A Synthesis of Psychoanalytic Method and Cognitive Behavioral Theory - Research Paper Example

A Synthesis of Psychoanalytic Method and Cognitive Behavioral Theory By themselves, the psychoanalytic method of counseling patients and cognitivebehavioral therapy are inadequate to bring about the intended result of the psychiatric intervention. Cognitive behavioral therapy (CBT) is a talking therapy, which endeavors to resolve issues regarding dysfunctional behaviors, emotions, and cognitions through a highly structured, goal-oriented process. The psychoanalytic method is a less structured technique of in which the patient verbalizes cognitions such as fantasies and dreams, from which the psychoanalyst extrapolates the unconscious dysfunctions that result in the patient's outward symptoms. The specialist interprets these readings for the patient in order to generate insights with regard to the resolution of the symptoms. Because these two techniques are so starkly different, they often miss insights that the other method may provide. For instance, while CBT is highly structured, psychoanalysis relies less on structure than on the free associations of the patient and their interpretations. Accordingly, each method may have a great deal to learn from the other, and a synthesis of these two treatments may provide for a valid and reliable treatment procedure. Background From personal experiences, it seems that counseling psychologists are most effective when they facilitate a discussion with patients, rather than interrogating them. Psychoanalysis provides the opportunity for a psychologist to guide a patient to those insights relevant to the underlying problem; however, in the act of psychoanalysis, autonomy of insights is removed from the patients and trusted to the psychoanalyst for the solution. Although CBT allows some autonomy for the patient to draw his own conclusions, it ignores the role of psychoanalytic transference, which seems to be an important issue to be addressed in a counseling session. Human Nature The idea that patients ought to be given the autonomy to interpret their own unconscious, once it has been questioned by the counselor, is based on a view of human nature as metaphysically free. With a free will, human beings are not bound by the rules and laws set forth by their unconscious; in fact, people have the inherent power to change the subconscious conclusions and philosophies that affect their emotional livelihood. However, the status of thoughts and cognitions in the unconscious leaves them inaccessible to the patient by his own devices. For that reason, he needs an active intervention from the counselor, which is a defining feature of cognitive behavioral therapy. On this second premise, human nature is also seen as fundamentally social: that, in order to resolve their psychological difficulties, human beings must seek the help of others as critical questioners. Only by using the guiding questions of others can one identify (and thus resolve) his emotional, cognitive, and behavioral problems. Personality According to the id, ego, and superego framework of the psychoanalytic theory of personality, humans are fundamentally conflicted creatures. The id, which represents the unconscious, conflicts with the ego in terms of social appropriateness. A strong ego is able to manage this conflict; however, a weak ego is not. Personality problems are thought to occur because of the relative strength or weakness of the ego in dealing with the pressures of conflict (Kohut, 2009). Unlike a psychoanalytic counseling session, a CBT session is highly structured (Lemma & Patrick, 2010). In the case of a synthesized therapy, this structure could revolve around these elements to settle the conflict between them. For instance, the therapist could lead the patient into a discussion about conflicts the patient has had between his base desires and the principle of reality in attempt to pinpoint why he has a maladaptive personality. Definition of Counseling Counseling is a branch of applied psychology that attempts to derive solutions to individual problems revolving around person-environment interactions, process and outcome, career and education, and personality. The premise of counseling is that there are psychological problems that humans show outward and inward symptoms of, which can be readily and reliably identified by a psychologist (Leung, Chan, & Leahy, 2007). The nature of these mental symptoms and the process by which they should be treated is the subject of disagreement between different schools and types of counseling psychology. Although psychoanalysis has developed its own procedure for diagnosing mental problems, much of the practice is commensurate with other counseling techniques such as cognitive behavioral therapy, which differs from psychotherapy in the means toward a psychological solution to mental problems but not in the end result of the treatment. Functions of a Counselor A counselor, as a mental doctor, is given the two-part task of diagnosis and treatment. Although not merely a speaking partner, a counselor may utilize tactics that employ as much as a 50/50 division of speech time between therapist and patient (Lemma & Patrick, 2010). The counselor ideally guides the patient through his treatment in