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Psychotherapeutic Orientation and Theories

Psychotherapeutic orientation is unique to every therapist. The basic tenets of psychoanalysis and psychotherapy are experience, cognition and human behavior which are determined by irrational and innate drives. There are three main theories in counseling. These theories are psychodynamic therapy, behavioral/ cognition behavioral therapy and humanistic therapy. Psychodynamic therapy was developed by Sigmund Freud which focuses how the unconscious impacts the humans and their functions. The goal of this psychoanalysis is to free the repressed and trapped feelings with the use of “free association” ( Abou-Saleh et al.,2011),( Prochaska,& Norcross, 2014). The second therapy is Person centered counseling or humanistic approach to counseling developed by Carl Rogers in the 1950’s. In this therapy the counselor provides a facilitative environment that comprises of six sufficient and necessary conditions that help a client to find the resources they have within themselves. The third therapy is Cognitive behavioral therapy that was developed by Aaron Beck in 1960’s. This therapy focuses on attitudes, thoughts, beliefs and images that are held by the client and how the client’s way of dealing with emotional issues. In this essay we will critically evaluate the strengths and weaknesses of cognitive behavioural therapy and psychodynamic therapy in their assessments of human behavior and potential.

Psychodynamic therapy was developed by Sigmund Freud, a philosopher and medical doctor who developed the idea while working in Vienna with his patients. He collected information on his clients early childhood experiences, feelings and thoughts. His theory focuses on the unconscious mind and its mental forces (Abbass, Kisely, & Kroenke, 2009). This therapy is based on the fact that unconscious mind influences our behaviors and thoughts. The therapists practicing this therapy often spend their time in listening to the patients talk about their lives. This is why this therapy is often referred as “talk therapy” as during this therapy the therapist will look for patterns in significant events in the client’s lives (Abbass, Town,& Driessen, 2013),( Anestis, Anestis,& Lilienfeld, 2011). According to them the unconscious feelings, motivations and thoughts play a role in maladaptive behaviors and mental illness. Many people criticize this therapy as they claim that it is generally ineffective, time consuming and expensive. But this therapy has numerous benefits as a therapist provides a non judgmental and empathetic environment to the client in which they feel safe to express their feelings that is leading to stress and anxiety in their life. “Psychodynamic therapy” is the understanding of the areas of human mind such as the conscious, the subconscious and the unconscious. Freud main interest was to bring the feelings from the unconscious part of the mind to the conscious. This practice is called as the “psychoanalysis” in which the psychologist or therapist encourages the client to discuss about their childhood and gain a deeper understanding about the events that associate and hold the negativity in their life. It is based on the assumption that only on realizing and becoming aware of our dilemmas, we can progress psychologically. According to Freud the personality consist of three elements that are Id, Ego and Superego where Id is the part that is concerned with satisfaction of basic needs like pleasure, comfort and food. It is usually referred as the present form as it is present from before birth. Ego is defined as the “realistic awareness of oneself” it is the logical and brings the common sense into our personality. Freud believed Ego develops as a infant when he or she becomes aware of its being separate from his or her parents. The Superego is which develops later in life as a child. This part controls the basic instincts of the Id, and even curbs it if the instinct is socially unacceptable. According to Freud everybody experiences conflict and tension between the elements of their personalities for example when Superego curbs basic instinct of Id by the moral sense of right or wrong. Psychodynamic therapy stresses on the importance of the early experiences in life and how these childhood experiences still affect us later in life. It argues that talking helps people to find ways to understand their problems by understanding their past incidences (Driessen, et al.,2010). This therapy relies heavily on the relationship between the therapist and the client. There are numerous benefits or strengths of this therapy such as it addresses the root of the psychological distress or issues, it is one of the therapies that focuses on the personality, it is observed that clients are benefitted in the long run, it encourages the client to set the agenda for the therapy session giving them the free speech and expression. This therapy focuses on the person’s history along with the here and now. It is recommended for patients with depression, post traumatic stress disorder, anxiety, sexual difficulties, panic disorders, stress related physical ailments, prolonged sadness and persistent feelings of loneliness and isolation (Knekt, et al., 2007),( Leichsenring et al., 2013),( Leichsenring, & Leibing, 2005).

