused on the specific distressing thoughts and behaviors that brought you into therapy. The focus for each of the sessions will depend on whether you’re working on psychoeducation, cognitive restructuring, or developing new coping skills.
• Present-Focused: Traditional CBT sessions also largely stay focused on how your symptoms and behaviors are impacting you in the present moment. While there is some historical focus when exploring underlying beliefs, a majority of time will be spent on your current thoughts, feelings, and behaviors.
• Homework: Traditional CBT will often end the session by determining homework that the client practices until the next session. This is to help the client become accustomed to the new behavior or thought process in order to build a new long-term habit to replace old unhelpful thought patterns and behaviors.

What is Psychotherapy?

Psychotherapy, sometimes informally referred to as “talk therapy,” is the process of sitting with a therapist to talk through your history, motivations, beliefs, values, and understandings of yourself, others, and the world. While CBT is a form of psychotherapy, in this article, we will be distinguishing between CBT’s more structured approach vs. psychotherapy’s more flexible approach to processing with clients.

Therapeutic Techniques of Traditional Psychotherapy

Traditional psychotherapy is much more focused on the relationship being the primary processing tool within treatment instead of focusing on the mechanics of the dysfunction. By processing with a therapist who is a good fit, the client not only understands themselves better but also has what is called a “corrective experience” of what healthy relationships can and should look like.

• Person-centered focus: This means that the treatment and each session is focused on what the client feels they are needing and would benefit from most each session, instead of what the therapist thinks would be most beneficial for the client each session. This helps the client to feel empowered and play an active role in their own healing.
• Unconditional Positive Regard: Regardless of how the client shows up, the therapist reflects that the client still has inherent worth as a person who deserves care and respect. There are different ways that this can show up in the room (this will be communicated differently if a client is experiencing self-loathing vs. a client showing up and pushing a therapist’s boundaries), but the underlying message remains the same.
• Collaboration: The client and therapist work together to understand past experiences and current behaviors, instead of the client sharing and the therapist being the one that holds the knowledge or answer to the problem.
• Therapeutic Trust: Trust determines whether a client feels comfortable enough to open up to the therapist about the full breadth of experience with any given issue, and it is essential for successful therapy. By allowing a client to safely build trust, they may get a new and deeper understanding of the vulnerability required for more fulfilling relationships with themselves and with others in their lives.
• Active Listening and Validation: Active listening actually requires a lot of emotional and mental focus and energy, and many people often have not experienced this outside of a therapy room. This level of being witnessed and heard can add validity to a person’s experience and help them see their own experience in an entirely new way.

What to Expect in a Traditional Psychotherapy Session

A traditional psychotherapy session will often start and follow the client’s lead on what needs to be processed during that session, the pacing that the client wants to take with this, as well as the depth of processing that the client is comfortable with. The therapist acts more as a guide to seek clarity instead of a teacher with more knowledge on the topic than the client. The therapist will share insights and hep the client reflect and understand how their feelings and behaviors have affected their lives, often pointing out misunderstands that the client has (such as a client who falsely believes that they are unlovable or incompetent).

A typical traditional psychotherapy session will involve:

• Presentation of Session Topic: Oftentimes, this is done by the client identifying where they would like to focus for the session, but the therapist may bring up overarching themes/goals or topics from the previous session if the client is unsure where to start for the day.
• Processing and Exploring: After the session topic has been identified, the client and therapist begin exploring the issue. The client may outline the different ways this is impacting their life and functioning. The therapist will ask clarifying questions that may help the client gain insight into motivations, past experiences that influenced this stressor, and fears the client holds related to this. The client may actually end up discussing several stressors or events over the course of the session while thinking about the implications of the original topic.
• Integration: At the end of the session, the client and therapist examine the implications of the new level of insight or processing that the client did within the session. The client may continue to process and think about this until the next session, and the therapist and client may review coping skills to help the client tolerate the new level of insight.

How Is CBT Different From Psychotherapy?

There are many differences between CBT and psychotherapy, but these differences can be categorized under the larger umbrella of structure. Psychotherapy ebbs and flows based on the needs of the client, and CBT follows a more prescriptive approach in all aspects of the treatment — with the length of treatment, structure within the sessions, the focus of the sessions, work between sessions, and the pacing of topic processing.

Here are 5 differences between CBT and psychotherapy:

1. Length of Treatment

Cognitive Behavioral Therapy is a time-limited approach that usually doesn’t last more than 6 months if done according to traditional protocol, with some people finishing in as little as 12 weeks. The length of treatment for CBT depends on the severity and complexity of the presenting issue, as well as on the client’s ability to implement the learning of each session.

Psychotherapy does not have a set duration or number of sessions that a therapist can reliably project, because this depends on the complexity of the presenting issue(s) and the client’s ability to gain insight and address the things processed within sessions. It’s not uncommon for a client to be in psychotherapy for years.

2. Structure within Sessions

The structure within each session is another point where CBT and psychotherapy are very different. CBT will tend to focus on providing a review of any necessary psychoeducation, walking through identifying and challenging any cognitive distortions, and then reviewing/making a plan for how the client will practice the new skills and engage with coping skills until the next session.

