CBT and interpersonal therapy

As well as believing that people have an unlimited potential for growth, humanistic therapy also believes that, just as we are now, we are basically and fundamentally OK (Harris, 1967). Transactional analysis founded by Eric Berne takes these concepts into consideration where it is essentially described via three ego state, parent, adult and child (Berne, 1968) similarly to Freud theory of psychosexual stages in terms of super ego, ego and I. However Transactional Analysis is very much an operational tool rather than a metapsychological entity.

Berne defined an ego -state as a system of feelings accompanied by a related set of behavioural patterns that is not hugely interested in the existential status or in concepts like the unconscious but rather in the usefulness of learning to recognise different ego-sates in one self and in others (Berne, 1968). Therefore one of the fundamental parts to Transactional Analysis is to educate the client to recognise their own shifts between ego-states and the advantages and drawbacks to each state depending on the situation. Transactional Analysis also extensively explores what it calls ‘crossed transactions’ and therefore the interpersonal difficulties that arise when people are communicating from different ego states, for example parent to child and vice versa (Stewart and Jones 1987).

Berne also believed that life scripts are written in childhood again similar to aspects of Freudian thinking. Bern proposed that having written our infant life story we are likely to go ahead and live it out for at least some of the time in our adult life. Thus a life script is based on inadequate or out- dated information and the more rigidly followed, the less good the results are likely to be. Situations like suicide, drug addictions or psychosis all result from scripts and hence in TA language- are capable of being ‘changed’ and therefore ‘free’ from our life script. This consequently suggests a definition of autonomy: behaviour, thinking or feeling which is a response to the here and now reality rather than a response to a script belief (Berne 1961).

In terms of humanistic theory there is a clear distinction from models like psychoanalytical theory that perhaps thus focus on ‘mental illnesses’ as a diagnosis which may exclude the client’s internal world. As a result humanistic therapy dismiss ideas relating to prognosis and treatment- traditionally rejecting this as ‘dehumanisation of clients’ (Clarkson, 1989) They believe that labelling people can strip clients of the unique ways in which they have chosen to give meaning to their existence (Kelly 1989). Rowan argues that ‘labelling does harm to clients even when the labels are correct’. In other words, one does not even have to validate diagnostic categories in order to argue that they are unhelpful, simply because they block the therapeutic relationship by suggesting that the therapist, rather than the client is the expert on the client’s problems and therefore unable to speak the clients language (Rowen, 1998).

Some current therapies therefore employ methods that are not entirely composed of ‘client language’ for the treatment of problems which were originally part of the traditional province of psychoanalysis. If we take Freud’s ‘traumatic neurosis’ (porter, 2002) as an example, we find that this has a number of current labels. One of the most common is Post Traumatic stress Disorder (PTSD) and one of the most novel methods of treatment is Eye Movement Desensitisation and Reprocessing (EMDR). PTSD is often diagnosed in soldiers returning from war and EMDR is a treatment specifically developed for those suffering from it. It is a collection of integrated therapy involving concepts derived from psychodynamic therapy and cognitive behavioural therapy (CBT) amongst others. Its distinguished feature is that it requires suffers to learn to focus their thoughts on traumatic topics and then control their eye movements thus a progressive reduction in the experience of trauma ensues.

The language used by those who employ concepts such as PTSD and treatments such as EMDR is very different from that used by Freud. An interesting question therefore arises: to what extent are modern day developments different from the type of talking cure offered by Freud and his early followers? One key element remains identical- the client is engaged in the first instance through the use of words. Therapist may employ a different mode of speaking, that is the type of language and the stated aims of the treatment may differ, but in each case, what is sought is the reduction or elimination of the client’s symptoms (Hall et al, 2010).

It is interesting to note that there is currently a suggestion among practitioners of EMDR that it achieves its results not through training of eye movements but because of the desensitisation. The precise cause of symptom change is difficult to characterised, distinguish and chart, no matter how many trails are carried out. Human thinking is evanescent, individual and by its very nature indefinable. EMDR exhibits the same problem as Freud’s observation of nightmares, night sweats and so forth, indicate dream disturbances and are one of ‘the masochistic trends of the ego’ in that they are not open to straightforward verification (Freud, 1920).

Psychoanalysis is therefore viewed as problematic because words are so elusive, with approaches labelling certain types of mental illness with a new extended label, and since Freud’s time a new vocabulary has been generated. For example neurasthenia is now known as depression and psychasthenia is more commonly known as obsessive compulsive disorder (Freud, 1926 and Wikipedia). Much ongoing work has taken place in psychiatry and psychology to redefine the complaints originally listed by Freud. The most well known classification systems are the Diagnostic Statistical Manual of Mental Disorder and the international Classification of Diseases and Related Health Problems.

If we were to add a list of treatments available for these ailments in 1926 and compare them to those available today, the outcome would look remarkably similar, nowadays however, the term ‘psychoanalysis’ in its general application would not be used, many variants of the talking cure thus are still available, in terms of the counselling world- the most common being psychodynamic. The problem with classification in relation to psychoanalysis therefore persists- a definition of illness provides no pointers to a potential cure.

Many humanistic practitioners would therefore argue that while symptoms do often lesson or disappear during therapy, this is a by product of the work rather than its primary goal. They thus acknowledge that recognition of repeated patterns in human behaviour (whether momentarily or long term) is intrinsic to the humanistic approach (Clarkson, 1989). This is, to increase overall wellbeing and quality of life by reconnecting the client to the sources of their own growth, differing greatly from the psychoanalysis in practise if not in theory. Analytically influenced work thus tends to stress compromise and realism, accepting difficulty and ambiguity and therefore can perhaps lack the openness to joy, creativity and optimism found in humanistic work.

Hence, albeit Freud’s desire to think of himself as a ‘natural scientist’, a frequent criticism directed at psychoanalytical theory is; there is no supporting scientific evidence for its claim to efficiency. Though Freud was still in principle committed to the scientific biology in which he had been trained, in actuality Freud’s psychodynamic proceeded without reference to neurological substrates (Porter, 2002). As a result the evidence based psychotherapies, CBT and interpersonal therapy and its variants have become much more popular in recent years, often at the expense of both humanistic and longer term psychoanalytical psychotherapies (Hall et al, 2010).

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