The Dispute Between CBT And Psychoanalysis

By Michael Roeske, PsyD

As a psychologist, I have worked and trained with psychotherapists who possess a wide range of training backgrounds and beliefs.  With that being said, I am sometimes dismayed at the lack of respect given to those who think differently than them.  Not surprisingly, the issue has been most strikingly seen between the cognitive-behavioral and psychoanalytic psychotherapists.  Indeed, I have heard adherents of each side be openly distrustful and markedly disparaging of the other.  And in the spirit of full transparency, sometimes that disparaging person was me.

Of course, the complete story of what led to this feud could likely fill a book.  But in an effort to understand it, I found myself drawn to a seemingly unrelated field…the philosophy of science.  In that regard, most people believe science progresses in a linear fashion with newer, better theories replacing older ones in a relentless march toward an objective truth.  Strangely though, up until the 1940s, few philosophers or historians actually tested this theory by sitting down and carefully reading the old documents.

So when a young graduate student, Thomas Kuhn, was asked to teach the bygone ideas of physics, he somewhat naively went to the library to prepare for his class.  And after an initial period of confusion, he was astonished to conclude that Newton, who’s theories revolutionized our views of the physical universe, was not, as one might have imagined, a better Aristotle (whose ideas he replaced).  Rather, to Kuhn, Newton simply presented a different paradigm for solving different problems.

Over the course of the next decade, Kuhn (1962) developed a theory of scientific change that broke with the positivists and led to his writing one of the most referenced books of all time, The Structure of Scientific Revolutions.  And integral to Kuhn’s theories was the idea that it is impossible to demonstrate the truthfulness of one paradigm using the rules of another.  The reason is that the old one is not just revised, it is replaced with a whole new set of terms and standards of assessment.  The new theory, then, is measuring and reporting on dissimilar things.

If this holds true for the field of psychology, and I believe it does, then different therapists from different schools of thought are not actually talking about the same things.  But to Kuhn the problem went even deeper.  Expanding upon the work by N. R. Hanson (1958), he believed observation is always influenced by previous experiences and existing assumptions.  Thus, no two scientists ever see the same thing.  Ironically, psychotherapists already have this built into their theoretical frameworks.

As a clinician, I was taught that my own history and culture influences how I feel about, think and work with patients (and, in my estimation, these factors also impact why we prefer one theory over another).  I was also taught that patients come to me with subjective worlds that take time to understand.  Yet, somehow, when it came to my peers, I was sometimes unable or unwilling to learn from them and their perspective.  But I have found that, when I listen closely and am honest with myself, we are much more alike than different.

Indeed, I believe CBT and psychoanalysis are just describing different perspectives and trying to solve different puzzles.  And neither is any closer to truth than the other.  My hope, then, is that by writing this down I continue to remember that.


Hanson, N. R. (1958). Patterns of Discovery: An Enquiry into the Conceptual Foundations of Science. Cambridge: Cambridge University Press.


Kuhn, T. S. (1962). The Structure of Scientific Revolutions. Chicago: University of Chicago Press.