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Abstract
8umaary ah4 Conclusion
psychoanalysis and other psychodynamically oriented
psychotherapies are based on efforts to help relieve
underlying intra psychic conflicts, usually unresolved since
childhood. Freud’s psychoanalytic theory rests on five basic
postulates : psychic determinism; the role of unconscious
process in influencing current thoughts, feelings, and
behaviour; the instinctual drives, especially sexual and
aggressive instincts; the structure of personality (id,ego,
superego) and the stages of psychosexual development (oral,
anal, phallic, latency, genital primacy). Freud considered
neurotic symptoms to be disguised expressions of unconscious
conflicts, usually over childhood sexuality.
As .a from of treatment, psychoanalysis aims at
resolving intra psychic conflicts through insight and self
examination. Both” free association and dream analysis are
employed to help make unconscious conflicts conscious and
thus open to sc~unity and self understanding. Transference
feelings toward the analyst are co.nsidered to· be
reenactmE!;ntsof childhood conflicts and thus provide an
opportunity to uncover and resolve them. Adequate outcome
studies on the effectiveness of psychoanalysis are rare,
although some, such as the Menninger Foundation Psychotherapy
Research Project, suggest positive gains,
particularly for people with high ego strength who can form
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positive interpersonal relationships.
Alternative psychodynamic approaches include Adler’s
individual psychology (life style investiqation and the
strengthening of social interest), Junq I s analytical
psychology (investigation of unconscious states and inner
world of symbols), the Neo-Freudians, such as Horney and
Fromm (influence of cultural factors over biological ones in
developing disorders).
Psychoanalytic therapy is the weakest with respect to
the cost effectiveness criterion. Psychoanalytic therapy
needs to reformulate its economic principle so as to replace
outmoded enerqy concepts with concepts expressed in terms of
learning, information theory and contemporary
neurophysiology. It must begin to use observational
techniques such as video taped interviews to validate or
refute theoretical constructs like transference, resistance,
defense and interpretation. from this will come increased
understanding of the psychotherapeutic process and more
precise demonstration of the criteria of cure, particularly.
evidence of personality change.
Brief psychodynamic therapy is an efficient and cost
effective treatment which has made it possible to offer help
to a greater number and to a wider range of patients than
long-term psychotherapy. It is also a convenient meeting
point for several contemporary models of treatment and
should thus appeal to a therapist who values eclectism and
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research to the clinical situation. Behaviour therapists
stress the empirical evaluation of treatment progress and
outcome and seek to develop specific therapeutic goals and
objectives in order to develop specific therapeutic goal and
objectives in order to facilitate the assessment of outcome.
The role of enviromental-especially social-variables in the
maintenance and modification of deviant behaviour is
stressec;1..
In behaviour therapy the procedures used depend on the
specific nature of clients problem. Se’veral behavioural
strategies have been developed for the treatment of anxiety
and phobias. In systematic desensitization,
anxiety-eliciting situations are ranked hierarchially by the
client. The client is usually taught relaxation, a response
incompatible with anxiety. While relaxed, the client is then
exposed, in imaginatio’n, to gradually increasing
anxiety-arousing situations, moving on to the next situation
only when the previous one can be tolerated comfortably. In
real life, desensitizatio!l involves gradual exposure to
stimuli relaxation and has been found to be a more powerful
procedure than the imaginal variety. Flooding (or implosion)
is a strategy based on the principle of extinction. If a
client can be induced to remain in a fearful situation long
enough experience that the unconditioned stimulus, or
dreaded consequences, will not actually occur, then anxiety
responses will extinguish. Flooding may be accomplished
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either in real life or in imagination.
In participant modeling, clients·observe a model engage
the feared stimulus and then are encouraged to engage it
themselves, sometimes with direct coaching by the therapist.
Exposure to the feared stimulus appears to be the· key
element, in that exposure permits extinction of anxiety
responses.
Response prevention, modeling and thought stopping have
shown their efficacy with obsessional neurosis.
Operant. methods have been widely employed in
psychotherapeutic sett.ings and are especially useful and
powerful in closed environments. A token economy is a way of
bringing the principle of reinforcement to bear on the
behaviour of chronic mental patients. Token economies are
demonstrably effective in changing the institutional
behaviour of chronic mental patients, but is less certain
that they promote better adjustment after patients leave the
hospital.
Aversion is another behaviour therapy strate~y. It is
used primarily to reduce or eliminate serious behavioural
excesses such as self destructive behaviour, drinking,
smoking, .·or drug abuse. In aversive counter conditioning,
previously attractive stimuli such as the sight of a drink
come to acquire aversive properties by being paired
repeatedly with an aversive event such as electric shock. In
punishment, an aversive stimUlus is applied contingently on
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the performance of some undesirable behaviour in order to
suppress the behaviour. Concerns about the possible side
effects of punishment as well as humanissues restrict its
application.
cognitive-bahavioural therapy is an extension of the
earlier behavioural paradigm that emphasized overt
responses. cogniti ve processes may become the targets of
intervention efforts or maybe used to implementtherapeutic
procedures • cognitive-behavioural therapy is used
successfully in treatment of depression.
