Therapies Based on Psychodynamic Approach

Free association: 

• Client is encouraged to express anything that comes to mind. Each incident may then lead to free association of thoughts lead to other ideas and memories perhaps to do with childhood.
• Client must not censor material and in this freewheeling way, ego defences may be lowered & repressed material accessed.
• Role of therapist must intervene occasionally. In addition, during the free association, the therapist will be identifying key themes and ideas that can be analysed further during the therapeutic process.
• Freud introduced this to try and get around the defences put up by the ego and so bring surface material from the unconscience. Can also be used with dream analysis.

Dream analysis:  Freud felt during dreams the normal barriers to unconscience material  were lifted and the symbolic imagery of dreams was a reflection of this unconscience material. Therefore, therapist maybe able to identify significant conflicts repressed into the unconscience. For Freud, dreams were wish fulfilment but the wishes often sexual or agressive from the id were too threatening to be consciously acknowledged. Made various assumptions:

• Dreams have obvious content that the client can recall. Freud referred to this as manifest content. 
• Beneath the manifest content lies the actual meaning of the dream that could only be revealed through the therapist's interpretation. - latent content.
•  The dream work was the process by which the latent content was distorted into the manifest content. This can happen through various processes.
• Therapist's role to use their understanding of how the dream work operates to interpret the symbolism of the dream. Placing together the themes that gradually emerge through the continuing processes of free association and dream analysis  regular anxieties and conflicts emerge. Client works through them with therapist. 

Processes involved in converting latent to manifest content;

• Displacement = where the client substitutes something else for an object that maybe too threatening to dream of. E.g: client strangling white dog (substitute for sister-in-law) 
• Symbolisation = objects and images came to represent significant ideas. (penis shaped objects like train, snake and swords. Vagina shaped like cupboards, tunnels and ships). 

Projective tests: 

• Client is required to project or impose their own thoughts and associations on some particular stimulus material. Ink blot test - famous one. Rorschach

Evaluation:

• These therapies accept humans to be complicated and many adult disorders maybe deeply rooted into childhood and is repressed material.
• Since the need to identify roots of psychopathology, the therapy can be very long lasting and therefore expensive. 
• Depend on client developing insights into their condition.
• Not suitable for all disorders by developing insights.
• Ethical issues in confronting clients with distressing material. 

Freud said he wanted to reduce unhapiness rather than curing it. 

Behaviour therapy: 

• Therapies based on classical conditioning include - systematic desensitisation, flooding and aversion therapy.  - Pavlov's dogs - assumes fear can be associated through classical conditioning with certain objects and situations. 

Systematic desensitisation: 

A form of counter-conditioning, where therapist attempts to replace the fear response by an alternative and harmless response. This uses fearful situations: 

• For spider phobics, therapist will ask the person to list situations from least to most fearful.
• Therapist trains the client in deep relaxation techniques - relaxation is the alternative harmless response to the feared situation and the aim of the procedure is to replace the fear response with relaxation. 
• Therapise then asks the client to visualise the least feared situation. Simultaneously they perform their deep relaxation procedure.

Continuation:

• Once client feels comfortable, asked to imagine the next situation in the hierachy. Same procedure is repeated, with visualisation of the feared situation associated with the alternative response of relaxation. 
• Over a series of sessions, client will cope with every level of the hierachy although they can stop at any time. Eventually, they can cope with the top of the hierachy. 

Alternative to visualising is to use real examples, like pictures of spiders to feeling life-like noodles. 

Flooding: 

• Aim is to extinguish the learned association between the stimulus and the response. This approach uses inescapable exposure to the feared object or situation. This procedure assumes that high levels of fear and anxiety cannot be sustained and will eventually fall. 
• Phobia could be reinforced if flooding sessions ends too soon when anxiety levels are still very high. 

Continuation:

• Flooding is clearly highly threatening and a stressful procedure. It is very quick if works. 

Aversion therapy: 

• Aims to associate undesirable behaviour with an unpleasant stimulus. Idea is to pair an unpleasant stimulus with for instance, smoking or drinking. One way to do it is to make the person feel sick using pills, simultaneously whilst smoking. Through classical conditioning feeling of sickness is associated with smoking and should act to prevent smoking in the future.

Evaluation:

• Therapy targets learnt associations. - no attempt to target deeply rooted psychological issues
• Systematic desensitisation can be extremely effective in the treatment of simple phobias. 
• Ethical issues in relation to flooding and aversion therapy in that clients are subjected to intense fear and anxiety.

Behaviour Modification:

• Based on the principles of operant conditioning. Attempt to change a person's voluntary controlled behaviour rather than the reflective behaviours involved in classical conditioning. 

Token economy: 

• Increasing desirable behaviours by reward or positive reinforcement. Used in institutions where tokens are given for improved behaviour. Aim to reduce antisocial behaviour by subsituting desirable responses. 
• Token economy is modifying behaviour but not directly addressing symptoms. 
• Can have some clinical relevance. E.g those with anorexia can have visitors or being allowed to leave the hospital can be effective and encourage weight gain. 

SLT: 

• Adds a cognitive element to operant conditioning techniques in that observation and imitation of models is an important feature. When a model is rewarded for certain behaviour the observer is more likely to imitate. Bandura 1969 has demonstrated the importance of SLT in normal development. Useful in helping those with social anxiety and phobic people. 

Evaluation: 

• Rewards effective way of changing behaviour and token economies are useful. Do not target specific symptoms.
• Token economies usually set in highly structured institutions. Key problem is whether the behavioural improvement generalises the outside world when patient returns to community. 
• Ethical aspect to token economies that they follow very mechanistic approach of treating patients as stimulus-response machines - highly reductionist approach.
• SLT includes cognitive processes such as observation and imitation and emphasises the role of models in changing behaviour. 
• Ignores genetic and biological factors in psychological disorders as well as behaviour therapy.