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1. PsychoanalysisA little bit about the cause according to psycho dynamic theories…….In short, psychoanalysists believe that psychological conflicts usually arise…
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  • 1. PsychoanalysisA little bit about the cause according to psycho dynamic theories…….In short, psychoanalysists believe that psychological conflicts usually arise inchildhood and are a result problems and conflicts between the developing personality(the ID, Ego and Superego). Also that unconscious, repressed instinctual drives(like sex and aggression) and negative early childhood experiences are mainlyresponsible for an individuals problems.These problems are unconscious to the individual and usually manifest as ‘Egodefense mechanism’ e.g.: repression, projection, denial, regression,sublimation, displacement, humour, rationality and intellectualization.Ego defense mechanisms protect the person from distress but can cause problems intheir own way.Main assumptions behind the treatmentPsychoanalysis is often known as the talking cure. The main premise ofthe theory is to make the unconscious conscious so that the individualunderstands why psychological problems are occurring and can theythen stop the maladaptive behaviour.The therapist has to train for years and undergo psychoanalysisthemselves so that they can understand/interpret/confront thepatient’s: language, dreams, fantasies, wishes and desires.Psychoanalysis refers to a specific type of treatment in which the patient verbalizesthoughts, including free associations, fantasies, and dreams, from which theanalyst induces/interprets/translates the unconscious conflicts causing the patientssymptoms and character problems, and interprets them for the patient to createinsight for resolution of the problems. Specifics things an analyst might typically doinclude: confronting and clarifying the patients pathological ego defenses, wishes andguilt.
  • 2. Freudian psychoanalysis in its original form concentrated heavily on the patientsrepressed sexual fantasies and early childhood experiences. Freud hoped to help hispatients confront traumatic memories in a safe environment in order to understandtheir current difficulties.Free association:In free association, psychoanalytic patients are invited to relate whatever comes intotheir minds during the analytic session, and not to censor their thoughts. Thistechnique is intended to help the patient learn more about what he or she thinks andfeels, in an atmosphere of non-judgmental curiosity and acceptance. Psychoanalysisassumes that people are often conflicted between their need to learn aboutthemselves, and their (conscious or unconscious) fears of and defenses againstchange and self-exposure.Dream Analysis • Freud called dreams "The royal road to the Unconscious" meaning that dreams presented a way to understand things that the patient had buried and didnt want to look at directly. Freud thought that dreams were symbolic of our unconscious desires which derive from the ID. If out subconscious was known it would be harmful to us and we would activate the Thanatos (death wish) and we would self destruct thus, dream analysis allows us to understand our dreams and symbolism in a non harmful way. Therefore the deeper truth about the self could be understood if one were to analyze dreams. • As the rational mind is supposed to be suspended during dreams. Freud emphasized that through dream analysis you could tap into the subconscious. Dreams analysis made it possible for the analyst to help the patient by bringing problems to the conscious level.FreudFreud had very little to do with Schizophrenia and psychotic disorders (where aperson loses touch with reality) because he felt that it would be impossible to develop
  • 3. a therapeutic relationship with a patient who was psychotic. This is because thenature of their symptoms e.g. disordered thinking, language would make them lesssusceptible to psycho analytic techniques and forming the close interpersonalrelationships necessary for therapy to proceed. Moreover, Freud believed thatSchizophrenia was not a psychological but a biological in origin. Freud concentratedon neurotic disorders.Other psychoanalysist’s, however, have developed theories have andtreatments that they believe are suitable for Schizophrenia. The twopsychoanalysists that will be discussed in this account are: HarryStack Sulivan and Frieda Fromm- Reichmann (They both actually workedtogether for a time and Fromm- Reichmann cited Sulivan as a