Psychoanalytic and Cognitive Behavioral Approach in Counseling and Psychotherapy

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Throughout the 20th century, psychoanalysis has been the main reference point in the field of psychotherapy. Since the 1950s, many other therapies have emerged: Roger counseling, transactional analysis, Gestalt therapy, Ericksonian hypnosis, etc. Today, one of the main currents is cognitive-behavioral therapy (CBT) (Corey, 2016). These therapies are defined as treatments for psychological problems based on scientific psychology, or as methodically evaluable procedures that deal with psychological problems by teaching new behaviors, thinking, feeling, and acting. The goal of psychotherapy, common to most psychotherapeutic approaches, can be formulated as follows: to help patients change their thinking and behavior in such a way as to become happier and more productive. When working with patients, this goal is differentiated into several tasks, namely (Sommers-Flanagan & Sommers-Flanagan, 2018):

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  1. the therapist helps the patients to better understand their problems;
  2. eliminates emotional discomfort;
  3. encourages free expression of feelings;
  4. provides the patient with new ideas or information on how to solve problems;
  5. helps the patient to test new ways of thinking and behavior outside the therapeutic situation.

Despite the commonality of key tasks, the respective approaches also have significant differences. In particular, psychoanalysis and cognitive-behavioral therapy (CBT) differ in methods and strategies; they may also differ slightly in purpose. Psychoanalysis takes a more holistic approach.: the desire is to better understand the brain and how thinking works, and the relationship between thinking, personality, and behavior. The task of psychoanalysis is to transfer the unconscious material of the human psyche into the field of consciousness and subordinate it to its goals (Imel et al., 2015). CBT takes a more sophisticated approach to problem-solving and focuses primarily on behavior (Salza et al., 2020). It cares less about the whole person and is more interested in finding immediate tools that can help the person to engage in a particular type of thinking that people often find hurting.

In psychoanalysis, the method typically involves the therapist or analyst creating an attractive space that allows the client to talk about whatever he wants to talk about. Psychoanalysis is a multifaceted concept. This is a psychotherapeutic method, and the theory of the psyche (in which the unconscious is assigned a leading role), and the theory of personality (its three structures: “Self,” Super-Self,” “It”). The main idea of Freud’s teaching was that unconscious childhood sexual fantasies and forgotten childhood experiences are the cause of neuroses and personality disorders in adulthood (Elliott, 2015). One of the main “tools” in psychoanalytic work is the personality of the analyst. He must be able to immerse himself in the patient’s unconscious, to experience with him/her most secret inner conflicts and tragedies, at the same time analyzing them and accurately understanding what is happening in the patient’s soul. The result largely depends on the conditions in which the meetings with the analyst take place. They are always clearly defined (analysts call these rules “setting”): the patient comes to the same place at a predetermined time (Eremie & Ubulom, 2016). All missed appointments will be charged regardless of the reason they were missed. Analysts are confident that such stability and clarity of conditions helps the patient feel responsibility for the work, develops his/her internal analytical process.

During the session, the patient lies on the couch, and this helps him to stop controlling external reality – after all, he cannot follow the analyst’s reaction (he sits at his head), but only hears his voice. The patient has the feeling that he is talking simultaneously with a real person, with himself, and with the fantasy image of the analyst that arises in him (Sommantico et al., 2017). The psychoanalytic model argues that the causes of emotional problems are associated not so much with a specific actual situation in which the client is, but with the typical characteristics of his living situations, which are due to previously unconscious decisions made by him. In this model, the roots of the earliest such decisions are in the client’s childhood experience. Psychoanalysis as a therapeutic procedure is precisely aimed at the patient’s awareness of his unconscious conflicts, including the earliest ones.

The patient says everything that comes into his head, even something that is unpleasant, embarrassing, or painful to report (these are free associations). Trying to follow this rule, he projects his unconscious desires, feelings and conflicts onto the analyst and experiences them with renewed vigor (this phenomenon in psychoanalysis is called transference. However, it is equally important for the result of the work that the analyst also captures the emotions that arise in response to the patient’s experiences (such reactions are called “countertransference.” This helps to understand even the deepest unconscious experiences of the patient and interpret them, that is, transform the unconscious into the conscious.

