Therapy is generally used to respond to a variety or specific or non-specific manifestations of clinically diagnosable crises. Treatment of everyday problems is more often referred to as counseling (a distinction originally adopted by Carl Rogers) but the term is sometimes used interchangeably with "psychotherapy".
Psychotherapeutic interventions are often designed to treat the patient in the medical model, although not all psychotherapeutic approaches follow the model of "illness/cure". Some practitioners, such as humanistic schools, see themselves in an educational or helper role. Because sensitive topics are often discussed during psychotherapy, therapists are expected, and usually legally bound, to respect client or patient confidentiality.
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is a psychotherapy based on modifying everyday thoughts and behaviors, with the aim of positively influencing emotions. The general approach developed out of behavior modification and Cognitive Therapy, and has become widely used to treat mental disorders. The particular therapeutic techniques vary according to the particular kind of client or issue, but commonly include keeping a diary of significant events and associated feelings, thoughts and behaviors; questioning and testing assumptions or habits of thoughts that might be unhelpful and unrealistic; gradually facing activities which may have been avoided; and trying out new ways of behaving and reacting. Relaxation and distraction techniques are also commonly included. CBT is widely accepted as an evidence-based, cost-effective psychotherapy for many disorders. It is sometimes used with groups of people as well as individuals, and the techniques are also commonly adapted for self-help manuals and, increasingly, for self-help software packages.
Psychodynamic psychotherapy
Psychodynamic psychotherapy is a type of psychotherapy, where the psychotherapist and client meet about once or twice a week. It is different from other systems of psychotherapy, for instance psychoanalysis or cognitive therapy in that it uses a range of different techniques, applied to the client considering his or her needs. A psychodynamic therapist may find that Object relations theory may be best for a client with Borderline Personality Disorder, and the next client who displays some anxiety in her marriage may be given some cognitive therapy to give symptom relief.
History
Psychodynamics was born with the 1874 publication of Lectures on Physiology by German scientist Ernst von Brucke who supposed that all living organisms are energy-systems governed by the principle of the conservation of energy. During this year, at the University of Vienna, Brucke was also coincidentally the supervisor for first-year medical student Sigmund Freud who adopted this new “dynamic” physiology. Later, the theory of psychodynamics was developed further by those such as Carl Jung, Alfred Adler, and Melanie Klein.
Approaches
Most psychodynamic approaches are centered around the idea of a maladaptive function developed early in life (usually childhood) which are at least in part unconscious. This maladapted function (a.k.a. defense mechanism) does not do well as it formed instead of a normal/healthy one. Later on the client will feel discomfort when they notice (or do not notice) that this function causes problems day to day. The psychodynamic therapist will first treat the discomfort associated with the poorly formed function, reveal to the client that such a function exists, then change, remove or replace it with a proper one.
Psychodynamic psychotherapy involves a great deal of introspection and reflection from the client. Usually this level of insight is unfettered when the client wants to be helped or is pushed by family or friends. Speaking to this is also the client's ability to dive into their past; they must possess enough resilience and ego-strength to deal with/use the onslaught of feeling a new perspective brings. The more fragile client may be treated with a different treatment, for instance, cognitive therapy.
Psychoanalysis
"I am actually not at all a man of science, not an observer, not an experimenter, not a thinker. I am by temperament nothing but a conquistador--an adventurer, if you want it translated--with all the curiosity, daring, and tenacity characteristic of a man of this sort" (Sigmund Freud, letter to Wilhelm Fliess, Feb. 1, 1900).
"By the 1950s and '60s, the master's warning had been drowned in a tumult of excited voices. Psychoanalysts and psychiatrists could cure even schizophrenia, the most feared mental disease of all, they claimed, and they could do it simply by talking with their patients" (Dolnick, 12).
"The person best able to undergo psychoanalysis is someone who, no matter how incapacitated at the time, is basically, or potentially, a sturdy individual. This person may have already achieved important satisfactions—with friends, in marriage, in work, or through special interests and hobbies—but is nonetheless significantly impaired by long-standing symptoms: depression or anxiety, sexual incapacities, or physical symptoms without any demonstrable underlying physical cause. One person may be plagued by private rituals or compulsions or repetitive thoughts of which no one else is aware. Another may live a constricted life of isolation and loneliness, incapable of feeling close to anyone. A victim of childhood sexual abuse might suffer from an inability to trust others. Some people come to analysis because of repeated failures in work or in love, brought about not by chance but by self-destructive patterns of behavior. Others need analysis because the way they are—their character—substantially limits their choices and their pleasures." (American Psychoanalytic Association)
Sigmund Freud (1856-1939) is considered the father of psychoanalysis, which may be the granddaddy of all pseudoscientific psychotherapies, second only to Scientology as the champion purveyor of false and misleading claims about the mind, mental health, and mental illness. For example, in psychoanalysis schizophrenia and depression are not brain disorders, but narcissistic disorders. Autism and other brain disorders are not brain problems but mothering problems. These illnesses do not require pharmacological or behavioral treatment. They require only "talk" therapy. Similar positions are taken for anorexia nervosa and Tourette's syndrome. (Hines 1990: 136) What is the scientific evidence for the psychoanalytic view of these mental illnesses and their proper treatment? There is none.
