Assessing What Works in Psychotherapy

Treatment for mental illness can take several forms, including talk therapy, medication, or a mix of the two, and can last for a few hours or many years. Despite the fact that there are numerous treatment approaches available, the components of psychotherapy remain the same. They include the presence of a diagnosable mental disorder, agreement on treatment goals, collaboration between the patient and the psychotherapist to attain the goals, and a healthy and good connection between a trained psychologist and the client.  It is notable that there is an increased candidness to the different theoretical approaches utilized in the field of professional psychotherapy. The aspects of theories of therapeutic change and personality such as humanistic, psychoanalytic and behavioral have been discussed as suitable methods used in professional psychotherapy (Hoglend, 1999).

However, these three approaches have their criticisms as well as support, and it all depends on what kind of condition a psychologist applies an approach to handle. This study attempts to identify the components of psychotherapy that cut across several theoretical orientations with the aim of establishing the elements of psychotherapy that work during treatment. This paper will achieve its purpose by assessing the theories of psychotherapy in the next section of the article, followed by a look at the differences between the frameworks. An analysis of the elements that cut across the models such as the importance of patient-therapist relationship and the need for behavior change in treating mental disorders will then be discussed.

The Theories

Psychodynamic approach

This method of psychology includes all the theories that perceive human functioning based on how forces and drives interact within the person. The approach first developed by Sigmund Freud explains human motivation and behavior using the unconscious and conscious forces and how the two interact. Freud developed the psychoanalysis method of treating mental disorders as well as a theory that explains the behavior of humans. For treatment, the psychodynamic approach involves talking to the patient which helps them to bring the information present in the unconscious part of the mind to the conscious after which the patient can deal with the problem and get healing.

As per the psychodynamic approach, the brain comprises of the entities called id, ego, and superego (Freud, 1989 14-15). These components of the brain are not physical but rather theoretical conceptualizations of vital functions of the brain. The assumption is that the id operates on an unconscious level and it contains two biological drivers called the Eros and Thanatos. The Eros is the life instinct that helps humans to survive by directing activities that sustain life such as eating, respiration, and sex (Freud, 1989). The Thanatos, on the other hand, is a death instinct that is typified by destructive forces and all human beings possess the Thanatos (Freud, 1989). But according to Feud, (1989), the Eros is stronger than the Thanatos that is why people can survive instead of destroying themselves.

The ego matures from the id during infancy, and its purpose is to gratify the needs of the id in a socially acceptable and safe way. However, the ego functions both in the unconscious and conscious mind (Freud, 1989). The superego grows during the early stages of childhood and serves to ensure that moral standards are adhered to. Superego functions on the principle of morality which motivates the individual to behave in a socially acceptable and responsible way (Freud, 1989). Freud (1989), purported that dreams can come from either the ego or the id and that in dreams, the defenses of ego are lowered to enable some repressed information to come to the conscious mind and thus to awareness. In other words, dreams provide valuable indications on how the unconscious mind functions.

While assessing the usefulness of psychodynamic therapy Shedler, (2010), asserts that the approach is worth because it encourages the discussion and exploration of the complete scope of the patient’s emotion. Also, through psychodynamics, the therapists can guide the patient to make the description of words and put them into feelings including clashing emotions. Such feelings may act as threats or cause trouble to the patient, and the client may not be able to identify them until the discussion between him/her and the therapist takes place (Shedler, 2010). But there are contentions on the Efficacy of Psychodynamic Therapy (PDT), and several conclusions have been drawn. Fonagy (2015) puts it that authors of literature relevant to the usefulness of PDT need to declare their interests are owing to the fact that the conclusions drawn by most authors reflect their theoretical orientations.

Similarly, studies differ in the manner in which they correlate with the first writer’s affiliation. Aside from the contentious thoughts, PDT treatment approaches have been found to benefit people with somatic problems, depression, eating disorders and some forms of anxiety. Also, the long-term implementation of the treatment tends to help individuals presenting complex disorders which show as a combination of spectral level and syndromal problems. Nonetheless, no enough evidence put PDT above other therapeutic approaches. PDT implementation in most cases depends on the presence of appropriately trained psychologists and their level of willingness to acquire particular methods that have been proven to have high efficacy levels when applied by personnel giving treatments. And the speed of recovery compared to the cost-effectiveness of the PDT is important in determining the effectiveness of the intervention (Figany, 2015).

