I had been perplexed for a very long time, given the emotional symptoms I was experiencing, which, it had always been obvious to me, were in large part related to my childhood experiences, why I had never been offered therapy, by the NHS, which could specifically address this issue. In fact, the professionals I had seen, including GPs and psychiatrists, rarely, if ever, asked me about my childhood, nor did they seek, in any way that I could ascertain, to link my symptoms to it. I can only assume that therapy addressing emotional problems which are linked to childhood experiences are deemed to be too expensive; perhaps it relates to where you happen to live, as different regions have different budgeting priorities. I know, though, that such therapies are available.
MEDICAL MODEL :
It is a common problem. In the UK, mental illness is almost invariably addressed using the MEDICAL MODEL (ie drugs are used to alter brain biochemistry). Some studies have shown, however, that anti-depressants work no better than PLACEBOS. We must ask, then, if, in many cases, treating mental illness with drugs is simply inappropriate? Would it not be better, in a lot of cases, to address the root cause of the symptoms -childhood trauma and/or other relevant life experiences?
PSYCHODYNAMIC AND PSYCHOANALYTIC PSYCHOTHERAPY:
These therapies seek to address the root causes of adult psychological difficulties. Many of my posts have already discussed the fact that childhood trauma, very often, lessens (often, through physiological effects on the brain) the individual’s ability to cope with stress in adult life. Here is a recap of symptoms childhood trauma can lead to:
– alcohol/drug misuse
– dissociative disorders
– self-harm (eg cutting self with a sharp instrument, burning self with cigarette ends
– suicide attempts, suicide
– eating disorders
– acute depression
– extreme anxiety
– post-traumatic stress disorder
– obsessive-compulsive disorder
Clearly, such difficulties can cause the individual severe distress, so it is important to investigate ALL the possible treatment options.
Psychodynamic and psychoanalytic psychotherapy aims, as I have already said, to address the root cause of distressing psychological symptoms: they are based upon the idea that we all SUPPRESS (ie bury deep down in the mind) feelings that, if they were allowed full access to consciousness, would OVERWHELM us with ANXIETY and EMOTIONAL PAIN. However, this requires psychological effort, and, in order to keep them suppressed, we must employ DEFENSE MECHANISMS (these may be employed both on conscious and unconscious levels). Examples of such defence mechanisms are PROJECTION and REACTION FORMATION:
– PROJECTION: this refers to how we EXTERNALIZE things we dislike about OURSELVES. For example, someone who is (needlessly) ashamed of being homosexual may go around calling everybody else ‘gay’ (using the word in a pejorative sense, of course)
– REACTION FORMATION: here, the individual feels the need to constantly proclaim s/he is not what, deep down, perhaps unconsciously, s/he feels s/he actually is. For example, someone who suppresses their aggressive instincts may feel the need to constantly proclaim how peace-loving they are and how incapable of inflicting physical harm on others. In Shakespeare’s play, HAMLET, Iago seems to be aware of this psychological concept of reaction formation when he states, heavy with insinuation: ‘Methinks she protests too much’. Indeed, many of Freud’s ideas were anticipated in Shakespeare’s works.
There are other defence mechanisms which would take up too much space to go into here, but they all involve CUTTING OURSELVES OFF FROM OUR TRUE FEELINGS or trying to banish them in other ways, due to real, or perceived societal and cultural demands.
It is thought that the MORE PAINFUL AND DIFFICULT KEEPING THE FEELINGS SUPPRESSED IS, THE MORE PSYCHOLOGICAL EFFORT THE MECHANISM OF SUPPRESSION TAKES UP, and, therefore, THE MORE INTENSE THE REPERCUSSIONS, OR COSTS, IN TERMS OF PSYCHOLOGICAL SYMPTOMS, ARE (see list above for examples of these symptoms).
Psychotherapy aims to get us in touch with the feelings we are suppressing and work through them; some types of psychotherapy aim to bring what is buried in the unconscious into conscious awareness to enable such a process.
TYPES OF THERAPIES AVAILABLE:
1) SHORT-TERM PSYCHODYNAMIC PSYCHOTHERAPY: this usually consists of about 20 sessions spread over 20 weeks.
2) PSYCHOANALYTIC PSYCHOTHERAPY: this can consist of 2 or 3 sessions per week. There is no time limit – as many sessions are provided as required.
3) PSYCHOANALYSIS: this can comprise up to 5 sessions per week. Again, there is no time limit and as many sessions are provided as required.
By working through suppressed feelings (such as anger or fear) with the therapist, the rationale is that the past gradually loses its grip on the present, and, thus, its power to cause continued suffering.
DOES IT WORK?
Certainly, if considering such therapy, great care is needed when selecting a suitable therapist (e.g. checking their training, success rate, recommendations etc.) as it is possible the treatment can do more harm than good if not properly implemented.
The psychologist, Hans Eysenck, argued that patients who underwent psychoanalysis recovered from their psychological difficulties no better than untreated controls. HOWEVER, there is, in fact, plenty of research which SUPPORTS its effectiveness; for example Roth et al (1996) and, also, Holmes et al (1995).
David Hosier BSc Hons; MSc; PGDE(FAHE).
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