Psychodynamic, humanistic and cognitive behavioural

Outline the major differences between psychodynamic, humanistic and cognitive behavioural approaches, ensuring that historical perspectives are included.

Over 400 approaches to counselling and psychotherapy have been presented/promulgated in the last 40 years. In this essay I will be outlining just 3 most historically prominent approaches, considering their historical creation, and finally major differences in their theory and delivery. The BAC (British Association of Counselling) defines counselling as:

“When a counsellor sees a client in a private and confidential setting to explore a difficulty the client is having, distress they may be experiencing or perhaps their dissatisfaction with life, or loss of a sense of direction and purpose.” (BAC, 2009)

Much can be determined from the Greek words ‘psychi’ (meaning soul/mind) and ‘dynami’ (force) that make up Sigismund Freud’s (1856-1939) psychodynamic approach. The idea of forces and the mind’s unconscious are evident throughout his work. Although many of the ideas that Freud worked with were around at the time, he was the first to put these into a model that can be used. His original model arose from work with a patient, Anna O, who was suffering with ‘paralyses’ and ‘mental confusion’. Freud and Viennese physician Josef Breuer worked together developing an approach using hypnosis which they called ‘cathartic’ (purging of the emotions). This approach suggested that psychic trauma that was painful was ‘suppressed’ into the unconscious, where their energy caused the symptoms they saw. This was revolutionary, although the unconscious had already been coined; it was seen as

‘a passive dustbin where everything that we no longer had any need to remember could be thrown.’ (Dryden, 1999, p.29)

However, Freud’s peers were not convinced; sometimes hypnotism could not be induced. Searching for an alternative he developed ‘free association’ where the client is encouraged to say whatever comes into their thoughts. Freud believed we censor our dialog; if speech is uncensored the ‘repressed’ will surface to the conscious and can be explored. Freud also pioneered a model of the mind. The mind has 3 elements; Id- pleasure (principle) seeker, basic biological drives, completely unconscious. Superego- morals, demands from the outside (e.g. Society’s rules), partially conscious. The Ego- rational thinking, sense of self, memory functions, mainly conscious, is seen as a regulator of the primitive Id and superego.

‘The poor ego…serves three masters and does what it can to bring their claims and demands into harmony’ (Freud 1933, p.77)

Freud also believed to be able to lead comfortable lives this ‘ego’ employed ‘defence mechanisms’. His theory was that they sometimes caused and maintained psychological problems. Examples defence mechanisms are repression, denial, reaction- formation, projection. Freud also described 5 stages of psychosexual development; oral, anal, phallic, latency and genital. In the therapeutic relationship he also talked of transference which can be explained as:

‘A client attaches feelings towards the therapist that were previously unconsciously directed towards a significant person in their life, who may have been involved in some form of emotional conflict.’ (ITS Dictionary, 2009)

The name Person-centred illustrates the need for the client to be the focal point of therapy.

Rogers (1902- 1987) who pioneered this approach believed that if the correct conditions were created, the client themselves would be able to find their own way forward, removed from any constraints and therefore overcome any psychological problems. The main emphasis of this approach is therefore not expertise or techniques of a therapist but the relationship between the client and the counsellor. Whist working in child study Rogers became increasingly unhappy with how scientific practice was, and with ‘tools’ such as interpretation. He experimented with more subtle interpretations, and whist working with a mother of a ‘problem child’ she began to tell him about her sense of failure of her own marriage. This had not arisen in the formal notes from the analysis. Rogers did not attempt to interpret but let her take the direction of the conversation, this proved successful. He later put forward a paper to the University of Minnesota ‘Some newer concepts in psychology’, which placed more emphasis on the emotions and the therapeutic relationship. He was the first to use the word client instead of patient; it showed more equality and didn’t imply that the client had an illness that needed expert help. Although Rogers did not believe in strict theories he did realize some structure would be necessary. He developed three core conditions which he must be present for therapeutic change to occur; Congruence described as being genuine or transparency, this gives the client the understanding that it is alright to be in connection with their inner selves is good. Unconditional positive regard described as offering a non-judgemental blanket of acceptance and respect, free from any conditions of worth. Empathy:

