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Theoretical Framework and Stages of Psychoanalytic Therapy

1. Apply psychoanalytic therapy for peter and clearly describe the therapeutic processes involved in treating his conditions. Explain the stages and the processes involved. For simplicity, the stages can be divided into early, middle and late stages.
2. Critique the psychoanalytic approach.
3. Discuss how other modalities can address or overcome the limitations of this approach.
4. Do provide a simple introduction and conclusion in this essay.
5. Do use clear paragraphing to identify and support your answers.
6. Correctly reference all works used in the creation of your essay (minimum 8) and provide in text citation of the location in your essay you have used this work.

Psychoanalytic therapy is based on the theory of Sigmund Freud who gave the idea that people with repressed emotion, anxiety disorder and experiences can be cured by making them conscious about their unconscious thoughts. This therapy is based on exploring the conscious mind of the affected person, to determine its influences on his thoughts and behavior (Sanville, 2013). Psychoanalytic therapy can continue for months or year in a person based on severity of the condition (Hall, 2013). 

This essay analyzes the case of Peter, a 40 year old who is suffering from inter-personal conflict at home and work. He had sought help from mental health professional to resolve his issue but he still has not recovered. Considering the state of Peter, this essay evaluates the benefit of psychoanalytic therapy for Peter and application of other modalties to overcome the limitation of the therapy.

In analyzing the benefits of psychoanalytic therapy for Peter, it is necessary to understand how therapeutic benefit is achieved through different stages of therapy. It begins with an analysis of any early childhood experience(s) in the patient which has contributed to his current mental state. The main purpose of the therapy is to bring significant changes in the personality and emotional development of affected person. Psychoanalytic therapy is based on the assumption that psychological problem are rooted in unconsciousness and may be caused by repressed conflicts (Rutan, Stone, & Shay, 2014). 

Psychoanalytic therapy proceeds through three stages. The initial stage is the disclosure stage in which the therapist tries to identify the problem faced by patient to determine the suitability of the therapy for him. Based on interaction with patients, the therapist investigates the patient’s symptom and their causes. During the first stage of psychoanalytic therapy, therapist tries to engage client in conversation to explore issues that affect them by verbal and non-verbal cues (Shedler, 2012). The middle stage of psychoanalytic therapy is the transference stage in which the therapist tries to establish a relationship which is followed by the consolidation phase or goal setting phase in which the therapist is able to comprehend the inner conflict of patients and they plan a course of treatment to cure their problem. The appropriate intervention depends on symptoms and issues of client (Flores, 2013). The final stage of the psychoanalytic therapy is the resolution stage in which all unconscious conflicts of client is consolidated by the therapist and new behaviors are strengthened. The therapist will make client face reality and transference process may be repeated if some symptoms still exist. When all problems are resolved, the therapy comes to an end (Dreher, & Sandler, 2013). 

Benefit of Psychoanalytic Therapy for Peter

The middle stage of psychoanalytic therapy is related to the client’s response to the transference stage and resistance displayed by the client. Client’s initiating psychoanalytic therapy is very likely to display resistance to treatment due to the weak relationship and interaction with therapist (Werbart, Andersson, & Sandell, 2014).  In this stage, therapist tries to find solutions to address the issues faced by client in treatment. The main therapeutic process involved in this stage is to understand the feelings and internal conflict of client and then comprehend those feelings to determine the next course of action. This may involve noting the difference or similarity in the pattern between patient’s past and current thought process (Lichtenberg,  Lachmann, & Fosshage, 2016). At this stage, all the distorted views and fear of patients become prominent and the therapist can take then course of treatment on the basis of those clues. By the end of this stage, patient is able to take better choices in life after their distorted thought pattern is treated by the therapist (Flores 2013).


In the case scenario, Mr. Peter has been suffering mental issues due to interpersonal conflict at work and home. In order to promote recovery of Peter, the main aim of psychoanalytic therapy is to interpret the factors that lead to such conflict in Peter. It will help the therapist to understand the factors that affect their emotions and behavior. Psychoanalytic therapy is delivered through interpretation of mental and emotional state of individual by drawing conclusion from object relations and self psychology. The aim of psychoanalytic therapy is to help patients understand their unconscious mind and its processes (Shedler, 2012). The psychotherapist goal in treating patients is to demonstrate how their unconscious minds are effecting relationship and work commitments. Any change developed over time responsible for affecting their current state is also discussed with therapist. One-on-one interaction with the patient is the important part of therapy so as to identify their unconscious mind and then bringing patients back to their full consciousness after gaining full knowledge patient’s life condition and issues. The treatment focuses on uncovering internal conflicts of people and resolves them eventually through several stages of psychoanalysis therapy (Dreher & Sandler, 2013). 

