Side-by-side comparison
Compare orientations across the Behavioral Medicine Y-Model (Ramezani et al., 2016): a shared set of core dimensions. Philosophy, etiology, time orientation, the therapy relationship, and how each teaches and supervises. Motivational Interviewing sits at the stem of the 'Y'; CBT and psychodynamic therapy are the classic arms. Pick the approaches to compare, then optionally a clinical presentation to see how each formulates it.
3 orientations selected
Leave as “None” to study the differences in the abstract, or pick a presentation to see each orientation’s formulation of it below.
Philosophy & theory
| Dimension | Cognitive Behavioural Therapy (CBT) | Motivational Interviewing (MI) | Psychodynamic Psychotherapy |
|---|---|---|---|
| PhilosophyThe worldview the therapy rests on | Stoicism and rational-empiricism | Person-centered humanism (Rogerian roots), the stem of the Y-Model | Romanticism |
| Etiology of symptomsWhat causes the problems | Diathesis–stress: latent/dormant core beliefs (learned early) get triggered by current life stressors | Ambivalence blocks change; motivation is a fluctuating state, not a fixed trait | Unconscious conflict and relational attachments |
| ConsciousnessHow much is in vs. out of awareness | Nonconscious neural information processing | Conscious ambivalence and values, the balance of change talk vs sustain talk | Unconscious emotional drives |
| Theory of personalityHow the person is understood | Learned schemas of belief, emotion, and interpersonal role | An autonomous person capable of resolving their own ambivalence | Superego, ego, and id fixation in psychosexual stages |
| Symptom mechanismWhat factor keeps the problem going | Cognitive distortions and perpetual activation of schemas | Sustain talk outweighing change talk; the clinician's 'righting reflex' feeds resistance | Defense mechanisms used by the ego (repression of emotions) |
Time orientation
| Dimension | Cognitive Behavioural Therapy (CBT) | Motivational Interviewing (MI) | Psychodynamic Psychotherapy |
|---|---|---|---|
| Focus of time orientationWhich time frame the work centers on | Present and future | Present readiness | Past |
| Progression of time orientationHow past and present get connected | Connect present to past | Present readiness directed toward a valued future | Connect past to present |
In the therapy room
| Dimension | Cognitive Behavioural Therapy (CBT) | Motivational Interviewing (MI) | Psychodynamic Psychotherapy |
|---|---|---|---|
| Patient–therapist relationshipThe stance between them | Collaborative role (collaborative empiricism) | Collaborative, evocative partnership. A guide, not an expert authority | Doctor–patient role |
| Therapist's roleWhat the therapist mainly does | Socratic method | Evoke, don't install. OARS micro-skills and rolling with resistance | Free association |
| Therapist tracksWhat the therapist watches for | Distortions in thoughts | Change talk vs sustain talk (DARN-CAT) | Affect or emotional charge of a topic |
| SessionsStructured vs. unstructured format | Structured. Set agenda, in-session worksheets, between-session homework | Semi-structured, agenda set collaboratively, one behavior at a time | Unstructured, open, emergent, follows the patient's associations |
Teaching & supervision
| Dimension | Cognitive Behavioural Therapy (CBT) | Motivational Interviewing (MI) | Psychodynamic Psychotherapy |
|---|---|---|---|
| Therapist teachesWhat the client is helped to learn | Adaptive skills and thoughts | Information via Elicit–Provide–Elicit, only with permission | Insight into transference and countertransference |
| Purpose of teachingWhy that learning matters / how it heals | Adaptive skills and thoughts change insight | Strengthen the person's own commitment to change | Insight changes behavior and one's way of relating to self and others |
| Supervisor–supervisee relationshipHow trainees are supervised | Education, role-play, modeling, and practice | Coaching with MI-adherence feedback (e.g. MITI coding) | Education; supervisor helps supervisee identify transference and countertransference |
Source. The comparison dimensions adapt the Behavioral Medicine Y-Model. Plakun et al. (2009) [1], elaborated by Ramezani et al. (2016) [2]. In which Motivational Interviewing forms the shared “stem” and each orientation is an “arm.” Cell values are concise teaching summaries pending clinical review.
- [1] Ramezani, A., Rockers, D. M., Wanlass, R. L., & McCarron, R. M. (2016). Teaching behavioral medicine professionals and trainees an elaborated version of the Y-Model: Implications for the integration of cognitive-behavioral therapy (CBT), psychodynamic therapy, and motivational interviewing. Journal of Psychotherapy Integration, 26(4), 407–424.
- [2] Plakun, E. M., Sudak, D. M., & Goldberg, D. (2009). The Y model: An integrated, evidence-based approach to teaching psychotherapy competencies. Journal of Psychiatric Practice, 15(1), 5–11.