Mental Health - Case Study Example

Introduction and Purpose There is a wide variety of research-based and highly-effective therapeutical approaches that may be utilized when a mental health professional wishes to treat a patient who suffers from some type of mental or behavioral disorder. The type of approach that is chosen by the mental health professional will necessarily differ based on what type of disorder is being treated. One common disorder of this type that mental professionals face the challenge of treating is substance abuse. The purpose of this paper is to compare and contrast two research-based therapeutic approaches for working with patients with a substance abuse and addiction. Mental health professionals may choose to approach a particular patient’s individualized treatment program by choosing from a number of research-proven approaches, or combinations thereof, based on the individual needs of that particular patient. For substance abuse and addiction, some of these therapeutic approaches include Psychodynamic, Cognitive Behavioral, Motivational Interviewing, and Enhancement Therapy. For the purposes of this paper, the research-based therapeutic approaches that will be compared and contrasted are Psychodynamic versus Cognitive Behavioral Therapy. In order to complete the process of effectively developing the content of this assignment, seven scholarly articles from high-quality psychology and behavioral health and therapy journals and related reliable sources have been utilized. In addition, since this is a comparison and contrast assignment, both the strengths and weaknesses of each of the aforementioned chosen therapeutic approaches will be discussed, along with the basic purpose of each of the therapies. Psychodynamic Therapy Definition, Pros & Cons Psychodynamic Therapy holds its roots in Freudian Psychoanalysis, and is also referred to under the term Insight-Oriented Therapy. This type of therapy is centered around the mental health professional’s ability to accurately and effectively interpret behaviors that are being exhibited by a particular patient, as well as to successfully decipher the meaning of that patient’s words. According to Psychology Today, “This approach holds that bringing the unconscious into conscious awareness promotes insight and resolves conflict. This therapy involves more frequent sessions than Cognitive Behavioral Therapy does” (2007, p. 1). The goal of psychodynamic therapy is to observe a client’s behavior in order to focus on things that they do unconsciously. The ideal end result is that the client will become aware of the ways in which his or her past is affecting his or her present state. “In its brief form, a psychodynamic approach enables the client to examine unresolved conflicts and symptoms that arise from past dysfunctional relationships and manifest themselves in the need and desire to abuse substances.” Since the therapy is briefer than other forms of therapy, it may be better well suited for some clients than others. Those who are thought to benefit from it in its brief form the most are those who are recovering in a stable fashion, those with coexisting psychopathology, those who are not in need of or are not currently hospitalized or being detoxified, and those without brain damage or other mental disorders. Essentially, the level of functioning that a client is exhibiting determines the nature of his or her treatment (HSTAT, 2007, p. 1). The alliance between the therapist and the client in this type of therapy plays a tremendous role in the overall outcome and whether or not it is successful. This has been found to be true in studies involving both alcoholic and cocaine-dependent patients. “These findings suggest that the therapeutic alliance exerts a moderate but significant influence on outcome in the treatment of substance abuse disorders. The specific outcomes measured vary from study to study but include length of participation in treatment, reduction in drug use, and reduction in depressive symptoms” (HSTAT, 2007, p. 1). Pyschodynamic Therapy has been around longer than any of the other types of modern therapies. Since this is the case, there has been plenty of time to refine its unique therapeutical approaches over the years and, hopefully, make this particular approach more effective for patients who suffer from substance abuse and addiction. This therapy’s age, thus, is definitely a benefit over more recently developed approaches, such as Cognitive Behavioral Therapy, as it is considered a more tried-and-true, as well as solidly expanded, progressive, and comprehensive approach when it comes to effectively treating patients who abuse drugs and are seeking proper treatment (Harvard Mental Health Letter, 2006, p. 5). According to Harvard Mental Health Letter, “Psychodynamic therapy focuses on unconscious processes as they are manifested in the clients present behavior. The goals of psychodynamic therapy are client self-awareness and understanding of the influence of the past on present behavior” (2006, p. 5). Even though this approach has been around a long time, many mental health professionals, researchers, and scholars—specifically those who are considered to be more contemporary and less old-fashioned in their treatment methods—believe that it is due for additional modifications and advancement to keep it up-to-speed with some of the more eclectic therapies. This opinion is particular valid for those mental health professionals who strongly believe that times have changed and that therapies should adjust to accommodate those changes