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Psychodynamic Approach To Clinical Psychology

The psychodynamic approach to clinical psychology was founded under the psychoanalytic school of Sigmund Freud who theorized about personality and the psychosexual stages of development. However, some parts of his theories have been revised and challenged by some other scholars in the psychoanalytic school.

The psychodynamic approach to clinical psychology is based on the following assumptions or ideas:
-         Human behavior is to a large extent determined by unconscious motives, desires, impulses, and conflict that goes on within the mind, and therefore called ‘intra-psychic conflict’. The intra-psychic factors determine both normal and abnormal behavior. Abnormal behavior occurs as a result of unresolved and unmet needs.
-         Early childhood is crucial for human behavior and overall personality development.
-         The foundations for behaviour are set down in childhood through satisfaction or frustration of basic needs and impulses. Because of their central role in these needs, early relationship with family, peers, and authority figures are given special attention.
-         Clinical assessment, treatment, and research should emphasize the aspect of intra-psychic activity, though often hidden from direct observation, must be uncovered if behaviour is to be understood and behavioural problems are to be alleviated.

The goals of psychodynamic approach in therapy are:
To help bring the client to the awareness of the maladaptive ways they have been trying to cope and the sources of their unconscious conflicts. The advocates of this therapeutic approach believe that freeing the client from the grips of the past will give a sense of urgency in making changes in the present (Wolitzky, 1995; Wolitzky & Eagle, 1997; Messer & Wolitzky, 1997; Eagle & Wolitzky, 1986; Wolitzky & Eagle, 1999).

 Psychodynamic psychotherapy is a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension.[1] In this way, it is similar to psychoanalysis.
To discover and resolve unconscious conflicts that drives psychological symptoms.
Another goal is to help the client unify aspects of his/her personality that have been split off. Splitting refers to the unconscious failure to integrate aspects of self or others into a unified whole.
Splitting is a term that came out of classical (psychoanalytical or psychodynamic) schools of thought and refers to an unconscious ego defense mechanism by which a fairly complex entity cannot be accepted into consciousness in its entirety because it contains aspects that are both acceptable to a person as well as unacceptable. Relatively underdeveloped personalities, most especially borderline personalities, have a hard time incorporating into consciousness seemingly contradictory aspects of the same person or thing. So, they unconsciously separate or “split” objects into two categories, seeing the “good” side of a person or thing as the part they find acceptable and the “bad” side of the person or thing as the part they find painful or unacceptable. And, it’s much more than just seeing both a good and a bad side to everything. They actually “split” a single entity into two opposing realities, conceptualizing for example a mother who has both a gentle and a terrifying side as alternately “good mommy,” or “bad mommy.” As a result, they will often alternate between over-idealizing and devaluing the same person. Underdeveloped and poorly integrated personalities not only separate difficult to integrate external “objects” or persons this way, but they also “split” into disparate parts aspects of themselves that are hard to integrate into a cohesive whole. So, extreme degrees of internal splitting can result in a fragmentation of the self through such mechanisms as dissociation or even multiple personality formation.
To resolve intra-psychic conflicts, there is a need to let out these conflict, motives, and demands repressed in the unconscious mind through the following techniques:

-         Free association
-         Resistance
-         Transference
-         Slip of tongue (Freudian slip)

Free association
Freud and others have developed the method of ‘free association’ in which the client s taught to talk freely about whatever comes to mind, not to censor or withhold any of his thoughts.
The idea behind this is that, by ‘turning off’ his censor, a client may find himself talking about subjects or memories the he did not even realized in his mind. The therapist notices what themes seem to occur in a client’s free association and can make his deductions from there.

Resistance is the refusal of a client to answer the questions the therapists expect him to answer. This often occurs in the phase of investigating the unconscious mind. The clinician discovers that anytime he mentions similar issue, the client may give excuses or divert the topic of discussion to something else. This is called ‘client’s resistance’. For example, the clinician may ask, ‘’when last did you see your uncle?’’. The client may respond that ‘’my uncle? Just leave him alone’’. Clinicians usually take this very important because the most threatening conflicts are the ones the ego tries hardest to repress; the clinicians try to interpret the conflict.
This is a situation whereby a client reacts to the therapist as if the therapist were an important person (such as a mother, father e.t.c.) in his early development. Most times, therapists use ‘’working through’’ that is, going over and over painful memories and difficult issues and are therefore, able to construct them into their self-definition in ways that are acceptable and allow them to move forward in their lives.

Slip of tongue (Freudian slip)
Also called parapraxis, is a minor error in action, such as slip of the tongue, supposedly the result of repressed impulses. This can also help to reveal the contents of the unconscious mind.

A very important issue in psychodynamic therapy is ‘’therapeutic alliance’’. By being emphatic, supportive and listening non-judgmentally, the therapist creates a relationship of trusts with the client that gives the client the freedom and courage to explore the difficult issues. This does not mean that the therapist never confronts the client about issues that the client may be avoiding but rather, the therapist make use of confrontations and interpretations so that the client can receive and respond to these without undue anxiety (Luborsky and Crits-Christopher).

Criticism against the psychodynamic approach
The criticism against the psychodynamic approach is that it is unscientific in its analysis of human behaviour. Many of the concepts central to Freud’s theories and subjective, making them difficult to test.
Image source: Huffington post

Wolitzky, D.L. & Eagle, M. (1999) The psychodynamic treatment of panic disorder and agoraphobia. In , A.S. Bellack & M. Hersen (Eds.), Handbook of Comparative Treatments for Adult Disorders. New York: Wiley

Wolitzky, D.L. and Eagle, M. (1997) Psychoanalytic Theories of Psychotherapy. In, P.L. Wachtel & S.B. Messer (Eds.) Theories of Psychotherapy: Origins and Evolution. Wash, D.C.: American Psychological Association.

Messer, S.B. and Wolitzky, D.L. (1997) The Traditional Psychoanalytic Approach to Case Formaulation. In, T.D. Eells (Ed.) Handbook of Psychotherapy Case Formulation. New York: Guilford Press.

Eagle, M. & Wolitzky, D.L. (1997) Empathy: A Psychoanalytic Perspective. In, A.C. Bohart & L.S. Greenberg (Eds.), Empathy Reconsidered. Wash., D.C.: American Psychological Association.

Wolitzky, D.L. (1995) The Theory and Practice of Traditional Psychoanalytic Psychotherapy. In, A.S. Gurman & S.B. Messer (Eds.), Essential Psychotherapies. New York: Guilford Press.

Eagle, M. & Wolitzky, D.L. (1986) Book Review. The Process of Psychoanalytic Therapy: Models and Strategies. Psychoanalysis and Contemporary Thought, 9, 1, 79-102.

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