DESCRIBE AND CRITICALLY EVALUATE THE TREATMENT FOR A SPECIFIC PSYCHOLOGICAL DISORDER (E.G. SOCIAL ANXIETY OR DEPRESSION) FROM ONE THEORETICAL PERSPECTIVE (E.G. CBT OR PSYCHODYNAMIC).
This essay will address the treatment of social anxiety and phobias using the psychodynamic approach. It will consider the basic principles of the theory and the different methods used by therapists. It will also detail the symptoms of the disorder and then evaluate the success achieved by the treatment.
Sigmund Freud is credited with the founding of the psychoanalytical approach to personality development. Psychodynamic refers to the active forces with each person’s personality that motivates that individual’s behaviour. The inner causes of behaviour, held within the subconscious are also part of the personality structure. The psychoanalytical theory of Freud formed the basis of subsequent psychodynamic theories.
Freud’s theory considered the personality to comprise of the conscious self and the unconscious self. He also proposed that there are three parts to the personality – the id, the ego and the superego. The id is developed by the body’s need to alleviate any tension or stress by giving into the raw basic urges for gratification. It is solely governed by the primitive pleasure principle. It is totally unsocialised and the major instincts are aggression and sexuality.
“…contains everything that is inherited, that is present at birth, that is laid down in the constitution – above all, therefore, the instincts… “ (Freud, 1923)
The ego seeks to gratify the id. It is essential that it is logical and rational in achieving a means to an end. It is governed by the reality principle. Whereas the id is concerned with the here and now the ego is concerned with finding the right time and place (deferred gratification).
“.. that part of the id which has been modified by the direct influence of the external world…” (Freud, 1923)
The superego develops when we gain morals and principles from our social setting. We internalise parental and social morals.
“ -… it observes the ego, gives it orders, judges it and threatens I with punishment, exactly like the parents whose place it has taken.” (Freud, 1923)
It is the superego which forms our conscience and will lead the individual to behave in an socially appropriate manner. There can be neurotic conflict between the id and the ego and also moral conflict between the superego and the ego. This can manifest itself in dreams, neurotic symptoms and defence mechanisms. This is a central focus of the psychoanalytic therapy.
Freud set out five psychosexual stages through which a child will progress during his young life – oral, anal, phallic, latent, genital. The progression of these stages is central to the development of a ‘healthy’ personality. The oral stage (0 – 1 year) is when everything is centred on the mouth. The child will enjoy oral sensitivity. A child will initially enjoy sucking and swallowing then move on to biting and chewing. These times are closely linked to the biological development of the baby e.g. In the early months the child gets pleasure from sucking while feeding. Later he will progress to more aggressive oral movements as he develops hard gums and subsequently teeth. A child who enjoys the sucking stage most will have a placid personality whereas one who liked the biting best will be more aggressive. The anal stage (1 – 3 years) is focused on the bowel movements and the child can use this as a means of control: the child will show compliance by using the toilet and will show his disobedience by withholding the use of the toilet. Freud proposed that when a child has gained most enjoyment from compliance (anal expulsive) he will be caring and giving whereas when the child has gained most enjoyment from disobedience (anal retentive) he will be very precise and have great attention to detail. The phallic stage (3 – 5/6 years) is when the focus is on the genital areas. It is during this time that a child will experience a conflict of emotions to the same sex parent. Boys experience the Oedipus Complex and girls experience the Electra Complex. The boy feels great love towards his mother and gets annoyed as he sees his father as an opponent for the mothers affection. He subsequently realises that he is not as powerful as his father and also fears that his father will castrate him, so he realises that he cannot beat his father for his mother’s affections, and consequently he identifies with his father. It is through this identification with the aggressor that the boy develops his superego. The successful resolution of this complex will directly affect the personality of the individual. The latency stage (5/6 – puberty) is a time where the child focuses on achieving knowledge and skills. The genital stage (puberty – maturity) marks the start of adolescence and more mature sexual desires.
Freud believed that when the ego deals with reality and the conflict between the id and the superego, the individual will develop defence mechanisms. This is a means whereby anxiety is reduced by blocking or distorting the impulse. Psychotherapy can bring to the conscience many of these ego defence mechanisms. Repression is whereby there is a motivated forgetting of an experience which causes distress in the conscious mind. Displacement is when an emotion is redirected to a suitable target. Projection is when a person sees his own unacceptable desires in another person. Other defence mechanisms are turning against oneself, regression, reaction formation, humour and rationalisation. There is also the mechanism of sublimation which can be seen in a positive way – e.g. someone who is very hostile may direct their attention into a hobby.
The psychoanalytic approach says that most behaviour cannot be taken at face value. Freud arguably never saw behaviour as pure black and white but rather as a cover up for what is going on in the unconscious mind. It is necessary, therefore, for clinical methods to make the unconscious conscience. This is done in a variety of ways.
Hypnosis was the original method used by Freud. Initially, this seemed to work with the analysand (the person undergoing psychoanalysis) to have insight into the unconscious and become aware of his repressed thoughts. Freud stopped using this method, however, when he realised that the client could not remember details when he came out of hypnosis. Moreover, some who did remember found the whole experience very upsetting and distressing.