accordingly (Harvard Mental Health Letter, 2006, p. 5). Those who support modern-day adjustments to this theory particularly believe that these modifications are necessary when it comes to using the approach for treatment programs. This is particularly true for those programs that differ in type or that are very specific, such as treatment of substance abuse and addiction (Harvard Mental Health Letter, 2006, p. 5). Psychodynamic Therapy has proven itself to be extremely useful in the effective treatment of multiple thousands of mental and behavioral health patients over the years, including those who suffer from substance abuse and addiction. Even though this fact has been found to be true in many cases, this particular approach is rather intricate and complicated, especially when it comes to adjusting the therapy to suit the needs of individual patients, including those who suffer from substance abuse and addiction. According to Krause, de la Parra, Aristegui, Dagnino, et al., “There are four major schools of psychoanalytic theory, each of which has influenced psychodynamic therapy. The four schools are: Freudian, Ego Psychology, Object Relations, and Self Psychology” (2003, p. 1). Each of the four aforementioned schools of Psychoanalytic Theory have influenced Psychodynamic Therapy, each one has done so in its own unique way. Furthermore, some of the schools have influenced Psychodynamic Theory more than others have, particularly Ego Psychology and Self Psychology (Krause, de la Parra, Aristegui, Dagnino, et al., 2003, p. 1). Ego Psychology focuses on encouraging an individual to be able to effectively defend himself against negativity and improper behavior, more readily adapt to new environments and other changes, and face the demands of reality. Self Psychology deals with the way a person perceives him- or herself, particularly in cases where the person in question has a low self-esteem. “The explanatory power of the new psychology of the self is nowhere as evident as with regard to the addictions. Kohut postulated that persons suffering from substance abuse disorders also suffer from a weakness in the core of their personalities--a defect in the formation of the ‘self.’ Substances appear to the user to be capable of curing the central defect in the self” (Krause, de la Parra, Aristegui, Dagnino, et al., 2003, p. 1). The fact that drugs appear to so strongly affect a person’s self-esteem in a positive manner really helps to explain to mental health professionals why some individuals choose to abuse drugs in the first place, and understanding why a person could become addicted to a substance is the first step in designing an effective treatment program. The fact that Psychodynamic Theory focuses so strongly on Self Psychology certainly makes it a truly effective therapeutic approach for those who suffer from substance abuse and addiction. Psychodynamic Therapy can be administered in either a short-term or a long-term fashion within a patient’s individualized treatment program chosen by his or her mental health professional(s). Long-term Psychodynamic Therapy has been found to be very effective in the treatment of substance abuse and addiction, but short-term Psychodynamic Therapy has not been found to quite reach that mark in many cases. This is due in particular to the nature of the behavioral disorder itself (Krause, de la Parra, Aristegui, Dagnino, et al., 2003, p. 2). Those who abuse drugs or suffer from addiction also perceive things in a different manner than those individuals who do not. This fact means that drug abusers and addicts have a much harder time than the average person would when it comes to solving problems and being able to accurately look inside themselves and their disorder. This problem is lessened or nonexistent at all in cases where Brief Psychodynamic Therapy has been combined with other types of therapies in a patient’s overall treatment program, including but not limited to drug and alcohol treatment programs (Krause, de la Parra, Aristegui, Dagnino, et al., 2003, p. 2). As previously mentioned, one of the biggest pros of Psychodynamic Therapy is that it has been around longer than the other types of modern-day therapies and, thus, has had time to be subjected to experiments and trials to test its overall effectiveness against disorders like drug abuse and addiction. Nilsson, Svensson, Sandell, and Clinton discuss 17 such trials that were conducted over the course of 35 years. According to them, “Dynamic therapists concentrate on emotional conflicts and identify patterns in the patient’s feelings and behavior, often with special attention to wishes, dreams, and fantasies. They emphasize the patient’s relationship with the therapist, especially as it involves feelings transferred from earlier relationships and childhood experience in particular” (2007, p. 673). The studies that were discussed in their article are particularly relevant to this assignment, since Psychodynamic Therapy was compared to Cognitive Behavioral Therapy in each of them, and one of the main areas of focus included addiction. Overall, it was found that Psychodynamic Therapy appeared to be more effective than other alternatives, and that, “It improved symptoms of the diagnosed disorders, other symptoms, and overall psychological and social functioning” (Nilsson, Svensson, Sandell, and Clinton 2007, p. 673). Cognitive Behavioral Therapy Definition, Pros & Cons According to the National Association of Cognitive-Behavioral Therapists, “Cognitive-Behavioral Therapy is a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do,” and that the term “is a very general term for a classification of therapies with similarities.  