chiefinspiration in her life work).In Sulivan and Fromm- Reichmann’s view, Schizophrenia reflects a return to earlychildhood forms of communication. The individual with Schizophrenia has a fragileego and is unable to handle the extreme stress of personal challenges so regressesback to childish patterns of talking. Also, that their difficulties in living and personalityare the remains of earlier unsatisfactory relationships with their family and in particularthe Mother. Indeed it was in 1948 Fromm-Reichmann suggested aSchizophrenogenic mother, one who is both overprotective and hostileto her children. Don’t worry too much about describing the theorythough as it’s the treatment you need to discuss.TreatmentThey did all the usual Freudian stuff: E.g. lying on a couch (to relaxthe patient and foster trust between the therapist and patient), dreamanalysis and free association but in short they were just more sensitivein their treatment of the patient.Their ideas were based on observations that the tendency of schizophrenics towithdraw reflected a conflict; that they were torn between intense longing for and anequally intense fear of personal relationships. Sulivan and Fromm-Reichmannconsidered the patient extremely sensitive and advocated that the therapist avoid
  • 4. thinking, saying or even feeling anything that would trigger the patients fear ofcloseness, such as even looking them in the eye. The therapists role was to make upfor the patients inadequate mothering through constant warmth and continuouseffort to reach a harmonious relationship.In more detail:Sulivan and Fromm-Reichmann thought the first task of therapy was to identify thedistortions within their relationship and communicate to the patient verbally and non-verbally that they (the patient) was not the person the patient they thought they were.The next step was to try to determine what in the patients early life (a personalbiography) may have been the basis for the distorted perceptions – this was a difficultand long term undertaking. The implementation of this process worked best when thetherapist communicates by using questions or stating possibilities rather than bymaking assertions, which can lead to mistrust. Also, during the process, the therapistmust continually monitor their own feelings and actions so as to know for sure that thepatients perception of them was accurate, not distorted. Sometimes a therapistwould need to mimic a patients actions in order to gain some insight into an ongoingrelational problem.A02Critics of Psychoanalysis have said it is only a treatment for the rich. Itis very expensive and time consuming. It is not for instance offered onthe NHS.Relevance: Some critics argue that the theory is culture bound and haslittle relevance in other cultures or in modern times.Determinism: Does not blame the individual but blames parents, esp.Mother (so not very nice for parents). Why the Mother, Verymisogynistic? Also, individual has no choice about gettingSchizophrenia if his family is disturbed.
  • 5. Reductionist: Reduces the complexity of Schizophrenia to earlychildhood trauma and problems with personality. There is evidence thatbiology is a factor. Eclectic approach?Is Psychology a Science? Can’t falsify the theory, e.g., f a therapist fails touncover the unconscious problem they do not admit they are wrongand say sorry about wasting your time and money, they would just saythe problem is buried to deep to uncover., so you can’t falsify or provethe theory wrong. Moreover the treatment is difficult to testscientifically, there have been very few controlled studies investigatingpsychodynamic treatments.Also, the research and treatments are case studies (idiographic) butthe theory itself is nomothetic. Make up your mind? An approach can’tcombine scientific approaches like this.Sulivan and Fromm- Reichmann claimed a massive success rate indealing with Schizophrenics.Some research has suggested the patients that Sulivan and Fromm-Reichmann treated were not schizophrenic according to DSM or ICDcriteria. Furthermore, they were not even very disturbed.Roth an d Fonagy have suggested that psychodynamic therapy is noteffective even when combined with drugs.More disturbingly, research into the effectiveness of the treatmentshas suggested that it actually has a negative effect on patients makingthem more likely to be hospitalized. Roth and Fonagy have concludedthat patients especially in the acute stage of the disorder may tovulnerable to withstand a therapy that is so intrusive and emotionallyintense.Maybe Freud was right after all.
