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There is a wide variety of research-based and highly-effective therapeutical approaches that may be utilized when a mental health professional wishes to treat a patient who suffers from some type of mental or behavioral disorder. The kind of approach that is chosen by the mental health professional will necessarily differ based on what kind of mess is being treated. One common disorder of this type that mental professionals face the challenge of treating is substance abuse. The purpose of this paper is to compare and contrast two research-based therapeutic approaches for working with patients with substance abuse and addiction.Mental health professionals may choose to approach a particular patient’s individualized treatment program by choosing from several research-proven approaches, or combinations thereof, based on the individual needs of that specific patient. For substance abuse and addiction, some of these therapeutic approaches include Psychodynamic, Cognitive Behavioral, Motivational Interviewing, and Enhancement Therapy. For this paper, the research-based therapeutic strategies that will be compared and contrasted are Psychodynamic versus Cognitive Behavioral Therapy. To complete the process of effectively developing the content of this assignment, seven scholarly articles from high-quality psychology and behavioral health and therapy journals and related reliable sources have been utilized. Also, since this is a comparison and contrast assignment, both the strengths and weaknesses of each of those mentioned above chosen therapeutic approaches will be discussed, along with the essential purpose of each of the therapies.
Definition, Pros & Cons
Psychodynamic therapy holds its roots in Freudian Psychoanalysis and is also referred to under the term Insight-Oriented Therapy. This type of treatment is centered around the mental health professional’s ability to accurately and effectively interpret behaviors that are being exhibited by a particular patient, as well as to decipher the meaning of that patient’s words successfully. According to Psychology Today, “This approach suggests that bringing the unconscious into conscious consciousness facilitates understanding and conflict resolution, requiring more regular sessions than is the case with Cognitive Behavioral Therapy” (2007, p. 1).
The goal of psychodynamic therapy is to observe a client’s behavior to focus on things that they do unconsciously. The ideal end result is that the client will become aware of the ways in which his or her past is affecting his or her present state. psychodynamic approach, in its short form, allows the client to examine unresolved conflicts and symptoms resulting from past dysfunctional relationships and to manifest themselves in the need and Desire for substance abuse. Because therapy is briefer than other forms of treatment, for some clients it may be better suited than others. Those who are thought to benefit from it in its short form the most are those who are recovering stably, those with coexisting psychopathology, those who do not need or are not currently hospitalized or being detoxified, and those without brain damage or other mental disorders. Essentially, the level of functioning that a client is exhibiting determines the nature of his or her treatment (HSTAT, 2007, p. 1).
The alliance between the therapist and the client in this type of therapy plays a tremendous role in the overall outcome and whether or not it is successful. This is true in studies involving both alcoholic and cocaine-dependent patients. “These results indicate that, in treating drug abuse problems, the clinical partnership exerts a modest but important effect on outcome. The specific results measured vary from study to study but include duration of treatment participation, reduction in drug use, and reduction in depressive symptoms” (HSTAT, 2007, p. 1).
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Psychodynamic therapy has been around longer than any of the other types of modern treatments. Since this is the case, there has been plenty of time to refine its unique therapeutically approaches over the years and, hopefully, make this particular approach more effective for patients who suffer from substance abuse and addiction. This therapy’s age, thus, is a benefit over more recently developed approaches, such as Cognitive Behavioral Therapy, as it is considered a more tried-and-true, as well as solidly expanded, progressive, and comprehensive approach when it comes to effectively treating patients who abuse drugs and are seeking proper treatment (Harvard Mental Health Letter, 2006, p. 5). “Psychodynamic therapy focuses on unconscious processes, as they are reflected in the current actions of the person, according to the Harvard Mental Health Letter.
Psychodynamic counseling goals are client self-awareness and perception of past impact on current actions” (2006, p. 5).Even though this approach has been around a long time, many mental health professionals, researchers, and scholars—specifically those who are considered to be more contemporary and less old-fashioned in their treatment methods—believe that it is due for additional modifications and advancement to keep it up-to-speed with some of the more eclectic therapies. This opinion is particularly valid for those mental health professionals who firmly believe that times have changed and that therapies should adapt accordingly to accommodate those changes (Harvard Mental Health Letter, 2006, p. 5).
Those who support modern-day adjustments to this theory particularly believe that these modifications are necessary when it comes to using the approach for treatment programs. This is particularly true for those programs that differ in type or that are very specific, such as treatment of substance abuse and addiction (Harvard Mental Health Letter, 2006, p. 5).
