Introduction
This paper is a discussion of two therapeutic approaches namely brief psychodynamic therapy and Cognitive Behavioral Therapy (CBT). The paper’s main focus is to compare and contrast the two therapeutic approaches in regard to how they are used to treat depression and anger. Even though both therapeutic approaches are applicable in the treatment of anger and depression, CBT is most suited to deal with the problems of anger and depression.
The paper starts with a discussion of the two approaches and their key concepts; which include denial, transference, countertransference, defence mechanisms, behaviour change, cognitive processing and trauma. What follows is an explanation of the problems of depression and anger and how the two approaches can be used to treat them.
Brief Psychodynamic Therapy
This therapy has its background from Freud’s psychoanalytic theory which has four main schools of psychoanalytic theory. They include Freudian psychology school, the object relations school, the self psychology school and the ego psychology school. All these schools have influence on psychodynamic therapy.Freudian psychology is based on Freud’s personality theory which divides personality into three parts namely the Id, the Ego and the Super Ego. These three parts are combined to form people’s personalities based on their early experiences in life (Demand Media, 2010).
Freud described the Id as the part of personality which is present at birth. At birth, people operate at the pleasure principle which is characterized by immediate gratification of drives like hunger or sex. The Id explains why children bring everything they come across to their mouths. Freud described this part of personality as being irrational and illogical because it is not guided by the norms of society and the reality. While it is true that people have drives, they do not simply go on gratifying them anyhow. For example, if a person has a desire for sex, he or she cannot just go around fulfilling his or her desire with everyone, but he or she must fulfill it in a way that does not violate the norms and values of society (Dewan, Steenbarger & Greenberg, 2012).
The Ego, which Freud called the reality principle in the sense that it mediates the Id and the Super Ego (which are partly irrational) prevents people from immediate gratification of drives and directs them to wait for a convenient time. For example, when a person is walking along a street and sees fried chicken displayed in food outlets, the Id instructs him or her to go and eat, but the ego advises the person to delay that drive until when it is convenient him or her us to do so; may be the person may not have the money to pay for the chicken or he or she may be in a hurry (International journal of psychoanalysis key papers series, 2003).
The Super Ego is the part of our personality which Freud described as operating at the moral principle, dictating to people what is right and wrong. It is composed of the conscience and the Ego ideal. Since the Super Ego represents the society, the needs of the society are different from those acquired by people during their childhood, which are characteristic of the Id and this makes the two to be in conflict because the social needs acquired during childhood are not in harmony with what the society is ready to offer. People therefore develop various personalities based on their childhood social needs and the available opportunities for people to meet the needs in the societies which they live in (Malan, 2001).
Freud argued that the Ego tries as much as possible to meet the demands of the Id and Super Ego. But sometimes, the demands may become too high that the Ego cannot meet them. In order for the Ego to retain its dignity, it employs what Freud called Ego defense mechanisms, which are aimed at distorting the desires of the Id and Super Ego to levels which the Ego can manage. The defense mechanisms are aimed at reducing anxiety and pressure from the desires of the Id and the Super Ego, which enable the individual to cope with life (Levenson, 2002).
The core defence mechanism is repression, which entails the repressing of the things in the unconscious mind back to where they belong and preventing them from occupying any space in people’s minds. All defence mechanisms are therefore based on the principle of denial and to this regard; they cultivate various personalities in different people depending on what people went through during their childhood (Jessica, 1988).
Object relations theory explains personality formation based on internal and external objects especially during childhood. Its explanation of personality development focuses on the first three years of life and the influence of mother and infant relationship as the basis of personality development. This conceptualization is similar to that of Sigmund Freud, who is associated with the traditional psychotherapy. As Freudian theory, the object relations theory explains personality development in terms of Id, Ego and Super Ego which develop as a person grows (Levy & Ablon, 2009).
The way a person is brought up determines how his or her future life will be. This therefore means that if a person passes through the stages of personality development without any fixation, then he or she grows to be a “complete human being” in terms of behaviour, morals and personality. The theory attributes problems in future life of an individual to earlier unresolved conflicts. In psychotherapy, the theory focuses on the relationship between the client and the therapist (Beck & Alford, 2009).
The therapists allow the clients to express their fantasies to them, which Freud referred to as transference. This enables the therapists to understand their client’s inner profiles and the issues affecting them. In this case, the therapists’ acts like external objects for the clients to identify with or associate their fate with. The therapists react with countertransference to the transference of the clients so as to understand the problems further. However, the therapists must be careful not to hurt the clients with their countertransference (Budman & Gurman, 1988).