‘To perceive the internal frame of reference of another with accuracy and with the emotional components and meanings which pertain thereto as if one were the person, but without ever losing the “as if” condition.’ (Rogers, 1980, p. 140)

He believed a sense of ‘Self’ is present from birth and develops independently of interaction with others. However, the self-concept is developed from interaction with others,

‘Composite of beliefs and feelings that is held about oneself at a given time, formed from the internal perception and perceptions of others’ reactions.’ (Anon, 2009)

Probably the most famous of his developments was the ‘actualizing tendency’, all living things drive towards fulfilment of ‘all that it possible for us to become’. A common phrase he used was ‘maintains and enhances’; maintaining holds the idea ‘to keep in existence, to preserve’ whilst enhancement is considered as ‘growth and development’. He believed that we could never reach actualization, or fulfilment.

He believed it was blocking of the actualizing tendency by the overwhelming need for positive regard, which cause conflicts between the self and self-concept, if persistent, could cause psychological problems.

There is no distinct Cognitive Behavioural Therapy, but several different techniques. I believe the most influential of which is Rational Emotive Behavioural developed by Albert Ellis (1913- 2007). REBT deals with present thoughts and reactions to present events. It believes the person has almost complete responsibility of their feelings; it is not an event itself but perception of an event that can be distressing. It is the role of the therapist to identify and initiate change any ‘irrational thoughts’ usually through ‘homework’. He also believed we had two biological innate characteristics, the predisposition to think ‘irrationally’ and that we can ‘exercise choice’ to change our thoughts.

Before coining his theory Ellis trained as a psychoanalyst. Whilst in practice he found patients gained successful insight to their difficulties they still continued to have emotional problems. He began seeing clients, giving interpretations much earlier on in therapy and began ‘giving clients a new way to think’ he found it was very easy for clients to hold onto ‘irrational thought’ especially it had been reinforced from birth.

Ellis created ABC model to explain relationship between thinking, emotion and behaviour.

“ ‘A’- Activating events, Clients disturb themselves about key aspects of a situation.

‘B’-Beliefs, our emotions are primarily determined by beliefs we hold about the activating events

‘C’- Consequence of the beliefs at ‘B’, When the client hold a belief about ‘A’ they will experience emotion, she will tend to act in a certain ways and they will think in certain ways.

‘D’- Disputing In REBT we challenge or dispute our clients irrational beliefs

‘E’-Effects of disputing. When effects of disputing are successful, the client experiences more constructive emotive, behavioural and cognitive effect about ‘A’ “ (Dryden, 2003, p.112)

With this model behaviour seems deceptively simple and independent; ‘A’ event, ‘B’ we have a belief, ‘C’ we feel or act a certain way. However we tend to do something, and then have thoughts and feelings about it, almost A-B-C- BA, this may then affect our ‘C’ differently. Ellis believed that there were two types of emotional disturbance, maintenance of ‘irrational thought’; ‘ego disturbance’-

‘Realties to the demands individuals make about themselves, others and life conditions. When they fail to live up to the demands they make about themselves, they rate themselves negatively’ (Dryden, 1999. p.112)

and ‘discomfort disturbance’- the idea that an individual may forgo a long term goal to refrain from short term discomfort when they possess absolute personal comfort. This is also linked Low frustration tolerance where they believe they cannot tolerate any frustration, and would rather remain as they were than go through pain to change. Beck furthered Ellis’s work, introducing ideas such as the ‘negative triad’, and developing ‘Cognitive Therapy’ which is still used today for depression and illnesses such as chronic fatigue syndrome.

