I was trained as a psychodynamic therapist. This is a very broad term and there are many different theories that fall under this umbrella, but since this blog is not about that, suffice it to say that I was trained to look past surface level symptoms and try to understand their deeper meaning, subconscious sequelae and the developmental events that led to their development. In much the same way, a natural scientist wouldn’t be able to learn all they need to learn about a lake from studying the surface of the water – they would need to dive under the surface and study the motion of tectonic plates, the oxygen and water exchange that take place in the depths, the presence (or absence) of microscopic organisms in the water, in order to truly understand the lake’s properties.

By contrast, therapists who are trained under the cognitive behavioral umbrella (again – a broad category that include many different approaches) are taught to focus not on the past but on the present, and not on subconscious phenomena but on specific, identifiable and quantifiable behaviors and thinking patterns. The analogy here would be that of you want to learn to surf, you really don’t care what the tectonic plates are doing and how aquatic species get their oxygen – you really only need to understand the pattern of the waves on the surface and learn to interact with them in a way that will prevent you from wiping out.

Both of these approaches are tremendously valuable and practitioners from both of these broad schools routinely integrate ideas and techniques from the other school into their practices. However, being that I personally was trained psychodynamically, I will speak here to why I have been finding myself more and more implementing behavioral techniques with my clients, even when my long-term goal is to help them understand the deeper processes involved in their suffering.

The long and short of it is: I have been taught that when people engage in a destructive behaviors that appears to be “simple” (i.e., both the behavior and it’s inverse can be easily defined, like: not exercising > finding one physical activity in a week to engage in), the reason why they haven’t “fixed it” yet is because of deep psychological, and usually subconscious processes, and once they get to the bottom of those, they will organically improve the behavior. For example, if someone harbors feelings of worthlessness and therefore does not take care of their body, they will start taking care of their body and exercising once they work through the traumatic circumstances that have led them to develop such a painful belief in the first place. Well – the more I practice the more I see that this is not always true. Some people (many people, actually), with appropriate support and guidance, can start changing maladaptive behaviors before they are able to understand when and how they have acquired a propensity to engage in them, and when this happens people’s ability to work through the deeper stuff actually improves as well. So you see – it becomes a positive feedback loop: The more someone is able to try new behaviors just on faith (i.e., without full understanding of the traps they have lived in), the more that person will be able to start entertaining new ways of thinking and the sooner they may reach new insights.

Allow me to illustrate. Suppose someone grew up in a family where their needs were neglected and they were rewarded for ignoring their own needs. Such a person may grow up believing that their needs are not important, that they should put everyone else’s interests first, and moreover, that other people will abandon them if they speak up about their own needs. A psychological profile like that can result in a lot of pain. A person with such subconscious beliefs is more likely to find themselves with an inattentive romantic partner. They are generally more likely to stay in situations that are not healthy for them, and this is a complicated and difficult-to-define phenomenon that will require a lot of work in therapy to unravel, because it is famously difficult to define a good relationship or friendship or job. However, some specific instances of this phenomenon are not difficult to define at all. Suppose this person goes to sleep late each night because their partner is a night owl and they have never spoken up about needing an earlier bedtime.  Suppose they always let their coworkers pick times for meetings and never suggest the times that would work for them.

Those specific instances of neglecting one’s own needs seem quite “simple” – they are easy to describe and even the person engaged in these behaviors would usually be able to flag them as problematic if a friend were engaging in them. However, the problem is that if someone never tried calling their own shots, they really don’t know what it feels like when you do, so they don’t know what they are missing, so they don’t really see the extent to which they have been doing themselves dirty. See – getting to a place where one is ready to switch careers, end bad friendships and so forth might take many months or even years. But some people, with a lot of active guidance, proper tools and active encouragement may be coached to say “Monday night doesn’t work for me for this meeting, how about Tuesday” much sooner, and once someone tries doing that, a few things sometimes happen (not always, but enough of the time):

1. They see that nothing bad happened. Their coworkers didn’t abandon them. They didn’t get fired. Most profoundly – no one really cares. This is valuable evidence contradicting their maladaptive beliefs, and I believe that people need to start building this kind of evidence as soon as possible.

2. Self-neglecting people are often used to the small inequities of life and they often think that those are “no big deal”: “It’s just one meeting, one bad meal, one late night. So what? Who cares? This is nothing major and not worth worrying about.” Of course, it’s never “only one” inconvenient meeting – it’s usually a full schedule of them, but such people don’t realize that. But once they experience the feeling of being comfortable, meeting when it is convenient for them, sleeping the right number of hours – that’s when they sometimes experience an epiphany that expedites the other, deeper work

3. People are creatures that seek consistency and therefore we are very driven to square away our actions, thoughts and beliefs. While we are engaged in an action that is actually harmful to us we often find a way to justify it in our thoughts. The converse is also true: When we engage in an action that puts our needs first we also tend to find ways to justify it, which is something that a therapist would be wise to use. Sometimes when a person who has long neglected themselves is coached to change a relatively simple behavior in the direction of taking care of their needs, that person gets to thinking: I am putting my needs first > It makes sense in this situation to do that – it is okay to put my needs first > Oh my God! It makes sense to care about my needs! > Oh my God! I haven’t been doing that until now!

 4. Finally, this one is a very simple, general principle, which makes it no less important: People who have better days have more energy, which they can use to tackle the very difficult task of dismantling childhood traumas. Hence, if someone can be coached to eat and sleep just a tiny bit better, be just slightly more assertive, engage in just a few healthier behaviors, they sometimes start making better progress in therapy.

For all the reasons outlined above, and a few more thoughts that I will leave to future blogs, I have been finding myself integrating more cognitive behavioral techniques into my otherwise psychodynamically-oriented practice.

Copyright © 2025 Anna Braverman