Treatments

Specification

• Systematic desensitisation.

• Psychoanalysis, including free association and dream analysis, transference and counter transference, and the object relations school of thought.

Systematic Desensitisation

There are two behaviourist therapies used to treat phobias, systematic desensitisation and flooding. Both therapies use the principles of classical conditioning to replace a person’s phobia with a new response – relaxation.

Systematic desensitisation uses reverse counter-conditioning to unlearn the maladaptive response to a situation or object, by eliciting another response (relaxation).

There are three critical components to systematic desensitisation:

• Fear hierarchy

• Relaxation training

• Reciprocal inhibition

Firstly, the client and therapist work together to develop a fear hierarchy, where they rank the phobic situation from least to most terrifying.

For example:

Thereafter, an individual is taught relaxation techniques, for example breathing techniques, muscle relaxation strategies, or mental imagery techniques.

The final component of systematic desensitisation involves exposing the patient to their phobic situation, while relaxed.

According to systematic desensitisation, two emotional states cannot exist at the same time, a theory known as reciprocal inhibition.

Therefore, a person is unable to be anxious and relaxed at the same time and the relaxation should overtake the fear. The patient starts at the bottom of the fear hierarchy and when the patient can remain relaxed in the presence of the stimulus, they gradually progress onto the next level. The patient gradually moves their way up the hierarchy until they are completely relaxed in the most feared situation; at this point systematic desensitisation is successful.

Evaluation of systematic desensitisation

One strength of systematic desensitisation comes from research evidence which demonstrates the effectiveness of this treatment for phobias.

McGrath et al. (1990) found that 75% of patients with phobias were successfully treated using systematic desensitisation, when using in vivo techniques (see below). This shows that systematic desensitisation is effective in treating phobias.

Extension: Further support comes from Gilroy et al. (2002) who examined 42 patients with arachnophobia (fear of spiders). Each patient was treated using three 45-minute systematic desensitisation sessions. When examine three months and 33 months later, the systematic desensitisation group were less fearful than a control group (who were only taught relaxation techniques). This provides further support for systematic desensitisation, as a long-term treatment for phobias.

However, systematic desensitisation is not effect in treating all phobias. Patients with phobias which have not developed through a personal experience (classical conditioning) for example, a fear of heights, are not effectively treated using systematic desensitisation. Some psychologists believe that certain phobias, like heights, have an evolutionary survival benefit and are not the result of personal experience, but the result of evolution. These phobias highlight a limitation of systematic desensitisation which is ineffective in treating evolutionary phobias.

Psychoanalysis

Psychoanalysis is defined as a set of psychological theories and therapeutic methods which have their origin in the work and theories of Sigmund Freud.

The primary assumption of psychoanalysis is the belief that all people possess unconscious thoughts, feelings, desires, and memories.

The aim of psychoanalysis therapy is to release repressed emotions and experiences, i.e., make the unconscious conscious. It is only having a cathartic (i.e., healing) experience can the person be helped and "cured."

Basic Assumptions

• Psychoanalytic psychologists see psychological problems as rooted in the unconscious mind.

• Manifest symptoms are caused by latent (hidden) disturbances.

• Typical causes include unresolved issues during development or repressed trauma.

• Freud believed that people could be cured by making conscious their unconscious thoughts and motivations, thus gaining insight.

• Treatment focuses on bringing the repressed conflict to consciousness, where the client can deal with it.
  

How can we understand the unconscious mind?

psychoanalysis is a therapy as well as a theory. Psychoanalysis is commonly used to treat depression and anxiety disorders.

In psychoanalysis (therapy) Freud would have a patient lie on a couch to relax, and he would sit behind them taking notes while they told him about their dreams and childhood memories. Psychoanalysis would be a lengthy process, involving many sessions with the psychoanalyst.

Due to the nature of defense mechanisms and the inaccessibility of the deterministic forces operating in the unconscious, psychoanalysis in its classic form is a lengthy process often involving 2 to 5 sessions per week for several years.

This approach assumes that the reduction of symptoms alone is relatively inconsequential as if the underlying conflict is not resolved, more neurotic symptoms will simply be substituted.

The analyst typically is a 'blank screen,' disclosing very little about themselves in order that the client can use the space in the relationship to work on their unconscious without interference from outside.

