Comparison Between Psychodynamic Remedy And Cognitive Behavior Therapy

In this article, Psychodynamic remedy will be detailed and its own key theories and concepts described. How these ideas and ideas are applied in professional medical practice will be evidenced through published case material to explicitly demonstrate these points. There may also be a discussion on how a Cognitive Behaviour Therapy practitioner may have approached this particular client diversely. Psychodynamic remedy is the oldest of the present day therapies and is also also called insight-oriented remedy. Its primary target is to expose the unconscious content and processes of an client's psyche to be able to ease any psychic tension which may be manifesting itself outwardly by means of disadvantageous behaviour or ideations. Therapy's extra focus is ideal for the therapist to permit the client to increase their own personal- recognition and help them to get an understanding of how past events and encounters affect their present behaviour and ideations. Key principles in psychodynamic therapy include the perception that psychopathology grows from early youth experiences and that these experiences are planned around interpersonal connections. There is an emphasis about how unconscious conflicts relate with the development of the client and these unconscious conflicts are explored by the use of Free Relationship. Another major principle within psychodynamic therapy is the use and development of BODY'S DEFENCE MECHANISM by the client. Therapy will try to uncover the way the consumer uses these to be able to protect themselves from the psychic stress of unconscious issues. There is also the fact that these unconscious issues will re-emerge as transference and counter-top- transference within the therapeutic romance and therapy's goal is to sort out the interpretations of the conflicts. The recovery and change process during long-term psychodynamic remedy typically requires at least 2 years of periods. This seemingly long length of time of treatment permits the change of certain undesirable areas of the client's individuality or personality, or to regain key developmental learning skipped while the customer was having difficulties at an earlier stage of mental development, which would not easily be achieved during brief remedy. Lenneberg (1964) put forward a theory that the key period of terminology acquisition ends around age 3-5 years which if no terminology is learned before that level of development, then it might never be learned in a fully useful sense. This became known as the 'Critical Period Hypothesis'. Psychodynamic remedy also recognises critical periods of development in your client, however, the focus is on psychological development and, with work, these durations can be re-visited and any skipped learning can be regained through the therapeutic relationship. In its simple form, therapists from the psychodynamic strategy think that some changes can occur through a more quick process or that an initial short treatment will begin a continuing procedure for change that will not need the therapist's regular participation. They further think that this enables your client to look at unresolved issues and symptoms which have arisen from earlier dysfunctional relationships which are currently manifesting themselves in the necessity and need to abuse chemicals. A central principle in brief therapy is that there should be one major target for the remedy rather than the more traditional psychoanalytic practice of allowing the client to associate widely and discuss unconnected issues. In simple remedy, the central concentration is developed during the initial evaluation process, occurring through the first a couple of sessions. This emphasis must be mutually agreed upon by both client and the therapist. This central emphasis prioritises the most crucial issues thereby setting up a structure and in so doing, identifies an objective for the treatment. The therapist's clear plan in keeping the program focused on the primary issue makes it possible to do all the interpretive work within a comparatively short time period, as the therapist is only responding to the prioritised concern. Several different methods to short psychodynamic psychotherapy have improved from psychoanalytic theory and also have been clinically put on a wide range of psychological disorders. In this essay, however, the concentrate will be on Object Relations theory and how it applies to the treatment of depression and nervousness. The term 'Object Relations Theory' was formalised by Ronald Fairbairn, (Fairbairn, 1952) and was actively pioneered throughout the 1940s and 50s by Uk psychologists Ronald Fairbairn, Melanie Klein, Donald Winnicott, Harry Guntrip, Scott Stuart, amongst others. Object relationships theory is a derivative of psychoanalytic theory that places the emphasis on the client's social relationships, generally within the family and more especially between your client and his / her mother through the client's childhood. It is a modern changes of psychoanalytic theory that places more emphasis on human relationships being the primary motivational power in life rather than on Freud's sex drive and aggression as motivational forces (Freud, 1961). 