The Psychodynamic Model
This model is largely based on Sigmund Freud’s psychoanalytic theory.
Psychoanalysis is the name used for the theory and the therapy.
- Psychological causes – Mental illness is the result of psychological, rather than physical, causes. Freud’s first patient, Anna O. (Freud, 1910) suffered from paralysis. He demonstrated that these physical symptoms were psychological because, as soon as she was able to express her unconscious conflicts related to her father’s death, her paralysis recovered. (Anna O. later threw some doubt on Freud’s explanations).
Early experience – Mental illness can be understood in terms of early experiences. In childhood, the ego is not sufficiently developed to cope well with traumatic experiences and, therefore, these may be repressed. Freud suggested that depression occurs when a child experiences early loss (e.g. the death of a parent) and represses the associated feelings. If, later in life, the individual has further experiences of loss, this awakens the earlier repressed feelings and leads to depression. Students often confuse definitions and explanations of abnormality. Consider a person who is severely depressed. Why do we regard this as abnormal? Perhaps because their depression prevents them functioning adequately. However, we might also ask why that person has become depressed. Perhaps it is because of some abnormal
neurotransmitters? First, we have defined what is abnormal about their depression, then we explained why they might have become depressed in the first place.
- Unconscious conflicts – Conflict creates anxiety in the ego. Ego defences form to protect the ego, e.g. projection or repression, and the conflicts become unconscious. Recovery depends on making the unconscious conscious and dealing with repressed anxieties. The associated method of treatment, psychoanalysis, is described here.
Strengths:
- Freud’s explanation of mental illness was the first attempt to explain mental illness in psychological terms.
- It is supported by extensive theory and therapeutic practice.
Weaknesses:
- It is not a scientifically rigorous approach. The model is based on concepts that are difficult to prove or disprove (i.e. they lack falsifiability) and Freud based his ideas about the development of the normal personality on studies of abnormal adults (only one child was studied – Little Hans).
- It is a reductionist model, suggesting that the patient is controlled by instinctual forces and help must come from an expert.
- It is also a determinist model based on biological mechanisms (e.g. id and ego, psychosexual stages) and their interactions with life experiences.
- Freud was overconcerned with sexual factors, though this may reflect the culture in which he lived. Subsequent psychoanalytic theories (e.g. Erikson) have replaced sexual with social influences.
The Behavioural Model
- Learning theory – Behaviourists base explanations of all behaviour on learning theory. Abnormal behaviours, like any other behaviours, are learned through the processes of classical and operant conditioning. For example, a phobia may develop because a dog bites you (classical conditioning), or because avoidance of something fearful is rewarding (operant conditioning) or because you model your behaviour on someone else (social learning theory).
- The focus is on behaviour only – Only behaviours that are currently observable are important. The patient’s history does not matter, nor does any understanding of feelings or thoughts. There is no conscious activity involved in learning. It occurs through conditioning (i.e. association, reinforcement or punishment).
- Treatment – What can be learned can be unlearned using classical and operant conditioning techniques and focusing only on behaviours (symptoms rather than causes).
According to the behaviourist view, there are no mental disorders because the mind is irrelevant. Psychological disorders are maladaptive behaviour patterns that have arisen through traumatic or inappropriate learning.
Strengths:
- The firm scientific basis and operationalised procedures make the theory and therapies easy to research.
- The approach has produced successful therapies for a range of disorders, e.g. systematic de-sensitisation for phobias (see section 2 here), exposure and prevention therapy for obsessive-compulsive disorder (see section 2 here) and aversion therapy for developmental disorders (see section 1 here). In fact, for some disorders, it is the only viable option, e.g. when the brain is injured. On the other hand, if there are causes of a particular disorder, then just treating the symptoms is only a short-term solution, and the success of behavioural therapies may be quite unrelated to learning theory. For example, it may be a matter of giving increased attention.
Weaknesses:
- Behaviourist explanations on their own do not provide adequate explanations of many disorders, such as depression and schizophrenia. Cognitive-behavioural (the cognitive-behavioural approach draws on both cognitive and behavioural
explanations). explanations are a subsequent development and have been more successful as therapies than behaviourist therapies on their own. - Behaviourist explanations do not fully explain behaviour. For example, not everyone who is bitten by a dog becomes a phobic, and equally, some people who have phobias have not necessarily had a fearful experience (e.g. spider phobias).
- Behaviourist explanations are oversimplified and based more on animal behaviour than human behaviour, which is more greatly influenced by thoughts and feelings.
The Cognitive Model
The cognitive model emphasises the role of thoughts, expectations and attitudes (i.e. cognitions) in mental illness, either as causes or as mediating factors.
- The role of thinking – All behaviour is directed by thinking. The cognitive (or cognitive-behavioural) model grew out of the behavioural model because the latter was seen as inadequate in its focus on external behaviour only.
- Faulty thinking – It is the way you think about a situation that is maladaptive, which is different to having maladaptive behaviour (as suggested by the behavioural model). ‘Cure’ can be achieved by restructuring a patient’s thinking and enabling them to change their self-beliefs and motivations.
- Client-centred approach – The cognitive model, unlike the other models, sees the client as being in control of their own behaviour. In all the other models, mental disorder is explained as the consequence of some external force controlling a person’s behaviour (biological factors or life experiences). The cognitive model describes mental disorder as the product of a person’s own faulty control and, therefore, the only one who can change their behaviour is that person, with the guidance of a therapist. The client is the only one who knows their own cognitions.
Strengths:
- The cognitive model has led to cognitive/cognitive-behavioural therapies that have been successful for disorders such as depression, and are becoming increasingly popular.
- It is an objective approach that lends itself to research.
Weaknesses:
- Like the behavioural model, this approach does not investigate causes but just treats behaviours. However, this appeals to some patients, who prefer not to search for deep meanings.
- Irrational beliefs may be realistic, for example, a depressed person may have a realistic view of their situation, and trying to change this view may be unrealistic and unhelpful.
- Irrational beliefs may be an effect rather than a cause of mental disorder and, therefore, the explanation of faulty thinking may be erroneous (flawed).
PROGRESS CHECK
- Identify one explanation for abnormality, offered by the psychoanalytic model.
- Suggest one key difference between the psychodynamic and behavioural approaches.
- Which model suggests that the patient is in control?
- What is meant by ‘faulty thinking’?
ANSWERS
- E.g. Unresolved conflicts create anxiety; Ego defences against anxiety lead to neurotic behaviour.
- E.g. The behavioural model focuses on external behaviour only.
- The cognitive model.
- Thinking that is maladaptive.
