Two pioneers of psychodynamic treatment were Joseph Breuer and, of course,
Sigmund Freud. Breuer was a proponent of using hypnosis in order to help
the patient to reach a catharsis. Freud, who collaborated with Breuer in
developing this school of treatment, did not believe that hypnosis was necessary
in order to reach the stage of catharsis. Freud instead relied on a method of
talk therapy known as free association. For Freud, whose methods of
treatment became known as psychoanalysis, catharsis was neither the only
nor the ultimate goal of therapy. Rather, through such methods as free
association and dreams, one could garner great insight into aspects of the
unconscious. Insight, which Freud believed sufficient for curing the disorder,
was reached through the tool of interpretation. Through interpretation, the
analyst is able to bring hidden meaning to past events in order to enlighten the
patient but must face resistance produced by the
defense mechanisms of the
individual. The goal of the analyst, however, is not to eliminate these defense
mechanisms, which are essential for normal functioning, but to replace unhealthy
ones with more adaptive, functional systems.
Psychoanalysis also attempts to
help the patient become aware of his or her basic psychological needs and
drives, and devise healthy ways to achieve them.
Psychoanalysis Treatment
Individuals undergoing psychoanalysis usually meet with a therapist several
times a week for about two years. Because this form of treatment involves a lot
of time, expense, and introspection, it is sometimes only an option for those
individuals who are financially well off and relatively well functioning. Over
time, it has become a type of therapy not used to treat disorders specifically,
but as a conduit for gaining self-understanding. Individuals suffering from
neurotic disorders, such as
anxiety
disorders, tend to benefit more from this form of
treatment than those suffering from personality
disorders and
psychotic disorders, such
as
schizophrenia.
The major premise of psychoanalysis treatment is that pathologies are caused by
unconscious conflict caused by some traumatic event that occurred, which
arrested psychosexual development. The goal of psychotherapy, then, is to make
unconscious conflict conscious and provide relief through catharsis. The
role of the therapist is that of a blank slate or tabula rasa. The
therapist, in an attempt to maintain a neutral stance and to minimize their
effect on free association, does not say much and cannot be seen by the
patient. Thus begins the process of transference wherein the therapist and
patient assume whatever roles are necessary in order to play out the conflict.
Other Forms of Psychodynamic Theory
Unlike psychoanalytic therapy, therapists in other forms of psychodynamic
therapy are usually more engaged, directive, and warm. These forms of therapy,
although still long-term, are briefer and less expensive than psychoanalysis.
The premise of psychodynamic therapy is also that pathologies are a result of
unconscious conflict, but the traumatic event and accompanying conflict did not
have to occur within the first few years of life. The goal of psychodynamic
therapy, like psychoanalytic theory, is to bring the conflict to light by
providing
insight-oriented therapy. Yet, the realization, unlike in
psychoanalysis, does not necessarily have to come through an epiphany but
instead can be a gradual process. One category of psychodynamic theory is that
of ego analysis: Whereas Freud emphasized the role of the
id in the
etiology of mental disorders, ego
analysts also recognize the importance of the
ego's role in dealing with
reality.
Followers of the psychodynamic tradition, such as Erik Erikson and Harry
Sullivan, focus on the family of origin and believe that interpersonal
relationships perpetuate a lot of the conflict. To individuals in this school
of thought, then, such theories as John Bowlby's attachment theory, which views
the forming of close relationships as a basic human necessity, are significant
because of the
primary role they allot to interpersonal relationships on a
functional level.
