alternatives to medical model - psychodynamic

• psychodynamic explanation

  Theoretical approach to mental illness, emphasising the influence of the unconscious mind, early trauma and quality of early relationships on mental health issues. This approach is clinically derived ie based on what patients have said to therapists
• hydraulic model


  Taken from literature due to use of phrases like 'to cry oneself out' and 'to blow off steam' were commonly used to describe emotional responses - such phrases suggest that the mind is a system in which psychic energy (emotion) has the same properties as physical energy - it can be stored, transformed or discharged, but not destroyed . Trauma and inability to express instincts resulted in a build up of psychic energy that led to the symptoms of mental disorder.
• freuds ideas about sexual trauma and fantasy

  Very socially sensitive and controversial. In his early work he proposed seduction theory, in which he emphasised the role of childhood sexual abuse in causing psychological problems. 'Whatever case and whatever symptom we take as our starting point, in the end we infallibly come to the realm of sexual experience', Freud 1896. 'Sexual experience' is quite broad and describes a range of sexual traumas - eg Anna O. whose deafness in early adulthood was linked to her childhood experience of eavesdropping on her parents having sex (Breuer & Freud, 1896). Freud identified sexual abuse as a major cause of psychopathology. In his later work he shifted his emphasis from real sexual abuse to sexual fantasy (now considered to be a serious mistake). In the case of Dora (Freud, 1905) Freud suggested that Dora's symptom of psychological loss of voice was not the result of the trauma of being molested by a family friend but due to suppressing her desire for him.
• freudian theory of depression

  1917, Freud proposed that some cases of depression could be linked to experiences of loss of a parent, or rejection of a parent. Freud drew a parallel between feelings we have as adults when in mourning for a lost loved-one and the experience of depression years after a childhood loss experience. An important part of adult mourning is anger, and Freud proposed that the same anger is important in children's responses to loss. The child's anger at being 'abandoned; through separation/rejection cannot be expressed because of love for the object of anger, and instead is repressed, turning inwards and causing guilt and low self-esteem as the ego 'ranges against itself.
• psychodynamic explanation of schizophrenia

  Fromm-Reichmann (1948) - proposed the existence of a schizophrenogenic mother based on her patients' accounts of their childhoods (schizophrenogenic - causing schizophrenia). She proposed that where families were characterised by high emotional tension and secrecy, and when the mother was cold and domineering in her attitude, children were at high risk of developing schizophrenia. Fromm-Reichmann drew link between the secrecy in the family and the development of delusions of persecution.
• psychodynamic treatments

  psychoanalysis (therapy)
• psychodynamic therapy - psychoanalysis original form

  *very intensive

  *takes place 4-5 times a week

  *lasts for several years

  *patients lie down on couch not facing therapist/analyst
• psychotherapy (modern psychodynamic therapy)


  *less intensive

  * typically 1-3 times a week

  *can last between 1-5 years

  *patient faces therapist, seated in comfortable chairs
• psychodynamic therapy as a whole

  *no attempt to teach patient more constructive patterns of thinking/behaviour

  *emphasis on exploring patients past and linking it to their current symptoms

  *early experiences of loss/rejection are particularly important in depression, so these may be explored

  *patient may vividly recall experiences (abreaction) and 'discharge' the associated emotion (catharsis - anger/upset)

  *these negative emotions can become transferred on to therapist, who can be treated as if they were the absent or rejecting parent - therapist can feed this back to patient who can gain insight into way they transfer anger onto others

  *in brief psychodynamic therapy (BDT) rather than waiting for negative emotions to be transferred onto therapist, patients are educated about links between their current functioning and their past experiences