Cognitive behavioral therapy with Classical Freudian Analyses
How do therapists with each of these persepectives view the client and clients problem?
Let's take the following problem that I recently encountered: The situation of a child being estranged from the parents and whilst parents seek contact with the child, the child, based on a long and entrenched history of child abuse, refuses to maintain contact with the parents. The classical Freudian approach attempts to explain personality, motivation, and psychological disorder by focusing on the influence of early childhood experiences, on unconscious motives and conflicts, and on sexual and aggressive urges. The analyst, accordingly, may perceive the situation as one arising from covert sexual urges on part of child, possibly initiating from some infantile / developmental dislocation of one or more stages occurring in either child and/or parent, and certainly as the influence of early childhood experiences as regards all three individuals (Weiten, 2007).
The philosophy of the Freudian analyst is that the psyche of the human is like an iceberg with just the top peeking above the water but so much subconscious and hidden urges and experiences lurking underneath. Freud's psychoanalytic approach posits the id, ego, and superego as driving forces of motivation, the id being the primary urges (e.g. sex), the ego acts as control between superego and id, the superego restrains according to social / cultural / religious expectations and norms.
Being a deterministic approach, the Freudian approach would see the client as being puppeted and dominated by forces beyond his control. "Slips of the tongue" for instance often reveal a person's true feelings. It believes that via the patient talking openly and unreservedly about his feelings, and via the counselor allowing the client to talk and listing to those articulations, some of the hidden parts of the 'iceberg' will be revealed and released, and the client will feel relieved.
Other typical Freudian mechanisms include therapist transference, where it is believed that the client's attachment to therapist is because he/she sees therapist as original parent figure and is transferring his emotions to her, and defense mechanisms that are largely unconscious reactions that protect a person from unpleasant emotions such as anxiety and guilt. An example of a defense mechanism is rationalization, for instance, where the parents would rationalize their abusive actions to the child as being for the child's good. Repression, another defense mechanism may be part of the child's makeup -- repressing the painful memories, and the analyst would work on having those memories surface. Projection (attributing one's thoughts, feelings, or motives to another), displacement (diverting emotional feelings), regression (reversion to immature behavior), reaction formation (behaving in an opposite manner to one's feelings), and identification (bolstering self-esteem by identifying with a particular individual or group) are all examples of defense mechanisms that the Freudian analyst would use in order to understand the client (and parent's) conduct (Weiten, 2007).
The concept of psychosexual stages is another tool that the classical Freudian analyst would use to approach the case in question. Essentially, the child goes through various stages of development and problems may emerge by fixation at a particular stage where the child, for whatever reason, evidences failure to move forward.
Cognitive behavior therapy is almost an entirely diametrically different system. Perhaps its sole commonality may be the listening model where the counselor actively listens to client while enabling him to talk. Interpretation is also, to a slight extent, practiced but only in terms of soliciting feedback regarding correctness of counselor's conceptions. The thrust of the therapy is on the behavioral and cognitive aspect, in other words on the client's behavior / actions and way that he/she thinks.
Behaviorism opines that his or her environment affects the individual and that the best way to heal a problem is by changing one's actions, by modifying one's habits. Behavior shapes the personality; it deals with the problem. Talk on the problem is not only extraneous and unnecessary but also deflects the client from dealing with it. Techniques would include modeling, reinforcement, conditioning (such as operant conditioning where environmental consequences -- such as reinforcement, punishment, extinction) determine behavior / response. Positive reinforcement increases a certain action; negative consequences weaken that action.
The cognitive approach focuses on the thought and opines that it is the modes of the thoughts of the individual that determines actions thus situation and / problem. The way a person thinks determines his or her judgments, consequently actions. Change those thoughts and one's judgments will become more successful, more positive and hence one's actions will show similar appreciable results.
How are the goals of treatment similar or different in these approaches?
The goals of treatment are similar in that the client is the center of the equation and in that the therapist listens carefully to the client's statements and encourages him or her to speak about his or her situation. Psychoanalysis is more talk-directed than CBT is. Otherwise, there are very few commonalities and more dissimilarities. Psychoanalysis is deterministic believing that the client is preordained by forces beyond his client (id, ego, superego) to behave in a certain fashion, whereas CBT takes the diametrical opposite approach and believes that the client is fully able to control his thoughts and actions would he or she so wish to do so.
Furthermore, psychoanalysis places greater control in the hand of the analyst whose interpretations and narrative drives the sessions. CBT, on the other hand, shifts control to the client believing that it is the client who is in charge of her life and that, even though the therapist can instruct client regarding optimum ways of thinking and behavior, ultimately the client is in the driver's seat, the therapist next to her and the client is the one who, at the end of the day, can best make changes in her life.
Similarly, psychoanalyses places greater emphasis and faith on talking and on dream interpretation where it is thought that problems resurface, therefore can be found by analyses of the dreams, whereas CBT emphasizes thought and action, with cognition involving not so much reflection but, rather, scrupulous monitoring of one's thought patterns and willfully catching and transforming those thoughts.
In that manner, Psychoanalysis is fixated on the past -- the variables that made the individual what he is -- whereas CBT focuses purely and thoroughly on the moment and on the future. Speculation and analysis are pushed aside. Life is meant for living. A humans 'being' is just that -- action and, therefore, instead of spending session after session reliving on, analyzing, and interpreting the past, the CBT counselor encourages the client to change and review his thoughts and behavior so as to change his personality and situation. In that way, psychoanalysis could be seen, in a manner of speaking, as being more passive compared to the active approach of CBT.
How would the processof therapy be different?
The process of therapy is different in so many ways:
With psychoanalysis, the patient - not necessarily lies on the couch although still does, and the therapist encourages him to speak, interpreting and providing him with explanations of why he behaves the way he does. The session is mainly past-centered and based on elements that are allegedly in the 'unconscious'.
With CBT on the other hand, interventions involve journaling (where client records his activities as both review and as means of monitoring); a contract between counselor / client to assess, monitor and adopt or break certain habits; the reward or punishment of certain actions, and instructions on the philosophy behind detrimental thoughts and how to change thoughts. Client questions evaluations and beliefs; gradually faces and deals with fearful situations and stimuli (via gradual extinction); experiments with new ways of behaving and thinking; adopts stress-reducing techniques such as relaxation, visualization, mindfulness, and distraction. The whole procedure is practical, action-oriented, and in the moment. Interpretation is rarely if ever used. Treatment is often brief, direct, and time-limited (usually 12-16-hour long sessions) as opposed to the years and years that a patient can spend on the psychoanalyst's couch. Sometimes, mood medication is integrated such as with bipolar disorder.
Other differences include the fact that CBT can be extended to group sessions as well as to individual sessions, whereas psychoanalysis applies to individual sessions alone.
Finally, the classical Freudian approach, although having changed with time, still remains one homogeneous orientation as compared to CBT that resembles a variety of approaches and therapeutic systems; some are more behavioral than cognitive, and others the reverse; methods include rationale emotive behavior therapy (Albert Ellis (2001); philosophical / psychological approach that integrates behavior and emotional thoughts and uses emotional thoughts to change behavior), cognitive therapy (devised by Aaron Beck (1999): identifying and changing dysfunctional thought, behavior, and actions), and multimodal therapy (Lazarus (1971); that humans are comprised of several modalities that need to be treated in a holistic manner), different practitioners preferring one or more approaches depending on that particular therapist.
What would be your overal comment about how these approcahes…