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Behavioral Therapy vs. Freud's Psychoanalysis
Amazing advances have been made in the treatment of mental illness throughout the years (Merck, 2004). An understanding of what causes some mental health disorders has resulted in a greater sophistication in customizing treatment to the underlying basis of specific disorders. Thus, many mental health disorders can now be treated almost as successfully as physical disorders.
Most treatment methods for mental health disorders are either categorized as somatic or psychotherapeutic (Merck, 2004). Somatic treatments include drug therapy and electroconvulsive therapy. Psychotherapeutic treatments include individual, group, or family and marital psychotherapy; behavior therapy techniques; and hypnotherapy. There are many others, as well
Research reveals that for major mental health disorders, a treatment plan involving both drugs and psychotherapy is more effective than either treatment method on its own. This paper will discuss two treatment methods -- behavioral therapy and psychoanalysis -- in an effort to shed some light into how they are similar and different.
The Two Types of Therapy
Freud coined the term "psychoanalysis" in 1856 (Beystehner, 1997). In modern times, psychoanalysis has withstood the test of time and remains a valid option for patients suffering from mental illnesses. The acceptance and popularity of psychoanalysis is seen by the number off institutes, organizations, and conferences established around the world with psychoanalysis as their focus. The theory of psychoanalysis was innovative and revolutionary, and is one that has lasted for many years.
Psychoanalysis is the oldest form of psychotherapy (Merck, 2004). Sigmund Freud developed this method in the early 20th century. During psychoanalysis, a patient usually lies on a couch in the therapist's office 4 or 5 times a week and says whatever comes into his mind. This method is called free association.
A great deal of the focus is on understanding how past patterns of relationships repeat themselves in the present. The relationship between the patient and the therapist is a key part of this focus. An understanding of how the past influences the present helps the person develop new and improved ways of functioning in relationships and at work.
Behavior therapy is related to cognitive therapy (Merck, 2004) and was coined by BF Skinner, who used positive or negative reinforcers to encourage desirable behavior and punishments to discourage undesirable behavior. In many cases, a combination of the two, which is called cognitive-behavior therapy, is used. The theoretical basis of behavior therapy is learning theory, which holds that abnormal behaviors are the result of faulty learning. Behavior therapy involves numerous interventions that are designed to help the patient unlearn maladaptive behaviors while learning adaptive behaviors. Exposure therapy is one example of a behavior therapy.
There are many theoretical schools of psychotherapy, which are too numerous to list here. The most commonly used theoretical approaches are cognitive therapy, behavior therapy, and psychodynamic therapy. In many cases, psychologists combine cognitive and behavioral theoretical approaches, depending on the problem and the treatment goals.
Cognitive psychotherapy concentrates on present problems and conflicts, although past issues may be part of treatment if they influence present life adjustment. This approach assumes that psychological problems are the result of maladaptive expectations, assumptions, beliefs, and perceptions about oneself and others, resulting in ineffective coping behavior.
Most times, cognitive psychotherapy sessions are scheduled once per week, although additional appointments may be scheduled as needed. The length of treatment is dependent on the nature of the problem. Treatment may last only ten to twelve sessions, or may take years. Frequently, treatment is completed within twenty to thirty sessions or less.
As a therapy, psychoanalysis is based on the concept that individuals are unaware of what causes their behavior and emotions (Beystehner, 1997). These unconscious factors can potentially result in unhappiness, which is expressed through a score of distinguishable symptoms, including disturbing personality traits, difficulty in relating to others, or disturbances in self-esteem or general disposition (American Psychoanalytic Association, 1998).
Psychoanalytic treatment is an individualized form of therapy, which seeks to reveal how the unconscious factors affect behavior patterns, relationships, and one's mental health (Beystehner, 1997). Treatment traces unconscious factors to their origins, determines how they have evolved and developed over many years, and ultimately helps patients to overcome the challenges they face in life (National Psychological Association for Psychoanalysis, 1998).
