Psychosocial Approaches to Therapy | Psychology

After reading this article you will learn about the psychosocial approaches to therapy in treatment of abnormal behaviour.

In-spite of the wide use of biological therapies, nobody can deny the importance of psychosocial therapies. Specially psychotherapy including psychoanalysis has not been forgotten as some might have thought.

Thus Alexander (1946) has rightly observed “psychotherapy is not far removed from the view of most of us.”

The aim of psychotherapy by and large is to:

(a) Charge maladaptive behaviour patterns.

(b) Minimize or eliminate environmental conditions that be the cause of such behaviour.

(c) Improving interpersonal and other competencies.

(d) Resolving handicapping or disabling inner conflict.

(e) Modifying inaccurate assumptions about oneself and one’s world.

(f) Fostering a clear cut sense of one’s self identity and the opening of pathways to a more meaningful and fulfilling existence.

Faulty parent-child relationship reinforced by many years of life experiences, often lead to unhealthy self concept, lower self image and it makes psychotherapy difficult. Moreover in addition to psychotherapy adequate marital, occupational and social requirements need considerable change in the patient’s life situations.

For severe disorders, psychotherapy takes place in a hospital or clinical setting. For minor disorder however, psychotherapy helps on an outpatient basis or it helps the clinical psychologist in private practice.

The steps of psychotherapy are the following through which it progresses:

(1) Creation of a therapeutic atmosphere and relationship,

(2) Emotional release or catharsis,

(3) Insight,

(4) Emotional re-education and

(5) Termination.

Dynamics of Psychotherapy:

Patients must undergo at least a partial change of personality. The psychiatrist must modify his immature, emotional attitudes, eliminate unhealthy but firmly ingrained traits and reorient his views on life. Establishment of a favourable emotional relationship or rapport with the patient is very essential.

Function of the Therapist:

The therapist by his sincerity, good behaviour and understanding must produce a sense of confidence in the patient to get his cooperation. He must be a patient listener, tolerant, sensitive to the feelings of the patient. He must not in any case condemn or ridicule the thoughts and actions of his patients. Unless the patient has confidence on the therapist, the therapy will not be a success.

The patient must be encouraged to persist in his search for greater self understanding. The patient has to be helped to get back his shattered self confidence. The job of the therapist is to show the mirror to the patient so that he can see the reflections of his unconscious desires and wishes and difficulties, can try to solve his difficulties through his own efforts and be able to develop again a healthy mental life.

Freudian Psychoanalysis:

The first formalized type of psychotherapy devised by Freud is called psychoanalysis. According to the Freudians, problems in early psychosexual developmental period lead to the development of certain complexes, repressed memories, motives and conflicts.

Psychoanalysis is mainly an intensive and long-term therapeutic procedure to bring into consciousness these problems and to resolve them in the light of adult reality.

Psychoanalysts insist that by developing an insight into such repressed materials and complexes, the individual will be free from wasting his energy in using unhealthy and unnecessary defence mechanisms.

The theory of psychoanalysis has been postulated by Freud who recognised the existence of unconscious, the storehouse of biological impulses and childhood traumatic experiences. These biological impulses and traumatic experiences cause either neuroses or psychoses or any other type of mental disorder.

Mental disorders result from childhood experiences which weaken the effectiveness of the control and intensity of the intellectual demand consequence anxiety in men. Faulty operation of the control mechanism and overcrowding the personality with dangerous impulses coming from the biological instincts ‘eros and thantos’ — cause great deal of stress and anxiety.

The aim of all psychoanalytical therapy is to attain psychological maturity. The psychotherapy increases the ego strength and decreases the pressure of impulses, giving the patient freedom to run his own life.

When such an aim is achieved the patient develops insight and self knowledge to control his behaviour effectively with the external physical and social world. The four basic techniques of psychoanalysis are free association, dream interpretation, analysis of resistance and analysis of transference.

Free Association:

In the association technique the therapist and the client take their respective seats in the therapeutic room. Usually the patient sits comfortably on a chair or lies in a relaxed position. He is then instructed to allow his mind to wander freely and express spontaneously his thoughts, feelings and desires.

