Over time, there have been a variety of therapeutic orientations based on multiple theories that have been developed to treat mental health. The theories I will be expanding on are psychoanalysis, humanistic, and behavioral/cognitive behavioral (CBT). I will start with a brief overview of each theory and sharing some of the different approaches within the theories.
I will also explore the commonalities or fundamental shared assumptions within theses theories along with the differences in assumptions of each. I will conclude with a discussion on which theory resonates most with me and why.
This theory was first termed as psychoanalysis by Austrian neurologist Sigmund Freud in the late 1800’s. Over time, various schools of thought that have formed from Freud’s Theory of psychoanalysis and together they fall under the umbrella of psychodynamic theory.
The schools of drive theory, ego psychology, object relations, self-psychology, interpersonal and relational/intersubjectivity are analytical, and center around analyzing an individual’s personality- characteristic habits of mind- to better understand how these dynamics affect a presenting problem and general quality of life (Gerhart, p. 35).
Also shared among the theories are the basic practices of analyzing or conceptualizing personality structures, and functioning, fostering client insight into their personality dynamics, and working through these insights toward action (Gehart, p.35). A key element to psychodynamic therapy is the counselor’s ability to be a container for the client. The therapeutic relationship is the arena in which unconscious relational patterns are evoked, enacted, and resolved.
In psychodynamic therapy, a goal is to foster a therapeutic relationship that allows the client to open up and uncover the conflicting emotions and unconscious content of their mind.
Psychodynamic therapists use techniques such a free association, which allows the client to speak their ‘truest’ mind without judgement, interpretation, which is where the the therapist gives feedback or meaning to what the client has revealed, and working through transference and countertransference.
Transference is when a client is reacting to the therapist as they would have someone in their life, and/or an emotional projection occurs and countertransference is the reaction of the therapist toward the client. Working through the thoughts and emotions evoked by the acts of transference and countertransference can allow the client achieve insight into the influences of the past and the therapist can recognize what is coming up for them in the experience, for instance, their own biases or energies they are bringing to the space.
The humanistic theory takes on a perspective that “views people as capable and autonomous, with the ability to resolve their difficulties, realize their potential, and change their lives in positive ways” (Seligman, 2006).
The philosophical foundations that exist in humanistic theory are phenomenology which is the study of the unconscious, inner self and emotions, humanism which is the belief that people have a natural tendency toward positive growth, and existentialism which the belief that life is inherently meaningless, or neutral, until a person creates meaning (Gerhart, p.130).
Person-Centered Therapy, Existential Counseling, and Gestalt Counseling are the three approaches that fall under the umbrella of humanistic theory. All of the approaches are insight based and in modern counseling, therapists draw from the entire range of humanistic approaches although initially the approaches were separately formed. P
sychologist Carl rogers developed Person-Centered Therapy (PCT). Rogers believed that all people had the potential to change and improve, and that the role of the therapist is to foster self-understanding in an environment where adaptive change is most likely to occur (Rogers, 1951).
Using core conditions of empathy, counselor genuineness, and unconditional positive regard, this approach to therapy focuses on the emotional and relational process to promote change. Existential counseling is rooted in the neutral assumptions about the human condition. Considered to be a less optimistic approach than humanistic approaches, this approach emphasizes insight and reflection on existential issues to more effectively resolve underlying anxieties.
Gestalt counseling is similar to PCT, it focuses on self-actualization and ones ‘true’ self. Different from PTC, this approach uses techniques that are emotionally provocative and confrontational (Gehart, p.129-130)
Behaviorism is a theory that can be the considered the counter to Freud’s postulations about the inner-dynamics of the mind (Markel, 2018). Behaviorism views psychology as a science and focuses on the objective reality and logic, with an emphasis that behaviors are learned and can essentially be unlearned.
Behavioral, cognitive, and cognitive behavioral approaches emphasize the use of active techniques and psychoeducation to achieve changes in behavior, cognition and affect. Action-oriented approaches to therapy are brief, target specific medical symptoms, and have empirical foundations which are some of the reasons why they are highly favored by insurance companies (Gehart, p. 203).
Behavioral approaches evolved in three stages. The first wave of behaviorism was the original ‘pure’ approach based on classical and operant conditioning, and social learning theory. The second wave of behaviorism blended both cognitive and behavioral practices, and today, the third wave is transforming behavioral practices, incorporating mindfulness approaches which integrating compassionate acceptance of feelings and thoughts which is a paradox to the foundations of the theory.
Over the years distinct modes of therapy have been developed, multimodal, Rational-emotive behavior therapy (REBT), reality therapy, and mindfulness based approaches.
When looking at the basic assumptions of each theory, the commonalities in the assumptions lie in the idea that they all have assumptions about human development, how behavior is determined and influenced, and the components of personality. Within the theories the differing modes of therapy also share commonalities such as establishing a therapeutic relationship, creating specific goals for the client, and treatment plans.
Differences that show up between the theories are highlighted in what the assumptions are. In regards to human development, psychodynamics assumes that the psychosexual stages occur at specific stages of life and there is an emphasis on childhood experiences, especially ones between child and parent/caregiver.
Humanistic assumes that innately humans are good natured and that the most important aspect of development is a person’s own sense of self worth. Behavioral and cognitive-behavioral theories do not look into the past, these theories focus on the present.
When looking at how behavior is determined and influenced, psychodynamics assumes that the unconscious mind, which we have no control over, motivates and drives human behavior. Humanistic assumes the belief that humans have a choice on how they behave based on free-will.
Behavioral assumes that individuals, along with their behaviors are shaped and influenced by their environment and that maladaptive behavioral reinforcement results in problem symptoms (Gehart, p.204), while cognitive-behavioral assumes it is not the specific experiences that create emotional and behavioral problems but the thoughts one has about the experience or situation that is the source of the problem.
In regards to personality development psychodynamics assumes the personality has three stages: Id, Ego and Superego. Humanistic views the personality as unified whole. Behavioral and cognitive-behavioral theory take on a purely scientific approach that redirects the subjective focus of shifting one’s personality to managing the symptoms of maladaptive behaviors and thoughts.