The Humanistic Approach

The Humanistic psychology perspective came into prominence in the mid-twentieth century. The method is based on the philosophies of phenomenology and existentialism. It takes a holistic approach to the existence of humans through the analysis of freedom, values, personal responsibility, spirituality, self-actualization and meaning (Ajvol et al., n.d). Sometimes, the humanistic approach can be understood within the milieu of three distinct forces of psychology which include psychoanalysis, humanism, and behaviorism. Ivan Pavlov’s conditioned reflex work created behaviorism and formed the basis for academic psychology in America that is associated with the names of B.F Skinner and B, Watson. But it is Abraham Maslow who called behaviorism the second force with the first force referring to Sigmund Freud’s psychoanalysis (Ajvol et al., n.d).

Towards the end of the 1950s, Maslow Clack Moustakas and Carl Rodgers formed the professional association committed to psychology which focused on human issues deemed unique such as health, the self, hope, self-actualization, becoming, being, love, individuality, creativity, meaning and nature. One type of the humanistic therapies is the Emotion Focused Therapy (EFT, which suggests that emotions form the foundation for the construction of a person or the self. Thus emotion is an important determinant for the organization of self (Greenberg, 2004). The emotion intelligence is believed to involve the sharpening of the capability to utilize emotions for guidance without falling into a slave of emotions. Most of the emotion theories stipulate that the tactic appraisal of a condition in the designation of individual goals is a crucial source of emotion production at a psychological level (Greenberg, 2004).

The other humanistic counseling therapies and approaches include the depth therapy, Gestalt therapy, holistic health, humanistic psychotherapy, encounter groups, body work, marital and family therapies and sensitivity training (Ajvol et al., n.d). Most of the humanistic approaches tend to look beyond the medical paradigm of psychology with the aim of making open a non-pathologizing perspective of the person. That means a psychologist must ignore the pathological aspects of the patients’ life and concentrate on the healthy aspects. One critical component of humanistic psychology is the therapist and client’s meetings plus the chances of the two having a dialogue. Thus the major goal of humanistic therapy is to help a patient get towards becoming stronger and to experience self-actualization (Ajvol et al., n.d).

Greenberg, (2004), presents that humanistic therapy through emotion coaching improves the patients’ capability of coping with feelings and helps them to gain knowledge or awareness of their emotional experiences which in turn enables them to make sense of such experiences. Just as mentioned in the previous paragraph concerning the relationship between therapist and patient, a great collaboration between the therapist and the client is crucial for the success regarding acceptance and change (Greenberg, 2004).

The person-centered therapy also known as the client-centered therapy and requires the conditions of genuineness, unconditional positive regard, and empathy for the treatment process. These components are deemed enough to ignite personality change in a patient. In the person-centered therapy, the psychologist goes through the stages of trust, intimacy, and mutuality to be developed within the therapeutic relationship. According to person-centered therapy, the client experiences change by moving from negative self-evaluation to a positive one which reinstates their worth from within (Churchil, 2010).

The experiential therapies combine the emotion-focused therapy and the focused oriented psychotherapy. The focus oriented psychotherapy involves perceptiveness levels which refer to the level to which the therapist can bring material out of the patient’s frame of reference and the standard of authority and expertise employed. This kind of therapy helps the clients to obtain a step by step experience which enhances the change (Churchil, 2010).

The Gestalt therapy concentrates on human contact process which begins with an emotional drive and completes when the urge is gratified and adjusted. The experience of instability during the connection cycle are considered the foundation for treatment and therefore become the focus of the therapy. A therapist using Gestalt intervention provokes and supports the weaknesses to the contact period with the objective of finding a solution to the disturbance and helping the patient to finish the contact cycle. The Gestalt therapy was previously conducted through confrontational design, but they have slowly become dialogue based and even softer (Churchil, 2010).

One of the widely discussed strengths of the humanistic therapy is the focus of individual thus shifting attention to the entire person. However, several downsides of the humanistic therapy have been identified as well. Rowan, (2015), argues that the humanistic approach is more concerned with growth than cure or adjustment. The therapies do not clear a psychological problem by making the patient experience or face the problem but instead works by meeting the therapist. Rowan, (2015), exemplifies that a person who has issues of fear for flights cannot solve that by going to meet a therapist.

Also, the humanistic therapies have been criticized for its relational method of working which is considered to be a means of wanting to spend more time with the patient taking their time and energy. The therapies may not work for individuals who are impatient because they may lack a chance to dedicate for meetings with a therapist for longer periods (Rowan, (2015). Moreover, humanistic theories tend to assume that the problems of clients may be deeper than presented by them and so clients who feel that they have no other problem apart from the ones already stated may stop the therapy process (Rowan, (2015).

Cognitive Behavioral Approach

The cognitive behavioral approach is an evidence-based practice and the most widely used psychological intervention for the treatment of mental diseases. The cognitive behavioral therapy (CBT), involves the development of individual coping strategies that are useful in solving an existing problem. Beck, (2011), puts it that when individuals learn how to assess their thinking in an adaptive and more realistic way, they tend to undergo a change in their behavior and emotion state.

