Psychotherapy Approaches – Detailed Study Notes

Psychoanalysis (Freud’s “Original Baby”)

• Core Assumptions
  • Human behaviour is largely driven by unconscious conflicts.
  • Anxiety–provoking material is actively re-pressed (kept from consciousness).
  • Therapy goal: bring unconscious material to conscious awareness → insight → symptom relief.
• Key Techniques
  • Free association – client says whatever comes to mind; analyst listens for themes.
  • Dream analysis – dreams = “royal road” to unconscious; manifest vs. latent content.
  • Analysis of resistance – noticing what the client avoids ("mental blocks"); e.g. Bernice never discusses her mother when fear-of-flying comes up.
  • Interpretation – analyst offers possible meanings to coax hidden themes into the light.
• Practical / Ethical Issues
  • Evidence base: interpretations are difficult to falsify → low scientific testability.
  • Logistics: $4\text{–}5$ sessions ⁄ week for years; modern insurance rarely pays.

Psychodynamic Approaches (The “Descendants”)

• Descended from Freud but broadened (Carl Jung, Alfred Adler, Karen Horney, etc.).
• Similarities to psychoanalysis
  • Insight-oriented; emphasize early childhood, unconscious forces, relational patterns.
• Differences
  • Less emphasis on id/ego/superego, sexual drives.
  • Fewer weekly sessions; briefer duration; more conversational.
• Example – Bernice
  • Therapist highlights avoided mother topic → possible root of flying phobia (mother ran off with a pilot).

Existential–Humanistic Therapies

• Main Figures: Carl Rogers, Viktor Frankl, Fritz Perls.
• Philosophical Foundation
  • People possess inherent capacity for rational choice, self-acceptance, self-actualization.
  • Confronting existential givens (death, freedom, isolation, meaning) is key to growth.
• Carl Rogers’ Client-Centred Therapy
  • Language shift: “clients” not “patients.”
  • Core conditions the therapist must supply:
  • Genuineness (congruence)
  • Unconditional positive regard (acceptance)
  • Empathy (via active listening, reflecting, clarifying)
  • Safe, non-judgmental climate → client explores & integrates experience → self-actualization.
• Existential Emphasis (Frankl, Perls)
  • Anxiety = result of denying death & other existential facts.
  • Goal: find meaning & live authentically despite inevitable mortality.
• Bernice Illustration
  • Present-focused dialogue: “What emotions are you feeling right now as you speak of depression?”
  • Therapist initially resists interpreting; offers accepting presence → Bernice feels heard → empowered to face repressed feelings.

Behaviour Therapies

• Conceptual Basis
  • Maladaptive behaviour itself is the problem; insight alone is insufficient.
  • Change behaviour → change emotion/mood.
• Learning Theories Utilised
  • Classical conditioning (Ivan Pavlov’s drooling dogs).
  • Operant conditioning (E. L. Thorndike’s law of effect; B. F. Skinner’s reinforcement).
• Techniques
  • Counter-conditioning – pair feared stimulus with new response.
  • Exposure therapies – confront feared situations (real or imagined).
  • Systematic desensitization: relaxed state $\rightarrow$ hierarchy of anxiety-provoking stimuli.
  • Example ladder for Bernice: thinking of planes $\rightarrow$ looking at photos $\rightarrow$ sitting in grounded plane $\rightarrow$ actual flight.
  • Aversive conditioning – pair unwanted behaviour with unpleasant stimulus (e.g., emetic + alcohol).
  • Positive/negative reinforcement schedules to increase desirable acts.
• Empirical Status
  • Effective for specific phobias, $\text{GAD}$, major depression, etc.
  • Often combined with cognitive methods for maximal effect.

Cognitive Therapy

• Founder: Aaron Beck (USA).
• Core Proposition
  • Emotional disturbances stem from distorted, irrational, or catastrophic thinking.
  • Alter thoughts $\Rightarrow$ alter feelings & behaviours.
• Method
  • Socratic questioning – therapist probes client’s beliefs → exposes logical errors.
  • Homework: thought records, evidence lists, cognitive restructuring.
• Bernice Example
  • Catastrophic chain: “If I fail the exam $\Rightarrow$ grad school ruined $\Rightarrow$ life over.”
  • Therapist challenges probability & impact assumptions; encourages balanced self-talk → reduced anxiety, increased motivation.
• Key Equation (thought–emotion link)
  $\text{Situation} + \text{Interpretation} \rightarrow \text{Emotion/Behaviour}$

Cognitive-Behavioural Therapy (CBT)

• Integration of behavioural skill-building with cognitive restructuring.
• Currently most empirically supported modality for many disorders (depression, anxiety, OCD, PTSD).
• Typical Sequence
  1. Psychoeducation about cognitive model.
  2. Identify automatic thoughts.
  3. Test & reframe thoughts.
  4. Behavioural experiments/exposure.

Group & Other Formats

• Most schools can be delivered in group settings.
• Benefits
  • Cost-effective; insurance-friendly.
  • Peer modelling & feedback.
  • Yalom’s curative factors (universality, altruism, etc.).

Comparative Snapshot

• Psychoanalysis – deep past, unconscious, lengthy, interpretive.
• Psychodynamic – similar focus but shorter & broader.
• Humanistic/Existential – here-and-now, growth, authenticity, unconditional acceptance.
• Behavioural – observable actions, learning principles, conditioning.
• Cognitive – internal dialogue, thought patterns, logical disputation.
• CBT – combined thought & behaviour modifications, strong research support.

Practical / Ethical Considerations Across Modalities

• Evidence base vs. theoretical elegance (scientific validation strongest for CBT & exposure).
• Insurance & accessibility: shorter, structured therapies favoured.
• Therapist competence: integrating methods requires proper training & supervision.
• Cultural relevance: therapists must adapt techniques to client values & contexts.