'Relationships' identifies interpersonal human relationships and suggests that past relationships affect the client in the present. It is this fundamental human need to initiate and maintain romantic relationships that forms the basis for libidinal and aggressive drives gaining meaning. Object relationships theorists are interested in the client's inner images of his / her personal and their interpretations of the internal images of others and how these interpretations manifest themselves within interpersonal situations. Probably the most crucial of the key concepts of subject relations theory is the 'thing' itself. Freud used 'object' to indicate anything that an infant will direct his / her drives toward to be able to gratify their hunger. Modern object relations theorists, however, assume that 'object' refers to the person that is the object of the client's thoughts or motives and who is also the mark of absent relational needs within the client's development. Things can be inside (a ram or fantasy in regards to a person, place, or thing) or they could be external (an actual person, place or thing a person has spent with sentiment). An thing can be a part subject such as a hand or breast, or a complete object such as a person who is identified by your client as having rights, thoughts, and needs similar to their own. Object constancy is the term found in object relations theory when the client shows capabilities in keeping a romance of some duration with a specific thing, or when they reject substitutes for this particular subject. Mahler (1975) identifies object constancy as "the capability to identify and tolerate adoring and hostile emotions toward the same subject; the capability to keep thoughts centred on a particular object; and the capacity to value an subject for attributes other than its function of gratifying needs. " Another key idea within object relations theory is that of Splitting. This occurs when a client cannot keep two contradictory thoughts or feelings in the mindful mind all together as it causes such a psychic anxiety, and so they keep carefully the conflicting feelings aside and focus on one among them. The department may take on any form, from visible appearance to principles such as good and bad. The good part can then be maintained and loved, as the bad part is ridiculed or repressed. "Splitting is a boundary-creating setting of thought and for that reason a part of an order making process. " (Ogden, 1986). Two main analysts in object relationships theory are Donald Winnicott and Margaret Mahler. After briefly considering each subsequently, this essay will illustrate the key things of object relationships theory through a published review on the case of Ms A. (Traub & Lane, 2002) who was simply treated for major depression, anxiety, and dependent character characteristics. Winnicott, a pediatrician, viewed many mothers and babies interact. According to Winnicott, it was how this connection played out as time passes, that was crucial to infant development and development and there have been three levels of care (Winnicott, 1953). The foremost is 'Positioning', which involves actual physical positioning of the child, and caring for the child over time as this has both a mental health benefit and a physical benefit; the second reason is that both Mother and child live together; and the ultimate an example may be that Father, Mom and child, all live together. Although, nowadays, the idea of the original 'nuclear' family is somewhat old fashioned given that, based on the Country wide Office of Information Census 2001 - Families of Great britain and Wales, one parent families made-up 9. 6% of homes in England and Wales, that is nearly one in ten households, and 9 out of ten of the households are headed by the mother. That notwithstanding, relating to Winnicott, with 'good enough' care and attention the true personal can emerge, this is actually the area of the child that seems real and spontaneous. Phony self applied emerges in the lack of 'good enough' care and attention. Winnicott also believed that Transitional things are the child's first 'not-me' belongings, for example, a security blanket or doll. This transitional subject allows the child to let go of the mother and develop more self-reliance, become less clingy. The kid can take the object anywhere and receive a quick dosage of comfort whenever it seems anxious thus lessening the strain of parting. Transitional phenomena are behaviours, such as rocking or developing fantasies, which also serve to reduce the parting stress. Mahler arranged with Winnicott over the importance of holding a kid. For Mahler, it was a way of reducing pressure in the kid and engaged the mother creating a space within that your child can be itself and feel protected and secure. Wrong holding often means refusal to carry the child literally or psychologically when it requires to be presented, or by retaining it so firmly that the kid feels smothered, so the child does not have an opportunity to develop as a person. Mahler believed in the growing child's 'mental beginning', (Mahler et al, 1975). An excellent mom will encourage this mental awareness in lots of ways, like a mobile in the child's cot. Soon, the kid begins to get a sense of self, and they learn to have a memory. For Mahler parting from the object is an internal mental process wherein