118 CHAPTER 4
factors; we’ll consider psychodynamic therapy, client-centered therapy, and
cognitive-behavior therapy. These treatments differ in the specifi c psychological
factors that they target, their goals, and the methods used. However, when suc-
cessful, all of these treatments affect mental processes, mental contents, affect,
and behaviors.Client-Centered Therapy
Sigmund Freud’s psychoanalytic theory (see Chapter 1) radically changed concep-
tions of how psychological problems arise and how best to treat those problems.
Freud promoted psychic determinism, the theory that all behavior, no matter how
minor (except for biological functions), has underlying psychological causes. In
particular, he believed that the unconscious contains drives and urges concerning
sex and aggression, and the individual’s behaviors are responses to those uncon-
scious drives or urges. Such drives arise from the id, one of three psychic structures
of the mind. The drives are restrained and regulated by the superego, which houses
the internalized morals of society and the family. And the ego mediates among the
id, the superego, and the constraints of reality.
Freud held that psychological problems arise in large part from confl icts among the
urges of the id and from the regulatory actions of the superego and ego. Rather than
treating such problems medically—with medications or medical procedures, as was
done in Europe at the end of the 19th century—Freud treated patients by having them
talk about their problems and trying to discern the unconscious causes of the problems.The Goals of Psychoanalysis and Psychodynamic Therapy
Psychoanalysisrefers to the intensive psychotherapy based on Freud’s view that psy-
chopathology arises from unconscious confl ict. The ultimate goal of psychoanalysis
is to help patients manage impulses and urges more adaptively. To attain this end,
the patient tries to: (1) understand the events in his or her past (especially interac-
tions with his or her parents), and (2) understand how those events and his or her
unconscious urges infl uence current diffi culties. The theory holds that once patients
become aware of the unconscious urges that are creating problems, they will be ca-
pable of more adaptively handling impulses arising from those urges. That is, when
patients have attained suffi cient insight into their problems, they can make more
satisfying and productive choices; insight, according to proponents of psychody-
namic therapy, is the main catalyst of change.
Psychoanalysis is time-consuming and expensive (and rarely covered by health
insurance plans). Patients meet with their psychoanalyst(a therapist who provides
psychoanalysis) four or fi ve times per week, and the average patient participates in
835 sessions over at least 4 years (Voth & Orth, 1973). Psychoanalysis is diffi cult
to study scientifi cally because each patient receives a unique course of treatment
(tailored to his or her own personal issues) over a long period of time. Nevertheless,
the available studies have not usually found this treatment to be effective for many
disorders. Psychoanalysis is less common today than in previous decades because of
the time and cost involved and its uncertain benefi ts.
The more common treatment that is based on psychoanalysis ispsychodynamic
therapy, which involves less frequent sessions, less emphasis on aggressive and
sexual drives, and more attention to present experiences (in contrast to psychoanal-
ysis’s focus on past experiences). Very brief forms of this less intensive treatment
can consist of as few as 12 to 20 sessions (Bloom, 1997; Malan, 1976; Sifneos,
1992). Table 4.2 outlines the major differences between psychoanalysis and psycho-
dynamic therapy.
Both psychoanalysis and psychodynamic therapy are designed to help patients
understand that their unconscious motivations infl uence their behavior in specifi c
ways and to help them make better choices. According to Freud, however, such
treatment is not a cure, but a method for transforming deep misery into mundane
unhappiness.Psychoanalysis
The intensive psychotherapy based on
Freud’s view that psychopathology arises
from unconscious confl ict.
Cognitive-Behavior Therapy
A form of psychotherapy based on
psychoanalysis but that involves less
frequent sessions, less emphasis on
aggressive and sexual drives, and more
attention to present experiences.