The psychodynamic and cognitive behavioural therapies - Essay Example

? Critically Differentiate Between the Psychodynamic and Cognitive Behavioural Therapies and Then Critically Evaluate the Role They Have To Play In Clinical Hypnosis By [Name of Student] [Name of Institution] [Word Count] [Date] Introduction Clinical hypnosis is one of the strategies used by clinicians to treat and help patients manage conditions and issues such as pain relief, smoking problems, self esteem improvement and weight loss among others. One principle of clinical hypnosis is that its use in a clinical setup can only be undertaken upon consultation with a qualified and competent health care provider. In other terms, the said health care provider must have been thoroughly trained on the usages, strengths and the limitations of clinical hypnosis (Faymonville et al., 2006). Although a rather common clinical approach, the term clinical hypnosis has a range of definitions, depending on the prevailing circumstances or perspectives in which it is applied. For instance, the definition could range from physiological to psychoanalytical. An example of the definition of clinical hypnosis is presented by the American Psychological Association, which defines the term as the process in which a health care professional suggests that his/her patient experience changes in sensations, thoughts, behavior or/and perceptions to yield a positive change in a given aspect of his/her life (Faymonville et al., 2006). To start a hypnotic procedure in whatever context is an induction process of which there are different approaches. These induction procedures include suggestions to the client or patient to relax, stay calm and to generally promote his/her well being. To relax, a patient or a client may be asked to picture, think or imagine pleasant experiences and environments. There are several benefits of clinical hypnosis that have been identified. These include the fact that it offers those who practice it a great deal of relief from pain, anxiety, depression, behavioural disorders, stress and other psychological and medical conditions. As a matter of fact, clinical hypnosis has been shown to be pretty effective in pediatric settings, childbirth, and for provision of anesthesia during painful medical procedures such as surgery. Besides its many benefits and the settings within which it is applicable, clinical hypnosis is often applied rather cautiously since it exposes some risks to mentally upright people who may feel dizzy if they get up rather immediately after a clinical hypnosis session. In fact, a client on certain dosages such as insulin and sedatives may require adjusting such dosages if placed on clinical hypnosis. A point worth noting is that clinical hypnosis may not be recommended for people with personality disorders such as narcissistic disorders and schizophrenia and/or depression. One is thus advised to carefully select the rightly qualified health care providers to offer clinical hypnosis. Additionally, such a health care provider must be trained, certified and licensed to offer such services. The idea of clinical hypnosis as a therapeutic technique has undergone quite major revisions in recent years and it today encompasses a multiplicity of treatment approaches anchored on widely divergent theoretical orientations. Although hypnosis could be equally applicable in analytic and behavioral therapies, the nature of the hypnotic relationship brings warrants changes into the treatment structure which sets it off from non-hypnotic forms of therapy. This paper explores the differences between Cognitive-Behavioural Therapy (BCT) and the Psychodynamic Therapy (PT) approaches and their role in clinical hypnosis. What is Clinical Hypnotherapy? In the contemporary context, clinical hypnotherapy implies the use of modern methods of hypnosis among other techniques in the treatment of diverse medical and psychological problems. In fact, it has been reported that as many as 85% of patients respond to clinical hypnotherapy while the rest respond to other similar conventional techniques applied in different countries and regions of the world (Alladin, 2008). What is more, clinical hypnotherapy has been shown to succeed in situations where conventional treatment methods have failed to give the desired outcome. In contemporary times, clinical hypnotherapy has become rather integrated as it encompasses the most effective and best principles and elements of other types of therapy (Alladin, 2008). Examples of the elements of therapy integrated into clinical hypnotherapy are cognitive psychology, EMDR (Eye Movement Desensitization and Reprocessing), NLP (Neuro-linguistic Programming), analytical and quantum hypnotherapeutic techniques and behavioural psychology. Elements of classical theories proposed by psychologists of great renown such as Freud, Jung and Adler and the latest physiological research