CBT or psychodynamic therapy (PDT) – what's the difference?

CBT and psychodynamic therapy (PDT) are the two dominant psychotherapeutic traditions in Sweden. Both are evidence-based, both are used in public healthcare: but they differ in underlying philosophy, method and recommendations. Here is an honest comparison, without making a straw man of either.

Underlying philosophy: what actually is a problem?

CBT sees mental health problems as learned patterns of thoughts, feelings and behaviours that keep themselves going. The core question is: "What is the person doing today that keeps the problem alive?" Treatment changes what is accessible: behaviours, interpretations, attention.

PDT sees problems as expressions of inner conflicts, often rooted in early relationships and unconscious processes. The core question is: "What does the symptom represent? Which conflict or feeling does the person not have access to?" Treatment works more slowly to build self-understanding and relational capacity.

Structure and timeframe

What is recommended in Swedish healthcare?

Socialstyrelsen’s recommendations are condition-specific. CBT is recommended for several anxiety disorders, and CBT with ERP has high priority for OCD. For mild to moderate major depression in adults, CBT, interpersonal therapy (IPT) and short-term psychodynamic psychotherapy are options with different guideline priorities. Choice also depends on severity, patient preferences and clinician competence. Sleep difficulties, PTSD and harmful substance use or dependence require consideration of their condition-specific recommendations.

What does a typical session look like?

A CBT session usually has an agenda: a brief review of last week's rating scales, follow-up on homework, a new technique or exercise, and planning the next step. The patient is active and learns concrete tools. A PDT session is more open, the patient speaks more freely, the therapist listens for recurring themes and links them to past experiences and relational patterns.

When does which suit you?

Choose CBT if...

• You have a clear symptom (panic, OCD, phobia, sleep problems) and want to work towards specific goals.
• You want concrete tools to practise between sessions.
• Treatment time is limited – primary care, occupational health, insurers.
• You prefer structured conversations with measurable goals.

Choose PDT if...

• You recognise recurring patterns in your relationships or self-image.
• You have long-standing, unclear difficulties without an obvious diagnosis.
• You want to understand yourself more deeply, not just reduce a symptom.
• You are prepared to let the work take time.

What do training providers choose?

On Step 1, you must choose an orientation before you start. We teach a CBT orientation because it is the method recommended in the most guidelines and has the broadest applicability in the public sector. A PDT orientation is offered by other training providers. Your Step 1 orientation can affect which psychotherapist programmes you are eligible for; check each programme’s requirements.

Are the methods combined in practice?

Yes, in practice many clinicians work integratively. A CBT therapist seeing a patient with long-standing relationship problems will borrow concepts from PDT and schema therapy. A PDT therapist seeing a patient in acute panic often uses CBT techniques. Purity is rarer in clinical practice than in training. But the main orientation shapes how you think about the case.

Frequently asked questions