Two Paths in Therapy: Skills and Insight
Broadly speaking, therapies tend to fall into two categories: those that focus on building skills and those that foster insight.
Skills-based therapies assume that psychological problems arise from a lack of coping skills, and they attempt to remedy this by teaching skills. A CBT therapist might teach you to reframe the way you think about certain situations. A DBT therapist might introduce mindfulness practices or strategies for setting boundaries with others.
Insight-oriented therapies, in contrast, recognize how hard it is to truly know ourselves. Psychodynamic therapy, the form of insight-oriented therapy I practice, explores the unconscious processes that shape our thoughts, feelings, and behaviors. These hidden patterns can trap us in maladaptive cycles, and gaining awareness of them can help us achieve greater freedom and control over our lives.
Skills-Based Therapies
Learning new skills can certainly be useful, especially if you’ve never learned them before. But in my experience, most people already have a solid set of skills. Often, the problem isn’t not knowing what to do — it’s not being able to act on what we already know.
I’ve often heard people say: “I know it shouldn’t bug me when my partner does that thing, but I get so mad and just can’t stop from reacting.” Or: “I know I should be over that event by now, but I can’t get myself to move on.” In situations like these, adding more skills doesn’t usually resolve the issue.
The Promise of Insight
This is where insight-oriented work can help. On the surface, our reactions might seem irrational, but at a deeper level they generally make perfect sense. Psychodynamic therapy explores these deeper patterns — often rooted in early experiences, unresolved conflicts, or unconscious beliefs — to help you understand why you feel and act the way you do. Once we uncover this unconscious meaning, you can, perhaps for the first time, exercise real autonomy.
The difficulty, of course, is that the unconscious is hard to access. Not only does it contain important thoughts and feelings, but it also resists being uncovered. At this deeper level, our minds operate by the maxim “ignorance is bliss.” And yet, for those struggling enough to seek therapy, ignorance is clearly not working.
The Hard Work of Seeing Ourselves
As both a patient and clinician, I’ve found that certain truths about ourselves can only be reached in the context of a therapeutic relationship. We’re simply too adept at deceiving ourselves; in certain important ways, we can only see clearly with the help of another.
Insight-oriented therapy is not always easy. Our minds have buried painful thoughts and feelings for a reason, and bringing them to light can be uncomfortable. That’s why this work depends on a trusting, nonjudgmental relationship.
But if you’re willing to face some short-term discomfort, psychodynamic therapy can offer something more lasting: the chance to experience yourself and your relationships with greater clarity, freedom, and authenticity.