findings have also been integrated into clinical hypnotherapy. Another important aspect of modern day clinical hypnotherapy is that it could either be context-oriented or context-free. In the latter case, a client may not necessarily state or explain the nature of the current psychological problem. As mentioned above, analytical techniques are more recommended whenever an issue has its causes in the past. Since not all psychological problems are rooted in the past, analytical techniques may not be applied in going back to a client’s past to resolve a current problem (Gottsegen, 2011). The two main categories of clinical hypnotherapy are traditional and modern hypnotherapies. There are two major therapeutic approaches used in clinical hypnosis namely the Cognitive-Behavioral Therapy (CBT) and the Psychodynamic Therapy (PT). Although both the CBT and the PT have the main role of curing clients’ distress and symptoms, there are several differences between these therapies that professionals ought to recognize, more so with regards to clinical hypnosis. For instance, while the psychodynamic therapy aims at understanding the reasons a patient feels or behaves in a given manner, thus uncovering the unconscious motivators of such behaviours and feelings, the CBT simply seeks to alleviate one’s suffering through the suggestion and training of one’s mind so that he/she replaces negative and dysfunctional perceptions, thought patterns, behaviours and feelings with positive ones (Sundberg, 2001). In other words, CBT does not seek to know more about the problems clients have but seeks to replace the client’s negative feelings and behaviours with more positive, realistic and helpful ones. In addition to the above difference, those advocating for the psychodynamic therapy in clinical hypnosis assert that it is a deeper approach that yields lasting solutions to a wide range of medical and psychological disorders (Sundberg, 2001). Similarly, supporters of CBT argue that it is equally effective for a wide range of disorders. Nonetheless, reports from researches accord both approaches some level of importance in clinical hypnosis, implying that both should be considered in clinical settings, depending on the prevailing individual circumstances (Sundberg, 2001). There are certain features with which both CBT and PT are identified. For instance, CBT is characterised by its relative brevity and time-limitedness since it often lasts between twelve weeks and six months. Second, CBT is rather instructional and entails a lot of homework as a core component. Third, CBT is quite highly structured with the therapists required to direct and set the agenda for each session. However, the goals of these sessions must be mutually agreed upon by both the client and the therapist. The fourth outstanding feature of CBT is that it lays a lot of emphasis on the immediate situation rather than on a client’s history. Importantly, CBT focuses on the relationship between a therapist and the client during treatment. On the other hand, whereas PT could be brief, there are instances in which it could last for six months or more. Second, it is less structured compared to CBT, which is characterised by a lot of homework. In the PT approach, it is clients who set the agenda for treatment sessions by freely discussing with the therapist what is on their mind. Besides focusing on the immediate situation of a client, the PT approach also centers on the personal history of its client (Sundberg, 2001). Finally, the PT approach to clinical hypnosis focuses on the therapist’s relationship with the client. The interaction and integration of CBT and hypnosis has resulted in a type of hypnosis referred to as cognitive hypnotherapy, which uses CBT as its basic theory (Sundberg, 2001). This is particularly so given that the cognitive theory unifies psychotherapy and psychopathological. Further, the cognitive theory integrates psychopathological theories and clinical practice. It thus helps solve the problem of lack of a good theory to explain clinical treatments for psychological disorders, hence also solves the problem of lack of conceptual consistency. CBT is also technically eclectic. Besides routinely using behavioural and cognitive techniques, CBT also regularly uses psychotherapeutic techniques. Thus, the cognitive hypnotherapy uses any clinical technique that would facilitate the practical investigation of a client’s maladaptive interpretations and conclusions (Sundberg, 2001). However, the techniques are not often chosen haphazardly but in the context of the formulation of the cognitive case at hand as such matching of patient circumstances and treatment have been proved to increase outcomes. The eclectic nature of both clinical hypnotherapy and cognitive therapy are supported by the fact that the framework of the cognitive model a psychotherapist applies is based on the specific needs of a client (Lynn et al., 