The psychoanalyst uses various techniques as encouragement for the client to develop insights into their behavior and the meanings of symptoms, including inkblots, parapraxes, free association, interpretation (including dream analysis), resistance analysis and transference analysis.

Free Association

A simple technique of psychodynamic therapy is free association, in which a patient talks of whatever comes into their mind.

This technique involves a therapist reading a list of words (e.g.. mother, childhood, etc.) and the patient immediately responds with the first word that comes to mind. It is hoped that fragments of repressed memories will emerge in the course of free association.

Free association may not prove useful if the client shows resistance, and is reluctant to say what he or she is thinking. On the other hand, the presence of resistance (e.g., an excessively long pause) often provides a strong clue that the client is getting close to some important repressed idea in his or her thinking, and that further probing by the therapist is called for.

Freud reported that his free associating patients occasionally experienced such an emotionally intense and vivid memory that they almost relived the experience. This is like a "flashback" from a war or a rape experience.

Such a stressful memory, so real it feels like it is happening again, is called an abreaction. If such a disturbing memory occurred in therapy or with a supportive friend and one felt better--relieved or cleansed--later, it would be called a catharsis.

Frequently, these intensely emotional experiences provided Freud a valuable insight into the patient's problems.

Dream Analysis

According to Freud the analysis of dreams is "the royal road to the unconscious." He argued that the conscious mind is like a censor, but it is less vigilant when we are asleep.

As a result, repressed ideas come to the surface - though what we remember may well have been altered during the dream process.

As a result, we need to distinguish between the manifest content and the latent content of a dream. The former is what we actually remember.

The latter is what it really means. Freud believed that very often the real meaning of a dream had a sexual significance and in his theory of sexual symbolism he speculates on the underlying meaning of common dream themes.

Transference

A client undertaking psychoanalysis sees the analyst as an important figure from their childhood. The client feels and behaves towards the analyst how they felt and behaved towards the person from their childhood. The analyst then uses this behaviour to understand the client better and enable the client to gain insight into their behaviour.

Counter-transference

Counter-transference is when the therapist responds to their client in the same way the client’s parents (etc.) may respond.. This allows the therapist to see how the client responds and then explore how this reaction from the client’s parents (etc.) may have led to the client’s unconscious response of acting in a certain manner (i.e. childlike).

Evaluation

• Therapy is very time-consuming and is unlikely to provide answers quickly.

• People must be prepared to invest a lot of time and money into the therapy; they must be motivated.

• They might discover some painful and unpleasant memories that had been repressed, which causes them more distress.

• This type of therapy does not work for all people and all types of disorders.

• The nature of Psychoanalysis creates a power imbalance between therapist and client that could raise ethical issues.

• Fonagy (1981) questions whether attempts to validate Freud's approach through laboratory tests have any validity themselves. Freud's theory questions the very basis of a rationalist, scientific approach and could well be seen as a critique of science, rather than science rejecting psychoanalysis because it is not susceptible to refutation.

• The case study method is criticised as it is doubtful that generalisations can be valid since the method is open to many kinds of bias (e.g., Little Hans).

Past Paper Questions

3 Markers

• Describe counter-transference in relation to Tameka and her client. (3) June 2018

• Describe transference as a feature of psychoanalysis. (3) January 2020

4 Markers

• Describe the therapy/treatment Amelia’s therapist would offer. (4) October 2017

• Explain one strength and one weakness of the object relations school of thought therapy/treatment. (4) October 2017

• Psychoanalysis uses many different techniques. Describe free association as it is used in psychoanalysis. (4) June 2018

• Describe how the therapist could use systematic desensitisation to reduce Julio’s fear of bread. (4) January 2019

• Explain one strength and one weakness of systematic desensitisation. (4) January 2019

• Explain one strength and one weakness of psychoanalysis. (4) January 2020

• Explain one strength and one weakness of Phillipe using dream analysis to treat his client. (4) October 2019

8 Markers

• Discuss how Lotte may use psychoanalysis to help Olaf with his problems working with his new manager. You must refer to the context in your answer. (8) January 2018

• Assess the effectiveness of systematic desensitisation as a treatment/therapy. (8) June 2018

• Assess the use of dream analysis as a therapy. (8) June 2017