Psychodynamic And Behaviour Therapies

Introduction

Modern clinical observations indicate a shifting paradigm of psychotherapy from long-term to short-term approaches. According to Craighead & Craighead (2001), these approaches do play a role in providing the theoretical framework and rationale within which interventions towards various mental disorders are implemented. These approaches have proven to be useful in various clinical contexts such as in general practice (GP) when there is a need to identify patient’s problem in more methods than just conducting a clinical assessment, in NHS’s Improving Access to Psychological Therapies (IAPT) services as well as in voluntary services such as disaster management. There are various therapeutic approaches that can be applied to the management of psychological distress. Such approaches may include psychodynamic therapy, behavioural therapy, and existential therapies. However, it is important to note that behavioural therapy, especially Cognitive Behavioural Therapy (CBT) is the most commonly applied in the UK McKay et al (2015), and that the appropriateness of these approaches are dependent on various factors such as the particular cause that has led to the client’s problem, how the cause came into existence, the most appropriate method of treatment for a particular client and the nature of therapeutic relationship between the therapist and the client. Nonetheless, this essay will focus on only two generic therapeutic approaches i.e. psychodynamic and behaviour therapies, to evaluate a case study that involves a 29 year old man with psychological distress. Ideally, psychodynamic therapy assumes that the conflicts experienced by the client in their internal psych are the main cause of the psychological distress they are currently facing (Barker & Mills, 2018). On the other hand, behaviour therapy is applied based on the underlying principle that the client’s psychological distress is as a result of their cognitions and learning behaviour. Particularly, both psychodynamic and behaviour therapy have been selected for this particular essay due to their appropriateness and applicability to the case study under evaluation.

Psychodynamic Therapy
Problem Formulation

Formulating Luca’s problem based on the psychodynamic approach would need an assumption that these problems are caused by Luca’s intrapsychic conflict, which also means that his psychological distress is as a result of the conflicts he is currently facing in his psyche. In practical terms, some of the conflicts that could be contributing to his psychological distress include his anxiety regarding what career he really wants to pursue, his social anxiety and especially in regards to sex and relationship with women, lack of motivation and the fact that within a social context, he relates differently with others.

The psychodynamic therapy would also assume that the anxiety factors that have principally contributed to Luca’s psychological distress came into existence as a result of various unfulfilled desires in his childhood as well as the childhood fears that contribute to his intrapsychic conflicts (McDonnell, 2017). For instance, Lucas faced a lot of childhood fears that the psychodynamic approach would assume to be the root cause of his psychological distress: first, Lucas feared his Dad watching him play yet he was not the best player among his team, leading him to develop self-esteem issues. Secondly, he feared for the way his foster father, Pedro felt bad regarding the fact that they no longer lived together as a family, this could have been a contributory factor to his social anxiety issues. Thirdly, he feared to leave his mum home alone while he is away in college pursuing a degree in economics. Fourthly, he feared to develop any romantic relationship with women based on his belief that he could have a powerful impact on them. On the flipside, there are various unfulfilled childhood desires in Luca’s life that could be the root cause of his psychological distress. For instance, Lucas envied how his friend, Kit could easily interact with women and thrive with them to as opposed to him. Moreover, whereas Luca’s main desire was to do a foundation course in art, he was unable to fulfil this desire because his mother preferred an economics course. In fact, his dislike for a degree in economic made him drop out of college after two terms. Whereas the psychodynamic therapy enables the formulation of Luca’s problems based on these two accounts, it is important to note that this formulation is not exhaustive and is subject to reformulations as more insights are gained on Luca’s problems.

Psychodynamic Intervention Plan

The first interventional procedure for psychodynamic therapy is to elicit the client’s intrapsychic conflict, fundamentally because the approach views such conflicts as the main cause of the client’s psychological distress (Venesa, 2018). Against this backdrop, McDonnell (2017) identifies the method of ‘free association’ as one of the main methods used in eliciting the client’s intrapsychic conflicts. Particularly, this method would enable Lucas to associate one thought with another while speaking whatever comes into his mind – in a trusting and relaxing atmosphere (Rodin, 2017). For instance, in Luca’s case, this method would allow him to speak to the therapist freely about his conflicts and desires without the therapist’s interruption. Ultimately, according to Cristian et al (2019), the therapist shall have enabled Lucas to give a verbal narrative in a free and uncensored manner, thereby giving the therapist a window of access to Luca’s unconscious mind. Moreover, according to Demazure et al (2017), this method would allow the client to give a indirect narrative of their conflicts and desires, a phenomenon that is advantageous to the therapeutic process because if these desires and conflicts are expressed directly, the client’s ever-vigilant ego would cause suppression into them thereby leading into anxiety.

The psychodynamic approach holds two distinct treatment modalities that are applicable to Luca’s case i.e. interpretation and transference (Kobach et al, 2017). But, for purposes of brevity, this essay will focus on transference. Upon bringing the unconscious forces are brought into the conscious realm through the process of free association, Lucas will begin to view the therapist with the authority figure of the past (i.e. as in childhood). Besides, Lucas might view the therapist as an authoritative father or negligent mother, yet they maintain a permissive and non-judgmental attitude that allows Lucas to easily continue with the process of emotionally identifying himself, a process termed as ‘transference’. Ideally, according to Wilz et al (2017), transference is highly encouraged for clients with unfulfilled desires and childhood fears because it helps the therapist have a clear understanding of the client’s unconscious conflicts. Moreover, Van de Water et al (2018) observed that transference encourages the client to express their frustrations, fear, anger, and depression they might have been harbouring from the past but couldn’t express them then. Then Lucas may get into a process of transference neurosis that enables the therapist to become aware of the intrapsychic conflict occurring within Lucas. Besides, in reference to the works by Beatty et al (2018), the therapeutic process may come to a stage called ‘positive transference’ where Lucas may begin to fall in love with the therapist and attempt to seek the therapist’s approval.