The psychoanalytic process can be defined as a psychotherapeutic situation in which the analyst intervenes with his clarifications and interpretations of the patient’s conflicts, especially by addressing the resistance and conflicts associated with the analytic situation here-and-now. Such a specifically dyadic transfer of knowledge during treatment stimulates the patient to further reflect on his experience and, especially, about unconscious motives. The described form of patient thinking is called insight; the consequence of the process of insight is that new material can be brought to the surface, which in turn means an increase in knowledge and allows the patient to reach new insights leading to a cure (Sommantico et al., 2017). Changes in the patient depend to a large extent on the quality of the analyst’s contribution, represented by his ability to choose the right moments of intervention, the type of psychoanalytic intervention and its content, as well as the intelligibility (clarity) of this intervention.

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Psychoanalysts work with all psychological problems and personality disorders. The method is effective in working with those who want to understand themselves deeper, for whom it is important to open the unconscious meaning of their experiences or disturbing life situations. Anyone who wants to undergo psychoanalysis must acknowledge their psychological problems and difficulties and understand that their source is within the person himself (and not only in the external world). Overall, psychoanalytic therapy is based on the following theoretical postulates:

  • In the human psyche, there is an unconscious part that largely determines the feelings, thoughts, actions, desires of people.
  • Events that happened to a person in childhood, especially before the age of five, affect his future life.
  • All the characteristic features of a person, patterns of behavior, defenses, ways of thinking and feeling, peculiarities of perception, etc. manifest in relationships with all people, including in relationships with the therapist.

The unconscious expresses the fundamental foundation of the human psyche, the most important determinant of individual consciousness, social behavior, and cultural creativity of the individual. “Applied psychoanalysis” is understood as the application of psychoanalytic knowledge to problems of explanation, methodology, or technology that have arisen in disciplines or fields of human activity other than the psychoanalytic practice itself; or using insights from clinical psychoanalysis to expand and deepen our understanding of various aspects of human nature, culture, and society (Sommers-Flanagan & Sommers-Flanagan, 2018). Psychoanalysis as an innovative therapeutic technique initially exists in indissoluble unity with a wide cultural context, which, through analogies, historical parallels, and symbols, is included in the structure of psychoanalytic knowledge. Psychoanalysis introduces an individual historical perspective into the coordinate system of the process of cognition of social objects. The emphasis is placed not on the general cultural conditions for the realization of human life, that is, the context of its existence, conditionality by tradition, values of the past, which are also of great importance, but on the individual history of the cognized phenomenon.

About behavioral and cognitive-behavioral psychotherapy, the therapist using this method identifies the basic patterns of thinking and behavior of a person, determines how the person reinforces them, and what impact they have on his life. CBT focuses on irrational thinking, such as automatic and catastrophic thoughts. After a detailed analysis of thinking and behavior has been carried out, the therapist and patient will work together to decide what needs to be changed to solve the existing problems (Pilecki et al., 2015). This process can be repeated several times until the goals of psychotherapy are achieved.

The cognitive approach is based on theories that describe personality in terms of the organization of cognitive structures. Namely with them, the psychologist works in the correctional plan, and in some cases, it is not only about violations of the cognitive sphere itself but also about the difficulties that determine the problems of communication, internal conflicts, etc. Cognitive psycho correction is focused on the present. This approach is directive, active, and focused on the client’s problem, it is applied both in individual and group form, as well as for the correction of family and marital relations. The following features can be distinguished: The focus is made not on the client’s past, but on his present – thoughts about himself and the world. It is believed that knowledge of the causes of violations does not always lead to their correction. Correction is based on teaching new ways of thinking, and there is a widespread use of the homework system aimed at transferring the acquired new skills to the environment of real interaction.

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Some of the techniques used in CBT are relaxation, systemic desensitization, social skills training, and self-confidence training. Many techniques that relate to this type of psychotherapy come from the works of Pavlov, Watson, Wolpe, Skinner. The cognitive-behavioral direction studies how a person perceives a situation and thinks, helps to develop a more realistic view of what is happening, and hence more adequate behavior. The main task is to create a model of a psychological problem that would be understandable to the client and with which he could work independently (Craciun & Rascol, 2019). Cognitive counselors teach patients to correct cognitive processing defects themselves and to reinforce assumptions that enable them to cope with the situation.

In experimental work in the field of cognitive psychology, in particular, in Piaget’s research, clear scientific principles were formulated that could be applied in practice. Even the study of animal behavior has shown that it is necessary to take into account their cognitive capabilities to understand how they learn (Easterbrook & Meehan, 2017). In addition, it became clear that behavioral therapists unknowingly use the cognitive abilities of their patients. Desensitization, for example, exploits the patient’s willingness and capacity for imagination (Craciun & Rascol, 2019). Social skill training is not conditioning: patients are not trained in specific responses to stimuli, but in the set of strategies needed to cope with situations of fear. Using imagination, new ways of thinking, and applying strategies involves cognitive processes.