There are several approaches to cognitive-behavioral therapy, including Rational Emotive Behavior Therapy, Rational Behavior Therapy, Rational Living Therapy, Cognitive Therapy, and Dialectic Behavior Therapy” (2007, p. 1). Cognitive Therapy has been helpful in treating a wide array of disorders, including problems with anger control, panicking, and substance abuse. This is particularly true since the way a person behaves or feels can be significantly affected by things such as attitudes, attributions, beliefs, cognitive schema, and perceptions. “To the extent that our thinking processes are faulty and biased, our emotional and behavioral responses to what goes on in our life will be problematic. According to this theory, changing the way a client thinks can change the way he feels and behaves. They also tend to reflect reliance on substances as a means of coping with boredom and negative emotions, a negative view of the self as a person with a substance abuse problem, and a tendency to facilitate continued substance use” (HSTAT, 2007, p. 1). Irrational thoughts and erratic behaviors go hand-in-hand with substance abuse disorders. People tend to avoid their problems, are unable to let go of problems they have experienced or mistakes they have made in the past, tend to hold a pessimistic view of the world, and avoid responsibility. “Treatment, therefore, is directed primarily at changing distorted or maladaptive thoughts and related behavioral dysfunction. Cognitive restructuring is the general term given to the process of changing the clients thought patterns. Once a specific faulty thought is identified, the therapist will challenge a client to look at alternative ways of seeing the same event. Whenever a client has difficulty changing a perception, the therapist can give him homework to test the truth of his cognitions. Once the maladaptive thoughts are discovered in a persons habitual, automatic thinking, it becomes possible to modify them by substituting rational, realistic ideas for the distorted ones to create a happier and healthier life without substance abuse” (HSTAT, 2007, p. 1). Even though there are various approaches that exist to this type of therapy, they do collectively hold certain commonalities. They are all based on the Cognitive Model of Emotional Response, they take place over a shorter period of time than therapies such as Psychodynamic Therapy, a solid relationship with the mental health professional conducting the therapy is necessary but not all that is needed, both the mental health professional in question and the client must equally contribute to the overall therapy program, they stem from stoic philosophy, they utilize the Socratic Method, they follow a structured and narrowed pathway, educational models form the overall basis for their structure, they use the Inductive Method, and patients are required to do homework between therapy sessions (National Association of Cognitive-Behavioral Therapists, 2007, p. 1). Warman and Beck state that “Cognitive-Behavioral Therapy (CBT) is an empirically supported treatment that focuses on patterns of thinking that are maladaptive and the beliefs that underlie such thinking.” People who undergo this type of therapy are encouraged to take negative thoughts and behaviors that they perceive in their own minds to be factual and instead turn them into beliefs or hypotheses that are subject to experimentation. Those who suffer from mental and behavioral disorders often suffer from automatic thoughts, and are “encouraged to monitor and log thoughts that pop into their minds (called "automatic thoughts") in order to enable them to determine what patterns of biases in thinking may exist and to develop more adaptive alternatives to their thoughts” (2003, p. 1). Therapists and other mental health professionals who utilize Cognitive Behavioral Therapy are very focused and active in their patients’ treatment programs. This is perhaps the main reason that it has been found to be so effective in the treatment of a wide variety of mental and behavioral disorders, including substance abuse and addiction disorders. It has the additional benefit of also being an effective treatment option for depression, anxiety, schizophrenia, and related disorders, which often accompany drug abuse and addiction (Warman and Beck, 2003, p. 1). Another benefit of Cognitive Behavioral Therapy is that it has a solid level of empirical support. This has, in turn, led to its growing popularity and usage in recent years, as both mental health professionals and patients are aware of its potential benefits (Warman and Beck, 2003, p. 1). The National Institute on Drug Abuse reports that Cognitive Behavioral Therapy is particularly effective for those who suffer from drug abuse and addiction, particularly when it involves cocaine. They cite several reasons for this opinion: it is brief and, therefore, easier for treatment facilities to accommodate when they are furnished with inadequate resources for longer, more complex treatment programs; “CBT has been extensively evaluated in rigorous clinical trials and has solid empirical support as treatment for cocaine abuse. In particular, evidence points to the durability of CBTs effects as well as its effectiveness with subgroups of more severely dependent cocaine abusers.” (2007, p. 1). In addition to the aforementioned benefits, the National Institute on Drug Abuse reports that Cognitive Behavioral Therapy’s solid structure and focus