Psychodynamic therapy has proven itself to be extremely useful in the effective treatment of multiple thousands of mental and behavioral health patients over the years, including those who suffer from substance abuse and addiction. Even though this fact is true in many cases, this particular approach is rather intricate and complicated, especially when it comes to adjusting the therapy to suit the needs of individual patients, including those who suffer from substance abuse and addiction. According to Krause, de la Parra, Aristegui, Dagnino, et al., “There are four major schools of psychoanalytic theory, each of which has influenced psychodynamic therapy. Freudian, Ego Psychology, Object Relations, and Self Psychology are all four schools “(2003, p. 1).
Each of the four schools above of Psychoanalytic Theory has influenced Psychodynamic Therapy; each one has done so in its unique way. Furthermore, some of the schools have influenced Psychodynamic Theory more than others have, particularly Ego Psychology and Self Psychology (Krause, de la Parra, Aristegui, Dagnino, et al., 2003, p. 1).
Ego Psychology focuses on encouraging an individual to be able to effectively defend himself against negativity and improper behavior, more readily adapt to new environments and other changes, and face the demands of reality. Self Psychology deals with the way a person perceives him- or herself, particularly in cases where the person in question has low self-esteem. “The explanatory power of the new psychology of the self is nowhere as evident as it is with regard to addictions. Kohut postulated that persons suffering from substance abuse disorders also suffer from a weakness in the core of their personalities—a deficiency in the formation of the ‘self.’ Substances appear to the user to be capable of healing the central defect in the self” (Krause, de la Parra, Aristegui, Dagnino, et al., 2003, p. 1).
The fact that drugs appear to so strongly affect a person’s self-esteem positively really helps to explain to mental health professionals why some individuals choose to abuse drugs in the first place and understanding why a person could become addicted to a substance is the first step in designing an effective treatment program. The fact that Psychodynamic Theory focuses so strongly on Self Psychology certainly makes it a truly effective therapeutic approach for those who suffer from substance abuse and addiction. Psychodynamic therapy can be administered in either a short-term or a long-term fashion within a patient’s individualized treatment program chosen by his or her mental health professional(s). Long-term Psychodynamic Therapy is very effective in the treatment of substance abuse and addiction. Still, short-term Psychodynamic Therapy has not been found to quite reach that mark in many cases. This is due in particular to the nature of the behavioral disorder itself (Krause, de la Parra, Aristegui, Dagnino, et al., 2003, p. 2).
Those who abuse drugs or suffer from addiction also perceive things differently than those individuals who do not. This fact means that drug abusers and addicts have a much harder time than the average person would when it comes to solving problems and being able to look inside themselves and their disorder accurately.
This problem is lessened or nonexistent at all in cases where Brief Psychodynamic Therapy has been combined with other types of therapies in a patient’s overall treatment program, including but not limited to drug and alcohol treatment programs (Krause, de la Parra, Aristegui, Dagnino, et al., 2003, p. 2).
As previously mentioned, one of the biggest pros of Psychodynamic Therapy is that it has been around longer than the other types of modern-day therapies and, thus, has had time to be subjected to experiments and trials to test its overall effectiveness against disorders like drug abuse and addiction. Nilsson, Svensson, Sandell, and Clinton discuss 17 such trials that were conducted over 35 years. According to them, “Dynamic therapists focus on emotional conflicts and identify patterns in the feelings and behaviors of the patient, often with particular attention to wishes, dreams and fantasies. They emphasize the patient’s relationship with the therapist, especially as this relates in particular to feelings transferred from earlier relationships and childhood experience “(2007, p. 673).
The studies that were discussed in their article are particularly relevant to this assignment, since Psychodynamic Therapy was compared to Cognitive Behavioral Therapy in each of them, and one of the main areas of focus included addiction.
Overall, it was found that Psychodynamic Therapy appeared to be more effective than other alternatives, and that, “It improved symptoms of the diagnosed disorders, other symptoms, and overall psychological and Social work “(Nilsson, Svensson, Sandell, & Clinton 2007, p. 673).
Cognitive Behavioral Therapy
“Cognitive-Behavioral Therapy is a type of psychotherapy that stresses the essential role of thought in how we feel and what we do,” according to the National Association of Cognitive-Behavioral Therapists, and that the word “is a very broad term for a group of therapies with similarities. There are different approaches to cognitive-behavioral therapy, including Logical Emotional Behavior Therapy, Moral Behavior Therapy, Logical Living Therapy, Cognitive Therapy, and Dialectic Behavior Therapy” (2007, p. 1).