1996). In other words, a therapist could be using cognitive therapy with predominant behavioural and emotion-releasing techniques. Further, cognitive therapists may use other psychotherapeutic approaches provided they meet certain criteria, which include consistency with the principles of cognitive therapy. Second, the technique must be logical to the theory of therapeutic change. Third, the choice of technique must be based a comprehensive conceptualisation of the case at hand. Such a conceptualisation should entail a patient’s characteristics such as problem-solving abilities. Additionally, the technique must be guided by the standard interview structure and collaborative empiricism (Lynn et al., 1996). CBT thus offers a good framework for the integration of hypnotic and cognitive strategies for various psychological disorders. Differentiating the CBT and the Psychodynamic Therapies It is of the essence that therapists and their clients are acquainted with the two common psychological therapies encountered in clinical settings, namely the Cognitive Behavioural Therapy (CBT) and the Psychodynamic Therapy (PT). Enough information on these therapies should therefore be availed for use by these parties. This section of thus undertakes a basic overview and comparison of the two most prevalent and effective therapies. First, it is important to note that these approaches are dissimilar to some extent since they are based on different assumptions, making it possible for patients to determine the therapy that best suits them (Godwin, 1999). What is more, if a patient is not appeased by any of these approaches, he/she may opt for alternatives. However, patients are advised to try these approaches out with actual therapists since clinical researches have pointed out the importance of quality relationship between therapists and clients in the success of psychotherapy (Godwin, 1999). Thus, what matters most is the comfort that accompanies the application of a given therapy in a session. It is also important that a patient develops confidence in the abilities of his/her therapist. Cognitive-Behavioural Therapy emerged in the 1950s as an alternative to psychodynamic therapy. Generally, CBT entails therapies that focus on the role of thinking on peoples’ feelings and actions (Godwin, 1999). Being manual and technical, it is an approach hat seeks to reduce or suppress as quickly and as economically as possible. The sub-categories of CBT are Dialectic Behavioral Therapy, Rational Emotive Behavior Therapy, Cognitive Therapy, Exposure Therapy and Acceptance and Commitment Therapy. Most of these categories are also based on the assumption that peoples’ thoughts cause their feelings and behaviors rather than some external forces such as people, situations, and events (Godwin, 1999). CBT thus targets the uncovering and alteration of distorted thoughts and perceptions to change peoples’ behaviours and emotional state. Additionally, it is advisable that clients continue practicing the skills learnt in CBT sessions to help them keep disorders or their symptoms at bay. Despite the fact that the course of a CBT could be briefer, it could take months (or years) of practice to learn to identify, challenge, and remodel one’s negative thoughts (Kroger, 2008). Among the conditions for which the effectiveness of CBT has been scientifically proved include generalized anxiety disorder, depression, social phobia, chronic pain, addictions, post-traumatic stress disorder (PTSD), panic disorder, obsessive-compulsive disorder (OCD), borderline personality disorder and insomnia. CBT is recommended for people with the capacity for introspection and those ready to make extra efforts at self-analysis and to incessantly practice coping skills not only during but also after CBT treatment (Dowd, 2000). CBT is also best for short-term and directive treatment. On the other hand, PT is a psychoanalytic approach also referred to as insight-oriented that goes deeper in examining the complexities of interpersonal relationships and is based on two main assumptions. These assumptions include the uniqueness of an individual and his/her disorders and the notion that factors beyond peoples’ awareness influence their thoughts and behavior (Dowd, 2000). Although its traces its roots to the Freudian theory of psychoanalysis, PT is similarly quite modern. Just like CBT, PT’s efficacy has also been supported by research findings. Since it emphasises that people have unique problems, there is not single treatment approach in PT that could fit all patients to result in a lasting change. PT also postulates that peoples’ personalities are determined by the developmental stages they undergo including infancy, childhood, adolescence, and young adulthood and adulthood (Godwin, 1999). All these stages and experiences largely affect the way people see the world, their relationships and feelings. It is thus upon the therapist