Research has been conducted on the various kinds of
behaviour therapy. Behaviour therapy does appear to be
demonstrably more effective than other therapies for certain
specific problems such as anxieties or phobias, sexual
deviation I sexual dysfunctions and depression with
cognitive-behavioural ’t,herapy. But the relative
effectiveness of behaviour therapy for most mental health
problems remains unknown. Cost effectiveness may be’ the
major advantage of behaviour therapies, because they require
relatively less formal training, tend to be shorter in
duration, and seemapplicable to a wide variety of problems.
Spiritual therapy showed the effect of religion in
treatment and prevention of drug addiction, introversion,
depression, suicide and sexual perversion. Increased
interest among professional counselors in spiritual
dimensions of counseling had been referred to.
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Art therapy is a new therapy that struggles toward
recognition. The similarity between the methodology of art
therapy and psychoanalytic therapy provides the art
therapist with an enormous amount of clinical information
that implies a greater appreciation for this modality as a
diagnostic and therapeutic process.
Phenomenlogical theories contend that behaviour is
-determined by the meaning an individual gives to an
experience, not by the experience in itself. sometimes
called the third force, this humanistic view opposes the
Freudian idea that behaviour is deterained by instincts as
well as the behavioural view humans as strictly creatures of
conditioning. The mature person is seen instead as rational,
capable of making and acting on the basis of conscious
Choices, and able to plan for the future. Disordered
behaviour to the phenomenolgist represents a failure in the·
growth process. Therapeutic intervention is focused on the
present, the here and now.
Client centered therapy, the most familiar
phenomenlogical process, was developed by Carl Rogers, who
urged therapists to help the clients natural drive toward
self actualization by creating a permissive non
authoritarian, nonjudgmental therapeutic atmosphere. If
therapists were genuine and experienced empathy and
unconditional positive regard toward the Client, and that
person perceived the therapists attitude, then Rogers
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believed effective personality change could come about.
unlike most phenomenologists, Rogers has actively pursued
outcome research on the therapeutic process~
Gestalt therapy, founded by Fritz Perls, is also a here
and now approach that stresses the persons awareness; to
Perls, nothing exists except the now. Frequently using a
group workshop setting, Gestaltists urge their clients to
become aware of how they use their resources ineffectively
and what they do to block achieving what they want, rather
than speculating on why. Perls use of dream material is
unique in that he has the client assume all the parts of
dream as parts of himself or herself.
Existential psychotherapists view individuals as free
to make conscious choices in giving meaning to their lives,
at the same time taking responsibility for the existence
they have created through their choices. In particular they
aim at such common manifestations of anxiety as loneliness,
detachment, alienation, depersonalization, and aimlessness.
Existential psychotherapy is an approach focusing on
the patients ways of experiencing and responding to the four
major facts of human life :dealth, freedom I responsibility,
isolation I sepez-at.eneas , and meaninglessness. These are
present in everyday existence. The focus of existential
psychotherapy is the in-depth exploration of the thought
content and processes of the patients inner experiences.
This focus encourages patients to take responsibility for
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• both successes and the failures in their lives. The
therapist explores the patients experiences witWbut prior
assumptions, prejudices, or presuppositions. Patients are
invited to talk, exlpore, and discover themselves as much as
possible and are encouraged to spell out their concerns. As
awareness and clarification of their experience increase and
as patients qrow to trust themselves more, they qain a
greater sense of control, freedom and choice.
Group psychotherapy is an established method of
treatment in which patients may achieve relief of symptoms
and resolution of intrapsychic and interpersonal problems as
a result of interactions with other patients and the
.therapist, both in inpatient and out patient settings.
Therapy groups may be heterogenous or homogenous, open or.
closed.
The. major benefits of group therapy are mediated by
group membership. Compared with individual therapy, its main
advantages are a greater sense of reality, reduced social
isolation, group acceptance and support, the imitation of
successful coping styles, opportunities for feedback as well
as altruism, increased sensitivity and holding out of hope.
Group therapy is practiced in a variety of ways, most
outstanding are psychoanalytic groups, psychodrama,
transactional analysis, behaviour therapy groups, encounter
groups, marathon groups.
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The question of group therapy’s effectiveness posses a
number of difficult methodological and conceptual problems,
although overall there seems to be evidence that the
app roach is potent and effective especially with
schizophrenics. The clear superiority of one type of group
treatment over another has not yet been established.
Encounter group have also been found to have a modest
positive effect on participants, although the experience is
potentially hazardous for some people.
Family therapy is a valid·type of psychotherapy whose
clinical effectiveness has been documented by researches.
Four theoretical approaches domin’ate the field today:
Psychodynamic, communications, structural and behavioural
theories of family theory. Recent studies suggest that
family therapy may be successfully used to treat problems
that do not respond to traditional treatment approaches, as
for example, the management of schizophrenic patients.
Studies have shown that sch~zophrenic patients living in
stressful family situations are prone to frequent relapses
despite ·drug therapy. Involvement of the families of
schizophrenic patients in therapy significantly reduces the
frequency of relapse and the need for·rehospitalization.
As regards combined psychotherapy and pharmacotherapy,
it was found that tnis combination leads to better results
than each modality used alone especially with schizophrenia
and depression.
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It was concluded in the end that psychotherapy in
general tends to be more effective than no treatment and
that no one kind of psychotherapy appears to be demonstrably
superior.
A high percentage of patients who go through any of
these psychotherapies gain from them. Psychotherapy and
pharmacotherapy combination leads to better results than
each modality used alone and thus we recommend their
combination.