one distinguishing oneself from the thing. Mahler explained four phases of this development process. . . The first stage is that of Differentiation also known as the 'hatching' period. The child starts to distance themself from the mom, but will check back again to her. There is a distinct transfer from outwardly-directed to inwardly-directed attention. The next period is the Practicing period. As the child is now more physically dynamic it starts to explore and be more faraway from the mom. However, the child will still look back to see if mother is there, and never stray too far away. A psychologically healthy child may go to another friendly adult, but a kid with a neurotic or overprotective mother may be delayed through this period. There are elements here of Bowlby's connection theory (Bowlby, 1969) and Ainsworth's Unusual Situation analysis (Ainsworth & Bell, 1970) in the similarities of the average person differences in attachment varieties of children and how they can express in psychopathology in later life. The third stage is Rapprochement. Here the kid realizes that his physical flexibility shows a psychic separation from his mom. The child may then become hesitant in his explorations and require the expectant mother constantly within his vision in order that he may continue discovering, however, the mother can misinterpret this need and be either impatient or unavailable to the kid. This can result in thoughts of abandonment and a concern with rejection in the child. Resolution of the psychic tension happens with the development of vocabulary and the superego, which can lead to the development of a larger autonomy for the kid. The final stage is Object Constancy. In this phase the child understands that the mother is a separate individual. This contributes to Internalization, which is when the kid forms an internal representation of the mother. This interior image of the mom within the kid provides child an unconscious level of support and comfort minus the mother actually having to be literally present. A poor internalization could result in psychopathology in adulthood. In relation to the situation of Ms A. and her treatment, the main element factors of psychodynamic remedy in general can be seen, for example, the fact that psychopathology grows from early years as a child experiences and these experiences are planned around interpersonal associations is illustrated in Ms A's depression and stress and anxiety stemming from her childhood experience of being burned internal fire and sense abandoned and turned down by her mom. In relation to object relations theory, the idea of keeping, considered so important to both Winnicott and Mahler is also in facts as Ms A referred to her mother as "unstable, unloving and unsupportive" and if Ms A was in any way disobedient, then her mom would "discipline yourself" or "inflict pain or ignore her completely". This would be considered by both Winnicott and Mahler as 'wrong keeping' and has resulted in Ms A failing to develop as a psychologically healthy specific. The aspect of 'good enough good care' espoused by Winnicott where Dad, Mother and child all live at home is not present in this particular circumstance as although Mom and child resided alongside one another in the house, Father was rarely present and this seemed to be yet another way to obtain psychic pressure for Ms A in creating possible abandonment issues and further stress within the house which might have aggravated the situation with her mom. Winnicott's 'phony self applied' emerges in Ms A's explanation of herself as needing to "wear a mask" during any interpersonal conversation with others. This developed as time passes beginning with her mother's inability to nurture and be a 'good enough' mother, hence Ms A's constant search for this distance in her mental development to be bridged for her by other folks, namely her husband, and later her fianc. Mahlers subject constancy is a poor internalisation of the mother. Ms A developed the defence mechanism of splitting her mother into two parts in order to protect herself from the psychic tension due to the 'not good enough mom'. Ms A determined with the 'good subject' that was the internalisation of the image of any good mom and repressed her anger and ambivalence towards the 'bad object' that was her mother the person. Psychodynamic remedy is not, of course, the only path to treat stress or depression, another popular treatment is that of Cognitive Behaviour Therapy (CBT) and, although there are some similarities with psychodynamic remedy, for example, they are both 'chatting treatments', however, there are some major differences. Within the cognitive model, psychopathology is regarded as simply irrational thoughts, or problems in thinking. It assumes that people's thoughts steer their feelings and behaviours. Ellis and Beck are 2 main brands within the cognitive model. Beck's (1967) theory of depression states that negative thinking leads to negative mod which contributes to depression. With negative thinking there's a 'cognitive triad' -

1) The Self - "I am worthless". 2) THE ENTIRE WORLD - "Everything is against me" 3) The Future - "Nothing is ever going to improve"