Dream analysis was described by Freud as ‘the royal road to… the unconscious’. Dreams consist of symbols and imagery. The manifest content of a dream is the reported content. This has hidden symbolism and imagery. Each object and action within the dream represents something within the subconscious mind. The true meaning of the dream is the latent content. The latent content represents an individual’s repressed sexual desires. Objects represent the male and female sexual body parts and interaction between them signifies sexual contact and intercourse.
Freud thought that by getting a client to talk about his dreams, he (Freud) could then gain insight into the individual’s true feeling and anxieties. The individual will make use of things that have happened during the day to evoke repressed feelings from an earlier age.
Free association : This method involves the analyse and lying on a couch with the therapist sitting behind so as not to distract or influence any responses. The analysand is asked certain questions to evoke a response. It is important to say whatever comes to mind. It can be quite difficult for a person to open up in this way and in early sessions may seem quite embarrassed by the replies. As time goes on he will find it easier and be more comfortable. It is important for the analysand to open up but the analyst must keep his/her distance and be non-judgemental: this is not a close personal relationship. The analyst will then interpret the associations being made by the client.
Social anxiety and phobias can be diagnosed as:
“A persistent fear of a specific situation out of proportion to the reality of the situation;
- A compelling desire to avoid and escape the situation;
- Recognition that the fear is unreasonably excessive;
- Symptoms not due to another disorder, e.g. schizophrenia “ (Hill, 1999).
It is the job of the therapist to consider these symptoms and decide on the most appropriate type of psychotherapy, (or combination of types), to resolve the conflict.
It is arguably not enough merely to establish a change in behaviour; a complete permanent cure will only be achieved by a change in, and resolution of, the problems leading to the behaviour.
The psychodynamic approach has had a hugely significant impact on the study of psychology. Most individuals will recognise defence mechanisms used by others. It is not unusual for someone to blame another for his own failings. For example, a person will state that someone else in the room at a party is too loud and a show-off in order to have an excuse to leave. The true source is the anxiety of the individual who will not own up to their true self and feelings. Free association gives the therapist the opportunity to gain some insight into the true inner feelings. It may be that the client was made to feel subservient by a parent and this conflict is being projected on to a total stranger.
Many psychologists now fully accept the importance of the role of the unconscious in behaviour. This comes through in various other types of therapy. Developmental psychologists now accept the role of early childhood on later life developments. Much of the terms derived from the work of Freud are now used freely in everyday situations e.g. ‘slip of the tongue’, ‘in denial’. This shows how Freud’s work has been assimilated into ordinary life and language.
The great emphasis which Freud placed on an individual’s personality development has been criticised more freely by other psychologists. When Freud was writing there was generally a much restricted and conservative attitude towards sexual feelings. This led many contemporaries to dismiss his theory in this respect. Boys and girls did not see each other without clothes on during childhood and there was considerable taboo associated with sexual encounters. Nowadays, there is a complete reversal of opinion due to the media and other sociological developments, and a much more liberated view of sex. Feminist psychologists completely dismiss the Oedipus Complex by stated that in our society where single parent families are commonplace it is impossible to explain role identification by means of resolution of this sexual conflict.
The work of Freud has been criticised on scientific grounds – the methods employed by Freud were totally unscientific and unquantifiable. In many instances, and in common with many other researchers of the time, he carried out case studies while never actually meeting the person face to face. His dream interpretation is completely open to speculation and subjectivity on behalf of the therapist. Having looked at these strengths and limitations, it should be noted that many individuals would say that they have benefited immensely from the psychoanalytic type of methodology. Despite criticism that it reduced behaviour to an over-simplistic explanation, it would seem to have a justifiable place in therapeutic situations.
We have considered the use of psychoanalysis in terms of general social anxiety and phobias but Freud used his theory to explain a vast number of topics:
“personality development – due to fixation/defence mechanisms;
- moral/gender development – the result of the Oedipus complex;
- aggression – caused by hydraulic drives and displacement;
- abnormality – the consequence of early trauma and repression;
- memory – forgetting caused by repression” (Hill, 1999).
There are many other types of therapy available to individuals based on alternative psychological theories e.g. Cognitive behavioural therapy which relies on the basis of learning theory, social learning theory and imitation and rewards, and Humanistic therapy which is based on the cognitive psychologists who emphasise the importance of the emotional interpretation of the behaviour. In some cases, therapists will use an eclectic approach whereby they will draw on the essential elements of a mixture of theories.
References:
Freud. S. – The Ego and the Id (1923/1984). Pelican Freud Library (11). Penguin. Harmondsworth
Gross, R. & McIlveen, R. – Therapeutic Approaches to Abnormal Behaviour (1999). Hodder and Stoughton. London
Gross, R. & Rolls, G. – Essential A2 Psychology (2004) Hodder and Stoughton. London
Hill, G. – Advances Psychology Through Diagrams (1999) Oxford University Press. Oxford