Initially the analyst and the patient may speak face to face, but after some time the patient is instructed to lie on a couch facing away from the therapist.

The therapist sits out of the patients vision and at this stage free association is applied. The therapist as is the usual practice sits behind the patient, so as not to interfere flow of associations of the client.

Then the analyst is asked to report all findings, ideas and associations freely and spontaneously that come to his mind. It is the task of the therapist to identify correctly the repressed materials which lie in the unconscious of the patient.

It is the job of the therapist only to show a mirror to the patient; he interprets the material to the patient, explains him his unconscious desires, guiding him towards increased insight of the underlying motives and conflicts of which he has not been aware till the moment.

This leads to the thought process to slow the conscious level of the mind of the patient. In other words, it is the job of the therapist to make frequent comments and interpretations which helps in upgrading the insight of the patient.

The therapist should encourage facilitating free association and providing opportunity to minimise responses to physical and social stimuli. In the beginning stage of free association thoughts may come up in symbolized manner to avoid censorship. The client should encourage to reduce the censorship as far as practicable to enable the loose thoughts to run their own course to the conscious level of mind.

At this stage the patient gets insight into the problem and discovers causes of his mental illness. This very awareness helps the patient to make self regulation and self control of his own behaviour and finally he is free from symptoms.

Dream Interpretation:

Dream is said to be the royal road or gateway to unconscious. Dream interpretation is another way to uncover and trace the repressed conflicts of the unconscious along with free association technique. By analysing one’s dream his unconscious motives; desires and conflicts can be revealed.

During sleep the repressive defences of the ego are lowered, the desires and wishes which were unaccepted by the ego and hence repressed, get free flow in dream.

But some wishes and desires which are very much forbidden and strictly unacceptable even come in symbolic and disguised form in the content of dreams. As discussed in chapter 6, a dream has two kinds of contents, the manifest and the latent content. The manifest content is the dream as it appears to the dreamers and the latent content consists of the real wishes, motives and desires of the patient.

By interpreting the various symbols in the manifest content of the dream the therapist can uncover these disguised desires, wishes, conflicts and motives which were repressed long back along with the cause or causes of his mental illness.

Freud has found out different symbols and their meanings for the purpose of knowing the significance of a particular dream from the psychological point of view.

Analysis of Resistance:

While the process of free association is in progress, the patient may experience a strong feeling of resistance i.e. inhibit or check the free flow of unconscious complexes and desires to the conscious level. Resistance refers to the unwillingness or inability to relate certain thoughts, motives or experiences.

This is otherwise known as blocking. For example, while disclosing an important personal feeling, immediately the patient might try to check it or change the topic. But in order to get insight into the unconscious process and make the expressed wishes reach the conscious level, it is desirable to break down the resistance This will help him to face his problems and conflicts in a realistic way.

Resistance can be of two types — Direct and Indirect. Refusing to pay, to talk, or to lie on the couch as instructed by the analyst may be categorized under direct resistance while making unreasonable demands for social involvement with the therapist, becoming too emotional and refusing to respond to various interpretations of the analyst may come under indirect resistance.

If, however, the resistance is properly handled, the client gains insight and healthier ways of looking at one’s life and feelings and represent the “corrective analytic growth process”.

Analysis of Transference:

During the process of psychoanalysis the patients act in a very emotional way either positively or negatively, i.e., they either very much like or hate the therapist. This Freud called the transference phenomenon. This is quite important in bringing the cure to the patient.

The transference phenomenon helps in releasing the repressed feelings towards persons resembling the analyst, may be one of the parents, may be the boss in the office, who resembled the parents and the analyst also.

Mrs. Rao, an employee in a particular plant, was very much at cross with her boss; hated her work a lot and it created so much conflict in her that she thought of giving up his job. Psychoanalysis revealed that the lady unconsciously hated her boss who resembled her father whom she terribly hated and feared.

