Abnormal Psychology. William J. Ray

Kane et al., 2016). As you will also learn, psychotherapy and biological approaches work through different brain mechanisms and at different levels of the brain. Throughout the chapters of this book, particular biological approaches will be described in terms of each disorder.

      In the next section, I will examine psychological factors involved in developing, maintaining, and treating mental disorders. What a person learns in interacting with other people as well as his or her environment is crucial. In addition, what individuals tell themselves or how they experience significant others in their lives is an important aspect of this perspective.

      Psychological Treatment Perspectives in the Twentieth Century

      In this section, I want to discuss three approaches to the psychological treatment of mental disorders. These are the psychodynamic approach, the existential-humanistic approach, and the cognitive behavioral approach. These approaches were developed somewhat independently and often in opposition to one another. For that reason, I will initially discuss each independently. I will introduce you to a historical understanding of the approach including its broad principles and then present one specific treatment that has been tested in a scientific manner.

      Different versions of dynamic psychotherapy have been shown to be effective for a number of disorders, especially the personality disorders.

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      Before the middle of the twentieth century, very little formal research had been performed to see how effective psychological interventions were. This was also true of traditional medical procedures. Beginning in the 1950s and 1960s, a movement started to determine the effectiveness of both medical and psychological treatments in a scientific manner. In medicine, this came to be known as evidence-based medicine. In psychology, the terms empirically based treatments and empirically based principles refer to treatments and their aspects for which there is scientific evidence of effectiveness.

      As researchers and clinicians began to focus more on approaches and principles for which there was scientific evidence that they were effective, there began a movement to develop effective treatments for particular disorders. There has been more willingness to integrate techniques from the three different approaches as well as from other perspectives. For example, in the chapter on personality disorders, you will see that one of the most researched treatments—dialectical behavior therapy (DBT)—is based on techniques from each of the three approaches described in this chapter. This effective treatment uses aspects of cognitive-behavioral techniques, dynamic techniques, and humanistic-existential techniques.

      psychodynamic perspective: approach to psychological therapy that emphasizes how behaviors and experience may be influenced by internal processes that are outside of awareness, often due to internal conflicts

      Psychodynamic Perspectives on Treatment

      The psychodynamic perspective is based on the idea that psychological problems are manifestations of inner mental conflicts and that conscious awareness of those conflicts is a key to recovery. Historically, Sigmund Freud laid the foundation for this perspective.

      By the beginning of the twentieth century, there was an understanding that psychological processes were an important source of information concerning mental illness. Sigmund Freud had worked with Charcot in Paris and observed individuals with hysteria. In this disorder, the experience, such as not feeling pain in a limb or difficulty hearing, did not match the underlying physiology. Witnessing this type of disordered behavior led Freud to seek psychological explanations for the cause and treatment of mental disorders.

      Sigmund Freud

      Library of Congress

      Sigmund Freud

      Sigmund Freud was initially trained as a zoologist before he completed medical school. The nature of the neuron was just being discovered, and Freud based his early theories on the neuroscience of his day. Freud was an enthusiastic reader of Darwin and credited his interest in science to an early reading of his work. A number of Freud’s ideas can be seen as coming from Darwin (Ellenberger, 1970; Sulloway, 1979), although Freud emphasized sexual selection over natural selection. For Freud, the sexual instinct (libido) is the major driving force for human life and interaction. Freud was also influenced by the suggestion of the neurologist John Hughlings Jackson that in our brains we find more primitive areas underlying more advanced ones. Thus, it is quite possible for the psyche to be in conflict with itself or at least to have different layers representing different processes.

      Hans Strupp

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      For Freud, higher cortical processes could inhibit the experience of lower ones, a process that would come to be called repression. Anxiety is the result of society and culture having inconsistent rules for the expression of sexuality and aggression. This anxiety and our inability to acknowledge these instinctual experiences lead to defense mechanisms and neurosis. Freud believed that the brain was basically a blank slate upon which experiences become connected with one another driven by instinctual processes of sexuality and self-preservation. The human psyche for Freud becomes the real-life laboratory in which nature and nurture struggle.

      Treatment for Freud was based on the search for ideas and emotions that are in conflict and the manner in which the person has relationships with other people. His specific treatment came to be called psychoanalysis. One basic procedure was free association, in which an individual lay on a couch with the therapist behind him or her and said whatever came to mind. It was the therapist’s job to help the client connect ideas and feelings that he or she was not aware of. One thing Freud was searching for was connections within the person’s psyche when external stimulation was reduced. Dreams were also analyzed in this way, since they are produced outside of daily life.

      psychoanalysis: treatment developed by Freud based on the search for ideas and emotions that are in conflict on an unconscious level

      Other aspects of psychoanalysis included examining resistance, or what the client is unwilling to say or experience, and transference, or the manner in which a person imagined how another person thought about him or her or sought a certain kind of relationship with that person. Freud has greatly influenced therapies based on insight. Insight therapy, which has been used to treat disorders such as anxiety and depression, is based on the principle of bringing patterns of behavior, feelings, and thoughts into awareness. In order to do this, it is necessary to discuss past patterns and past relationships to determine how they are being replayed or are influencing the present.

      A number of dynamically orientated therapies have been shown to be effective (Barber, Muran, McCarthy, & Keefe, 2013). One empirically supported therapy based on dynamic principles was developed by Hans Strupp and his colleagues. Strupp embodied the dynamic principles in a therapy of a few months’ duration (Strupp & Binder, 1984). The focus of this therapy is the relationship between the client and other individuals in her life. It is assumed that the client’s problems are based on disturbed relationships. The therapeutic relationship between the client and the therapist offers an opportunity to see disturbed relationships in a safe environment. Transference is an important mechanism in which the client tends to see the therapist in terms of significant others in her life. As the client talks with the therapist, she will replay prior conflicts and enact maladaptive patterns.

      The role of the therapist in this approach is mainly to listen. As the therapist, you listen to a client, seeking to understand what she is saying and how she feels as she describes her world. You would note to yourself when she finds talking to you difficult or experiences distress as