  • 6. Background on Harry Stack SulivanHarry Stack Sulivan (1923) an American psychiatrist pioneered the use ofpsychoanalysis with hospitalized Schizophrenic patients.Sullivan first became interested in Psycho-analytic theories at the ‘The SaintElizabeth’s Hospital’ in Washington. The hospital was a major center of psychiatricactivity and had introduced many new treatments there—in particular, the applicationof Freud’s psychoanalytic principles to the diagnosis and treatment of hospitalpatients. The hospital’s influence on Sullivan was profound and freely recognized bySullivan throughout his life. While Sullivan’s duties were only those of a consultant,he had diagnostic interviews with a large number of schizophrenic patients, and hisability to reach patients who had been thought beyond contact was soon recognized.He became progressively convinced that the interviews he had as a consultant hadimportant effects upon the patient and could not, therefore, be sharply distinguishedfrom treatment.This position gave him the opportunity for the detailed study of schizophrenicpatients that was needed if the patients were to be understood regularly in “human”terms. With detailed records on several hundred patients, he demonstrated that eventhe most disturbed patients do not develop any type of behaviour that is entirelyoutside the realm of the human, no matter how bizarre it may appear to be; it is,therefore, never impossible to understand the patient in some sense if sufficientcontact with him is possible. This is important because many people respondintuitively to much of schizophrenic behavior as if it were not human.Sullivan was believed that if the biography of the patient were fully known, it wouldexplain much of his pathological reaction. It was this biography and his clinicalobservations that led him to believe that nearly all such patients were damaged fromtheir childhood experiences.
  • 7. Background on Frieda Fromm- ReichmannShe employed this method in the development of her theory that schizophrenicpersons could be successfully treated through her brand of "psychoanalyticallyoriented psychotherapy". She spent her lifetime working towards defending andimproving her theory. Her detractors believed that schizophrenic individuals lackedthe ability to develop the transference relationship with the therapist necessary tobenefit from psychoanalysis. Fromm-Reichmann, on the other hand, felt they werecapable of extraordinarily intense transference relationships.In short • Based on 3 points • Patients are unaware of their unconscious conflict • They bring their conflicts into their conscious mind • All symptoms are meaningful and are caused by the history of the patient • The psychoanalyst aims to: • Build trust with the patient and learn their history • Replace their destructive consciousness with a more supportive, less destructive one • Once the patient has become healthier the patient will take a more active role in his/her therapy A02 • Critics of Psychoanalysis have said it is only a treatment for the rich. It is very expensive and time consuming. It is not for instance offered on the NHS. • Relevance: Some critics argue that the theory is culture bound and has little relevance in other cultures or in modern times. Determinism: Does not blame the individual but blames parents, esp. Mother (so not very nice for parents). Why the Mother,
  • 8. Very misogynistic? Also, individual has no choice about getting Schizophrenia if his family is disturbed.• Reductionist: Reduces the complexity of Schizophrenia to early childhood trauma and problems with personality. There is evidence that biology is a factor. Eclectic approach• Is Psychology a Science? Can’t falsify the theory, e.g., if a therapist fails to uncover the unconscious problem they do not admit they are wrong and say ‘sorry about wasting your time and money’, they would probably just say ‘the problem is buried too deep to uncover.’ They are unlikely to admit they are wrong and you can’t prove that they are not. Therefore, the theory can’t be falsified.• Moreover the treatment is difficult to test scientifically, there have been very few controlled studies investigating psychodynamic treatments. Fenton : said there is very limited justifiability of the treatment due to the lack of evidence or the lack of ability to produce experimental data due to the nature of the theory• Also, the research and treatments are case studies (idiographic) but the theory itself is nomothetic. Make up your mind? An approach can’t combine scientific approaches like this.• Sulivan and Fromm- Reichmann claimed a massive success rate in dealing with Schizophrenics.• Some research has suggested the patients that Sulivan and Fromm- Reichmann treated were not schizophrenic according to DSM or ICD criteria. Furthermore, they were not even very disturbed.• Roth and Fonagy have suggested that psychodynamic therapy is not effective even when combined with drugs. More disturbingly, research into the effectiveness of the treatments has suggested that it actually has a negative effect on patients making them more likely to be hospitalized. Roth and Fonagy have concluded that patients especially in the acute stage of the disorder may to vulnerable to withstand a therapy
  • 9. that is so intrusive and emotionally intense.Maybe Freud was right after all.
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