Psychotherapy sessions tend to primarily take the client’s lead within each session – the client identifies the stressor they would like to focus on, the therapist will ask questions to help the client expand their understanding of that stressor, and then the client and therapist reflect on how to move forward with the new understanding from the session.

3. Focus of the Sessions

CBT tends to be focused on one set of behaviors or symptoms that are causing the client to feel distressed (such as an anxiety disorder or OCD), and all sessions will focus on understanding and eliminating unhelpful thoughts and behaviors related to that main presenting issue. CBT sessions stay focused on the present time instead of examining past experiences that could be contributing to the current thoughts, feelings, and behaviors. Traditional CBT stays on this specific topic, without the client deviating and exploring unrelated stressors that may be coming up outside of the presenting concern.

Psychotherapy typically focuses on all aspects of the client’s life that could be contributing to current distress – including past experiences and trauma, current behaviors, and stress, as well as considerations for the client’s future life. Psychotherapy allows the client to take charge of deciding what the most important focus topic is in each session instead of following the treatment order of operations within a classic CBT approach.

4. Work Outside of Sessions

CBT therapy often features “homework” that a client is assigned to do or practice in between sessions in order to build new habits and to continue progress moving forward. While psychotherapy can often include the element of homework, the psychotherapy modality doesn’t rely on homework between every session in order to progress at any specific rate.

5. Pacing of Topic Processing

Because CBT therapy is a time-limited approach, focus on each element is often limited to only the amount required in order to demonstrate proficiency and move on to the next portion of treatment. Psychotherapy follows the client’s lead and stays on a topic for as long as it takes the client to feel they have fully processed and understand the information or event.

Pros & Cons of CBT & Traditional Psychotherapy

Classic CBT and traditional psychotherapy offer very different therapy experiences, which come with their own unique sets of pros and cons for each one. Depending on each client’s presenting problem, the generalized pros for one modality may be a drawback and vice versa. While these are the generalized pros and cons for each approach, it is much more important to consider individual factors when deciding what would work best for you.

Pros of CBT

Because CBT is a time-limited approach, one of its major pros is that it typically takes less time and then ends up costing less than traditional psychotherapy. Because of the focus on the presenting issue, there is very little deviation into topics that clients may not be ready to talk about and process, so it can be a comfortable place to start.

Cons of CBT

The focused nature of CBT can also be a drawback – without an exploration of past experiences that caused a person to adopt dysfunctional ways of thinking, a person may end up substituting alternate dysfunctional thinking and coping behaviors once they have unlearned the ones addressed in CBT therapy.

CBT also doesn’t tend to be effective at treating a person who has more than one presenting concern, such as someone who struggles with multiple diagnoses or who struggles with two or more very different issues (such as communication issues and lack of motivation). There are also certain diagnoses that CBT has been shown to be ineffective for, such as schizophrenia⁴ and bipolar disorder.⁵

Pros of Traditional Psychotherapy

One of the biggest benefits of traditional psychotherapy is that it goes at the client’s pace – which means that clients often feel less rushed than with CBT and feel a sense of empowerment in tackling their presenting concerns. The lack of a preset timeline also means that the client and therapist are able to focus on all things that contributed to the initial presenting concern, which tends to improve the long-term effectiveness of treatment.⁶

Cons of Traditional Psychotherapy

The very longer-term nature that contributes to the pros of traditional psychotherapy is also the thing that can make it difficult to access for many clients. Many clients may struggle with the long-term commitment and extended internal work that traditional psychotherapy requires. The longer treatment timeline also means that traditional psychotherapy tends to be more expensive than classic CBT treatment; because of this higher cost of care, many insurance companies will also limit the number of sessions that a client is allowed to claim within their insurance benefits.

How Do I Know If CBT or Traditional Psychotherapy Is Right for Me?

Determining what modality is right for you largely depends on what you’re coming to therapy for and how you’d prefer to process it. If there is one contained concern that you’re bringing to therapy, traditional CBT could be a good fit. If you would prefer to set the tone and pace and take time to understand why things are the way they are currently, then traditional psychotherapy might be a better option for you.

How to Find a CBT or a Traditional Psychotherapy Therapist

If you think you could benefit from therapy, there are several factors to consider when searching for a therapist who is a good fit. It can be helpful to consider your non-negotiables you need in a therapist, as well as to make a list of the preferences you have. Once you have outlined those, there are several places you can begin your search for a therapist. If sorting through those options feels overwhelming, an online therapist directory can cut down on some of the legwork. If you need a low-cost option for therapy, an online therapy platform can be an accessible option to get the help you need.

In My Experience

In my personal experience, clients usually benefit from a combination of CBT and psychotherapy. There are many elements of CBT that are important for a client to feel long-term relief — such as new coping skills, cognitive restructuring, and understanding the symptoms and diagnosis. There are also elements of psychotherapy that are important for a client to stick with their new habits and thought processes — such as understanding their past experiences that formed their maladaptive coping and thought processes — so that a client does not fall back into old habits from a lack of insight into past experiences. Being able to combine both approaches in an effective way requires a skilled therapist that is able to hold both modalities during the work together, but ultimately leads to more reliable long-term relief for the client in my opinion.