Describe and Discuss Two Alternative Psychological Approaches To Abnormal Behaviour

Meichenbaum believes that neurotic behaviour is due partly to faulty internal speech dialogues in which a patient fails to self-instruct successfully, for instance, people who have difficulty recovering after exposure to a trauma continue to behave in ways that may no longer be necessary. It is a therapist's task to help clients understand and appreciate the adaptive value of how they respond, but to also help them appreciate the "price" of continuing to respond in this fashion, when it is no longer needed. This approach helps clients reframe their reactions as adaptive strengths, rather than as signs of mental illness. The idea is to work together to help them not only change their behaviour, but also to tell their "stories" differently.

The goal is to help the client in the initial phase of stress to better understand what they have been through, how are things now, how would they like them to be, and what can their therapist do, whilst working together, to help them achieve their goals?

People in a post-traumatic stage will no doubt have intrusive thoughts, ie., denial , dissociation, moments of overwhelming rage, all represent coping efforts and all are perfectly understandable. For example, intrusive thoughts may be a way of making sense of what happened as an attempt to answer the "why questions". Denial may be an attempt to help oneself take timeout from dealing with huge amounts of stress and not have to deal with it all at one time

Similarily, Ellis believes that irrational thoughts are the main causes of all types of distress and abnormal behaviour. Irrational thinking leads to a self-defeating internal dialogue, consisting of negative self-statements. As with other disorders, the aim of therapy is to replace these irrational beliefs and ideas with more realistic ones. Basically patients are told to look on the bright side, stop worrying and pull themselves together. Some of the irrational beliefs more commonly associated with psychological problems are: ' i must be loved and accepted by absolutely everybody', 'I must be excellent in every possible way', 'I must never make mistakes otherwise i am worthless'. The patient is asked to prove that they are worthless because they make mistakes, or to say exactly how making mistakes makes them worthless.

This collaborative process of therapy is designed to help the client "say" different things to himself, as well as, to others. The main element of cognitive therapy is that an effective way of having people to talk to themselves differently is to have them behave differently, but such change is not enough, it is important for clients to take credit for the changes that they have brought about.

So although the ideas differ slightly according to the problem, the main objective of cognitive therapy is the same all round, to alter thought process.

Psychodynamic therapy was mainly the brainchild of Sigmund Freud.A key concept introduced by Freud is that the mind possesses a number of 'defence mechanisms' to attempt to prevent conflicts from becoming too acute, such as repression (pushing conflicts back into the unconscious). Repression is one of the defence mechanisms which the ego seeks to avoid internal conflict and pain.

Freud formulated and developed the idea that many neuroses (phobias, hysterical paralyses and pains, some forms of paranoia, etc.) originated from deeply traumatic experiences which had occurred in the past life of the patient but which were now forgotten and hidden from consciousness. The task of psychodynamic therapy is to find the repressions which are causing the neurotic symptoms by delving into the unconscious mind of the subject, and bringing the repressed feelings to the forefront of consciousness, to allow the ego to confront them in every way thus discharging them, and eventually removing the underlying psychological causes of the neurotic symptoms. Again, the aim of therapy is to provide the client with insight, knowledge and self-understanding. This kind of therapy is often used in people who have deep rooted feelings, usually connected with events that happened during childhood, and therefore to understand why the person is behaving in this way, there is a need to delve into their past, usually with emotional consequences.

Freud used three methods to reveal the client's unconscious mind, transference, dream interpretation and free association.

For the importance of this therapy, the analyst is meant to remain anonymous, he should not show any emotion or reveal any personal information and should not make any judgements regarding anything the client might say. Freud, for this reason used a couch which he would require the client to lie on whilst he (the analyst) would sit behind out of the client's field of vision. He would then encourage them to speak openly and freely in the belief that he could thereby make out the unconscious forces lying behind what was said. The process of transference was to redirect the feelings and emotions of love and hate from the memories of the perpertrator onto the analyst, who then becomes the new object of the patient's aggression. This in turn can be interpreted by the analyst, therefore providing a basis for identifying and accepting the problem.

Dream interpretation was another way of revealing what the patient was repressing. What we dream about and are conscious of when we awaken(the bit we remember) is called the manifest content, whilst the actual meaning of the dream (the wish being fulfilled) is the latent content. The manifest content is usually the product of piecing together certain fragments from that day's events and the forbidden wish. It often seems disjointed and fragmented, and sometimes bizarre and without making sense, but by disentangling bits from the manifest content , the latent content would be revealed.

Free association is a technique used to allow the client to say whatever comes into his mind, no matter how silly, irrelevant or embarrassing it may seem. Even if they don't make sense together, there may be some clues as to what the underlying cause of the problems are, hidden in what the client has to say.

In this sense, then, the object of psychoanalytic treatment may be said to be a form of self-understanding - once this is acquired, it is largely up to the patient, in consultation with the analyst, to determine how he shall handle this newly-acquired understanding of the unconscious forces which motivate him

It is difficult to specify what counts as a cure for a neurotic illness. Generally, however, the efficiency of a given method of treatment is usually clinically measured by means of a 'control group' - the proportion of patients suffering from a given disorder who are cured by treatment X is measured by comparison with those cured by other treatments, or by no treatment at all. Such clinical tests as have been conducted indicate that the proportion of patients who have benefited from psychoanalytic treatment cannot be separated significantly from the proportion who recover spontaneously or as a result of other forms of intervention in the control groups used. In fact according to Eysenck(1952), psychoanalytic therapies had lower success rates (44%) than other therapies, but later in 1977, Smith & Glass showed with a meta analysis of general success rates, that psychoanalysis is more effective for most people, than having no therapy at all. So the question of the therapeutic effectiveness of psychoanalysis remains an open and controversial one.

Cognitive therapies on the other hand, with problems such as depression, have shown to be just as successful as if being treated by drugs, with some studies reported to have shown higher success rates. Cognitive therapy can be done in group form which would probably be more beneficial as it would make individual clients understand that there are people in the same situation as themselves, thus making them rethink and realise that their thoughts are irrational. Psychoanalysts would argue that if the underlying causes of the disorder are not investigated, then the problem will crop up again in the form of another phobia. The only problem with psychodynamic therapy is that it can be a bit harsh in the way it delves into a person's past and sometimes unearths things that are best left alone, leaving the patient in a worse state than before.

So it's fair to say that there is no perfect cure for any disorder. Where psychodynamic therapy might benefit people with hysteria, phobias and obsessive compulsive disorders, cognitive therapy is more beneficial to people suffering from depression, stress and schizophrenia.