As the purpose of this essay is to determine the benefit of psychoanalytic therapy for Peter, it will be necessary to consider the key contributions of the psychoanalytic therapy for recovery of patients with severe anxiety, mood disorder and depression. Peter may benefit from psychoanalytic therapy because it will contribute to expression of deeply entrenched feelings of patients like Peter. Peter will be able to distinguish between reality and fantasy. The exploration of patients mind and thought pattern will help the patients understand their inner conflicts and address them. Hence, psychoanalytic therapy will help Peter to understand all aspects of his mental functioning. The session with therapist will provide Peter the opportunity to express about his issues and this could significantly relieve him from his symptoms of psychological illness (Kivlighan et al., 2015).

Limitations of Psychoanalytic Therapy


The psychoanalytic therapy has contributed to the clinical understanding of psychological development and treating patients with depression. Utilization of Freud’s theoretical conceptualization of unconscious mind, psychoanalytic and non-psychoanalytic understanding of personality development will lead to the derivation of factors that disrupts normal developmental process in an individual. Research validates the benefit of psychoanalytic therapy approach as therapist use empathetic and nonjudgmental environment to cure patients (Benecke et al., 2016). Due to non-judgmental and empathetic approach, patients like Peter will feel safe and trust the therapist to disclose his stress and difficulties in life.

Despite several advantage and contributions of psychoanalytic therapy, researchers also regard the therapy inappropriate due to many limitations. Firstly, psychoanalytic therapy is very time consuming and identification of inner conflicts in patient may require a lot of time. This therapy may not be applied in the long time because take a lot of time to get relief. This therapy is rejected by health care practitioners and theories because this approach lacks a theory of intervention and there is lack of clarity in psychoanalytic terms. In this treatment, there is immense focus of past life of patients, however patients with severe depression may not response and they may turn more aggressive during the counseling session (Shedler, 2012). Hence, people with severe mental disorder are not considered for the psychoanalysis treatment.

The concept of Freud’s theory for psychoanalytic therapy is mainly subjective and psychodynamic approach to treatment of mentally ill patient is criticized due to its unscientific analysis of human behavior. Researcher regard that psychoanalytic theory ignores the cultural and social development of affected person. Many are of the opinion that unconscious mind can be studied through scientific interventions like procedural memory and social psychology. From the analysis of weakness in psychoanalytic approach, it can be said that this approach lacks scientific validity. It has the ability to explain the cause of abnormality in patients; however it lacks the empirical research evidence to support the theory. Freund’s theory was mainly based on subjective analysis and this limitation can be overcome by integration of other models to the psychoanalytic therapy (Dreher & Sandler, 2013). 

Considering the limitation of psychoanalytic therapy, the efficacy of the psychoanalytic therapy can be improved by modifying the methodology involved in delivering the treatment to affected person. The features that can be changes in psychoanalytic therapy include the development of treatment manual, operationalization of adherence factors. The main aim of treatment manual will be to develop the essential feature of treatment such as building correct therapeutic relation with patients, use of transference approach to elucidate unconscious mind and interpret the reasons for patient’s resistance to treatment. The combination of medication and psychoanalytic therapy can also be useful in improving patient’s outcome and leading to fewer relapses in the future.

Other Modalities to Overcome the Limitations of Psychoanalytic Therapy


Psychoanalytic therapy has several pre-requisites for patients and competence of patients of therapist is required to enhance the efficacy of treatment method for patients. The psychoanalytic therapist can work to establish trusting relationship with client as this also have an effect on outcome and recovery of patients. Psychoanalytic therapy may fail due to adversial interaction with depressed patients and therapist should not argue with patient while making them distinguish between the unconsciousness and reality. As peter’s case is an example of social anxiety disorder, the modification of above mentioned approach may yield better outcome for Peter.

The limitations of the psychoanalytic therapy can be overcome by the integration of other psychology model to facilitate recovery of patients with mood disorder. By this approach, elements from different school of therapy can be useful in treating client.

Firstly, combination of cognitive behavioral therapy and psychodynamic therapy can be useful in alleviating psychological dysfunction of person. By the use of psychodynamic approach to counseling, treatment is done through exploration of issues in the past and present, personal development and coping mechanism of a person. The treatment is based on the Freud’s psychoanalytic theory that unconscious impulse leads to conflict and tracing the historical roots of symptoms helps in the resolution of maladaptive behavior in patients. In psychoanalytic therapy, the major emphasis is on integration maintaining therapeutic relationship with client. This therapy focus a lot on exploring the relation between past and present and all severe patients with depression may not be comfortable with recalling the past (Driessen et al., 2013). To reduce this risk, the CBT is combines it focus mainly on current symptoms to identify negative beliefs and cognitive distortion in individual. By the identification of this thought pattern, CBT approach restructures client’s thought pattern so that enable normal behavior and thinking pattern. Research proves the efficacy of both this approach in treating symptoms of depression. As time is major limitation of psychoanalytic therapy, combination of both models will help to reduce remission rates and quickly respond to severe psychiatric patients (Leichsenring et al., 2013).

