Skip to main content

Verified by Psychology Today


Psychoanalysis and CBT Go to Couples Therapy

What if psychoanalysis and CBT went to couples therapy?

Mark O'Connell
Source: Mark O'Connell

Inspired by an article in The Guardian titled, “Therapy Wars: The Revenge of Freud,” as well as the never-ending debates about psychoanalysis and CBT.

Cast of Characters:

Psychoanalysis - the original form of psychotherapy that involves the unconscious and talking about the past, and does not promise instant results.

Cognitive Behavioral Therapy (CBT) - a form of psychotherapy that involves improving thought and behavioral patterns in the present, and does promise instant results.

Couples Therapy - a form of therapy used to resolve relationship conflict.


Couples Therapy: So how long have you been together?

CBT: [Exasperated] Since the '60s… Wait, did that sound negative? [Takes deep breath. Tries again.] Since the '60s. [Nods approvingly]

Psychoanalysis: [Rolling eyes] I’d been around for decades when this young thing barged into my life.

CBT: Don’t patronize me.

Psychoanalysis: Here we go with the defenses! Honestly, we’ve been at each other from the start. In fact, the day we met...

CBT: Wait, really? You’re gonna waste our time with the past? How about the here and now! Namely you! All talk, no plans, no action. I mean, we still haven’t taken our honeymoon. We’ve just talked about taking it for 50 years.

Psychoanalysis: Ah, this again. You know perfectly well that if we took our honeymoon now, we might feel good for a few days, but it won’t last. Anything meaningful in life requires time and reflection and TALK and you’re resistant to all of that. But hey, you want to take our honeymoon? Oh-kaaay. How would that make you feel?

CBT: [to Couples Therapy] You see? You see how he bamboozles me into doing NOTHING with his condescending nonsense?! [To Psychoanalysis] Nothing you say can be trusted—or scientifically proven. You’re not a spouse, you’re a scam artist.

Psychoanalysis: Wow. I’m not even gonna touch that “scam artist” business—I expect you to project all over me. But He? How dare you?! You know I’ve (mostly) been a She since the '90s! You’re seriously gonna shove the same dull, superficial, ideas in my face without listening to me in return, without noticing the changes I’ve made? How can you sit here like a victim and pretend that I’ve been on high, preaching classic structural/drive theory to you all these years when I’ve totally adapted to a relational/intersubjective/ interpersonal approach over the past two decades? Do you even know me anymore? [Collapses into tears]

CBT: There there, stop that. Don’t give in to your negative self-talk. Try tapping your shoulder five times.

[Psychoanalysis continues to cry]

Couples Therapist: OK, it sounds like you’ve been in conflict for a long time. Psychoanalysis, I hear how invalidated you feel and how hurt you are.

Psychoanalysis: [Still crying] Don’t tell me how I feel, let me tell you.

Couples Therapist: Alright. CBT, how are you feeling?

CBT: Um, who cares how I feel? It’s what I think that matters. And I think he—or she, or ze, or whatever they want to be called—

Psychoanalysis: [Through sobs] Stop invalidating me.

CBT: —is manipulating me.

Couples Therapist: [To CBT] You don’t believe Psychoanalysis is really upset?

CBT: I believe my brain hurts because whenever she cries there’s nothing I can do to make it stop!

Couples Therapy: So when Psychoanalysis cries you feel ineffectual. Did I get that right?

CBT: No, I think she’s ineffectual when she cries. I think she wastes my time and my money, with a lot of blank staring and crying and sitting on the couch—sometimes several days a week—while life passes us by. And I want a divorce. That’s what I think!


Psychoanalysis: [Stops crying, suddenly poised] Listen here, my cocky little friend. You may think you’ve got it all figured out now, with your self-talk and your flowcharts and your three steps to happiness and your obsessive need to reduce human life to uncomplicated robotic parts! But you’ll see, somehow, some way—yes, I just referenced a mediocre Madonna song from the '90s, and no I’m not allowing the momentary shame I’m feeling as a result to consume me, and not because I’m “changing my core beliefs” about Madonna, but because I’m talking—yes TALKING!—through my anxiety about quoting her drivelly song, damnit—anyway, as I was saying, one day, while you’re all alone jerking off with one hand and typing up your schematic manifestos with the other—again, alone, did I say alone?—you’re gonna wish there was a warm, complex, human being—who CRIES—in the room with you, who you can see, and who listens and holds you, all of you, in her warm, irrational, impractical, imperfect, human mind.


Couples Therapy: [Inhales deeply and instructively] So, let’s take a moment. Can you both acknowledge how you affect each other? How you invalidate the other person and refuse to listen to their point of view? I think you both really want the same thing—to help make life more tolerable and meaningful for people, right? But you’re both too afraid to admit that. Too afraid to truly listen to the other person or let them know that you actually understand where they’re coming from. Why is that so hard?

CBT: [Bursting into tears] I’m sorry. I know I’ve been an A-hole. I wouldn’t exist without you, Psychoanalysis. You are the shoulders I stand on, the wind beneath my wings—ugh, I just quoted a mediocre Bette Midler song from the '80s, and I'm blushing with mortification, but you know? You're right. It feels much better to talk about it than to hold it inside or to force myself to get over it with random dumb exercises. The truth is, I feel safe and free when I’m with you and I actually come up with some of my best creative ideas when we’re just free-associating. But I get afraid sometimes that l love that too much and that my life will end before I get the chance to do something that makes sense—to the insurance companies.

Psychoanalysis: Thank you, CBT. I needed to hear that. I have to admit, you influence me too. Sometimes I find myself getting didactic and coachy, like you—especially when I need sleep or if I'm hungry or about to jump off a bridge, or if I need to be reimbursed by an insurance company—and I do feel more stable after I talk to myself with clear repetitive directions. I have you to thank for that.

[Psychoanalysis affectionately wraps CBT in her holding environment. They kiss. Cue mediocre music.]

Couples Therapy: Great work. That’s all we have time for today. So, who’s paying?

[Music stops suddenly. Psychoanalysis panics. CBT puffs up his chest, grins smugly, and convinces an insurance company to cover the session by describing it in terms of “measurable goals.” Psychoanalysis rolls her eyes. They argue. The progress they made is undone.

To be continued…

Copyright Mark O'Connell, LCSW-R

More from Mark O'Connell LCSW-R
More from Psychology Today