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Comparative outcome research in psychotherapy is faced with a dilemma - most therapies seem equivalent in outcome (Stiles et al 1986). This is rather a daunting blow to clinicians who may have spent years training in and then practising a particular therapy. One response is to challenge the idea of comparing whole treatments in a global way. As early as Paul was arguing for a more discriminate approach to research in psychotherapy when he asked ‘What treatment, by whom, is most effective, for this individual, with that specific problem, under which set of circumstances?’
More recently research has focused on the intensive analysis of specific events within the course of a therapy (Elliott 1983). The move then is away from global, non specific questions towards greater sensitivity in considering both the process of therapy and its outcome.
As a therapist who practises both cognitive behaviour therapy and psychodynamic psychotherapy I am in a position to examine the decisions which at assessment lead me to decide on a particular therapy for a given patient. I am also aware of the necessity to shift therapeutic approaches during the course of therapy and therefore identify those patients who seem to benefit from a combined model. The purpose of this paper is to consider the limits of cognitive-behaviour therapy from both theoretical and clinical perspectives and to discuss the possible integration of cognitive behavioural therapy with psychodynamic psychotherapy. The paper is in four sections. I consider first the theoretical limits of the cognitive-behavioural model and, secondly, its therapeutic limits. Thirdly, I discuss attempts at integrating the cognitive-behavioural with the dynamic model, and finally the possible limits to such integration.
One aim of this paper is to facilitate dialogue between clinicians who use different therapeutic methods. One barrier to dialogue, however, is the use of foreign languages. For example, the phrase ‘eliciting cognit