lPeople comment and wonder: “Is Psychology and Psychoanalysis the same thing?”, “I don’t know what kind of techniques my psychologist applies,” “I’ve been doing Psychoanalysis for 5 years, are there other schools in Psychology?… I don’t know. did I know”, “Cognitive Behavioral Therapy?, Gestalt?, Systemic Therapy? “I don’t know them… my analyst never informed me.”
These types of statements appear in patients when they are not informed about the differences between the various currents in Psychology. Frequently, in the “psi” world of Buenos Aires, people do not know that Psychology and Psychoanalysis are not the same.
The vast majority of psychoanalysts do not explicitly inform their patients that the psychoanalytic approach does not apply direct techniques to modify the behaviors, thoughts and emotions that cause suffering to the patient, much less that such procedures do exist, with proven scientific effectiveness. This fact acquires special relevance because, contrary to what happens throughout the Western world, Psychoanalysis undoubtedly constitutes the hegemonic and dominant theoretical framework in our city.
In our opinion, it is essential that the patient knows in a clear and transparent way the differences between the various currents of Psychology. It is therefore useful to define some terms:
- PSYCHOLOGY: It is the scientific study of behavior and mental processes.
- PSYCHOLOGY SCHOOLS: Various theories and applications that have emerged from at least five most influential currents: Behaviorism, Gestalt and Humanistic Psychology, Cognitivism, Systemic Theory and Psychoanalysis.
- PSYCHOANALYSIS: It is a theory of personality, developed mainly by Freud, as a form of therapy. It is based on the belief that psychological problems are symptoms of internal conflicts, repressed during childhood, and that the task of the psychoanalyst is to help the patient bring these hidden conflicts to consciousness so that they can be addressed effectively. . The psychoanalytic approach – at least the orthodox one – does not “directly” treat what the patient wants to change through a specific technique; It is based on the assumption that if the analyst aims directly at the elimination of the “symptoms”, he then interferes with the “discovery” of unconscious aspects of the person he consults.
- COGNITIVE-BEHAVIORAL THERAPY: It is a psychological intervention model based on contemporary scientific research. Its objective is the application of theoretical knowledge and psychological techniques aimed at changing behaviors, thoughts and emotions that generate discomfort in the patient. It is nourished by procedures that have empirical support, that is, that have proven their effectiveness in controlled scientific research.
Psychoanalysis is only one of the currents of Psychology, it is not Psychology
Next, we will go over the differences between Cognitive Behavioral Therapy and Psychoanalysis with respect to three key aspects: treatment modality, empirical support from research and information provided to the patient.
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- Treatment modality
- The psychoanalyst predominantly uses the technique of “free association”; It does not apply procedures aimed at behavioral change, since it is based on the idea (quite questioned today from other approaches) that authentic “healing” occurs only when the patient “discovers” aspects of the “unconscious” that were “hidden.”
- The cognitive-behavioral therapist implements therapeutic techniques whose objective is to change the behaviors, thoughts and emotions that cause suffering to the patient. In other words, the patient’s problem is directly addressed.
- Empirical support of treatments
- The origin of Psychoanalysis is located in the theoretical system initially developed by Sigmund Freud between 1885 and 1938. The current practice of Psychoanalysis is based on theories and hypotheses of various authors that make compatible and complement to varying degrees the original proposals of its creator. This results in a wide set of divergent currents within Psychoanalysis itself, to be more precise, there are approximately 200 schools of Psychoanalysis. Regardless of the empirical support it has in controlled studies, the analyst applies the theory that he believes or is convinced by.
- Regardless of whether or not he likes a certain theory, the cognitive-behavioral therapist must give priority to those approaches that have passed empirical testing through previous studies that prove the effectiveness of a technique in certain disorders. In several countries, scientific research has been stimulated in the clinical field, trying to establish precise criteria on which are effective treatments for different pathologies. Thus, the professional who works in Cognitive Behavioral Therapy must consider such criteria when choosing which techniques to apply to help their patients.
- Information about the techniques to the patient
- In Psychoanalysis, the patient is not usually informed that the analyst will not directly treat their problems or reasons for consultation. Furthermore, according to Freudo-Lacanian Psychoanalysis, the patient must “suppose” that the analyst has “knowledge”; In general, he cannot respond directly to the patient’s request for help by modifying the symptom, since in this way he “obstructs” or “interferes” with free association. For example, if the patient suffers from anxiety, the analyst does not apply relaxation techniques, since it would imply working on the “surface” and not on the supposed “conflict.” Naturally, the resulting ethical problem is that the lack of accurate information about the characteristics of the psychoanalytic approach leads to the patient spending months, even years, believing that the analyst implements techniques to change their problem.
- In Cognitive Behavioral Therapy the therapist must clearly inform the patient which procedures will be applied. Psychoeducation, that is, explaining basic theoretical notions and steps of the techniques, constitutes one of the unavoidable components in therapeutic programs for most psychological disorders. In this way, the patient is allowed to choose, since they are transparently informed about the intervention strategies that will be implemented and the reason for them.
The Ethical problem:
The professional would be indirectly “deceiving” the patient; That is, the patient asks and expects a specific intervention to change her behavior and emotions, but the analyst does not do it nor does he warn her that he will not do it. This transcends the discussion between theoretical currents; It is common sense and respect for the person asking for help.
The axis of our argument in this instance does not refer to the effectiveness or reason of the theoretical systems, but simply to inform the patient what procedures will be applied during therapy. Be it Cognitivism, Behaviorism, Psychoanalysis or any other, the patient must be informed:
- The therapeutic technique (what it is).
- How it can help you (how it is applied).
- In what cases it is predominantly used (what it is for).
Recommendations for patients:
- Observe if the psychologist has a qualifying title.
- Ask the psychologist to clearly inform you what type of guidance and techniques he generally applies.
- Seek information about therapies that are indicated as effective for problems like yours.
- Learn about the differences between the five main currents of Psychology detailed previously.
- Ask the professional for an estimate of the duration of the treatment.
In conclusion, then, the central idea is not under any point of view to force people to attend a certain type of “Psychology”, but rather that they can choose between the various options that exist. The discussion also does not point to which theory or technique is better; Not to mention that any of them should disappear. At most, it could only be required that all of them be evaluated empirically.
Far from the debate between schools, the topic is simple and common sense: simply show the person the various options and let them choose themselves. The problem arises when said choice is the result of ignorance of other options because the professional does not directly explain to the patient that he will not address her symptoms. Allowing patients to make choices based on general knowledge of Psychology without falling into dogma is respecting their individuality and human dignity.
At the end of the day, is it fair to deny patients the possibility of solving their problems with treatments that have been proven effective in similar cases, just because the psychologist who is their lot doesn’t like them? To mention at least one example, is it ethical that someone suffering from panic attacks should not be given cognitive restructuring, abdominal breathing and training in attentional refocusing; When there is ample scientific evidence regarding the effectiveness of these techniques for the treatment of anxiety and panic? If nothing else, shouldn’t we at least let you know that such procedures exist? Is it justified for the professional, because he or she does not believe or dislike a certain current in Psychology, to let the patient suffer with its problem, denying him the possibility of choosing?
In some ways, dogmas have their totalitarian side: for some, the best way to refute a theory is not to know it.
Authors: Lic. José Dahab, Lic. Carmela Rivadeneira and Lic. Ariel Minici
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