to seek to understand clients’ difficulties in the context of who they are, their family history and upbringing (Dowd, 2000). Psychodynamic therapy is also partly based on the notion that people are not transparent to themselves, implying that one may not know or understand about themselves and what causes them problems. This lack of awareness of the unconscious factors that expose one to problems empowers these factors to control them. Thus, people remain stuck in negative and unproductive patterns of thinking, feeling, and behaving. PT comes highly recommended for anxiety and fears, low self-esteem, repeated disappointments in relationships, self-destructive behavior patterns, and lack of goals, inability to sustain feelings of pleasure or happiness, difficulty in concentrating or in being motivated discouragement, depression and loneliness (Jensen, 2008). Curious people seeking self-knowledge, those with the capacity for self-reflection, desire for truth and honesty and willing to tolerate vulnerable and painful feelings stand to benefit greatly from PT. Differentiating Psychodynamic Therapy with CBT in Clinical Hypnosis Different stakeholders have a soft spot for different types of therapies, depending on their understanding of these therapies and the circumstances in which they are applied. For instance, those in support of the PT approach feel that despite the fact that it kind of scientifically lags behind the CBT approach, it is old time and seems to be more based on the theories of psychoanalytic thinking of fathers of psychology such as Sigmund Freud (Dobson, 2001). However, it is of the essence that the highly demanding nature of modern day psychology and the increasingly educated and informed public be recognised. Cognizant of these facts, many scholars and researchers have published quite numerous case studies supporting a given approach to psychotherapy. Additionally, the role of scientific randomised and controlled clinical trials cannot be overemphasised. To exhaustively compare and contrast the CBT and the PT approaches to clinical hypnosis, it is advisable that both approaches be defined first. First, psychodynamic therapy refers to an in-depth psychology treatment that targets and reveals a client’s psyche’s unconscious content with the sole aim of relieving or alleviating psychic tension (Etchegoyen, 2005). PT is thus a bit similar to psychoanalysis and relies on the interpersonal relation between clients and therapists. In fact, this is one of the stark differences between PT and other forms of psychology. The other outstanding feature of PT is its being more diverse than the other approaches (Etchegoyen, 2005). It thus takes techniques from diverse sources rather than rely on a single source or type of intervention. PT has also been used extensively used for individual, family and group therapy, thus useful in the understanding of and working with both institutional and organisational contexts. Notwithstanding the approach settled on, it is worth noting that most psychotherapeutic approaches are built around the idea that certain maladaptive processes or functions in play, albeit unconsciously (Etchegoyen, 2005). These presumed maladaptive functioning often develop early in life and end up causing disharmony in later life. It is these unconscious conflicts and their resultant symptoms that PT seeks to reveal and resolve. However, the PT first targets the treatment of the discomfort that results from these maladaptive functioning. Subsequently, PT seeks to assist clients in acknowledging the existence of the maladaptive functioning and work with the clients to develop and implement the strategies by which these maladaptive functioning may be addressed and reversed. To achieve these objectives, there are several techniques that psychologists apply in psychodynamic therapy. These techniques include working through painful memories and difficult issues, free association, building a strong therapeutic alliance, recognizing resistance, transference and catharsis (Gorassini & Spanos, 1999). Although these forms vary, they are based on several core principles and characteristics that should be recognised in clinical settings before an approach is settled on. First, the approach emphasises the centrality of intra-psychic and unconscious conflicts, also highlighting these concepts relation to development. The second principle of PT is the belief that psychopathology starts especially during early childhood experiences. Third, PT sees defenses as being developed in internal psychic structures to help avoid unpleasant consequences of conflict. Fourth, PT holds the view that internal representations of experiences are based on an individual’s interpersonal relations. The fifth importance characteristic of PT is its view that issues in life and other dynamics often re-emerge as transferences and counter-transference as clients and therapists