Welcome to Therapies: Helping the Mind Heal

In our study of Unit 2: Learning theories and development, we have looked at how behaviour is learned and how our personalities develop. But what happens when things go wrong? How do psychologists help someone overcome a debilitating phobia or deal with deep-rooted emotional pain? In this chapter, we explore two very different ways of treating the mind: Systematic Desensitisation (based on learning theories) and Psychoanalysis (based on the psychodynamic approach).

Don’t worry if these terms sound a bit "sciencey" at first—we will break them down step-by-step!


1. Systematic Desensitisation (SD)

Systematic Desensitisation is a therapy used primarily to treat phobias. It is based on Classical Conditioning (which you studied earlier in Topic D). The core idea is simple: if a fear can be learned, it can also be unlearned.

The Logic: Reciprocal Inhibition

The "secret ingredient" of SD is reciprocal inhibition. This is a fancy way of saying that you cannot feel two opposite emotions at the same time. You cannot be completely relaxed and incredibly terrified simultaneously. By teaching a patient to be relaxed in the presence of their fear, the relaxation "inhibits" (stops) the fear.

Step-by-Step: How SD Works

There are usually four main stages to this therapy:

  1. Functional Analysis: The therapist and patient talk to identify exactly what triggers the fear and how the patient reacts.
  2. Relaxation Training: The patient is taught techniques to achieve deep relaxation. This might involve deep breathing exercises or progressive muscle relaxation (tensing and then releasing muscles).
  3. Developing an Anxiety Hierarchy: The patient creates a "fear ladder." At the bottom is something that causes a little bit of anxiety (e.g., looking at a cartoon of a spider). At the top is the "scariest" thing (e.g., holding a giant tarantula).
  4. Gradual Exposure: The patient works their way up the ladder. They stay at each step until they feel completely relaxed before moving to the next. If they get too scared, they go back down a step.

Two Ways to Face the Fear

  • In vivo: This means "in life." The patient actually faces the real object (e.g., a real spider).
  • In vitro: This means "in glass" (imagination). The patient imagines the feared object.

Quick Tip: Think of SD like a video game. You can’t get to the "Final Boss" (the phobia) until you have cleared the easier levels first!

Key Takeaway: SD uses Classical Conditioning to replace a fear response with a relaxation response through a gradual "fear ladder."


2. Psychoanalysis

While SD looks at outward behaviour, Psychoanalysis goes deep underground into the unconscious mind. This therapy is based on the Psychodynamic approach. The goal is to bring hidden conflicts and repressed (pushed down) memories into the conscious mind so they can be dealt with.

Techniques of Psychoanalysis

How do you find out what is in the unconscious if the patient isn't even aware of it? Psychoanalysts use several tools:

A. Free Association

The patient is encouraged to relax (often lying on a couch) and say whatever comes into their head, no matter how silly, embarrassing, or irrelevant it seems. The idea is that if you stop "filtering" your thoughts, the unconscious mind will eventually leak out clues about your true feelings.

B. Dream Analysis

Freud believed dreams were the "royal road to the unconscious." Psychoanalysts look at two parts of a dream:

  • Manifest Content: What actually happened in the dream (e.g., you were being chased by a giant clock).
  • Latent Content: The hidden, symbolic meaning (e.g., the clock represents a fear of getting older or "running out of time").
C. Transference and Counter-transference

These are two very important concepts for your exam:

Transference: This happens when a patient starts to project feelings they have for someone else onto the therapist. For example, if a patient is angry at their father, they might start acting aggressively toward the therapist. This is actually a good sign in psychoanalysis because it "brings the conflict into the room" where it can be analyzed.

Counter-transference: This is when the therapist starts to project their own feelings back onto the patient. Therapists have to be very careful to avoid this, as it can interfere with the treatment.

Did you know? In traditional psychoanalysis, the therapist often sits out of the patient's sight. This is to encourage the patient to talk freely without looking for the therapist's reaction!

Key Takeaway: Psychoanalysis aims to unlock the unconscious mind using techniques like free association and dream analysis to resolve internal conflicts.


Summary and Comparison

To help you remember the differences, look at this quick comparison:

Systematic Desensitisation:
- Focus: Changing a specific behaviour (the phobia).
- Method: Relaxation and gradual exposure.
- Theory: Classical Conditioning (Learning Theory).
- Duration: Usually short-term (a few weeks).

Psychoanalysis:
- Focus: Understanding the "root cause" in the unconscious.
- Method: Talking, dreaming, and analyzing the relationship with the therapist.
- Theory: Psychodynamic Approach.
- Duration: Usually long-term (months or even years).


Common Mistakes to Avoid

  • Don't mix up the theories: Remember, SD is Learning Theory (Topic D). Psychoanalysis is Psychodynamic (Topic D).
  • Don't forget the hierarchy: When describing SD, students often forget to mention that the patient must be relaxed before they move to the next level of the ladder. If they aren't relaxed, the therapy isn't working!
  • Transference vs. Counter-transference: Just remember: Transference is from the Treated (patient). Counter-transference is the Clinician (therapist) reacting back.

Note: For more details on the evidence for these therapies, see the chapter on "Prescribed studies: learning theories and development," where we look at Capafóns et al. (1998) and their research into the fear of flying!