The object relations theory does not put a lot of emphasis on the power of instincts and unconscious mind the way the traditional psychoanalysis does. It does not also interpret the transference for clients , but rather , the therapist interprets and comes up with a solution unlike with psychoanalysis which involves the interpretation of dreams and fantasies of clients by the therapist so that the clients may gain some insights to their problems (The Gale Group, 2008).
Ego psychology focuses on enhancing the functions of the Ego and the individual’s ability to adapt and cope with the reality. Self psychology has to do with an individual’s perception of the self. If a person is a victim of drug and substance abuse, he or she is considered to be having a weak personality boundary which lowers his or her self esteem. The main goal of brief psychodynamic therapy is to alter an aspect of a person’s identity and reinforce learning which the individual may have missed during earlier stages of emotional development (The Gale Group, 2008).
The therapy therefore is based on or is focused on one major problem facing a client, which is in contrast to psychoanalysis which allows clients to associate freely and bring forth some unconscious issues in therapy sessions. The therapist and the client must therefore agree on the main issue to be solved and structure their relationship around that one area of focus or problem (Spiegler & Guevremont, 2010).
The key concepts in psychodynamic therapy include denial, transference and countertransference. Denial is a form of defence mechanism in psychodyamic therapy. Clients use denial in order to weaken their strong Super Ego which overpowers their Ego leading to anxiety and depression. Transference is a situation in which clients express their feelings and emotions towards the therapist in a bid to secure love, recognition and appreciation. Countertransference is a situation where the therapist reacts to the transference of clients with an aim of understanding the clients’ problems (The Gale Group, 2008).
Cognitive Behavioral Therapy
The proponents of the approach (John and Carl) define behaviour as a function of hereditary and environmental factors. One of the principles of the therapy is that human behaviour is learned and therefore is subject to change. One way of changing the learned behaviour is by altering the maladaptive behaviours in clients and make them adopt other behaviours which enable them cope with their problem(s) (Beck, 1995).
The proponents of this theory further argued that the principles of social learning (reinforcement and modeling) may be applied in the counseling process to help the client forget old ways of living and adapt new orientations in life. If for example the person is an alcoholic, he or she may be taken to a rehabilitation center whereby the alcohol is withdrawn gradually and replaced with something else which does not have similar effects. During the rehabilitation, the person is trained on how to live and survive in the absence of alcohol or drugs. The end result in this case is a change of life style by the client through the acquisition of a new meaning in life accompanied by new behaviours (Corey, 2008).
This mode of intervention is the same as the Cognitive Processing Therapy (CPT), which is based on the philosophy that the cause of trauma among patients is their poor understanding and conceptualization of their traumatic experiences. If they are educated to modify their thinking and the memories associated with a certain traumatic experience, they are able to live better. The underlying principle is that the patients should be assisted to view their traumatic encounters as something which could have befallen anybody else, but not something which was made for them (Schulz, 2011).
In treating depression, the therapy usually constitutes of 12 sessions in which the clients are taken through a systematic process which culminates in the complete elimination of the beliefs about themselves and the traumatic experiences which hinder their recovery from the trauma. In one of the significant stages of the process, clients are asked to write down their worst forms of trauma which they have undergone in their lives. After writing them down, they are asked to read and narrate them to the therapist (Resick & Schnicke, 1992).
The idea behind this is that the writing down of the experiences and narrating them decreases their chances of avoiding similar situations in life and helps the victims have the courage to dissipate similar experiences, which in turn leads to recovery by making the clients get back to normalcy through emotional adjustment.The therapists also use what is referred to as Socratic dialogue to engage the clients in speaking about their experiences. This helps them reduce the rate of self-blame and increase their ability to appreciate that the experiences could have befallen any other person. This leads to recovery (Epstein, 1983).
What is depression?
This is a mental illness which makes a person experience prolonged feeling of sadness and lack of interest in everything. It is also known as major depressive disorder, clinical depression or major depression. Depression negatively affects a person’s thinking, feelings and behaviors. It also interferes with a person’s ability to do his or her daily chores due to emotional disturbance. The person may also feel that life is not worth living. The major symptoms of depression include despair, loneliness, sadness, low self esteem, loss of appetite, insomnia and withdrawal from others. The major forms of depression include major depressive disorder and psychotic depression (Goldfried & Davison, 1994).
What is anger?
This is a type of emotion which has to do with a person’s emotional interpretation of offenses committed against him or her by others. It is a normal emotion in everybody and its primary role is to protect individuals from harm. Anger arises from provocation of a person by another. It can make people act in a retaliatory manner. People may also react by withdrawal or by becoming violent or aggressive (Novaco, 1983).
People with anger have increased heart rate and increased levels of blood pressure and adrenaline. They may also express anger in other forms such as facial and physiological expressions. One of the risks of anger is that it has the ability to alienate people from others or make them engage in activities which may make them regret in future (Tafrate, 2009).