relate. Sixth, PT emphasises free association as a tool for the exploration of clients’ internal problems. PT also focuses on defense mechanisms, interpretations of transference, and current symptoms. Additionally, PT focuses on working through current psychological problems and trust in insight being rather critical in clinical hypnosis (O’Hagan & Lynn, 2009). The Cognitive-Behavioural Theories and their Roles in Hypnosis In recent times, there have been increased efforts to integrate clinical hypnotherapy and CBT. These increased efforts have yielded quite interesting results with some indicating that cognitive-behavioural hypnotherapy is more effective than CBT alone. In fact, in a number of studies, it has been reportedly noted that between 70-90% of clients indicate that CBT is more effective when integrated with hypnosis. In other words, for many clients, cognitive-behavioural hypnotherapy is superior to CBT alone (Butler et al., 2005). Although this efficacy of cognitive-behavioural hypnotherapy has become more apparent in recent times, the relationship between cognitive-behavioural therapy and clinical hypnotism started long time ago and is rather complex. While hypnotism could be traced to the works of James Braid such as the psycho-physiological model, the behavioural theories of hypnotism could be traced to Pavlov’s physiological research and his recommendations for the development of a hypno-psychotherapy based on “cortical inhibition” in the late 19th century (Kroger, 2008). An exact and updated summary of the cognitive-behavioural model of hypnosis, as envisaged by many a scholar, is often based on the following factors. First is the enactment of the social roles of the hypnotized person. The second factor is the belief, perception and attitudes towards hypnosis, motivated engagement and fantasy involvement. Third is goal-directed activities and interpretation of suggestions and cognitive strategies. The other such factors are expectancies, response sets and automatic responses in one’s actions. Whenever a clinician or any other psychologist for that matter adopts the cognitive-behavioural view of hypnosis, certain innate similarities become rather apparent between hypnotherapy and CBT (Kroger, 2008). Among the most common and influential similarities between cognitive-behavioural and hypnotherapeutic theories of psychopathology were identified by historical figures in psychopathology such as Beck, Albert Ellis and Braid among others (Ellis, 2004). In essence, cognitive-behavioural models and therapies stress the important role of several factors, including but not limited to schemas, automatic thoughts (especially negative automatic thoughts) and the etiology of neuroses. The negative automatic thoughts of the involuntary dominant ideas have particularly been identified in quite many psychological problems including conversion hysteria. In this regard therefore, cognitive-behavioural therapy has become rather useful in breaking down a client’s pre-existing, involuntarily fixed and dominant ideas and their consequences in a client’s life. Cognitive-Behavioural Hypnotherapy & CBT Many a scholar has studied the therapeutic relationship between CBT and clinical hypnotism. However, there has been lack of consensual definition of cognitive-behavioural with some scholars defining it on the basis of a treatment being based on mediational model. On the basis of this model, CBT could be viewed as consisting of Beck’s Cognitive Therapy and Elli’s Rational Emotive Behaviour Therapy (REBT) among other methods (Beck, 1995). Although some of the models and therapies encompassed in this definition are beholden to behaviourism, they tend to appreciate the core role played by cognition. Nonetheless, hypnotherapy has also interacted a lot with behavioural psychology in its evolution just as it has inspired the emergence of quite many behavioural therapy interventions. In other words, for many years, hypnotherapy has applied behavioural psychology and its concepts and techniques to treat clients. Further highlighting the interconnectedness between CBT and hypnotherapy are the many clinical attempts to combine hypnotherapy techniques with those of CBT. However, the interrelation between the theories and practice of CBT and hypnotherapy is not in their entirety. That is, there are hypnotherapists who use CBT-related techniques without embracing cognitive-behavioural theories of hypnosis (Kirsch et al., 1999). Nevertheless, clinical hypnosis and cognitive-behavioural psychotherapy are quite suited to each other due to their historical interconnectedness and their procedural similarities. In fact, the use of hypnosis in cognitive-behavioural is a rather old practice due to the compatibility of cognitive and behavioural therapies and the cognitive-behavioural approach to hypnosis. The Role that Behaviour Therapy Principals Play in Clinical Hypnosis The main goal of