A combination of psychotherapy and pharmacotherapy can also be useful in treating adults with depression as research have shown moderate effect of combined treatment on patients with depression (Cuijpers et al., 2015). Another meta-analysis of randomized trial study showed that combination of pharmacotherapy and psychotherapy is superior for patients with depression, panic disorder and obsessive-compulsive disorder (Cuijpers et al., 2014).

The person centered approach can also be combined in psychoanalytic approach to facilitate recovery of patients like Peter. The person centered approach is based on the assumption that all people have the innate ability for psychological growth in the presence of idea environment in their life. Therapist working with this approach believes that people tend to develop interpersonal conflict when they lose touch with their self-actualizing factors. Therapist tries to expose people to ideal environment and self-actualizing beliefs. The main difference between person-centered approach and the psychoanalytic approach is that the person centered approach focuses on the current conscious mind of patients whereas the latter focus on the unresolved conflict in early days of life. Therefore, combination of both the therapy will help in getting insight about patient’s internal conflict and establishing connection with their self-actualization needs. By the display of trust, empathy and intimacy with clients, the therapist can work to provide relief for mental conflicts and shift their mind from negative evaluation of self to positive belief for themselves (Ahola et al., 2014).

From the essay on analysis of case scenario of Peter, it can be concluded that psychoanalytic therapy can be a beneficial treatment to relieve symptoms of inter-personal conflict in patient by combination with other psychology models. The evaluation of psychoanalytic theory revealed that this treatment is aimed to address the issues of unconscious mind and helps patients to distinguish between reality and fantasy. Due to the presence of limitations like of scientific validity and time consuming process of psychoanalytic therapy, it is recommended to combine other models like CBT or pharmacotherapy to optimize health outcome of affected person like Peter.

Reference

Ahola, K., Hakanen, J., Perhoniemi, R., & Mutanen, P. (2014). Relationship between burnout and depressive symptoms: a study using the person-centred approach. Burnout Research, 1(1), 29-37.

Benecke, C., Huber, D., Staats, H., Zimmermann, J., Henkel, M., Deserno, H., ... & Schauenburg, H. (2016). A comparison of psychoanalytic therapy and cognitive behavioral therapy for anxiety (panic/agoraphobia) and personality disorders (APD study): presentation of the RCT study design. Zeitschrift für Psychosomatische Medizin und Psychotherapie, 62(3), 252-269.

Cuijpers, P., De Wit, L., Weitz, E., Andersson, G., & Huibers, M. J. (2015). The combination of psychotherapy and pharmacotherapy in the treatment of adult depression: a comprehensive meta-analysis. Journal of Evidence-Based Psychotherapies, 15(2), 147.

Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F. (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta?analysis. World Psychiatry, 13(1), 56-67.

Dreher, A. U., & Sandler, J. (2013). What do psychoanalysts want?: the problem of aims in psychoanalytic therapy (Vol. 24). Routledge.

Driessen, E., Van, H. L., Don, F. J., Peen, J., Kool, S., Westra, D., ... & Dekker, J. J. (2013). The efficacy of cognitive-behavioral therapy and psychodynamic therapy in the outpatient treatment of major depression: a randomized clinical trial. American Journal of Psychiatry.

Flores, P. J. (2013). Group psychotherapy with addicted populations: An integration of twelve-step and psychodynamic theory. Routledge.

Hall, H. K. (Ed.). (2013). Psychoanalytic therapy and behavior therapy: is integration possible?. Springer Science & Business Media.

Kivlighan, D. M., Goldberg, S. B., Abbas, M., Pace, B. T., Yulish, N. E., Thomas, J. G., ... & Wampold, B. E. (2015). The enduring effects of psychodynamic treatments vis-à-vis alternative treatments: A multilevel longitudinal meta-analysis. Clinical psychology review, 40, 1-14.

Leichsenring, F., Salzer, S., Beutel, M. E., Herpertz, S., Hiller, W., Hoyer, J., ... & Ritter, V. (2013). Psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder: a multicenter randomized controlled trial. American Journal of Psychiatry.

Rutan, J. S., Stone, W. N., & Shay, J. J. (2014). Psychodynamic group psychotherapy. Guilford Publications.

Sanville, J. B. (2013). The playground of psychoanalytic therapy. Routledge.

Shedler, J. (2012). The efficacy of psychodynamic psychotherapy. In Psychodynamic Psychotherapy Research (pp. 9-25). Humana Press.

Werbart, A., Andersson, H., & Sandell, R. (2014). Dropout revisited: Patient-and therapist-initiated discontinuation of psychotherapy as a function of organizational instability. Psychotherapy Research, 24(6), 724-737.

Lichtenberg, J. D., Lachmann, F. M., & Fosshage, J. L. (2016). Self and motivational systems: Towards a theory of psychoanalytic technique (Vol. 13). Routledge.

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