When she discovered this, her lack of interest for the job disappeared. Thus, when the therapist makes attempts to resolve the transference and guides the patient to perceive the situation from a realistic angle, the disease disappears.

Transference according to Freud indicates the approach of a neurotic conflict in the patient’s early childhood. By transferring his repressed feelings, he gives release to it and reaches nearer to the gate of cure.

As viewed by Coleman (1981) “As patient and therapist interact, the relationship between them may become complex and emotionally involved. Often a person carries over and applies to the therapist attitudes and feelings that developed in his relationship with significant others in the past, perhaps reacting to the analyst as he did to his mother or father and feeling the hostility and rejection that he once felt towards his real parents.”

He further adds “In essence, the pathogenic effects of an undesirable early relationship are counteracted by working through a similar emotional conflict in a therapeutic setting. Since the person’s reliving of his own pathogenic past in a sense recreates his real life neuroses; this experience is often referred to as a transference neuroses.”

Not only the patient is emotionally involved with the therapist in the process of transference, the therapist may also develop some sort of mixed feeling towards the patient. This is called counter transference. The analyst must understand his own conflicts, frustrations, motives and complexes and should deal himself cautiously while handling the patient.

The purpose of psychoanalytic therapy is to unveil the mystery of unconscious which is full of conflicts, desires and motives. In addition to this, it also helps the patient to “integrate them into the conscious dimension of his personality.” The aim is to redirect thinking and psychic energies of the individual from neurotic channels into the most adaptive and constructive ways of living.

In course of the progress of therapy the patient gets added insight into his problems and complexes. Towards the end of the therapy the patient gets scope for emotional re-education. It also accelerates the generalisation of new insights into his real life situations.

Evaluation:

Indicating the tremendous importance of psychoanalysis in the treatment of mental diseases, Fine (1973) comments, “Psychoanalysis represents in the social sciences, the greatest intellectual revolution of the 20th century.

It has given mankind a new research tool through the concept of the unconscious and allied factors. It has classified the possibilities of happiness that exist in philosophers that have been prevalent in previous centuries; and it has provided a solid basis for the investigation of man in all his psychological and solid functioning.”

At the end of a successful treatment the individual comes out with a healthy and happy mental state developing a much reformed and positive attitude towards life. However, psychoanalysis has a lot of limitations.

Since it is very time consuming and costly, the benefits of the technique can only be available to a limited few of the society. It is in fact, limited to those who are financially able to have daily treatments for a period or for one year to three years.

In view of its limitations, the classical Freudian psychoanalysis has undergone quite an appreciable change in the direction of reducing the cost and time required. Contrary to the Freudian psychoanalysts, the modern psychoanalysts like neo Freudians have emphasised more on the patient’s current interpersonal relationship than on the childhood experiences of the patient.

Criticism:

But in-spite of these modifications, psychoanalysis still faces certain criticisms. Its application is quite limited as it expects individuals to get insight and achieve major personality change. It can only treat neurotic patients.

Psychoanalysis can only be applied to the clients who are intellectually superior and have the capacity of self introspection and self knowledge. Psychoanalysis is more successful with those clients who were more open and flexible in their mind. It is, therefore, not successful in case of people who are quite rigid in their cognitive structure and not amenable to change.

Psychoanalysis is usually successful in case of those clients who generally have high motivation to retrospect the inner mind, inner feelings and emotion. Its application is quite limited as it expects individuals to get insight and achieve major personality change. It can only treat neurotic patients.

As the cognitive structure of the psychotic patient is extremely rigid, psychoanalysis may not be able to expose his unconscious to the conscious field, there by lacking the scope to get insight into his own problems. Psychoanalysis is highly expensive and time consuming. It may continue in some cases from 1 to 10 years requiring lot of expenditure, patience and sacrifice. Therefore, it is only limited to people who can afford it.

Psychoanalysis is also criticised of based on a biased model of human nature, for neglecting the patient’s immediate problems in search for underlying causes and for lacking experimental evidence for its effectiveness.