According to Beystehner (1997): "The value and validity of psychoanalysis as a theory and treatment have been questioned since its inception in the early 1900s. Critics dispute many aspects of psychoanalysis including whether or not it is indeed a science; the value of the data upon which Freud, the founder of psychoanalysis, based his theories; and the method and effectiveness of psychoanalytic treatment. There has been much criticism as well as praise regarding psychoanalysis over the years, but a hard look at both the positive and negative feedback of critics of psychoanalysis shows, in my opinion, that psychoanalysis is indeed a "great idea" in personality that should not be overlooked."
To determine the strengths of Freud's theory of psychoanalysis, it is important to consider the qualities that make a theory of personality or behavior "great (Beystehner, 1997)." Among the qualities that people consider to be important are that "the theory addresses its problem, can be applied in practical ways, fits with other theories, and withstands the test of time." Additionally, a good theory, according to experts, is falsifiable, able to be generalized, leads to new theories and ideas, and is recognized by others in the field. It is generally believed that psychoanalysis meets many of these criteria.
Psychoanalysis was designed by Freud to help people get in touch with the origins of their problems, and ultimately eliminate the problems (HealthinMind.com, 2004). Freud did not think that psychoanalysis should be used for patients with psychoses. Psychoanalysis has always been a controversial method, and it has been replaced by or supplemented with many other types of individual psychotherapy. Some, like psychoanalysis, aim to provide patients with insights into their problems, but many have more pragmatic goals like helping patients adapt to their problems or eliminate symptoms.
Skinner made a more enduring contribution as an experimenter and psychological theorist. Today, there ar many forms of behavior therapy. One of the more successful individual therapies is cognitive-behavioral therapy, which aims to change the way the patient or client thinks about his or her problems (HealthinMind.com, 2004). Behavior is changed either directly or through changes in patterns of thought. This type of therapy has been proven to improve the functioning of depressed people, and is often used in combination with antidepressant medication.
According to HealthinMind.com (2004): "Behavior therapies are designed to change behavior directly, rather than as an indirect result of gaining insight into the origins of problems or changing thought patterns. Behavior therapy is usually combined with other therapies, most notably with cognitive therapy, to maximize benefits to clients."
Behavior therapy uses learning to develop behavioral change (HealthinMind.com, 2004). Operant conditioning, which is the process by which the environment shapes people's behavior, is the focus of the treatments. The theory behind operant conditioning is that behaviors improve when they are reinforced, and diminish when they are punished.
Positive reinforcement occurs when a person participates in a behavior and is rewarded, which results in an increase in that behavior. Negative reinforcement occurs when a person avoids a negative thing by performing a behavior. Thus, both positive and negative reinforcement aim to increase the probability of a behavior. However, punishment aims to decrease the behavior being punished.
According to HealthinMind.com (2004): "Behavior therapy can be used to treat a wide range of problems including anxiety, depression, sexual disorders, relational problems, and especially childhood disorders, for which behavior therapy is ideal and is usually taught to parents so that they can implement the techniques at home. Basically, any disorders that involve maladaptive behaviors in people who are physically capable of behavior change can be improved with behavior therapy."
All theories of counseling assume a position regarding formal content (Guterman, 1996). For example, in Skinner's behavior therapy and Freud's psychoanalysis, formal content is defined as environmental contingencies and repressed complexes, respectively. In addition, all models tend to fit informal content within their formal content during the change process. Therefore, in both behavior therapy and psychoanalysis, the client's understanding of the problem (i.e., informal content) is reframed in terms of the counselor's theoretical lens (i.e., formal content).
Freud analyzed behaviors from internal organizational aspects (Guterman, 1996). He believed that the unconscious controls a person's behaviors. On the other hand, Skinner believed that behaviors are formed from the S-R principle. He emphasized the importance of reinforcement system. In this light, Skinner was an externalizationist.. However, both men believed that human being's behaviors are not controlled by themselves. Human beings are the puppets. For Freud, they are controlled by unconscious; for Skinner, they are controlled by he environment.
Basically, Skinner rejected Freud's unobservable mental constructs like id, ego and superego. According to Lin (1997): "Behaviorists like B.F. Skinner argued that human behavior is determined by learned environmental contingencies of reward and punishment, not by internal…[continue]
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