The process of transference may yield an outcome called insight. According to Demazure et al (2017), insight is a gradual process where both unconscious and conscious memories and awareness are continuously integrated through the process of transference, and the Lucas may start to gain a proper understanding of them at an emotional and intellectual level, and consequently start to understand his problems and conflicts. An ultimate result of this therapeutic process is that Lucas will develop an intellectual insight, where he will begin to personally accept his irrational reactions to various unpleasant events such as not being able to thrive well with women as everyone else did, or not being able to develop romantic relationship with women for the fear of having a powerful impact on someone. In the end, Luca’s past conflicts, physical symptoms of chronic digestive issues and fatigue will begin to disappear, and he will begin to become psychologically healthy. This will mark the end of psychoanalysis.

Behaviour Therapy
Problem Formulation

As hinted before, evaluating Luca’s psychological distress through behaviour approach requires an assumption that his distress emanates from faulty behaviour or thought patterns (McDonnell, 2017). Hence, in formulating Luca’s problem, his past will not be as useful as it would be in the psychodynamic therapy, although it will be useful to the extent that it provides an understanding on the origin of his faulty thought and behaviour patterns. Nonetheless, from the case study, it is possible to assert that Luca’s encounter with distress is as a result of his faulty behaviour and through process such as hating the football club that his dad enrolled him into, even when everyone else is enjoying it; being shy whenever women expressed interest in him while his friend, Kit is obsessed with women, being bothered by his mother coming into the room crying about not being able to cope alone, even when his friend Kit, sees it as a normal behaviour; and dropping out of school upon developing increased anxiety.

Hence, from the analogy of Luca’s thought and behaviour disorders, a major issue of the target with the therapy is anxiety and social intolerance. Hence, the therapy will seek to help Lucas eliminate his lack of social tolerance and anxiety. When these areas are specifically targeted by the therapy, he will be able to become more socially welcoming and develop less social anxiety.

Upon identifying Lucas problem, it is important to note that the treatment will first begin with clinical formulations which also require re-formulations as more insights are gained into Luca’s therapeutic process. It is then these clinical formulations that the behaviour therapy will be built upon (Demazure et al, 2017).

Behaviour Therapy Intervention Plan

Demazure et al (2017) strongly believe that a client with physical symptoms of psychological distress that are not attributable to a physical disease should be undertaken through a therapeutic interview with an aim of analysing their behaviour patterns. Hence, in Luca’s case, the therapist will conduct a behavioural analysis to identify whether he could have developed any malfunctioning thoughts behaviours that could be the root cause of his psychological distress. For example, Luca’s thought that something is wrong with him, and his conclusion that he is not meant to be in emotional relationships would be of great interest to the therapist.

Upon identifying Luca’s behavioural and thought malpractices, a treatment plan is developed with an aim of eliminating or extinguishing these faulty thoughts and behaviours, replacing them with adaptive behaviour and thought patterns (McDonnell, 2017). According to Wilz et al (2017), one major technique that is applicable in treating anxiety among psychologically distressed clients is the application of relaxation procedures. In applying such procedures, the therapist would view Luca’s anxiety as an antecedent factor in causing the faulty behaviour of intolerance. For instance, Lucas dropped out of school when his level of anxiety was too high to bear. Lucas may have also decided not to engage in any emotional relationship with women due to his anxiety.

Upon identifying the relationship between anxiety and Luca’s unwanted thoughts and behaviours, the therapist would device various relaxation procedures to reduce his anxiety levels, thereby reducing his unwanted behaviours or thoughts that emanate from anxiety (McDonnell, 2017). For example, the therapist may decide to subject Lucas to progressive muscle relaxation, which involves contracting the muscles to release muscle tension. In the process, the would therapist informs Lucas that it is the muscle tension that is causing his present psychological distress and that he would have to release the tension to feel better. Afterwards, according to Demazure et al (2017), engaging the with a repeated practice of muscle relaxation would help them to relax all their body muscles.

Luca’s wanted and unwanted behaviour could also be addressed using differential reinforcement, which includes either positive or negative reinforcement. Ideally, according to McDonnell (2017), positive reinforcement involves positively reinforcing wanted behaviour and ignoring the unwanted ones. But according to Demazure et al (2017), this technique may be inappropriate for Luca’s anxiety behaviour partly because deferential reinforcement is difficult to apply in situations of anxiety, and the fact that they are mostly applied in kids.

In conclusion, two therapeutic approaches have been demonstrated to be effective in addressing some of Luca’s psychological issues, as well as his physical symptoms of chronic digestive issues. For instance, through the techniques of free association (psychoanalysis) and transference, the psychodynamic therapeutic approach has demonstrated that it can enable the therapist to elicit Luca’s intrapsychic conflicts and emotional identification respectively to help Lucas understand his conflicts and problems. On the other hand, behaviour therapy has proven the ability of address Luca’s anxiety through various techniques such as relaxation procedures, thereby helping in suppressing unwanted behaviours (e.g. dropping out of school) that Lucas engages in whenever he feels overwhelmed with anxiety. However, based on Luca’s anxiety circumstances and the fact that most of his psychological issues are related to anxiety, behaviour therapy proves to be the best intervention for him because it directly addresses anxiety as a psychological disorder. Nonetheless, it is monumental to acknowledge the fact that in most cases, the effectiveness of therapeutic interventions is determined by other factors such as the quality of the therapeutic relationship between the therapist and the client as well as the technical aspect of the chosen therapeutic approach.

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