There are few weaknesses or limitations of this therapy as it is less structured than other therapies like the cognition behavior therapy, the client-therapist role is the primary element of any therapy, it takes a longer commitment from the client as the results are seen with time, due to the length of the therapy many experts deem it expensive, it is all about your childhood and early experiences which can be uncomfortable for some clients, it lacks objectivity as it requires the therapist to interpret the experiences, it relies heavily on theoretical constructs such as unconscious mind that are difficult to prove, and it is also to test this therapy in a empirical manner. This theory introduces the use of personality assessments in the form of projective tests. This theory has a sexual basis but number of behaviors can have non-sexual and more rational explanation. For example babies chew as they are teething or hungry. In Freud’s psyche the physical aspect of the forces like physical Id, superego and ego are missing. All of these constructs are hypothetical (Thombs, Jewett, &Bassel, 2011). In his theory Freud also suggest that abnormal behavior is not due to the patient but is due to the parents which take away the stigma to an extent. This theory may be deemed as unscientific in the analysis of human behavior. As many concepts are subjective and are impossible to test scientifically. We cannot scientifically study tripartite personality and unconscious mind. The case studies that Freud used were based on studying a person in detail and in reference he has taken middle aged women’s from Vienna. Therefore generalizing it to wider population or the whole world is difficult.

Psychodynamic Therapy

Another important therapy is cognitive behavioral therapy also known as “CBT” which has emerged recently. This theory is based on the ideas of Aaron Beck who observed his counseling clients and came to a conclusion that they have a “internal dialogue” that influences their behavior ( Beck, 2013). This theory focuses on attitudes, beliefs and images of the clients and their way in dealing with the emotional issues. It focuses on two elements: cognitive restructuring of the negative thinking patterns and behavioral activation, where the client overcomes the barriers. This therapy is one of the major orientations of psychotherapy as it focuses on behavioral and cognitive psychological aspects of human behavior (Lynch, et al., 2009). This therapy is goal focused and brief. It focuses on the present and is highly structured. Behavioral theorists like Aaron Beck suggest that mental illnesses like depression are caused by irrational and faulty psychological perception which in turn causes distorted reasoning and learning (Beck,2016,). Beck came up with the negative cognitive triad which has three dysfunctional schemas that a depressive person has. These people view themselves as incapable to succeed, and always see themselves as victim of circumstances (Lynch, Laws, & McKenna, 2009), (McKay et al.,2015). They see all present and past experiences in the negative light. Cognitive theory has been found to be effective in treating depression and anxiety as it focuses on changing the core beliefs. It focuses on restructuring the destructive thinking and setting realistic goals (Newby et al.,2016). New ways and ideas are generated to form a positive attitude towards the environment, others and oneself (Spirito ,et al.,2011).

This therapy is insight focused where the patients recognize the negative beliefs and thoughts and work towards changing them. Through this therapy the therapist and the patient work as a team for the betterment of the client. But this therapy also has some weaknesses as many experts believe that this therapy may seem like superficial as it ignores the past experiences of childhood and works on the present. The patient has to work harder and the therapist has the role of supporting the patient. Therefore the client has to commit to the process and be prepared to work extra between sessions in the form of homework. This therapy may not work for complex mental issues due to it’s highly structure form. Sessions include confronting the anxieties and emotions which can be particularly uncomfortable in the starting. This theory is based on individual needs and ignores wider issues surrounding society and family. There are numerous strengths of this theory as well as it is found to be more affordable by many experts as it is goal focused and brief. It is found to be helpful in cases where drugs and medication have not worked. It can be done in groups and also individually. It is based on empowering the client to help themselves with the help of homework, exercises, computer programs and self help books. (Okumura, & Ichikura, 2014)

