Psychodynamic Treatments for Mental Disorders

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Psychodynamic Treatments for Mental Disorders
Laura Forryan, Lucy Gibbons, Laura Platt
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Introduction

• The Psychodynamic approach focuses on the
  unconscious influence of events during childhood.
  
• Freud is a key psychologist in this approach,
  believing that mental energy can be discharged or
  transformed, but not destroyed.

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Treatment Psychoanalysis

• The aim of psychodynamic therapy is to help the
  individual cope better with inner emotional
  conflicts that are causing disturbance.
• This helps them gain insight or conscious
  awareness of the repressed conflicts.
• This is a form of catharsis (releasing the power
  they exert over behaviour).

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Free Association

• Client reclines on couch with the therapist out
  of sight and is allowed the free flow of
  feelings/thoughts/images. As these come to mind,
  clients express them in words.
• The analyst must listen, suspending their own
  values and judgements and interrupting
  occasionally to ask client to reflect upon
  significance of associations which should arise
  from internal dynamic conflict.

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Word Association

• Client is read a list of words one at a time and
  asked to reply with whatever comes instantly to
  mind.
• The analyst pays particular attention to unusual
  responses, hesitations and mental blanks, which
  may indicate repression.

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Dream Analysis

• The role of the analyst is to help the client
  unravel the latent content of their dreams from
  the manifest content e.g. Symbols.
• Dreams are interpreted as wish fulfilment,
  usually of a sexual or aggressive nature.

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Transference

• This occurs when client redirects feelings
  towards the therapist that are unconsciously
  directed towards a significant person in their
  life (usually a parent) but which have been
  blocked from the conscious mind.
• It is important because it indicates that
  repressed conflict Is coming very close to
  conscious awareness.
• It must occur naturally and the therapist must
  not encourage or prevent it. The aim is to
  identify the source of the transference and the
  circumstances surrounding the repression.

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Projective Tests

• A client is asked to describe what they see in an
  ink blot or to tell a story around the picture.
  These are used as tools to uncover recurrent
  themes that may reveal the unconscious needs and
  motives of the person.

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Freudian Slips

• Freud saw Freudian slips as a route to the
  unconscious. Errors and mistakes we make in
  everyday life are unconscious thoughts finding
  their way into consciousness.
• Slips of the tongue can reveal repressed
  anxieties or desires that need to be dealt with
  consciously.

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Evaluation of Psychoanalysis

• Psychodynamic therapy is generally conducted over
  a number of years, which makes it expensive, and
  this has restricted its availability.
• It is generally regarded as appropriate treatment
  for anxiety disorders, depression and eating
  disorders.

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Evaluation of Psychoanalysis

• Comer (1995) cites the American Psychiatric
  Associations concerns over transference as a
  treatment for depression as patients have a
  tendency towards extreme dependency on important
  people in their lives.
• He also points out that Psychoanalysis may be
  detrimental to the treatment of
  obsessive-compulsive disorder as free association
  may inadvertently increase the persons tendency
  to ruminate and overinterpret.

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Evaluation of Psychoanalysis

• Boker (1992) points out that psychoanalysis
  wasnt very useful to schizophrenics as the
  treatment requires insight, but with the use of
  phenothiazines, psychoanalysis can be used to a
  greater extent on these patients.
• Eysenck (1952) claimed that psychoanalysis does
  not work.He reviewed two outcome studies which
  showed that 66 of the control group improved
  spontaneously, whereas only 44 of psychoanalysis
  patients improved.
• BUT Bergin (1971) said this study was unreliable
  as the patients in the control group were
  hospitalised and the other group were treated by
  their GPs. He also found that by selecting other
  outcome criteria, psychoanalysis improvement
  increased to 83 and the control decreased to 30.

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Evaluation of Psychoanalysis

• Thase et al (1997) looked at 6 studies with 595
  patients diagnosed with major depressive
  disorder. They examined the effectiveness of
  psychotherapy combined with antidepressants
  compared with psychotherapy alone over a twelve
  week period. It showed that with less sever
  patients, there was no significant difference
  between medication and no medication (37 vs 48)
  but with more severe patients, it was much more
  effective with treatment than without (25 vs 43)

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Evaluation of psychoanalysis

• Mufson et al (1999) conducted a 12 week study on
  48 majorly depressed adolescents between 12 and
  18 years and randomly assigned to a psychotherapy
  group or a control group. There was a 75
  decrease in depressive symptoms and increase in
  social functioning and problem solving skills
  compared to 46 in the control group.
• However, long-term effectiveness is not a sure
  thing.