Proponents of the cognitive-behavioral direction proceed from the fact that a person builds his/her behavior based on their own ideas about what is happening. How a person sees himself, people and life depend on his way of thinking, and his thinking – on how a person was taught to think. When a person uses negative, ineffective, or inadequate thinking, he has erroneous or ineffective ideas and hence – erroneous or ineffective behavior and the resulting problems. In the cognitive-behavioral direction, a person is not treated but taught to better thinking, which gives a better life. If a person is used to seeing himself as a victim, he behaves like a victim. Having learned to see himself as the author of his life, he begins to behave more actively and responsibly.

Although cognitive psychotherapy belongs to the cognitive-behavioral direction, it differs significantly from other approaches within this direction in its pronounced integrative orientation. When developing the theoretical foundations, the creators of cognitive psychotherapy turn to various philosophical concepts, modern methodology of science, psychological theories, and experimental data. At the same time, in the theoretical works of representatives of cognitive psychotherapy, the emphasis is on finding ideas in the history of philosophy that are consonant with the theory of cognitive psychotherapy (Pilecki et al., 2015). Such works are based on the principle of Jungian amplification rather than historical and scientific analysis – they enrich the meaning of the phenomenon under consideration (in this case, cognitive psychotherapy) by attracting analogous, “similar” ideas and images. The positive aspects of this approach include the fact that the impression of a deep rootedness of cognitive psychotherapy in world culture is created, and the essential shortcomings are the undifferentiation and fragmentation of the theoretical and methodological foundations reconstructed in this way.

Psychoanalysis is fundamentally a long-term method of work. First, a long period of rapport establishment is needed, then transference to the analyst must develop (a state in which the client allegedly transfers his relationship from early childhood (not always, but more often) to the analyst. In particular, the client can try to get his love, as he did with his mother. CBT has a simple learning relationship: the therapist teaches the client to think and act more healthily and adaptively. The duration of the therapeutic contact is recommended to be limited, for example, to thirty sessions (this is a lot, but much less than in psychoanalysis).

An important aspect of comparing the theories under consideration is their practical applicability. Psychoanalytic psychotherapy is indispensable for those who want to get rid of depression, fears, panic conditions, improve relationships with loved ones, cope with addictions and obsessive states. This type of therapy is suitable for those who are committed to serious and long-term work on themselves. In addition, it is one of the most powerful tools in knowing and understanding oneself. Many symptoms and behavioral problems are the results of gaps in training, education, and upbringing. To help the patient change maladaptive behavior, the therapist must know how the patient’s psychosocial development took place, see violations of the family structure and various forms of communication. This method is highly individualized for each patient and family and is dependent on cultural context.

CBT is a relatively new approach in the psychotherapy scene and is hailed with great hope and enthusiasm as a means of quickly relieving mental distress. In several areas, for example, in the British public sector, this practice is perceived as a more rational, faster, and more effective alternative to psychoanalytically oriented psychotherapy, and its effectiveness is considered to be proven (Corey, (2016).

Many different types of therapy fall into this group, but they have one thing in common – it is a method of interpretation. In psychoanalysis, the therapist attempts to explain the client’s symptoms and suffering through interpretations of his words and behavior. All of this is related to past experiences and is based on how a patient behaves at the reception. As a rule, this method implies long-term and frequent work, meetings with a psychoanalyst can take place several times a week.

The method of interpretation can be useful to those who feel the problem but do not fully understand what it is, from which side to approach the solution, and what result they would like to achieve. If the client is inclined to think carefully and weigh all aspects of the situation before acting, he is worried about his inner world, the psychoanalytic method will be useful for him. However, if he is an active person, accustomed to setting clear goals, then psychoanalysis is not the best choice. Also, do not use it if the client has a very specific problem or symptom that interferes with life.

Let us consider the relevant cases, the first of which is corporate psychoanalytic coaching. The head of a company is an example of a classic authoritarian leader who strives to keep everything in his hands and realizes full control over all processes in the company. The inability to effectively delegate authority to subordinates has created a real threat to the further development of the organization.

The manager’s request sounded like this: “I want to delegate my responsibility to subordinates, I am tired of controlling everything, my own life is important to me, which suffers a lot.” In this case, the manager’s request is the “explicit content” of the problem, which, of course, must be respected, but the psychoanalytic consultant understands that there is always something hidden, implicit – the unconscious, which controls people and organizations. The reason for this turn of events, from the point of view of psychoanalytically oriented business consultants, is the presence of the so-called hidden content, unconscious motives that provoke the leader to implement the model of total control.

