Psychodynamic and Psychoanalytic Therapy

The primary focus of psychodynamic therapy is to uncover the unconscious content of a client’s psyche in order to alleviate psychic tension.


Key Takeaways

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Defining the Psychodynamic Approach

” Psychotherapy ” is an general term that encompasses a wide variety of approaches to treatment. One such approach is psychodynamic therapy, which studies the psychological forces underlying human behavior, feelings, and emotions, as well as how they may relate to early childhood experience. This theory is especially interested in the dynamic relations between conscious and unconscious motivation; it asserts that behavior is the product of underlying conflicts of which people often have little awareness. The primary focus of psychodynamic therapy is to uncover the unconscious content of a client’s psyche in order to alleviate psychic tension.

Comparing Psychodynamic and Psychoanalytic Therapies

Psychodynamic therapy is similar to psychoanalytic therapy, or psychoanalysis, in that it works to uncover repressed childhood experiences that are thought to explain an individual’s current difficulties. Psychoanalytic therapy is based on the ideas that a person’s development is often determined by forgotten events in early childhood, and that human behavior and dysfunction are largely influenced by irrational drives that are rooted in the unconscious.

In terms of approach, psychodynamic therapy tends to be briefer and less intensive than traditional psychoanalysis; it adapts some of the basic principles of psychoanalysis to a less intensive style of working, usually at a frequency of once or twice per week. Compared to other forms of therapy, psychodynamic therapy emphasizes the relationship between client and therapist as an agent of change.

Core Characteristics of the Psychodynamic Approach

Psychodynamic theory emphasizes the systematic study of the psychological forces that underlie human behavior. It is especially interested in the dynamic relations between conscious motivation and unconscious motivation. In the treatment of psychological distress, psychodynamic therapies target the client’s inner conflict, from where repressed behaviors and emotions surface into the patient’s consciousness. All psychodynamic therapies have a core set of characteristics:

free association defense mechanisms transference

Types of Psychodynamic Therapy

There are several forms of psychodynamic psychotherapy, such as interpersonal therapy (IPT) and person-centered therapy.

IPT is a structured, supportive approach that strives to connect the external, such as interpersonal struggles, with the internal, such as an individual’s mood. IPT is particularly attentive to relationships and social roles. It is usually a time-limited treatment, typically lasting 12–16 weeks, that encourages the patient to regain control of mood and functioning.

Person-centered therapy is less structured and non-directive. Developed by Carl Rogers, this method of therapy proposes that the function of the therapist is to extend empathy, warmth, and “unconditional positive regard” toward their clients. By listening to and echoing back the clients’ own concerns, the therapist helps the client see themselves as another might see them. This can help them perceive inconsistencies or biases in their perceptions of the world and other people.


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History of Psychodynamic Therapy

Psychodynamic theory was born in 1874 with the works of German scientist Ernst von Brucke, who supposed that all living organisms are energy systems governed by the principle of the conservation of energy. During the same year, medical student Sigmund Freud adopted this new “dynamic” physiology and expanded it to create the original concept of “psychodynamics,” in which he suggested that psychological processes are flows of psychological energy (which he termed the “libido”) in a complex brain. Freud coined the term “psychoanalysis,” and related theories were developed further by Carl Jung, Alfred Adler, Melanie Klein, Anna Freud, Erik Erikson, and others. By the mid-1940s and into the 1950s, the general application of the “psychodynamic theory” had been well established.

Efficacy of Psychodynamic Therapy

The effectiveness of strict psychoanalysis is difficult to gauge; therapy as Freud intended it relies heavily on the interpretation of the therapist and is therefore difficult to prove. The effectiveness of more modern, developed techniques of psychodynamic therapy can be more accurately gauged, however. Meta-analyses in 2012 and 2013 found evidence for the efficacy of psychoanalytic therapy; other meta-analyses published in recent years showed psychoanalysis and psychodynamic therapy to be effective, with outcomes comparable to or greater than other kinds of psychotherapy or antidepressant drugs.

In 2011, the American Psychological Association made 103 comparisons between psychodynamic treatments and non-dynamic competitors and found that 6 were superior, 5 were inferior, 28 showed no difference, and 63 were adequate. The study found that this could be used as a basis to make psychodynamic psychotherapy an “empirically validated” treatment. In 2013, the world’s largest randomized controlled trial on therapy with anorexia outpatients, the ANTOP study, proved modified psychodynamic therapy to be more effective than cognitive behavioral therapy in the long term.

In contrast, a 2001 systematic review of the medical literature by the Cochrane Collaboration concluded that no data exist demonstrating that psychodynamic therapy is effective in treating schizophrenia and severe mental illness, and cautioned that medication should always be used alongside any type of talk therapy in schizophrenia cases. The Schizophrenia Patient Outcomes Research Team in particular cautions against following a psychodynamic approach in treating cases of schizophrenia due to its lack of empirical support.