In spite of these limitations, psychoanalysis has influenced various forms of individual psychotherapy. Many analysts still use it for the treatment of above average and intelligent neurotic patients. A lot of the people have also profited from psychoanalytic therapy. They report of greater self understanding, relief from inner conflict and anxiety and interpersonal relationship due to psychoanalysis.

Hypnotism:

Hypnosis is one of the oldest methods of psychotherapy having its origin in the 18th century B.C. The origin of hypnosis may be traced to Mesmerism. The method of suggestion which is the key concept of Mesmerism was used by Mesmer to cure mental diseases.

But the claim of Mesmer that he possessed magnetic fluid which enters into the patient’s body and cures him, being mystic and supernatural brought a lot of criticisms from all quarters especially from the physicians of Paris.

They found that the cure by Mesmerism was due to suggestion which was further temporary. Moreover, the French revolution did much to wipe out Mesmerism in France. Though many psychologists later on tried to establish hypnosis, yet James Braid was indeed the inventor of the name of hypnosis whose emphasis upon the subjective nature of hypnosis cannot be exaggerated.

However, Brenheim, Charcot and others built the foundation stone of modern hypnosis. The method of suggestion which was the main feature of hypnotism also became the key concept of hypnotism and cure under hypnosis solely dependent upon the method of suggestion.

Hypnosis, instead of being regarded as a supernatural and mystic method of cure like Mesmerism was considered as a psychological method of treatment because of its subjective nature along with the use of suggestion. Hypnosis historically formed the starting point of psychotherapy in general and psychoanalysis in particular.

The success of hypnotic method mainly depends upon the suggestion of the analyst which consists of the uncritical acceptance of the others by the patient. Unless the patient has strong faith on the analyst, unless the rapport between the analyst and the patient is established, cure of mental abnormality by the method of suggestion becomes useless.

Thus, Alexander says “The whole of the phenomenon of hypnosis was due to the patient’s will and by influencing the will it was possible to make him forget something which he knew perfectly well”.

Hypnosis is a psychological technique, which through the use of suggestion is able to influence the individual on his own line. Hypnosis gives the opportunity of understanding the influence-which one person can have on another person. In order to explain the subjective aspects of hypnosis, many causes have been advanced.

The question is — what is there in one individual which influences another individual.

Thus, White views, “The modern scientists have failed to understand the hints given by Charcot, the hints being that what the hypnotist communicates to his subject and what the subject tries to do about it White suggests that when a patient is suggested, something is communicated to his mind and thus he acts in a way about which he is completely ignorant and unconscious.”

The hypnotized person acts just like a machine and even sometimes, the individual may commit murder or may steal if he is suggested.

Suggestion, therefore being the main feature of hypnosis gives a psychological basis to it. For the phenomena of suggestion, a quiet and psychological atmosphere is necessary. The ‘S’ is told to lie down on a couch and to relax in a comfortable chair to share at some designated spot and to look straight at the hypnotizer. Then suggestions are made in a low monotonous voice, trying to create a sense of fatigue into the tone.

The phrases, “you are so tired that your eyes are closed, you feel sleepier and sleepier,” are the sorts of suggestions used. Now the hypnotizer will ask him to relax completely, to think of nothing except concentrating on a particular point.

Gradually his eye lids will start to feel heavy and change in his behaviour is noted. If the ‘S’ carries upon the suggestion and does what a hypnotiser says, hypnosis becomes effective, otherwise the attempt to hypnotize is abandoned.

When a suggestive state is created the ‘S’ is asked to behave very much like the one walking in the sleep. As a consequence of suggestion, the face may express profound emotion and the ‘S’ be made to move quite rapidly. At this stage, in order to create various psychological states and illusions and hallucinations in the patient, positive and negative suggestions may be used.

In positive suggestion, the ‘S’ is told that he senses something which is not actually present. So he behaves as though he was perceiving the object. Even if the water tastes salty, he behaves as if it were sugar. Thus a positive suggestion results in hallucinating perception of a non-existent state of affairs.

But a negative suggestion results in the failure to perceive what a non-hypnotic person observes without difficulty. Even if he is told that the man disappears and the chair is empty he will go himself, sit on the empty chair and will behave as if he were sitting on a man’s lap.

