The aim of psychodynamic therapy is not to ‘cure’ the ...



The aim of psychodynamic therapy is not to ‘cure’ the patient’s psychological problems, in the way that the medical profession might hope to find a cure for cancer. Rather, the aim is to enable the person to cope better with inner emotional conflicts that are causing disturbance. The problem is to be found in the unconscious. The aim of therapy is to make the unconscious conscious and then deal with it in the safety of the consulting room. Freud believed that disorders come from ego defence mechanisms, e.g. a phobia involves repression.

An important part of this is that confusing or traumatic childhood experiences can be better understood when looked at as an adult. Psychoanalysis is literally, analysing the mind. In psychodynamic therapy, a variety of techniques are used which include the following:

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|Treatment |Use of treatment |Mode of action |Appropriateness |Effectiveness |Ethics |

|Psychanalysis: |This is based on the assumption that |- Free association: The client is |- Psychoanalysis is based on Freud’s |Probably the most quoted criticism | |

| |individuals are often unaware of the |asked to recline on a chair with the |theory of personality; if that is |against psychodynamic therapy came | |

| |influence of unconscious conflicts on |therapist out of sight] and allow the |flawed, then so are the therapies. |from Eysenck (1952) who claimed that | |

| |their current psychological state. |free flow of feelings, thoughts or |Also, the theory cannot be falsified, |it simply does not work. He reviewed | |

| |Psychoanalysis helps to bring these |images. As these come to mind, clients|and the theory is based on a set of |two outcome studies, incorporating | |

| |conflicts into the conscious mind, |express them in words, without |non-representative sample |waiting list controls, which showed | |

| |where they can be dealt with. |criticism or censorship from either |(middle-class neurotic women) |that 66% of the control group improved| |

| |Conditions such as phobias, sexual |the ego or the analyst. The analyst | |spontaneously, whereas only 44% of | |

| |problems, etc. This is also useful in|must not use their own values and |- Eysenck (1966) therapy delays |psychoanalysis patients improved. | |

| |cases of neuroses. However, patients |judgements. The idea is that |recovery. It is appropriate only for |Eysenck’s papers were subsequently | |

| |with schizophrenia cannot use |associations should arise from the |certain mental illnesses (in which |reviewed by Bergin (1971) who found | |

| |psychoanalysis. |problems in the unconscious. There may|patients have insight into their |that patients in one of the control | |

| | |also be resistance from the |condition) and certain groups of |groups were in fact hospitalised and | |

| | |unconscious and this may appear in |people (those who are articulate and |those in the other group were being | |

| | |various forms, e.g. when the person is|have the time and money for |treated by their GP, creating very | |

| | |close to the problem, they may |treatments). |different groups, a fact that Eysenck | |

| | |unconsciously change their train of | |had ignored. | |

| | |thought, Freud saw resistance as |- False memories- memories recovered | | |

| | |natural because it is preventing the |from repression. Many critics argue |- Corsini and Wedding (1995) also | |

| | |painful conflicts being brought into |that many therapists are not helping |explain that there are too many | |

| | |their conscious awareness. |patients recover repressed memories, |variables involved to enable a | |

| | |- Dream analysis: Freud believed that |but are implanting false memories of |controlled and statistically valid | |

| | |our unconscious drives and wishes can |sexual abuse, alien abduction. |outcome study. Comparisons may be made| |

| | |be seen uncensored in dreams, although| |between symptoms at the beginning and | |

| | |they are disguised in symbols in order| |end of treatment, but during the | |

| | |to protect the conscious mind. The | |course of therapy other complications | |

| | |role of the analyst is to help the | |may arise as a direct result of what | |

| | |client interpret their dreams | |happens during therapy. Because | |

| | |significance. In Freudian | |treatment is over such a long period, | |

| | |psychoanalysis, dreams are interpreted| |there may also be other factors | |

| | |as wish-fulfilment, usually of a | |occurring in the client’s life during | |

| | |sexual or aggressive nature. Things | |the course of therapy which have an | |

| | |that happened during the day made the | |effect on the person’s life. Life may | |

