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Douglas, A.R. (1989). The Limits of Cognitive-Behaviour Therapy: Can it Be Integrated with Psychodynamic Therapy?. Brit. J. Psychother., 5(3):390-401.

(1989). British Journal of Psychotherapy, 5(3):390-401

Limits of Therapy

The Limits of Cognitive-Behaviour Therapy: Can it Be Integrated with Psychodynamic Therapy?

Anne R. Douglas


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 1967 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.

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