Anger is caused by a present problem or situation which offends a person. It can also arise from a present situation which reminds a person of past bad experiences. Anger becomes a problem when it leads to violence, aggression, hurting others or when it leads to other social or legal problems. It may sometimes be a sign of bipolar or major depressive disorder (O’Neill, 1999).
Comparison of the two approaches in treating depression
Cognitive behavioral therapy (CBT) and the psychodynamic approach share some characteristics in the treatment of depression. One of the shared characteristics is that both approaches are short term and are designed to attain long lasting outcomes through successive short periods of therapy. Another similarity is that both approaches can be combined with the use of anti-depressants in the treatment of depression. However, this is only applicable for the acute cases of depression. Mild forms of depression can be treated exclusively using these approaches (Persons, Davidson & Tompkins, 2001).
Another similarity of the approaches is that they are both focused on a specific aspect of therapy. The client and the therapist have to agree in the first session the major goals of the therapy and work towards that major goal. In other words, no room for clients to freely associate themselves with unconscious memories (Lam, 2011).
The two approaches consider depression as caused by a defect in one’s thinking process as well as unresolved mental problems which lead to the fixation of the clients. The approaches are therefore focused on correcting the ways of thinking and make the clients think in a constructive manner. Clients are also helped to understand the connection between their past mental conflicts and their present predicaments. Once they are made to understand that, they are able to see the inconsistencies in their thinking which causes their current mental problems and are challenged to avoid those negative thoughts and adopt healthier thoughts (Follette, 2006).
However, the two approaches have some differences. One of them is that psychodynamic therapy is based on psychoanalytic therapy which focuses on a person’s unconscious mind as the basis of therapy; that is, depression is interpreted from the lens of unconscious minds of clients. During therapy, the therapist tries to correct mistakes of the unconscious mind of the client. On the other hand, CBT is based on thinking process of clients. Depression is seen from the lens of wrong thinking patterns and therapy focuses on correcting and aligning the thinking process of clients with reality (Osimo & Stein, 2012).
Another difference is that in treatment of depression, the brief psychodynamic therapy has less intense therapy sessions with clients meeting the therapists once in every week and the sessions lasting for less than 50 minutes. CBT on the other hand is a bit formalized and is based on clearly defined outline with specific goals to be attained at every stage of therapy (Follette, 2006).
Another difference is that CBT is educational while brief psychodynamic therapy is not. CBT’s success is based on educating the clients about the flaws in their thinking with a view of showing distortions in the thinking of the clients. Clients are encouraged to write down some of their past experiences which are then used by the therapists to interpret the current problems facing the clients. With psychodynamic therapy, clients are just encouraged to remember their past experiences which may be connected with the present situation but the experiences are not necessarily included in the treatment of clients (David, 2008).
Comparison of the two approaches in treating anger
It is important to mention at the outset that anger has not been recognized as a mental illness by the Diagnostic and Statistical Manual of Mental Disorders (DSMMD-IV) edition four. This is because there has been a tendency to explain anger as a symptom of mental disorders but not as a disorder by itself (DeFoore, 2004).
This tendency has also been influenced by the fact that anger is to some extent a normal emotion found in every one just like happiness or joy. However, psychologists have discovered that anger can exist by its own as a mental problem, especially when it is persistent and thus there has been a significant progress towards the treatment of anger as a mental illness (Barlow, 2008).
Several therapies have been used in the treatment of anger. The brief psychodynamic therapy and the CBT are some of the therapeutic approaches which have been proposed to treat anger. In the treatment of anger, both focus on identifying the underlying causes of anger. They focus on changing the behavioural patterns of clients with a view of identifying and eliminating those behaviours which disrupt the normal thinking process of clients (Efran, 2002).
In both approaches, clients are taken through brief sessions of anger control and management. They are also advised on the best ways to deal with anger. The approaches also have a therapeutic relationship in which the therapists may allow the clients to express their transference. The therapists react by producing countertransference which helps them understand the real issues underlying the anger by the cleints (Chemtob, Novaco, Hamada, & Gross, 1997).
One major difference between the two approaches is that the CBT is wider in scope in that it focuses on prevention, treatment and educating the clients on how to cope and manage anger (post intervention). In this sense therefore, the approach is considered as proactive rather than reactive. On the other hand, the brief psychodynamic therapy is considered as reactive. This is because the approach focuses on the present causes of anger and what can be done to manage or control the anger. Even though therapy involves digging into the history of the client in regard to anger, the approach does not put the past into consideration in the treatment of anger (Beck & Fernandez, 1998).
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