| | |person think about repressed childhood| |have been favourable for some clients | |

| | |memories and desires. However, because| |and unfavourable for others. | |

| | |some desires are too disturbing for an| |Effectiveness is a subjective concept,| |

| | |individual to face, even when asleep, | |measurable only by the extent to which| |

| | |they are expressed in symbolic form. | |clients themselves feel that their | |

| | | | |condition has improved. | |

| | |Freud used the term manifest content | | | |

| | |to describe the content of the dream | |Despite difficulties in evaluation, | |

| | |as reported by the dreamer and latent | |psychodynamic therapies continue to | |

| | |content to refer to the dream’s | |thrive and newer versions are more | |

| | |presumed hidden or symbolic content. | |accessible and affordable. | |

| | |- Hypnosis: This is the method that | | | |

| | |Freud originally used to gain access | | | |

| | |to the unconscious. However, Freud | | | |

| | |abandoned it because the client might | | | |

| | |deny the accuracy of what had been | | | |

| | |revealed when they were hypnotised. | | | |

| | |Others found the revelations to be too| | | |

| | |premature and painful. | | | |

| | |- Transference: This occurs when the | | | |

| | |client redirects feelings [e.g. of | | | |

| | |hostility] towards the therapist, | | | |

| | |which are unconsciously directed | | | |

| | |towards a significant person in their | | | |

| | |life [usually a parent]. The person | | | |

| | |has feelings which the conscious mind | | | |

| | |does not allow to be expressed, so | | | |

| | |they are transferred onto the | | | |

| | |therapist. Transference is important | | | |

| | |because it indicates that repressed | | | |

| | |conflict is getting very close to | | | |

| | |conscious awareness. Transference must| | | |

| | |occur naturally, however, and the | | | |

| | |therapist must neither encourage nor | | | |

| | |prevent it. The aim is to identify who| | | |

| | |the person is really thinking of and | | | |

| | |the circumstances surrounding the | | | |

| | |repression. | | | |

|Psychodrama |- Psychodrama is an active method of group psychotherapy in which past and |It’s suitable for people with |- There are very few carefully |- There’s no agreed code of |

| |present experiences are explored, |unresolved issues in their lives, |controlled trials using randomly |ethics in psychodrama therapy.|

| |- Moreno developed psychodrama, and claimed that psychodrama is an extension |including family and relationship |assigned conditions to assess the | |

| |of children’s natural play. The tools are psychoanalysis are:- |difficulties, for those suffering from|effectiveness of psychodrama. |- Lazarus (1994) claims that |

| |- Director (leads the session, who provides direction to the other group |anxiety, loss or depression and those | |such ethical guidelines would |

| |members (auxilaries), also enables pps to explore their feelings and release |who want to realise their potential. |- Psychodrama is a flexible approach. |affect the creativity and |

| |their emotions (Catharsis), also allows pps to observe links between present |Psychodrama for people with mental |Pps can try out new responses to old |spontaneity. |

| |problems and past difficulties. |retardation has been most effective |situations. This is suitable for | |

| |- Protagonist – this is the person who is the focus of the session, whose |when a directive style with structured|people who have difficulty verbalising| |

| |experiences will be analysed |session is used. |their emotions. It’s a doing and | |

| |- Auxiliaries – other group members who play a part in the enactments. They | |showing rather than a telling therapy.| |

| |may act out roles of mother, father, brother, etc. | | | |

| | | | | |

| |There are three stages to Psychodrama: | | | |

| |- Warm-up: Cognitive, sensory, verbal, behavioural, and physical activities. | | | |

| |E.g., the ‘Empty Chair’ Task’, they ask the protagonist to think of a person | | | |

| |in the chair who they would like to talk to. | | | |

| |- Action phase: A theme is chosen, e.g., poor relationships with their | | | |

| |children). Simple props are used to make the situation more real. | | | |

| |- Sharing: This involves group members sharing what they experienced in the | | | |

| |drama. This helps to release one’s emotions. Judgements of the protagonist | | | |

| |should not be made. | | | |

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