Evaluate 3 Approaches to treating Mental Disorders: Psychodynamic, Biological and Behavioural Approach.

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Evaluate 3 Approaches to treating Mental Disorders:

Psychodynamic, Biological and Behavioural Approach.

When looking at the treatment of people with mental health issues there have been various methods tried, some having  limited success and some having long term success, in this essay I shall discuss the three listed in the title along with the benefits and weaknesses of each.

Psychodynamic Approach:

The concept of the psychodynamic approach is to explain behaviour in terms of the forces that drive it. The best known example of this approach is Freud’s theory of personality, although there are many other psychodynamic theories based on Freud’s ideas. Sigmund Freud was the first to challenge the view that mental disorders were caused by physical illness and proposed that psychological factors were responsible for the illness. The psychodynamic approach highlights the importance of the unconscious mind and early childhood experiences. Psychodynamic psychologist’s attempt to deal with the mental health issues of their patients by incorporating these ideas and creating therapies using these ideas. The basic concept behind psychoanalysis is that a patient that suffers from mental health problems such as depression can address any regressed feelings thus, the patient gains insight of and can learn to work through their emotional baggage. It is a generalised concept that if the cause of the symptoms were tackled it would only be logical that the symptoms would then cease.

The Psychodynamic theory assumes the personality is split into three parts, the id (most primitive, instinctive part we have from birth), the ego (logical, balances out the id and superego) and the superego or moral part of our personality. These areas influence our behaviour as well as the defence mechanisms of the ego, and the psychosexual stages of development. Defence mechanisms are used by the ego to help balance out the id and superego to make sure the person isn’t overly impulsive and behaves in a socially acceptable way, without being overly self-conscious. If a person’s superego majorly outweighs the ego, the person may be depressed and not feel good enough for anything. If the person’s id outweighs, they are likely to be more aggressive and immoral as their superego doesn’t have much control. Defence mechanisms such as repression put bad memories into the unconscious to try to get rid of the bad memory to help reach a balance, but depression can occur from this. Depression, anxiousness and aggressiveness are results of imbalances of the id and superego, and the defence mechanisms work to fight against the imbalance. Denial is another example of a defence mechanism and this is where we refuse to accept or admit something embarrassing which is occurring. The psychosexual stages of development oral, anal, phallic, latency and genital also affect personality as if someone experiences trauma, certain behaviours occur as a result of over tidiness at the anal stage. This links back to the assumptions of the approach, where childhood experiences may have an effect on the adult personality. People who suffer trauma during the oral stage between 0-1 years old, where the id is developed can become excessively dependant on others and have psychological problems with food or drink e.g. bulimia or anorexia. Trauma during the anal stage between 1-3 years old, where the ego is developed can result in stubbornness and stinginess, whereas problems during the phallic stage between 3-6 years old, where the superego is developed can cause a weak superego with no guilt or shame, a strong superego can lead to excessive guilt or tendencies to be overly sexual.

Psychodynamic therapies:

The psychodynamic approach utilises psychoanalysis, dream analysis and free association as forms of therapies, with dream analysis the aim is to make unconscious material conscious. It has been used to treat mental illnesses such as depression and anxiety as well as provide an explanation for it. It links back to the main assumptions of the psychodynamic approach that our mind and behaviour is controlled mostly by our unconscious thoughts, and if a traumatic event is experienced memories may be repressed into the unconscious, possibly leading to mental health problems.

