OCR Psychology A Level Book 2 sample

Psychoanalysis for depression Psychoanalysis is based on the idea that individuals are unaware of the many factors that cause their depression. Such factors operate at an unconscious level. In the case of depression (or melancholia) unconscious repressed memories of loss and anger in childhood may resurface when triggered by adult experiences of loss. During psychoanalysis, the psychoanalyst attempts to trace the unconscious memories to childhood events, such as the real or symbolic loss of a parent or having parents who were cold and rejecting. The therapist then helps the individual (called the ‘analysand’) to deal with these newly recalled repressed memories. The psychoanalyst uses a variety of different techniques to uncover the repressed material, and help the depressed patient deal with it, including free association and dream analysis. Free association In free association, the analysand is encouraged to express their thoughts exactly as they occur, even though the thoughts may seem unimportant or irrelevant. For example, the analysand may talk freely about their childhood and after several minutes or even hours they may mention a parent who left them as a youngster or made them feel like they were not good enough. Freud believed that the value of free association lies in the fact that the analysand is making links (or associations) as they express their thoughts, and these associations are determined by the unconscious factors that the analysis is aiming to uncover. The psychoanalyst listens carefully as their analysand talks, looking for clues and drawing tentative conclusions about the possible cause(s) of the problem. The analysand may initially offer resistance to the therapist’s interpretations (e.g. changing the subject to avoid a painful discussion about their parental relationships). The analysand may even display transference , where they recreate feelings and conflicts and transfer these on to the therapist (e.g. acting towards the therapist as if, for example, he or she was the despised parent whom they fear or feel guilt towards). Dream analysis According to Freud, dreams represent irrational desires, which are expressed symbolically. The real meaning of a dream ( latent content ) is transformed into a more innocuous form ( manifest content , the content you actually experience) that may be meaningless to anybody else. The process of dream analysis consists largely of reversing the processes that created the manifest content. The process of free association can be used to uncover the latent content, i.e. the analysand should be allowed to discuss each element of the dream, expressing any thought that occurs to them. A psychoanalyst does not offer any one particular interpretation of a dream—dream analysis involves suggesting various interpretations based on the analysand’s free associations and knowledge of their life experiences such as knowing that their mother left them at an early age. The psychoanalyst then asks the analysand to select the interpretations that make sense. Does psychoanalysis work for depression? Usefulness Psychoanalysis is criticised as being more useful for some patients than others. For example, William Schofield (1964) argued that it is only useful for ‘YAVIS’ type people. This is an acronym for ‘youthful, attractive, verbal, intelligent and successful’. This came from research in which he questioned 377 therapists about their ideal clientele. This means that psychoanalysis could be less useful for those who do not fit into these categories, or for those perceived not to by the therapist. Effectiveness Peter Fonagy (2015) randomly allocated 129 patients with depression to one of two therapy groups—either psychoanalysis or a standard treatment which included medication and CBT . The psychoanalysis group had a 50-minute session every week for 18 months. The ‘treatment as usual’ group also had 18 months of treatment, which occurred as frequently as prescribed by their clinician . For some participants this means they may have had weekly sessions—for others it may have been more, or less, frequently. Patients were assessed during their 18 months’ treatment and for a further 24 months after treatment (42 months in total). The 67 patients who undertook psychoanalysis showed a significant decrease in symptoms of depression after the two years following their treatment, in fact 44% were considered to no longer fit the diagnostic criteria for depression. The control group of 62 patients showed no such reduction in symptoms, and only 10% no longer displayed the criteria for a diagnosis of depression. This suggests that psychoanalysis can be an effective long-term treatment for depression. Practicalities Psychoanalysis is not a brief form of therapy. Together, psychoanalyst and analysand examine the same issues over and over again, sometimes over a period of years, in an attempt to gain greater clarity concerning the causes of their depression. Fonagy’s study, above, found no difference in symptoms of depression within the first two years, and only found differences in the long-term follow-ups. This suggests that psychoanalysis is not a quick fix. And is quite expensive. Sometimes the content of dreams represents a repressed thought—but sometimes, as Freud said, ‘ A cigar is just a cigar ’ and doesn’t represent anything. check your understanding 1. Outline the theoretical basis for systematic desensitisation. 2. What occurs during the ‘construction of the anxiety hierarchy stage’ of systematic desensitisation? 3. Outline what Lang and Lazovik’s study tells us about systematic desensitisation. 4. What is the difference between ‘in vivo’ and ‘in vitro’ systematic desensitisation? Use examples to illustrate your answer. 5. Explain the difference between manifest and latent content of a dream. 6. Outline one argument for and one argument against psychoanalysis as a treatment for depression, referring to Fonagy’s study. 49 Application: Non-biological treatment of one specific disorder