Treating Mental Illness From a Freudian Perspective
Everyone knows the stereotype that presents a man lying on a couch and the therapist being in the back, smoking and nodding his head while listening to the patient's story. This pattern has a specific reason that comes from the psychoanalytic theory? What does this theory exactly say? Is it scientifically proven?
Mental illness refers to every cognition, emotion or behavior that induces a great amount of distress and disability, both hindering a person's capacity to adapt to the daily lifestyle. In order to treat such a problem it is essential to understand its causes or at least the mechanisms that produce it. There are different models in psychology, each of them offering a different explanation and of course a different treatment. The dynamical-psychoanalytic model was developed by Sigmund Freud, and it was further developed in diverse directions by Yung, Adler, Erik Fromm, Ana Freud and many others.
The theory of this model says that a person has three major components: id, ego and super ego. The id functions in conformity to the instinct of pleasure and wants to express these desires through the ego. The problem is that the super ego represents all the social and moral rules which try to oppress the impulses coming from the unconsciousness. Because of these constrictions, the id represses its desires and expresses them through dreams, neurotic symptoms and even psychotic ones. In addition, events which took place in the early childhood (0 to 6 years) are events which influenced the present behavior the most.
Having this theory in the background, Freud and his followers developed a therapy that has a specific mechanism. He referred to two triangles. The first is the therapeutic triangle which has three components: the present, the therapeutic relationship and the past. Each of these three encompasses another triangle with other three components: anxiety, the impulse and defenses.
The therapist firstly works on the first component namely, the present. His aim for the first months is not to set a diagnosis, but just to listen to the problems presented by the patient. Because of the conflict triangle, the patient won't tell all his real problems from the beginning. The defenses are too strong and the therapist needs to listen and be careful to select the relevant issues.
The next step is to ask the client questions about his past experiences, especially those that occurred in the early childhood. The therapist needs to be very perspicacious in order to find the cause of the present problem back in the past. It is important to emphasize the idea that even when the therapist found the problem of the past he does not present the connection to the client. Not yet but all this time the therapist is working intensively focusing on his relationship with the patient. The relationship is the key of the Freudian perspective, because inside this therapeutic relationship the psychologist makes the connection between the present and the past. According to the theory, every emotion or behavior manifested by the patient towards the therapist represents a moment lived in the past with a significant figure. This process is called transference and the therapist works intentionally on this part. He tries to lead the relationship to unbalance till it reaches the point called "neurosis of transference". This point is the one wanted by the therapist because it represents a pattern which was lived in the past. At this very point the psychologist makes the connection between the past and the present. He tries then to explain to the client that back then, when he was a child he was supposed to use those defenses to protect his ego, but now, in adulthood, those defenses are not proper anymore, and they need to work together to solve the conflict.
The problem with this therapy is the fact that the theory cannot be scientifically proven. Some having this orientation might agree with this point but still argue with the fact that the therapy has results. The explanation for these results might be clarified thorough other mechanisms which also happen in this type of therapy. One of them is the cognitive restructuring which takes place during the intervention. But this can have nothing to do with the events that took place in the early childhood.
In conclusion, each model of therapy has its own ways to treat mental illness. The dynamical-psychoanalytical model links the present problems to a significant event in the past and makes this connection inside the therapeutic relationship, treating then the anxiety and solving the defenses.
The theory of this model says that a person has three major components: id, ego and super ego. The id functions in conformity to the instinct of pleasure and wants to express these desires through the ego. The problem is that the super ego represents all the social and moral rules which try to oppress the impulses coming from the unconsciousness. Because of these constrictions, the id represses its desires and expresses them through dreams, neurotic symptoms and even psychotic ones. In addition, events which took place in the early childhood (0 to 6 years) are events which influenced the present behavior the most.
Having this theory in the background, Freud and his followers developed a therapy that has a specific mechanism. He referred to two triangles. The first is the therapeutic triangle which has three components: the present, the therapeutic relationship and the past. Each of these three encompasses another triangle with other three components: anxiety, the impulse and defenses.
The therapist firstly works on the first component namely, the present. His aim for the first months is not to set a diagnosis, but just to listen to the problems presented by the patient. Because of the conflict triangle, the patient won't tell all his real problems from the beginning. The defenses are too strong and the therapist needs to listen and be careful to select the relevant issues.
The next step is to ask the client questions about his past experiences, especially those that occurred in the early childhood. The therapist needs to be very perspicacious in order to find the cause of the present problem back in the past. It is important to emphasize the idea that even when the therapist found the problem of the past he does not present the connection to the client. Not yet but all this time the therapist is working intensively focusing on his relationship with the patient. The relationship is the key of the Freudian perspective, because inside this therapeutic relationship the psychologist makes the connection between the present and the past. According to the theory, every emotion or behavior manifested by the patient towards the therapist represents a moment lived in the past with a significant figure. This process is called transference and the therapist works intentionally on this part. He tries to lead the relationship to unbalance till it reaches the point called "neurosis of transference". This point is the one wanted by the therapist because it represents a pattern which was lived in the past. At this very point the psychologist makes the connection between the past and the present. He tries then to explain to the client that back then, when he was a child he was supposed to use those defenses to protect his ego, but now, in adulthood, those defenses are not proper anymore, and they need to work together to solve the conflict.
The problem with this therapy is the fact that the theory cannot be scientifically proven. Some having this orientation might agree with this point but still argue with the fact that the therapy has results. The explanation for these results might be clarified thorough other mechanisms which also happen in this type of therapy. One of them is the cognitive restructuring which takes place during the intervention. But this can have nothing to do with the events that took place in the early childhood.
In conclusion, each model of therapy has its own ways to treat mental illness. The dynamical-psychoanalytical model links the present problems to a significant event in the past and makes this connection inside the therapeutic relationship, treating then the anxiety and solving the defenses.
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