Cognitive and Behavioral Therapies: Learn It 1—Psychoanalysis

  • Describe psychoanalysis as a treatment approach
  • Describe cognitive and cognitive-behavioral therapy as treatment methods
  • Explain the basic process and uses of behavior therapy
  • Describe systematic desensitization

Two Main Categories of Therapy

Mental health treatment generally falls into two main categories:

Psychotherapy is a psychological treatment that employs various methods to help someone overcome personal problems or attain personal growth. It involves talking with a trained mental health professional to address thoughts, feelings, and behaviors.

Biomedical therapy involves medication and/or medical procedures to treat psychological disorders. This category includes medications like antidepressants and antipsychotics, as well as procedures like electroconvulsive therapy.

In addition to these approaches, there is also a social approach to treatment, which focuses on family or group therapies. Many people receive a combination of psychotherapy and biomedical treatment.

Psychotherapy Approaches

Type Description Example
Psychodynamic Talk therapy based on belief that unconscious processes and childhood experiences influence current behavior Patient explores past relationships and recurring patterns
Behavior therapy Applies learning principles to change undesirable behaviors Patient learns to overcome fears, like anxiety or a phobia, through gradual exposure
Cognitive therapy Helps patients identify and change distorted thought patterns Patient learns to recognize catastrophic thinking. For example, a patient  learns not to overgeneralize failure based on single failure
Cognitive-behavioral therapy (CBT) Combines cognitive and behavioral techniques to change thoughts and behaviors Patient identifies self-defeating thoughts and practices new behaviors. For example, a person might identify self-defeating behaviors to overcome an eating disorder
Humanistic therapy Focuses on self-awareness, personal growth, and accepting oneself Patient explores feelings in a nonjudgmental environment. They to articulate thoughts that keep them from achieving their goals

 

Psychotherapy Techniques: Psychoanalysis

psychoanalysis

Psychoanalysis was developed by Sigmund Freud and was the first form of psychotherapy. It was the dominant therapeutic technique in the early 20th century, but it has since waned significantly in popularity. Freud believed most of our psychological problems are the result of repressed impulses and trauma experienced in childhood, and he believed psychoanalysis would help uncover long-buried feelings.

This photograph shows what Freud’s famous psychoanalytic couch looked like. The couch is draped in tapestries and pillows, and the room is decorated with sculptures, books and pictures on the wall.
Figure 1. This is the famous couch in Freud’s consulting room. Patients were instructed to lie comfortably on the couch and to face away from Freud in order to feel less inhibited and to help them focus. Today, a psychotherapy patient is not likely to lie on a couch; instead they are more likely to sit facing the therapist (Prochaska & Norcross, 2010). (credit: Robert Huffstutter)

Key Techniques

In traditional psychoanalysis, the therapist might use several techniques:

Free association involves the patient relaxing and saying whatever comes to mind without censoring. Freud believed that when patients encountered difficulty recalling certain thoughts—called resistance—this indicated important unconscious material.

Dream analysis involves the therapist interpreting the underlying meaning of dreams, which Freud considered the “royal road to the unconscious.”

Transference occurs when the patient develops strong feelings toward the therapist—positive or negative—that actually reflect feelings about other significant people in the patient’s life. For example, a patient might begin seeing the therapist as a parental figure, transferring unresolved feelings about their own parents onto the therapeutic relationship.

Modern Psychodynamic Approaches

Traditional psychoanalysis typically requires years of multiple sessions per week, making it impractical for many people. Today, the psychodynamic perspective has evolved to offer briefer treatments while remaining centered on the role of unconscious processes and internal conflicts.

Psychodynamic approaches can be applied to diversity, equity, and inclusion (DEI) efforts by helping people recognize unconscious biases that may contribute to discrimination. People raised in environments where diversity wasn’t valued may develop implicit negative attitudes toward those from different backgrounds. Psychodynamic approaches can help individuals understand how early experiences shaped these attitudes and work to overcome them.

Psychodynamic Approaches to Diversity, Equity, and Inclusion (DEI)

Psychodynamic approaches can help to combat discrimination by considering how unconscious biases contribute to discrimination and inequality. People may hold unconscious prejudices against certain groups based on race, ethnicity, gender, or sexual orientation—these biases may then manifest into discrimination in workplace settings as well as schools and other environments.

Psychodynamic approaches to diversity, equity, and inclusion (DEI) include considering how early experiences influence people’s attitudes and beliefs regarding diversity. For example, individuals raised in environments in which diversity wasn’t valued may develop more negative feelings toward people from backgrounds different than their own. Or those who have experienced trauma or discrimination may struggle to interact with other people due to anxiety, anger, or fear.

The psychodynamic perspective can assist people in understanding these difficulties and overcoming them more successfully. Psychodynamic coaching may help employees understand and overcome unconscious biases. It can also provide support for students who have been victimized by discrimination.

This photograph shows a person playing with objects in a small box filled with sand. The person is organizing these objects and small play figures in a form of treatment called sandplay.
Figure 2. This type of play therapy is known as sandplay or sandtray therapy. Children can set up a three-dimensional world using various figures and objects that correspond to their inner state (Kalff, 1991). (credit: Kristina Walter)

Psychotherapy: Play Therapy

Play therapy uses play and creative activities as a means to help children express their thoughts and emotions and work through challenges. Because young children are not developmentally able to engage in traditional talk therapy, play provides a natural medium for therapeutic work.

How Play Therapy Works

The Association for Play Therapy defines play therapy as using the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth. Through play with dolls, stuffed animals, sand trays, and other materials, children can express experiences and feelings they may not have words for.

Play therapy can address a wide range of issues including anxiety, depression, trauma, behavioral problems, and relationship difficulties. Meta-analyses of play therapy research have found moderate to large effect sizes, indicating that play therapy is effective for children with behavioral and emotional problems (Bratton et al., 2005; Ray et al., 2019).

Types of Play Therapy

Non-directive (child-centered) play therapy allows children to direct the play while the therapist observes and reflects the child’s feelings. The therapist creates a safe, accepting environment where the child can express themselves freely.

Directive play therapy involves more structure and guidance from the therapist, who may suggest topics, ask questions, or actively participate in play activities with the child.