Cognitive therapy has helped treat a wide array of disorders, including problems with anger control, panicking, and substance abuse. This is particularly true since the way a person behaves or feels can be significantly affected by things such as attitudes, attributions, beliefs, cognitive schema, and perceptions. “Our emotional and behavioral reactions to what’s going on in our life can be troublesome to the degree that our thought processes are flawed and biased. Changing the way a client thinks can change the way they feel and behave according to this theory. They also tend to indicate dependence on drugs as a way to cope with depression and negative feelings, a negative self image as a person with a substance abuse problem and a propensity to encourage continued use of substances” (HSTAT, 2007, p. 1).
Irrational thoughts and erratic behaviors go hand-in-hand with substance abuse disorders. People tend to avoid their problems, are unable to let go of problems they have experienced or mistakes they have made in the past, tend to hold a pessimistic view of the world and avoid responsibility. “Care is also specifically directed at altering skewed or maladaptive beliefs and the resulting behavioral disorder.
Cognitive restructuring is the general term given to the process of changing the client’s thought patterns. Once a specific faulty thought is identified, the therapist will challenge a client to look at alternative ways of seeing the same event. Whenever a client has difficulty changing a perception, the therapist can give him homework to test the truth of his cognitions. Once the maladaptive thoughts are discovered in a person’s habitual, automatic thinking, it becomes possible to modify them by substituting rational, realistic ideas for the distorted ones to create a happier and healthier life without substance abuse” (HSTAT, 2007, p. 1).
Even though various approaches exist to this type of therapy, they do collectively hold certain commonalities. They are all based on the Cognitive Model of Emotional Response; they take place over a shorter period than therapies such as Psychodynamic Therapy, a solid relationship with the mental health professional conducting the treatment is necessary. Still, not all that is needed, both the mental health professional in question and the client must equally contribute to the overall therapy program, they stem from stoic philosophy, they utilize the Socratic Method, they follow a structured and narrowed pathway, educational models form the general basis for their structure, they use the Inductive Method, and patients are required to do homework between therapy sessions (National Association of Cognitive-Behavioral Therapists, 2007, p. 1).
Warman and Beck state that “Cognitive-Behavioral Therapy (CBT) is an empirically supported treatment that focuses on patterns of thinking that are maladaptive and the beliefs that underlie such thinking.”
People who undergo this type of therapy are encouraged to take negative thoughts and behaviors that they perceive in their minds to be factual and instead turn them into beliefs or hypotheses that are subject to experimentation. Those who suffer from mental and behavioral disorders often suffer from automatic thoughts and are “encouraged to monitor and log thoughts that pop into their minds (called “automatic thoughts”) To encourage them to decide what patterns of prejudices that exist in their thinking and to establish more adaptive alternatives to their thinking” (2003, p. 1).
Therapists and other mental health professionals who utilize Cognitive Behavioral Therapy are very focused and active in their patients’ treatment programs. This is perhaps the main reason that it is so effective in the treatment of a wide variety of mental and behavioral disorders, including substance abuse and addiction disorders. It has the additional benefit of also being an effective treatment option for depression, anxiety, schizophrenia, and related disorders, which often accompany drug abuse and addiction (Warman and Beck, 2003, p. 1).
Another benefit of Cognitive Behavioral Therapy is that it has a sound level of empirical support. This has, in turn, led to its growing popularity and usage in recent years, as both mental health professionals and patients are aware of its potential benefits (Warman and Beck, 2003, p. 1).
The National Institute on Drug Abuse reports that Cognitive Behavioral Therapy is particularly effective for those who suffer from drug abuse and addiction, mainly when it involves cocaine. They cite several reasons for this opinion: it is brief and, therefore, easier for treatment facilities to accommodate when they are furnished with inadequate resources for more extended, more nuanced treatment programs; ‘CBT has been widely tested in comprehensive clinical trials and has strong scientific support as a treatment for cocaine addiction. In particular, evidence points to the efficacy of the effects of CBT as well as its success in more highly dependent cocaine abusers’ subgroups” (2007, p. 1).
In addition to the benefits above, the National Institute on Drug Abuse reports that Cognitive Behavioral Therapy’s solid structure and focus on specific goals is particularly beneficial to cocaine users since they suffer from problems that need to be controlled immediately; the individualized and flexible nature of Cognitive Behavioral Therapy appeals to a broad audience; it is compatible with other types of treatment that patients may concurrently participate in, and it is broad enough to cover several functions that are necessary to effectively treat drug abuse and addiction. Two of these functions that are considered key to this type of treatment program are functional analysis and skills training components explicitly designed for a patient’s needs (2007, p. 1).