psychotherapy being personal change, it is a science that is dedicated to the alleviation of emotional stress and the fostering of personal growth and development. In modern times, modern psychotherapists have endeavoured to integrate numerous research findings from divergent disciplines to expand and define psychotherapy. Most benefitted by this integration of disciplines is psychoanalysis, which has since acquired many new approaches to respond to the ever increasing and challenging societal needs (Chapman, 2006). In modern times, like in many other professions, the trend in psychotherapy is increased efficacy. That is, the need to address individual dilemmas and distresses in the shortest time possible without compromising the quality of the care given ranks highest for psychologists. This issue of quality care concerns both patients and therapists. Thus, in modern times, treatments are combined or combinations considered so that a treatment does not displace another. For an illustration, a patient could be placed under a psychoanalytically oriented psychotherapy and psychotropic medication or behavioral adjuncts at the same time. In this regard, hypnosis is rather complex, more so in its applications. In the past, hypnosis was directly used to remove the symptoms of a disorder. In these times, the client prejudiced sensation that a magical cure had been performed and that the forces behind the resolution of the disorder and its symptoms were beyond his/her control. In modern times, hypnosis seeks to explore the psychodynamics of the apparently increased sophistication of psychological concepts and condition (Braid, 2009). It thus fosters the experience of conflict resolution for clients and therapists. Since hypnosis has no set formula, it could be applied at the investigative, working through and termination stages of psychotherapy. While some clinicians apply hypnosis either as hypnotic or as non-hypnotic, others apply it on an as-needed basis. The Psychodynamic Theory of Hypnosis The psychodynamic theory of clinical hypnosis is a rather interesting one since it postulates that the unconscious mind is more important and more powerful than the conscious one, contrary to the common belief and has greater influences on an individual. As a matter of fact, were the conscious part of the brain in charge, people would not efficiently undertake normal activities such as writing, thinking and reading among other activities. Further one would not dream and have an astounding ability to concentrate and remember things due to absence of mental blocks. There is also the subconscious mind that enables an individual to do ridiculous things while at the same time prevents one from doing the things he/she wants to do, making the subconscious mind the wrongdoer (Kirsch & Lynn, 2006). Thus, the subconscious mind gets the condition or the behaviour it wants, regardless of the needs and the knowledge of the conscious mind. Thus, any behaviours or patterns that require changing can only be changed at the subconscious level (Kirsch & Lynn, 2006). Examples of behaviours and patterns that may be changed at the subconscious level include overcoming public speaking problems, gaining confidence, stopping smoking problems, overcoming public speaking problems and losing weight. In addition to the techniques therein, hypnosis also entails certain philosophies that are based on given group beliefs and the relationship between these groups and other people. Conclusions The important roles that the CBT and the PT approaches to psychotherapy plays in clinical hypnosis has been observed and scientifically proven by the many studies conducted so far in these fields. In fact, research findings have affirmed that better outcomes are observed in situation in which a combination of CBT and PT techniques are used with conventional clinical hypnotherapy approaches. The fact that both PT and CBT bring in different postulations, theories, and principles on board during therapies for medical as well as psychological disorders makes the integrated approach rather efficient. For instance, while CBT seeks to alleviate or eliminate the suffering and distress felt by patients, PT goes deeper to look at the root causes of these problems, yielding more effective results. Their differences notwithstanding, patients and therapists are advised to venture and try a combination of hypnotherapy, CBT and PT approaches in treating medical and psychological disorders. References Alladin, A. (2008) Cognitive hypnotherapy: an integrated approach to the treatment of emotional disorders. Chichester: John Wiley & Sons Ltd. Beck, J. S. (1995) Cognitive therapy: basics & beyond. New York: Guilford Press. Braid, J. (2009) The discovery of hypnosis: the complete writings of James Braid, the father of hypnotherapy. London: The National Council for Hypnotherapy (NCH). 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