In the case of the unconscious, the relationship between the leader and the company mimics the early mother-child relationship. In the group unconscious of the company, the leader is an all-consuming controlling mother, and all employees and the company as a whole are her babies. Psychoanalytic counseling allowed the leader to realize the internal conflict and discover in himself the “father’s principle” about his own company.

As to CBT, some patients lack problem-solving skills. In this case, direct instructions can help them: how to formulate problems, find and choose solutions, implement them and measure their effectiveness. Also, patients may have a deficiency of any other skills. They will need to practice these skills — for example, difficulties may be associated with effective parenting, interviewing, budgeting, and personal relationships.

CBT involves working with thoughts and behavior. This means that the specialist will give many explanations of what and why is happening to a client, how the client’s problems are arranged, and what his thoughts and actions lead to their occurrence (Shea, 2015). He will also ask many tasks that will have to be completed between meetings – for example, notice and write down certain thoughts that arise during the day (Wampold et al., 2017). This method can be useful for a person who is determined about the problem, is accustomed to actively coping with difficulties in life, and prefers clarity. This method is worth paying attention to if a person has been thinking about his/her problem for a long time and feel the need to solve it. In addition, the type of problem itself is important here: CBT is excellent at dealing with various types of anxiety disorders, concerns, and fears. Traditional CBT has limitations in its use – it gives the best effect for anxiety disorders and neurotic depression (a term, by the way, from psychoanalysis), i.e., with relatively mild cases of impairment. Although, for example, severe psychotic depression, anxiety disorders, eating disorders and even obsessive-compulsive disorders are quite amenable to correction with its help.

References

Corey, G. (2016). Theory and practice of counseling and psychotherapy. Cengage Learning.

Craciun, B., & Rascol, M. (2019). The goals and techniques of Cognitive Behavioral Therapy. Romanian Journal of Cognitive Behavioral Therapy and Hypnosis, 6(1-2), 1-6.

Easterbrook, C., & Meehan, T. (2017). The therapeutic relationship and cognitive behavioural therapy: A case study of an adolescent girl with depression. The European Journal of Counselling Psychology, 16(1), 1-24.

Elliott, A. (2015). Psychoanalytic theory: An introduction. Springer.

Eremie, M. D., & Ubulom, W. J. (2016). Review of psychoanalytic approach to counselling. International Journal of Innovative Psychology & Social Development, 4(2), 22-25.

Imel, Z. E., Steyvers, M., & Atkins, D. C. (2015). Computational psychotherapy research: Scaling up the evaluation of patient-provider interactions. Psychotherapy, 52(1), 19-30.

Pilecki, B., Thoma, N., & McKay, D. (2015). Cognitive behavioral and psychodynamic therapies: Points of intersection and divergence. Psychodynamic Psychiatry, 43(3), 463-490.

Salza, A., Giusti, L., Ussorio, D., Cassacchia, M., Roncone, M. (2020). Cognitive behavioral therapy (CBT) anxiety management and reasoning bias modification in young adults with anxiety disorders: A real-world study of a therapist-assisted computerized (TACCBT) program Vs. “person-to-person” group CBT. Internet Interventions, 19, Web.

Shea, D. (2015). Cognitive behavioral approaches for counselors. SAGE Publications, Inc.

Sommantico, M., De Rosa, B., & Parrello, S. (2017). Counselling university students: A psychoanalytic approach of the single case report. Mediterranean Journal of Clinical Psychology, 5(1), 1-14.

Sommers-Flanagan, J., & Sommers-Flanagan, R. (2018). Counseling and psychotherapy theories in context and practice: Skills, strategies, and techniques. Wiley.

Wampold, B., Flückiger, C., Del Re, A., Yulish, N., Frost, N., Pace, B., Goldberg, S., Miller, S., Baardseth, T., Lask, K., Hilsenroth, M. (2017). In pursuit of truth: A critical examination of meta-analyses of cognitive behavior therapy. Psychotherapy Research, 27(1), 14-32.

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PsychologyWriting. 2022. "Psychoanalytic and Cognitive Behavioral Approach in Counseling and Psychotherapy." February 3, 2022. https://psychologywriting.com/psychoanalytic-and-cognitive-behavioral-approach-in-counseling-and-psychotherapy/.

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