Strengths and Weaknesses of Psychodynamic Therapy

Psychodynamic therapy relies on the relationship of the therapist with the client, where the therapist gets an opportunity to examine the relationships that the client had in the past. This therapeutic relationship is central to this theory as the therapist gets to see how the patient interacts with his family and friends. The therapists are able to view the early life relationships that are affecting the patient’s life in the present.  This intimate and close look into the interpersonal relationships helps the patient to observe his or hers relationship patterns and gives him the power to transform or change the dynamic. In this therapy the therapists encourage their clients to speak freely to reveal their vulnerable feelings, fears, emotions and desires. The goal of this therapy is to foster internal resources that are needed to deal with the issues. It also recognizes the defense mechanisms like reactions that the client uses to ignore and avoid distressing feelings and thoughts.

The structure approach of the cognitive behavioral therapy enables the therapist and the patient to form goals for each session. This collaborative relationship helps in revealing the personal issues without the fear of judgement. According to the therapists CBT is about adjusting the thoughts that directly influence or reactions and emotions. This cognitive restructuring of the person’s thinking pattern and helping them to unlearn the negative reactions is the key to the sessions (Vyskocilova, & Prasko, 2016). The therapists help the patient to break down the overwhelming issues into small manageable problems by setting small goals. During the sessions the therapists adjusts with the patient through learning how the patient reacts in challenging situations. The therapists also give homework that has to be done outside the scheduled session’s timings. This enables the patient to continue working independently even when the sessions or even when the therapy has ended. This process of first identifying the negative thoughts and then changing them by the means of awareness and education is the central part of this therapy. (Wu, Schoenfelder, & Hsiao, 2016)

In conclusion we can denote that each therapy has its own strengths and weaknesses which may be suitable for one individual but will not be for another. Therefore depending on the preference and the severity of the mental illness the consideration to sought mental help should be focused for the recovery of the patient.

Reference 

Abbass, A., Kisely, S. and Kroenke, K. 2009,  Short-Term Psychodynamic Psychotherapy for Somatic Disorders. Psychotherapy and Psychosomatics, 78(5), pp.265-274. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0027209/ 

Cognitive Behavioural Therapy

Abbass, A., Town, J. and Driessen, E. 2013, Intensive Short-term Dynamic Psychotherapy: A Treatment Overview and Empirical Basis. Research in Psychotherapy: Psychopathology, Process and Outcome, 16(1), p.6. https://www.ncbi.nlm.nih.gov/pubmed/24647454 

Anestis, M., Anestis, J. and Lilienfeld, S. 2011, When it comes to evaluating psychodynamic therapy, the devil is in the details. American Psychologist, 66(2), pp.149-151. https://dx.doi.org/10.1037/a0022654

Abou-Saleh, M.T., Katona, C.L.E. & Kumar, A., 2011, Principles and practice of geriatric psychiatry, Chichester, West Sussex: J. Wiley. https://uic.pure.elsevier.com/en/publications/principles-and-practice-of-geriatric-psychiatry-third-edition 

 Beck, J. 2013, Cognitive behavior therapy. 1st ed. Johanneshov: MTM. https://www.elsevier.com/books/the-science-of-cognitive-behavioral-therapy/hofmann/978-0-12-803457-6

Beck, A. 2016, Cognitive Therapy: Nature and Relation to Behavior Therapy – Republished Article. Behavior Therapy, 47(6), pp.776-784. https://www.ncbi.nlm.nih.gov/pubmed/27993332 

Driessen, E., Cuijpers, P., de Maat, S., Abbass, A., de Jonghe, F. and Dekker, J. (2010). The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis. Clinical Psychology Review, 30(1), pp.25-36. doi: 10.1016/j.cpr.2009.08.010.  https://www.ncbi.nlm.nih.gov/pubmed/19766369 