The first comparison is the therapeutic relationship as they each have emphasis on different parts. The three core conditions literally underpin the person-centered; the egalitarian relationship is the main ‘tool’ the therapist uses. Although CBT still believes in using the core conditions, the therapist is more authoritative, teaching relationship. The psychoanalyst being, almost the ‘detective’, making the (using Rogers) ‘client’ feel safe enough to discover their unconscious feelings towards the world; using three completely different concepts to the other two; abstinence, anonymity and neutrality to encourage free association. Another notable difference it the structure of session; in the person-centered the sessions are client-driven, the therapist may prompt, but will not be as direct as other approaches. Psychoanalytic is very structured, the therapist directs the session, as is CBT, very structured. There is also a stress on life forces in the psychodynamic approach, described as the libido/Eros (Love) a ‘driving force’ along with and Thanatos (Death). The person-centred also describes the actualizing tendency, however CBT does not talk about any major force. The psychodynamic also lays out defined stages of development and emphasises the importance of the past, usually in the terms of the unconscious. This differs as the Person-centred finds it impossible to fit people into ‘boxes’ as everyone is different. Although it acknowledges the importance of the unconscious, the tense is very much on the present problems, the ‘here and now’. In CBT is similar to this as it concentrates on the present, it does though lay out a few stages of development, such as; by the age of two the child is able to formulate thoughts and theories. Another difference is how deterministic the psychodynamic approach is; everything has a cause, and is determined by prior occurrences (except if it’s a cigar of course, which he allegedly never actually said).The behavioural part of CBT is seen as deterministic, the cognitive part as mechanistic, which can be deduced to being deterministic in some ways, however Ellis did say that we have an innate choice to change cognitions. Whereas humanistic exercises that we have ‘free-will’. Rogers was always in the search for a ‘final confirmation’ of REBT as a ‘scientific discipline’, i can therefore determine it is not fully scientific. However whether psychoanalysis is scientific has been a debate for some time; however, can human behaviour ever be fully scientific? Thought echoed by the humanistic approach. The last difference I will highlight is in assessment. The psychoanalyst uses a very thorough assessment by the therapist to determine psychological disturbances, in REBT initial assessment is sometimes taken by the client filling out 2 forms. However, in the person-centred approach, no formal assessment is made. This may sometimes seen as a limitation and contribute to its infrequent use in the USA. Due most insurance companies require an assessment to be made before any payment is made.

Therefore, I must conclude that there are some major differences between the 3 approaches I have outlined however many writers agree that this is what makes them suitable to the wide range of clients’ and inevitably the ever increasing spectrum of clients’ psychological afflictions.

References

BAC, 2009. The BACP definition of counselling [online] Lutterworth,Leicestershire: BAC [Accessed 20 November 2009].

Dryden, W., 1999. Four approaches to counselling and psychotherapy. Florence, KY, USA : (s,n).

Freud, S. 1933. New introductory lectures on Psychoanalysis. Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 22, Edited and translated J. Strachey (1964), London: Hogarth Press and institute of Psychoanalysis.

ITS, 2009., Definition of Transference [online] ITS tutorial school (s.l.) : (s.n.). [Accessed 21 November 2009].

Rogers, A., 1980. A way of being. New York, New York: Houghton Mifflin Company.

ANON., 2009. Key Definitions [online] (s.l.) : (s.n.) [Accessed 21 November 2009].

Dryden, W., 2003. Albert Ellis Live! (s.l.) : Sage Publications Ltd.

Bibliography

Jacobs, M, 2004. Psychodynamic counselling in Action. 3rd ed. London: Sage Publications Ltd.

Masson, J., 1989. Against Therapy. Fulham, London: HarperColinsPublishers.

Trower, P., Casey, A., and Dryden. W., 1988. Cognitive- Behavioural Counselling in Action. London : Sage Publications Ltd.

McLoed, J., 2009. An Introduction to Counselling. 4th ed. New York, New York. Open University Press.