To create a lasting improvement in the mood and behaviors of patients, therapists need to work towards cognition of deeper level which includes the clients’ primary beliefs of themselves, other people and the world. Revision of the patients’ underlying negative beliefs generates a longer lasting change. Beck, (2011), exemplifies that if an individual continuously underestimates his abilities, the person may be having a dysfunctional underlying belief of incompetence. To adjust or change this thinking, the person must look at self as having both weaknesses and strengths and thus the thoughts of his inability to do anything correctly will change so that the individual identifies that there are only specific things that he can’t do right while others flow well for him.

Studies conducted on the efficacy of CBT show that the approach is useful in the treatment of a wide range of mental disorders medical problems with psychological elements and psychological problems. Research has also demonstrated that there are neurological changes attributed to the CBT treatment for various disturbances (Beck, (2011). For an effective implementation of the CBT, therapists must first be able to formulate cases through hypothesis testing. The case formulation involves assessment, development, and intervention so that data collected during assessment is utilized to create the formulation. The formulation is a hypothesis on the cause of the patients’ disorder, and the assumption is used as the basis for intervention (Persons & Tompkins, n.d).

The process of CBT adheres to several principles as outlined by Beck, (2011), including the fact that CBT is centered on the continuous evolvement of the client’s problems and the personal conceptualization of patients in cognitive terms. Secondly, there must be a solid therapeutic alliance for CBT to succeed. Thus the necessary ingredients required in therapy such as warmth, empathy and genuine regard may be incorporated to ensure success. Third, collaboration and active participation are emphasized in CBT. The patient is encouraged to view the therapy process as teamwork and make decisions on the number of meetings and helps the patient to be more active. Fourth, CBT focuses on the problem and remains goal oriented. The patient should list the problems that need to be worked on and together with the therapist strive to solve the problems by the end of the therapy.

Fifth, CBT focuses on the present problem and handles specific situations that are difficult. Moreover, CBT aims at educating the patient to become an own therapist and puts emphasis on the prevention of relapse. Also, CBT focused on time limitation by encouraging specific durations for therapeutic sessions. For example, most anxiety and depression disorders are treated sessions between six -14. The other principle of CBT is that the sessions are structured with the aim of maximizing efficiency and effectiveness. Also, the education of CBT helps patients to be able to identify, assess and respond to thoughts and beliefs that are dysfunctional. And, several techniques are employed in CBT to change the mood, thinking, and behavior of patients.

Key Elements of Effective Therapy

A read through the three approaches discussed in this paper indicates that there are some critical components of psychotherapy that cut across the approaches. These elements include the collaboration between the patients and the therapist, goal of the process and the need for adjustment in the behavior of patients. Whether a therapist opts for the humanistic, psychodynamic or the behavioral approach, the primary objective is to help the patient undergo some changes that would delete the psychological problems they have and replace them with the positive mental state.

Psychoanalysis and humanistic approaches involve talking to the patient until they reach a change. For the psychoanalysis, the change happens when the conscious mind is made aware of the information that was previously occupying the unconscious mind (Freud, 1989). The psychodynamic path to attaining change involves the mechanism of containment) and interpretation (Kaligor, Kenberg &Clarkin, 2007). The humanistic approach focuses on helping the patient change the personal view and embrace self-worth. And the behavioral change therapy is concerned with changing the behavior and emotion state (Beck, 2011).

The relationship between the patients and therapists has also emerged as an essential element that must exist in all approaches for them to be effective. In behavioral change therapy, the patient and the therapist work as a team and together agree on the number of sessions and suggest ways of going through it. In the humanistic approach, the patient has to collaborate all through the sessions no matter how long they take until the goal of treatment is reached. Similarly, in the psychodynamic approach, the patient and therapist develop a highly specialized relationship that is known as the psychotherapeutic relationship. And in the psychotherapeutic relationship, the patient is encouraged to tell the therapist the innermost needs as fully as possible (Kaligor, Kenberg &Clarkin, 2007).

Conclusion

There are several methods of treating mental illnesses most of which fall within the three most important approaches; psychodynamic, humanistic and cognitive behavioral. The psychodynamic approach is plausible for working on the complete range of a patients’ emotion. The behavioral change therapy focuses on specific and current problems while the humanistic takes a holistic approach to the human problem. It stands out that the cognitive behavioral change provides better solutions to several mental disorders however its focus on current issues only may not be useful for all patients. It is, therefore, necessary for therapists to go beyond a particular approach and combine useful elements of different approaches for the purpose of designing the most efficient treatment plan that tackles specific problems of each patient.

Reference

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