Knekt, P. Lindfors, O., Härkänen, T., Välikoski, M., Virtala, E., et al.  et al., 2007, Randomized trial on the effectiveness of long-and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up. Psychological Medicine, 38(05).689-703. https://www.ncbi.nlm.nih.gov/pubmed/18005493

Leichsenring, F., Abbass, A., Luyten, P., Hilsenroth, M. and Rabung, S. 2013, The Emerging Evidence for Long-Term Psychodynamic Therapy. Psychodynamic Psychiatry, 41(3), pp.361-384.  doi: 10.1521/pdps.2013.41.3.361. https://www.researchgate.net/publication/256423998_The_Emerging_Evidence_for_Long-Term_Psychodynamic_Therapy 

Leichsenring, F. and Leibing, E. 2005, The Effectiveness of Psychodynamic Therapy and Cognitive Behavior Therapy in the Treatment of Personality Disorders: A Meta-Analysis. FOCUS, 3(3), pp.417-428. https://www.ncbi.nlm.nih.gov/pubmed/?term=The+Effectiveness+of+Psychodynamic+Therapy+and+Cognitive+Behavior+Therapy+in+the+Treatment+of+Personality+Disorders%3A+A+Meta-Analysis.+FOCUS%2C+3(3)%2C+pp.417-428. 

Lynch, D., Laws, K. and McKenna, P. 2009, Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials. Psychological Medicine, 40(01), p.9. doi: 10.1017/S003329170900590X.  https://www.ncbi.nlm.nih.gov/pubmed/19476688 

McKay, D., Sookman, D., Neziroglu, F., Wilhelm, S., Stein, D., Kyrios, M., Matthews, K. and Veale, D. 2015, Efficacy of cognitive-behavioral therapy for obsessive–compulsive disorder. Psychiatry Research, 227(1), pp.104-113. DOI: 10.1016/j.psychres.2015.02.004

https://www.psy-journal.com/article/S0165-1781(15)00074-8/references 

Newby, J., Twomey, C., Yuan Li, S. and Andrews, G. 2016, Transdiagnostic computerised cognitive behavioural therapy for depression and anxiety: A systematic review and meta-analysis. Journal of Affective Disorders, 199, pp.30-41. doi: 10.1016/j.jad.2016.03.018. https://www.ncbi.nlm.nih.gov/pubmed/27060430 

Okumura, Y. and Ichikura, K. 2014, Efficacy and acceptability of group cognitive behavioral therapy for depression: A systematic review and meta-analysis. Journal of Affective Disorders, 164, pp.155-164. doi: 10.1016/j.jad.2014.04.023. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0067667/ 

Prochaska, J.O. & Norcross, J.C., 2014. Systems of psychotherapy: a transtheoretical analysis, Stanford: Cengage Learning. https://trove.nla.gov.au/work/8523474 

Spirito, A., Esposito-Smythers, C., Wolff, J. and Uhl, K. 2011, Cognitive-Behavioral Therapy for Adolescent Depression and Suicidality. Child and Adolescent Psychiatric Clinics of North America, 20(2), pp.191-204. 10.1016/j.chc.2011.01.012 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073681/ 

Thombs, B., Jewett, L. and Bassel, M. (2011). Is there room for criticism of studies of psychodynamic psychotherapy?. American Psychologist, 66(2), pp.148-149. https://www.cppnj.org/article_dodo2.php

Vyskocilova, J. and Prasko, J. 2016, Cognitive behavioral therapy in pharmacoresistant obsessive-compulsive disorder. European Psychiatry, 33, p.S203. doi: 10.2147/NDT.S101721 https://www.ncbi.nlm.nih.gov/pubmed/27042074 

 Wu, S., Schoenfelder, E. and Hsiao, R. 2016, Cognitive Behavioral Therapy and Motivational Enhancement Therapy. Child and Adolescent Psychiatric Clinics of North America, 25(4), pp.629-643. https://dx.doi.org/10.1016/j.chc.2016.06.002

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