Psychodynamic Psychotherapy and Behavioral Therapy: Differences and Similarities

The difference between the two approaches is significant and becomes apparent during the initial consultation.

This page explains which approach is right for you and who, in the end, has a say in the decision.

Depth psychology explores unconscious conflicts and the underlying personality structure. Behavioral therapy focuses on how a problem arose and what is maintaining it today.

There’s a misunderstanding right in the name itself. Under the term “behavior,” the Psychotherapy Guidelines explicitly include cognitive, emotional, motivational, and physiological processes as well, not just observable behavior. So the work is by no means limited to what can be seen from the outside.

Depth psychology-based psychotherapy addresses the unconscious psychodynamics of currently active conflicts and structural disorders, taking into account transference, countertransference, and resistance. In other words, it works through conversation, clarification, and interpretation, and takes the relationship with the therapist itself as material.

The differences between the approaches are less apparent in the definitions than they are during the first session.

On average, behavioral therapy tends to be more goal- and task-oriented, while depth psychology-based therapy is more conflict- and relationship-oriented. However, how a single session is actually structured depends just as much on the nature of the disorder, the treatment plan, and the therapist’s way of working. In my experience, the pure textbook form is rare. Most of us blend approaches more than the categories would suggest.

And the figure that doesn’t appear in any guidebook: the number of sessions. Under statutory health insurance, the maximum limit for depth psychology-based psychotherapy is 100 sessions; 80 sessions for behavioral therapy. In long-term therapy, up to 60 sessions are initially approved for both; any additional sessions must be justified and applied for anew.

There is no single answer. Depending on the disorder, the German guidelines on psychotherapeutic approaches state four different things. What applies to one disorder does not automatically apply to the next.

For depression, the National Disease Management Guideline (NVL) does not favor one approach over the other, and it explains why: There is so far no evidence on which treatment suits which patient. Therefore, according to Recommendation 4-27, the choice belongs in the consultation or the trial sessions, to be decided jointly. That is unusually open for a set of rules that otherwise prescribes exactly what to do and when.

For anxiety disorders, the picture shifts, with panic disorder as an example: behavioral therapy is to be offered, while psychodynamic therapy should be offered only if behavioral therapy is ineffective or unavailable, or if the patient explicitly prefers psychodynamic therapy.

For obsessive-compulsive disorder, here is the most uncomfortable statement on this page, as of 2022: according to the guideline on obsessive-compulsive disorder, there is no evidence from randomized controlled trials for depth psychology-based approaches. The guideline states that reliable statements about their effectiveness are therefore not yet possible, and with its strongest grade of recommendation it recommends disorder-specific cognitive behavioral therapy, including exposure, as the first-line psychotherapy.

For post-traumatic stress disorder, according to the most recent version from early 2026, trauma-focused psychotherapy is to be offered in an individual setting. So far, psychodynamic approaches appear there only among the recommendations for future research, not as a treatment recommendation. Many psychotherapists from both schools of thought have additional training in trauma therapy and can therefore be effective in this area.

Just as good, not better. That is the most honest summary of what was directly compared.

A meta-analysis of 23 studies with 2,751 patients tested this formally. Representatives of both sides evaluated the data together, which rebuts the common objection that each side interprets only its own studies favorably.

An analysis of 102 meta-analyses sets the stage: the effects of psychotherapy and medication are generally limited, a ceiling effect of current research. The study’s lead author, Leichsenring, was also involved in the study that had previously demonstrated the equivalence of psychodynamic therapy.

Measurements were taken in manualized short formats and not in the German guideline-based form of 60 to 100 sessions, and each result applies only to the diagnoses studied. What makes these therapies effective is an open question anyway: so far, there is no causal proof for any single factor. More on this under therapeutic factors.

No, that term does not exist in guideline-based psychotherapy.

Anyone comparing treatment approaches in psychotherapy will first encounter the legal framework. It recognizes three groups: psychoanalytically based approaches, behavioral therapy, and systemic therapy. The first group is further divided into two distinct forms of treatment, one of which is depth psychology-based, and the other analytical psychotherapy. That adds up to four approaches in practice, even though the Psychotherapy Guidelines list only three groups.

According to the Psychotherapy Guidelines, these three groups cannot be combined. Individual methods, by contrast, may be used within an approach, for example guided affective imagery within a depth psychology-based treatment concept. But there is a limit that points precisely to this issue: In psychoanalytically based approaches, exercise-based and suggestive interventions are excluded in principle, even as combination treatment. A depth psychology-based therapy with exposure exercises running alongside is therefore not provided for.

In succession, the picture is different, because the Psychotherapy Guidelines govern the combination, not the sequence. After one approach has been completed, another can follow, but then as a new application with its own justification.

Diagnosis is the top priority when choosing between different approaches; the guidelines above say what is needed on this. In addition, there are situations in which I recommend it regardless.

First: it is the will to engage in self-reflection that is permanently lacking, not the ability to do so. Depth psychology-based work thrives on this will. If it is absent, an approach involving clearer outward steps is often more honest.

A situation in which I am most cautious: a severe cognitive impairment, combined with a lack of willingness to engage with one’s own experience. Depth psychology-based work requires working with images, associations, and ambiguity, often over an extended period of time. When significant impairment and low motivation coincide, the obstacle lies in this way of working itself. An approach involving concrete steps often gets further in such cases.

The National Disease Management Guideline for depression calls for exactly this weighing of options in the initial consultation or in the trial sessions. And an analysis of 53 studies involving more than 16,000 patients shows: when a patient receives the treatment they prefer, they drop out less often and have slightly better outcomes.