Freud thought he understood the nature of schizophrenia. It is not a brain disorder, but a disturbance in the unconscious caused by unresolved feelings of homosexuality. However, he maintained that psychoanalysis would not work with schizophrenics because such patients ignore their therapist's insights and are resistant to treatment (Dolnick 1998: 40). Later psychoanalysts would claim, with equal certainty and equal lack of scientific evidence, that schizophrenia is caused by smothering mothering. In 1948, Frieda Fromm-Reichmann, for example, gave birth to the term "schizophrenogenic mother," the mother whose bad mothering causes her child to become schizophrenic (ibid. 94). Other analysts before her had supported the notion with anecdotes and intuitions, and over the next twenty years many more would follow her misguided lead.
Would you treat a broken leg or diabetes with "talk" therapy or by interpreting the patient's dreams? Of course not. Imagine the reaction if a diabetic were told that her illness was due to "masturbatory conflict" or "displaced eroticism." One might as well tell the patient she is possessed by demons, as give her a psychoanalytic explanation of her physical disease or disorder. Exorcism of demons by the shaman or priest, exorcism of childhood experiences by the psychoanalyst: what's the difference? So why would anyone still maintain that neurochemical or other physical disorders are caused by repressed or sublimated traumatic sexual childhood experiences or wishful fantasies? Probably for the same reason that theologians don't give up their elaborate systems of thought in the face of overwhelming evidence that their systems of belief are little more than vast metaphysical cobwebs. They get a lot of institutional reinforcement for their socially created roles and ideas, most of which are not capable of being subjected to empirical testing. If their notions can't be tested, they can't be disproved. What can't be disproved, and also has the backing of a powerful institution or establishment, can go on for centuries as being respectable and valid, regardless of its fundamental emptiness, falsity, or capacity for harm.
The most fundamental concept of psychoanalysis is the notion of the unconscious mind as a reservoir for repressed memories of traumatic events which continuously influence conscious thought and behavior. The scientific evidence for this notion of unconscious repression is lacking, though there is ample evidence that conscious thought and behavior are influenced by nonconscious memories and processes.
Related to these questionable assumptions of psychoanalysis are two equally questionable methods of investigating the alleged memories hidden in the unconscious: free association and the interpretation of dreams. Neither method is capable of scientific formulation or empirical testing. Both are metaphysical blank checks to speculate at will without any check in reality.
Scientific research into how memory works does not support the psychoanalytic concept of the unconscious mind as a reservoir of repressed sexual and traumatic memories of either childhood or adulthood. There is, however, ample evidence that there is a type of memory of which we are not consciously aware, yet which is remembered. Scientists refer to this type of memory as implicit memory. There is ample evidence that to have memories requires extensive development of the frontal lobes, which infants and young children lack. Also, memories must be encoded to be lasting. If encoding is absent, amnesia will follow, as in the case of many of our dreams. If encoding is weak, fragmented and implicit memories may be all that remain of the original experience. Thus, the likelihood of infant memories of abuse, or of anything else for that matter, is near zero. Implicit memories of abuse do occur, but not under the conditions which are assumed to be the basis for repression. Implicit memories of abuse occur when a person is rendered unconscious during the attack and cannot encode the experience very deeply. For example, a rape victim could not remember being raped. The attack took place on a brick pathway. The words 'brick' and 'path' kept popping into her mind, but she did not connect them to the rape. She became very upset when taken back to the scene of the rape, though she didn't remember what had happened there (Schacter: 232). It is unlikely that hypnosis, free association, or any other therapeutic method will help the victim remember what happened to her. She has no explicit memory because she was unable to deeply encode the trauma due to the viciousness of the attack which caused her to lose consciousness. The best a psychoanalyst or other repressed-memory therapist can do is to create a false memory in this victim, abusing her one more time.
Essentially connected to the psychoanalytic view of repression is the assumption that parental treatment of children, especially mothering, is the source of many, if not most, adult problems ranging from personality disorders to emotional problems to mental illnesses. There is little question that if children are treated cruelly throughout childhood, their lives as adults will be profoundly influenced by such treatment. It is a big conceptual leap from this fact to the notion that all sexual experiences in childhood will cause problems in later life, or that all problems in later life, including sexual problems, are due to childhood experiences. The scientific evidence for these notions is lacking.
In many ways, psychoanalytic therapy is based on a search for what probably does not exist (repressed childhood memories), an assumption that is probably false (that childhood experiences cause the patient's problems) and a therapeutic theory that has nearly no probability of being correct (that bringing repressed memories to consciousness is essential to the cure). Of course, this is just the foundation of an elaborate set of scientific-sounding concepts which pretend to explain the deep mysteries of consciousness and behavior. But if the foundation is illusory, what possibly could be the future of this illusion?
There are some good things, however, which have resulted from the method of psychoanalysis developed by Sigmund Freud a century ago in Vienna. Freud should be considered one of our greatest benefactors if only because he pioneered the desire to understand those whose behavior and thoughts cross the boundaries of convention set by civilization and cultures. That it is no longer fashionable to condemn and ridicule those with behavioral or thought disorders is due in no small part to the tolerance promoted by psychoanalysis. Furthermore, whatever intolerance, ignorance, hypocrisy, and prudishness remains regarding the understanding of our sexual natures and behaviors cannot be blamed on Freud. Psychoanalysts do Freud no honor by blindly adhering to the doctrines of their master in this or any other area. Finally, as psychiatrist Anthony Storr put it: "Freud's technique of listening to distressed people over long periods rather than giving them orders or advice has formed the foundation of most modern forms of psychotherapy, with benefits to both patients and practitioners" (Storr 1996: 120).
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