A man under the hypnotic state if told that he is Napoleon, he will proceed at once to behave like Napoleon. Following deep hypnosis, there is usually fairly complete amnesia for hypnotic experiences. Thus, hypnotic state, which is the resultant of suggestion creates illusion, hallucination and delusions, amnesia and many other psychological states in the organism.

But if the patient is not suggestible any effort to make him suggestible for communicating thoughts to him would be futile. It has been found that hypnosis becomes an utter failure in cases like obsession-compulsion neuroses and paranoid where suggestion is not effective.

Various hypnotics have suggested that it is possible to influence parts of the body which are not under conscious control. It is said that it is possible to produce redness of the skin and blistering by suggesting to the patient that the parts to be affected have been burnt.

Lastly, hypnosis as a subjective condition is not brought about by magic, but it is a physical condition produced in the body.

Therapeutic Value of Hypnosis:

The therapeutic value of hypnosis has been a matter of great controversy ever since Mesmerism. Hypnosis for the last 100 years was used in medical practice until Charcot picked up hypnotism, and it was declared that hypnotism has no place in medical research.

If chloroform would not have been invented in medical practice, most likely, hypnosis would have been more easily recognised. In fact in the 18th century hypnosis was used for the purpose of surgical operation.

Hypnosis as a method of treatment has not only theoretical but also therapeutic value. The main aim of psychotherapy is to help the patient to understand the causes of symptoms and thereby cure them. When a patient is hypnotized, he easily expresses all his repressed desires and wishes without hesitation and resistance which he would have done had he been in the conscious stage.

In older time when psychoanalysis did not occupy any place in psychotherapy, hypnosis as a method of treatment was abundantly used. The value of hypnosis as a therapeutic method is more significant in hysteria, traumatic neuroses, conversion hysteria etc. in which the patient can be made easily suggestible.

Charcot and Breiham gained much reputation by curing hysteria and war neuroses etc. by this method of hypnosis. Prior to the discovery of psychoanalysis, hypnotism was the only method used for the treatment of mental diseases.

Criticism:

Hypnosis as a method of treatment was subjected to much criticism due to its defects. It has been found from the case history of many mental patients that the disease cured by hypnosis relapses. Thus, the cure by this method is temporary.

This is because, hypnosis instead of going deep into the underlying causes of a mental disease attacks the symptoms only. So it treats the symptoms leaving the disease untouched. The disease is hence cured only temporarily.

The therapeutic value of hypnosis is very limited. Suggestion is somehow effective only when it is given in an authoritative manner by a person having prestige and high reputation. But it is not always possible to expect that the analyst would be a person having high prestige value.

Hypnosis does not work as an effective therapy in all mental diseases. It is effective only in hysteria and traumatic neuroses. But cases like obsession, compulsion and other acute psychotic mental diseases such as M.D.P., Schizophrenia, Paranoid, Epilepsy etc. cannot be cured by hypnosis, as patients suffering from these diseases cannot be hypnotized.

There are many people who are critical of themselves and their surroundings. Thus, hypnosis fails in this respect.

The success of hypnosis as a method of treatment depends upon the dependence, submissive and impatient attitude of the patient. Since one cannot expects patients of diverse mental diseases to have dependence and impatient attitude, hypnosis is not successful in cases of all mental diseases.

However, the total success of hypnosis depended upon the patient’s relation to the physician. Because of these defects of hypnosis, Freud developed psychoanalysis which is considered to be the unique method of treating psychoneuroses.

Today hypnosis as a method of treating mental diseases has little value. It is replaced by psychoanalysis. However, one cannot fully wipe out hypnosis from the pages of psychotherapy and cannot totally deny its value as a therapeutic method, as it is also used in hypnoanalysis.

Suggestion, which is the core concept of hypnosis is also used in psychoanalysis. Historically, hypnosis formed the starting point of psychotherapy in general and psychoanalysis in particular. Therefore, in-spite of its defects its value as a method of treatment cannot be totally dismissed.