Psychology has a long tradition of interpreting human behavior across different paradigms. The current paper investigates a method of incorporating four main psychological paradigms: psychoanalytic, behaviorist, cognitive, and humanist, into group counseling treatment for addictions and compulsive behaviors. Each paradigm is briefly discussed then the integration of aspects from theoretical models that spring from the paradigms is examined. This integration is based on previous empirically-based findings that support the use of a specific facet or an approach to treatment and counseling. The integration of these paradigms is discussed in terms of the ethical and cultural considerations, the development of groups, and a model developed specifically to avoid recidivism in addictive or compulsive behaviors.
Psychology has a long tradition of interpreting human behavior across different paradigms. The specific paradigm used defines what methods, hypotheses, and explanations will be accepted in describing behavior. Thus, the same behavior can be explained differently depending of the core propositions of each paradigm (Mcleod, 2007). Counseling also follows this approach. The specific counseling methods are derived from the major psychological paradigms. The five major perspectives in psychology are: the psychodynamic perspective, the behaviorist perspective, the humanist perspective, the cognitive perspective, and the biological perspective (McGraw-Hill, 2008). As the biological perspective is most often associated with the use of medications and psychiatry there will be no discussion specifically of that model in this paper, although counseling interventions are believed to have neurobiological effects.
The other four paradigms have direct applications to therapy and counseling for a number of different conditions. Psychotherapy or counseling for addictions has often been considered a difficult enterprise (Wurmser, 1978), but if approached from an integrative manner counseling for addictions and compulsive behaviors in a group or individual format can be effective. The current paper examines some of the aspects of each of the four remaining paradigms that this writer believes can be helpful in a group counseling approach to these issues and to forming a holistic approach to treatment.
The Psychodynamic Model
The psychodynamic paradigm was originated by Sigmund Freud and advanced by other famous psychologists, most from a clinical psychology or psychiatry background such as Carl Jung, Karen Horney, and Alfred Adler (Hall, Lindzey, & Campbell, 1998). In essence, the psychodynamic paradigm views the mind as a composite of three interacting and sometimes competing structures that were originally named by Freud as the id (the unconscious instinctual aspect composed of drives), the ego (the mostly conscious aspect that mediates reality with drives and rules), and the superego (the conscience, mostly unconscious but learned from parents). Most dynamically- oriented theorists/methods retain Freud's structural motif, although differing emphasis was placed on the role and importance of the ego and of personal (object) relations with others by later theorists. In a dynamic model much of human behavior is attributed to instinctual drives (for Freud these were sexual or procreative drives) and much of motivation is unconscious in nature. Thus, the person often has little insight and little conscious control over many or most (if not all) of their actions. Behavior is fueled by drives and needs that are innate and psychological problems result when drives are blocked or when anxiety occurs as a result of unconscious conflicts that transpire due to the interactions of the three structures of the mind. Often the anxiety is blocked by defenses mechanisms such as repression that protects the ego from the anxiety associated with id impulses gone awry. For most of the psychodynamic theorists the crucial time in the development of one's personality occur the first six or so years of life, although there are some exceptions such as the theories of Erik Erickson (Hall, Lindzey, & Campbell, 1998). Psychodynamic counseling relies on three main techniques: free association (the client just speaking what is on their mind at the time), transference (the projection of inner conflicts on the therapist), and interpretation (when the time is right the counselor provides limited insight into the meanings of associations and transference). Sometimes dream analysis can be used if appropriate.
Early psychoanalytic formulations of substance abuse and compulsive behaviors proposed that these behaviors stemmed from the unconscious self-destructive instincts of the id resulting in a "slow suicide" (Khantzian, 1980). These early dynamic treatments focused on these tendencies of the id as actions that were merely manifest symptoms of a repressed idea that leaks into consciousness. The actual repressed idea is unrecognizable, it appears on the surface as compulsive behavior or addiction but it is distorted by psychological defense mechanisms. Compulsive behaviors and addiction were initially thought of as a compromises resulting from the conflict of a repressed idea and the defenses against that idea (Morgenstern & Leeds, 1996). However, as psychoanalytic thought began to move away from drive reduction models of behavior and more towards the ego functions the conceptualization of psychodynamic models altered its focus. More contemporary psychodynamic approaches maintain that compulsive behaviors like addictions are the defense mechanism themselves (e.g., Khantzian, 2012). Addicts and those with other compulsive behaviors use those actions to protect themselves from depression, anxiety, shame, and other negative emotions. That is to say that these behaviors are attempts at "self-medication" (Khantzian, 1980). So in the more contemporary analytical thinking these negative affective states are not the consequences of addiction or compulsive behaviors, but instead are the causes of them (Khantzian, 2012). One of the early originators of this idea, Wurmser (1978) believed that the greater the legal penalties or social stigma associated with a specific drug or behavioral compulsion, the more severe the psychopathology that was involved in driving it. The logical conclusion would be that drug control laws or laws against certain compulsive acts and many forms of drug treatment miss the point because they merely focus on the acts themselves and not the underlying pathology. If indeed the self-medication hypothesis is true, then it would follow that different psychopathological states would result in different compulsions or dugs of choice. This also led to a large body of research aimed at being able to predict the type of drug addiction or compulsion one has or one will have as a result of their underlying psychopathology. There has been extensive research starting in the 1980's up to the present time attempting to predict a specific drug of choice from psychological data. For example, Suh et al. (2008) attempted to predict specific drug addiction/abuse in a large sample of drug users and nonusers based on the Minnesota Multiphasic Personality Inventory-2 special scales using logistic regression analyses. The results indicated that repression directly and the depression subscales indirectly predicted membership in the alcoholic group, psychomotor acceleration was a predictor of the cocaine abuse group, and cynicism predicted preference for heroin, partially supporting the self-medication hypothesis.
Group psychodynamic therapy would still follow many of the same principles that individual therapy follows. By focusing group therapy on particular issues the clients are directed to introspect on specific events regarding their behaviors and feelings and are given insight about their interpersonal relationships and transferences in the group. By listening to each others' introspections, conflicts, and transference behaviors the process of insight into psychodynamic therapy is can be significantly increased in the group process.
Behaviorists, like psychodynamic theorists agree that much behavior occurs beneath ones' conscious awareness, but in contrast the psychodynamic theorists, the behaviorists took a different approach to designing their theories. The bulk of early psychodynamic thought was derived from their observations and cases histories of clinical cases of people with psychological problems (in some instances very severe psychological problems) but the behaviorists developed their ideas initially from the experimental studies with animals (Hall, Lindzey, & Campbell, 1998). The early influential studies that formed the core theme of the behaviorists came from experiments by Pavlov, Thorndike, and Watson. Essentially the behaviorists took the view that what was externally observable was important and human behavior was based on the reinforcement or punishment of like behaviors in the past. In its most extreme form behaviorism viewed the mind as a "black box" from which little useful information could be derived (Skinner, 1966). In a sense then, behaviorism is the antithesis of the psychodynamic model in that it did not theorize about unconscious drives but instead relied on empirical evidence, measureable behaviors, and experimental models to derive their ideas B.F. Skinner, probably the most influential of all the behaviorists, took this notion to the extreme developing models of how schedules of reinforcement could be provided and offering a look at how behavioral theories could be applied to everything from education to psychotherapy to a model for developing society.
McAuliffe and Gordon (1980) proposed that addiction and compulsive behaviors are operantly conditioned responses that strengthen as a function of the quality, number, and size of the reinforces, which can be either positive (rewards like euphoria or peer acceptance) or negative (like anxiety reduction,…