Ellis (1962) proposed Rational Emotive Remedy (REBT) which espouses that thinking and emotion are inter-related. Thinking influences emotions and thoughts affect thinking. Whenever we think rationally, we react rationally. Matching to Ellis, people who think irrationally use words such as 'should'; 'ought'; 'must', a whole lot. The idea of this kind of therapy is that your client must establish their regarded as correct, and then replace the irrational thought with a far more rational one. Just how might a CBT therapist have treated Ms A? CBT differs from psychodynamic remedy for the reason that it addresses current thoughts and feelings somewhat than analysing the causes of depression. During a procedure, a CBT therapist would help Ms A. to chop her problems into smaller different parts. Ms A seems to have intellectualised her depression and therefore would be less inclined to be paralysed by her problems, and for that reason more in a position to confront them and deal with them effectively. Often during depression or other mental health issues, a person can feel confused with stress and anxiety, and all of these worries and anxieties may combine into one circumstance. The theory in CBT is the fact by breaking problems right down to more standard, clear issues, you can dwelling address each problem one-by-one and can also identify any common threads. A CBT therapist might to begin with require Ms A to self evaluate. In depression, self-evaluation is generally negative and critical. When something goes wrong, the client may think, "I messed up. I'm no good at anything. It's my fault things went wrong. " The therapist will then work through these ideations one at a time and encourage Ms A. to see more positive aspects in her day to day life. Sometimes a stressed out person may accurately identify a skill deficit within themselves. This is usually coupled with negative self-evaluation. Ms A detailed herself as a 'yesser', she thought that she possessed an inability to state no to people, and therefore, noticed that it was her mistake that she didn't get the life she wanted. A CBT therapist would help Ms A to realistically identify her skill deficits, and also help her to develop a detail by detail intend to improve those skills. As mentioned prior, Ellis (1962) first provided the idea that irrational values are at the heart of most psychopathology. CBT therapists would suggest these ideas are irrational because they're based on false assumptions, such as Ms A feeling that she cannot be happy unless everybody else is happy. She sacrificed her own needs for her man to her detriment. Why is these ideas irrational, is the fact that they can be always correct. The result, as for Ms A, is a loss of self-esteem, and depression. CBT therapist would help Ms A to identify these irrational ideas, and permit her to see that the ideas have to be changed to reflect reality. CBT is now more and more popular and it's been increasingly applied in different settings, however, there is a problem with cause and impact, quite simply, performed the irrational thoughts cause the depression or does the depression cause the irrational thoughts? It also ignores the likelihood that some so called irrational thoughts may be logical and the model has yet to answer fully the question of where irrational thoughts come from in the first place. To conclude, all psychological ideas provide conceptual frameworks to permit counsellors to believe systematically about human being development and the practice of counselling. These frameworks allow counsellors to decide how to view, respond to and treat clients' maladaptive behavior. Theories are had a need to make predictive hypotheses. Whenever a counsellor decides how to treat a specific client they can be actually developing a hypothesis. The same is also true for your client when they make predictions how best to live their lives. The exactness of these predictions is greatly enhanced if the data of proven counselling theories is open to them. However, Kline (1988) suggests a theory is not invalidated because it can't be tested scientifically. A couple of, however, cons to counselling ideas

- Roger's identification of clients is merely they are not self actualising and all they need is assist in this regard. - Ellis's view that it's merely the clients irrational values that are the condition neglects other aspects such as exact perception and the use of coping self-talk. - Behavioural psychology pays little focus on thoughts or feelings. - Freud's aspiration analysis to discover the unconscious brain does not look at the should try to learn effective behaviours to cope with day to day issues. - Counsellors becoming so entrenched in their preferred theory that they allow it cloud their evaluation and treatment of clients, resulting in 'rigor psychologicus'. - They could be seen as unscientific, for example Freud's Id, ego and Superego (Freud, 1962) are merely concepts, they cannot be observed or assessed.

Object relations theory itself will come in for particular criticism in that it generally does not look at the interpersonal norms and principles that can help to build pathology, and its superficiality is highlighted in its social method of the dyadic marriage between mother and child, which it seems to imply is partly responsible for any introduction of future psychopathology in the child.

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