Criticisms of Psychodynamic Therapy

Psychoanalysis continues to be practiced by psychiatrists, social workers, and other mental health professionals; however, its practice is less common today than in years past. Psychodynamic therapy, in contrast, is still commonly used today.

A common critique of psychoanalysis is its lack of basis in empirical research and too much reliance on anecdotal evidence by way of case studies. Both psychoanalysis and psychodynamic therapies have been criticized for a lack of scientific rigor, sometimes even referred to as “pseudoscience.” A French 2004 report from INSERM said that psychodynamic therapy is less effective than other psychotherapies (including cognitive behavioral therapy) for certain diseases. It used a meta-analysis of numerous other studies to find whether the method was “proven” or “presumed” to be effective in the treatment of different diseases. Numerous studies have suggested that its efficacy is related to the quality of the therapist, rather than the particular school, technique, or training.


Behavior Therapy and Applied Behavioral Analysis

Behavior therapy is based on the idea that maladaptive behavior is learned, and thus adaptive behavior can also be learned.


Learning Objectives

Discuss the goals, techniques, and efficacy of behavior therapy and applied behavior analysis


Key Takeaways

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Defining the Behavioral Approach and Applied Behavioral Analysis

Behavior therapy is a treatment approach that is based on the idea that abnormal behavior is learned. It applies the principles of operant conditioning, classical conditioning, and observational learning to eliminate inappropriate or maladaptive behaviors and replace them with more adaptive responses. Behavior therapy methods sometimes focus only on behaviors, and sometimes on combinations of thoughts and feelings that might be influencing behaviors. Those who practice behavior therapy, known as behaviorists, tend to look more at specific, learned behaviors and how the environment has an impact on those behaviors. Behaviorists tend to look for treatment outcomes that are objectively measurable.

Behavior therapy stands apart from insight-based therapies (such as psychoanalytic and humanistic therapy) because the goal is to teach clients new behaviors to minimize or eliminate problems, rather than digging deeply into their subconscious or uncovering repressed feelings. The basic premise is that the individual has learned behaviors that are problematic and maladaptive, and so he or she must learn new behaviors that are adaptive.

Foundations

Behaviorism focuses on learning that is brought about by a change in external behavior, achieved through a repetition of desirable actions and the rewarding of good habits and the discouragement of bad habits. There are two basic theories of learning that build the foundation for behaviorism:

Operant conditioning Classical conditioning

Operant Conditioning Approaches

Applied behavioral analysis (ABA) is a type of behavior therapy that uses the principles of operant conditioning; it is commonly used in the treatment of children with autism spectrum disorder (ASD). In this treatment, child-specific reinforcers (e.g., stickers, praise, candy, bubbles, and extra play time) are used to reward and motivate children with ASD when they demonstrate desired behaviors, such as sitting on a chair when requested, verbalizing a greeting, or making eye contact. Punishment such as a timeout or a sharp “No!” from the therapist or parent might be used to discourage undesirable behaviors such as pinching, scratching, and pulling hair.

The use of token economies is a behavior-therapy technique in which clients are reinforced with tokens that are considered a type of currency that can be exchanged for special privileges or desired items. Token economies are mainly used in institutional and therapeutic settings. Over time, tokens need to be replaced with less tangible rewards, such as compliments, so that the client will be prepared when they leave the therapeutic setting.

Contingency contracts are formal, written contracts between the client and the therapist. They outline behavior-change goals, reinforcements, rewards, and penalties for not meeting the terms of the agreement.

Modeling involves learning through observation and emulating the behavior of others. The modeling process involves a person being subjected to watching other individuals who demonstrate behavior that is considered adaptive and that should be adopted by the client. In some cases, the therapist might model the desired behavior; in other instances, watching peers demonstrate the behaviors may be helpful. The process is based on Albert Bandura’s social learning theory, which emphasizes the social components of the learning process.

Classical Conditioning Approaches

One commonly used classical conditioning therapeutic technique is aversive conditioning, which uses an unpleasant stimulus to stop an undesirable behavior. Therapists apply this technique to eliminate addictive behaviors, such as smoking, nail biting, and drinking. In aversion therapy, clients will typically engage in a specific behavior (such as nail biting) and at the same time are exposed to something unpleasant, such as a mild electric shock or a bad taste. After repeated associations between the unpleasant stimulus and the behavior, the client can learn to stop the unwanted behavior.

In exposure therapy, a therapist seeks to treat clients’ fears or anxiety by presenting them with the object or situation that causes their problem, with the idea that they will eventually get used to it. This can be done via reality, imagination, or virtual reality. A popular form of exposure therapy is systematic desensitization, wherein a calm and pleasant state is gradually associated with increasing levels of anxiety-inducing stimuli. Virtual reality exposure therapy uses simulations when it’s either too impractical or expensive to re-create anxiety-producing situations; it has been used effectively to treat numerous anxiety disorders such as the fear of public speaking, claustrophobia (fear of enclosed spaces), aviophobia (fear of flying), and post-traumatic stress disorder (PTSD).