Comparing and Contrasting the Two
In this assignment, the therapeutic approaches are known as Psychodynamic Therapy, and Cognitive Behavioral Therapy is being compared and contrasted. Although the two methods are vastly different in theory and technical application, it has been shown through research that roughly all of the theoretical approaches of this nature produce very similar outcomes when all is said and done. In other words, patients who complete programs that are designed around these two therapeutic approaches report very same opinions regarding their effectiveness as they are exiting the programs (Nilsson, Svensson, Sandell, and Clinton 2007, p. 673).
The main pro of Psychodynamic Therapy appears to be that this type of treatment is longer and, therefore, better suited for the needs of those who suffer from substance abuse and addiction. Also, this therapy is the oldest of modern-day treatments of this nature, and has, therefore, been subjected to more critical analysis and experimentation about its effectiveness. This type of therapy is considered to be more traditional, as well as tried-and-true. Old school mental health professionals, as well as knowledgeable modern-day therapists as opposed to those with more diverse beliefs, tend to rely more heavily on this particular therapeutic approach (Nilsson, Svensson, Sandell, and Clinton 2007, p. 673).
One of the main disadvantages of Psychodynamic Therapy appears to be a variation of the benefit above of its age. Those therapists and other mental health professionals who are more eclectic believe that this particular therapeutic approach is well overdue for modern-day adjustments that would make it more beneficial to today’s needs. Another considerable disadvantage to this approach appears to be, yet again, another variation of a previously mentioned benefit: duration. This type of program is more extended, and therefore, may be more difficult for average therapy institutions to commit to or sustain for the long run for financial reasons. This could have a significantly adverse effect on the patient, who may give up treatment due to the length of it as well (Harvard Mental Health Letter, p. 5).
The main advantage of Cognitive Behavioral Therapy appears to be that such institutions as the National Institute on Drug Abuse have found empirical evidence that supports the method being particularly beneficial for drug abusers. Also, the shorter nature of this type of therapy may allow more individuals to complete it and lessen the drain on treatment facilities. This therapy is also very focused and goal-oriented (National Association of Cognitive-Behavioral Therapists, 2007).
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The cons of Cognitive Behavioral Therapy appear to center around the length of treatment time, ironically. Research suggests that, since these treatment programs are shorter, they may not be as effective (National Association of Cognitive-Behavioral Therapists, 2007).
Conclusion
Although the very structure and approach of the two therapeutic approaches compared and contrasted in this paper—Psychodynamic Therapy and Cognitive Behavioral Therapy—are vastly different, the overall outcomes of the program when everything is said and done and balanced out appear to be roughly equivalent. In other words, the pros and cons of each are approximately equal, although they are entirely different. The main differences involve the quality and duration of the therapeutic approach that is chosen to treat a particular patient.
Works Cited
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A Cognitive-Behavioral Approach: Treating Cocaine Addiction. (2007). National Institude on Drug Abuse. Retrieved December 8, 2007, from http://www.drugabuse.gov/TXManuals/CBT/CBT3.html#why
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Cognitive Behavioral Therapy. (2007). National Association of Cognitive-Behavioral Therapists. Retrieved December 8, 2007, from http://www.nacbt.org/whatiscbt.htm
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Krause, de la Parra, Aristegui, Dagnino, et al. (2003). The evolution of therapeutic change studied through generic change indicators. Addiction Alternatives. Retrieved December 8, 2007, from http://www.addictionalternatives.com/philosophy/briefpsychodynamic.htm
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Nilsson, Svensson, Sandell, and Clinton. (2007). Patients’ experiences of change in cognitive-behavioral therapy and psychodynamic therapy: a qualitative comparative study. Psychotherapy Research, 17(6): 673.
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Psychodynamic therapy passes a test. (2006). Harvard Mental Health Letter, 22(10): 5.
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SAMHSA/CSTAT Treatment Improvement Protocols, Chapters 4 and 7. (2007). Online. http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.section.59652
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Warman and Beck. (2003). Cognitive-Behavioral Therapy. National Alliance on Mental Illness. Retrieved December 8, 2007, from http://www.nami.org/Template.cfm?Section=About_Treatments_and_Supports&template=/ContentManagement/ContentDisplay.cfm&ContentID=7952
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What’s your orientation? (2007). Psychology Today. Retrieved December 8, 2007, from http://psychologytoday.com/pto/methods.html