on specific goals is particularly beneficial to cocaine users since they suffer from problems that need to be controlled in an immediate fashion; the individualized and flexible nature of Cognitive Behavioral Therapy appeals to a wide audience; it is compatible with other types of treatment that patients may concurrently participate in; and it is broad enough to cover several functions that are necessary in order to effectively treat drug abuse and addiction. Two of these functions that are considered key to this type of treatment program are functional analysis and skills training components designed specifically for a patient’s needs (2007, p. 1). Comparing and Contrasting the Two In this assignment, the therapeutic approaches known as Psychodynamic Therapy and Cognitive Behavioral Therapy are being compared and contrasted. Although the two approaches are vastly different in theory and technical application, it has been shown through research that roughly all of the theoretical approaches of this nature produce very similar outcomes when all is said and done. In other words, patients who complete programs that are designed around these two therapeutic approaches report very similar opinions regarding their effectiveness as they are exiting the programs (Nilsson, Svensson, Sandell, and Clinton 2007, p. 673). The main pro of Psychodynamic Therapy appear to be that this type of treatment is longer and, therefore, better suited for the needs of those who suffer from substance abuse and addiction. Also, this therapy is the oldest of modern-day therapies of this nature, and has therefore, been subjected to more critical analysis and experimentation with regard to its effectiveness. This type of therapy is considered to be more traditional in nature, as well as tried-and-true. Old school mental health professionals, as well as knowledgeable modern-day therapists as opposed to those with more eclectic beliefs, tend to rely more heavily on this particular therapeutic approach (Nilsson, Svensson, Sandell, and Clinton 2007, p. 673). One of the main disadvantages of Psychodynamic Therapy appears to be a variation of the aforementioned benefit of its age. Those therapists and other mental health professionals who are more eclectic believe that this particular therapeutic approach is well overdue for modern-day adjustments that would make it more beneficial to today’s needs. Another large disadvantage to this approach appears to be, yet again, another variation of a previously mentioned benefit: duration. This type of program is longer, and therefore, may be more difficult for average therapy institutions to commit to or sustain for the long run for financial reasons. This could have a seriously adverse effect on the patient, who may give up treatment due to the length of it as well (Harvard Mental Health Letter, p. 5). The main advantage of Cognitive Behavioral Therapy appears to be that such institutions as the National Institute on Drug Abuse have found empirical evidence that supports the method being particularly beneficial for drug abusers. Also, the shorter nature of this type of therapy may allow more individuals to complete it and lessen the drain on treatment facilities. This therapy is also very focused and goal-oriented (National Association of Cognitive-Behavioral Therapists, 2007). The cons of Cognitive Behavioral Therapy appear to center around the length of treatment time, ironically. Research suggests that, since these treatment programs are shorter, they may not be as effective (National Association of Cognitive-Behavioral Therapists, 2007). Conclusion Although the very structure and approach of the two therapeutic approaches compared and contrasted in this paper—Psychodynamic Therapy and Cognitive Behavioral Therapy—are vastly different, the overall outcomes of the program when everything is said and done and balanced out appears to be roughly equivalent. In other words, the pros and cons of each are roughly equal to one another, although they are completely different. The main differences involve the quality and duration of the therapeutic approach that is chosen to treat a particular patient. Works Cited A Cognitive-Behavioral Approach: Treating Cocaine Addiction. (2007). National Institude on Drug Abuse. Retrieved December 8, 2007, from http://www.drugabuse.gov/TXManuals/CBT/CBT3.html#why Cognitive Behavioral Therapy. (2007). National Association of Cognitive-Behavioral Therapists. Retrieved December 8, 2007, from http://www.nacbt.org/whatiscbt.htm Krause, de la Parra, Aristegui, Dagnino, et al. (2003). The evolution of therapeutic change studied through generic change indicators. Addiction Alternatives. Retrieved December 8, 2007, from http://www.addictionalternatives.com/philosophy/briefpsychodynamic.htm Nilsson, Svensson, Sandell, and Clinton. (2007). Patients’ experiences of change in cognitive-behavioral therapy and psychodynamic therapy: a qualitative comparative study. Psychotherapy Research, 17(6): 673. Psychodynamic therapy passes a test. (2006). Harvard Mental Health Letter, 22(10): 5. SAMHSA/CSTAT Treatment Improvement Protocols, Chapters 4 and 7. (2007). Online. http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.section.59652 Warman and Beck. (2003). Cognitive-Behavioral Therapy. National Alliance on Mental Illness. Retrieved December 8, 2007, from http://www.nami.org/Template.cfm?Section=About_Treatments_and_Supports&template=/ContentManagement/ContentDisplay.cfm&ContentID=7952 What’s your orientation? (2007). Psychology Today. 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