order to provide insights into the underlying personality and emotional problems affecting the patient’s conscious mind. Although psychoanalytic theory is correct to identify the unconscious as the cause of many mental problems, it misses the mark in placing the counselor as an interpreter of dreams, free associations, and feelings. Rather, human beings as autonomous, free beings need counselors not as experts, but as facilitators, such as they are in cognitive behavioral theory. Despite the fact that people, as social animals, require the help of others to resolve deeply-rooted unconscious problems, it is only the individual who can subjectively examine his mind to find the problem. Process of Change A synthesis of psychoanalytic methodology and cognitive behavioral therapy accomplishes two tasks with respect to the observance of the process of change: first, the patient is motivated to discover the unconscious causes of his psychological problems and second, the patient plays an essential role in the resolution of these problems through a process of active participation in the counseling. By guiding them through the process, the counselor is able to observe the patient’s progress through a helper-relationship. The formation of this external relationship with the counselor is one of the first signs of a change, since it represents an internal desire of the patient to interpret and identify his own cognitive states. This synthesis therapy faces some resistance to a process of change, namely in how the patient is given autonomy to discover the roots of his own problems (Lemma & Patrick, 2010). This might strike some as unproductive in the sense that individualsare only given help, not answers, which stands in contrast to traditional psychotherapy, where the counselor gives direct insights into the probable source of the mental problems afflicting the patient. Culture, Gender, and Age Psychoanalytic couneling makes a clear distinction between genders with respect to how childhood experiences shape mental problems in adulthood. For instance, Freudian notions of intrafamilial sexual attraction depend on a notion of gender (Gyler, 2010). Likewise, a synthesis therapy for a child will differ significantly in the techniques and questions utilized from the techniques and questions employed when treating a child. Because a child’s unconscious is less complex than that of an adult, it is easier to access for the therapist and easier to identify problems of conflict. With respect to culture, differing social norms inevitably pose a challenge to the scope of some psychoanalytic techniques, and invites a cognitive-behavioral approach. Values Values are conceptual structures registered by an individual that function as directives to act (Patterson, 1959). Although counselors are advised against being judgmental and impervious to values in the process, psychoanalysis gives a clear role to values in the context of the procedure. In the synthesis of psychoanalytic method and cognitive behavioral therapy, the issue of values in a productive counselor-patient relationship is not ignored. Rather, it is embraced as an inevitable part of the process of developing solutions to psychological afflictions, as it is becoming in the wider counseling practice (Patterson, 1959). However, where this synthesis departs from traditional psychoanalysis is in the thought that the counselor should not attempt to impose his values on his patient through interpretations of the unconscious. Rather, because this new kind of therapy gives the patient autonomy to interpret the unconscious, as opposed to the counselor, there are no value being imposed and only those values that the patient has previously held are raised within the context of the actual therapy. Summary A synthesis of psychoanalytic therapy and cognitive behavioral therapy serves the interests of patients by providing them with the autonomy that they require in the process of resolving intrapersonal conflict. Methodologically, it is essential to facilitate a discussion with a patient, rather than investigation and imposing psychological principles like a physical doctor. Instead, the counselor should allow the patient to reach his own conclusions through a process of active engagement. This active engagement plays into the notion of human nature as fundamentally social and open to experiences where others help in the correction of unconscious dysfunction. This proposed shift in counseling technique is a matter of building relationships between autonomous parties that cooperate toward a common goal. Works Cited Gyler, L. (2010). The gendered unconscious: can gender discourses subvert psychoanalysis? New York: Routledge. Kohut, H. (2009). The analysis of the self: A systematic approach to the psychoanalytic treatment of narcissistic personality disorders. Chicago: University of Chicago Press. Lemma, A., & Patrick, M. (2010). Off the Couch: Contemporary Psychoanalytic Applications. New York: Routledge. Leung, S., Chan, C., & Leahy, T. (2007). Counseling psychology in Hong Kong: A germinating discipline. Applied Psychology, 56, 51-68. Patterson, C. (1959). Values and Psychotherapy. Retrieved 2011, from C.H. Patterson: http://www.sageofasheville.com/pub_downloads/VALUES_AND_PSYCHOTHERAPY.pdf Read More