Dream Analysis:

 Dream analysis is a form of therapy that enables the unconscious material accessible in order to deal with painful repressed memories and explain an individual’s depression. Dream analysis works by a patient visiting a therapist whose job it is to listen to them and provide an explanation or theory for what they are dreaming about. The manifest content is what is remembered as soon as you wake up and is irrelevant, but the latent content is what is important because this is what is used to explain what is going on. Freud described dreams as ‘the royal road to knowledge of the activities of the unconscious mind’. There are four dream analysis components symbolisation, condensation, displacement and secondary elaboration that are used as part of the explanation. Symbolisation is associating an object with someone or something else, secondary elaboration is piecing things together and sequencing them, displacement is dreaming of one person even though it really means someone else similar to them, and condensation is combining two things together. Dream analysis has been shown to work, here are some studies to show the effectiveness as Sandell (2000) conducted research whereby over 750 patients had dream analysis and demonstrated better long term results on measures of symptom relief, social maladjustment and existential attitudes for psychoanalysis compared to short term and other long term psychotherapies. Another study by Solms (2000) used Positron Emission Tomography (PET) scans to highlight the regions of the brain that are active when dreaming, the results showed that the rational part of the brain is indeed inactive during rapid eye movement (REM) sleep, whereas the forebrain centres which are concerned with memory and motivation are very active. In Freudian terms, the ego or rational and conscious thought becomes suspended while the id, more primitive, unconscious and driven part of the mind is given free reign. Another source of support comes from earlier research by Hopfield et al (1983) on neural networks, in which computer simulations were used to mimic the action of the brain, these simulations showed how neural networks deal with an overloaded memory by combining or condensing memories. This supports Freud’s notion of condensation where unacceptable desires are censored and dealt with by recombining fragments until they emerge in a new form or the obvious content of the dream. However there are some negatives associated with dream analysis, it is very expensive as often the therapy is longitudinal as it takes a long time therefore likely to cost more with the amount of sessions involved and any theories about dreams are very subjective as one therapist could have a different suggestion or explanation to another.


In psychoanalysis a therapist would have a patient lie on a couch, relax and talk freely about their past, childhood, dreams, personal experiences and memories that they feel are affecting them while the therapist  takes notes and tries to interpret these thoughts, feelings and memories. However due to the nature of defence mechanisms and the inaccessibility of the inevitable forces operating in the unconscious, psychoanalysis in its classic form can be a very lengthy process often involving 2 to 5 sessions per week for several years.  The approach assumes that the reduction of symptoms alone is relatively insignificant 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.  Freud believed that this showed associations between thoughts that are caused by unconscious forces. The job of the therapist is to work out and interpret these connections and bring unconscious thoughts into the conscious mind.

Free Association

A simple technique of psychodynamic therapy is free association where a therapist reads 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 by means of an excessively long pause often provides a strong clue that the client is getting close to some important repressed memory 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 later it would be called a catharsis.

Freud believed that pauses and embarrassed laughs gave clues to areas that were causing problems. In a famous study Freud initially collaborated with Josef Breuer another physician and physiologist who had a patient known as Anna O who was suffering from paralysis of the extremities on her right hand side, hallucinations and disturbances of speech and vision. Freud was convinced that she was suffering from hysteria caused by the death of her father.  During her treatment Freud and Breuer discovered that recalling traumatic experiences with the help of free association cured her paralysis.  In 1895, Freud and Breuer published Studies in Hysteria, which documented the cathartic method, also known as the talking cure. The case of Anna O is widely considered as the beginning of psychoanalysis.  Breuer initially attempted treatment via hypnosis but Anna herself found simply talking to be more effective and Free Association was born. Pole and Jones (1998) recorded more than 200 sessions of psychoanalysis with a single patient, where they compared the complexity of the free associations with the symptoms the patient was experiencing, and found that the symptoms were reduced during periods of particularly rich free associations, suggesting that free association does have a beneficial effect.

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Further Therapies:

Other therapies used by the psychodynamic model include the famous Rorschach inkblot test. Developed by Hermann Rorschach in 1918, after noticing that patients diagnosed with schizophrenia made radically different associations to the Klecksographie inkblots than normal people. He developed the Rorschach test as a diagnostic tool for schizophrenia. The Rorschach test involves looking at a set of cards containing pictures of inkblots that have been folded over on themselves to create a mirror image. The test is what psychologists call a projective test with the idea that when a person is shown an ambiguous or meaningless ...

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