Freya - franthompson

Dream analysis
Psychodynamic Approach
Psychodynamic approach on mental
• Mental disorders are said to come from the
unconscious mind
• Due to repressed thoughts or emotions from
Ice berg theory
• the conscious mind, the
preconscious, and the
unconscious mind—each
lying beneath the other.
Freud believed that
significant psychic events
take place "below the
surface" in the unconscious
mind, like hidden messages
from the unconscious. He
interpreted such events as
having both symbolic and
actual significance.
• In order to treat the mental disorder the
analyst must therefore access the patients
unconscious mind.
When we sleep our ego’s defences are more relaxed,
so material that usually stays in our unconscious ‘surfaces’
in the form of a dream
• This material that makes up dreams cannot be
let into our conscious mind in its actual form
as it may threaten our peace of mind
Content of dreams
• The bits we remember are called the manifest
• Whilst what the dream actually means is
called the latent content
What the analyst must do…
• Uncover the true meaning of the dream
• (analyst must have several recordings or
dreams to do this-not just 1!)
• One way to analyse dreams is via…
Free association
• Patient talks about thoughts, emotions and
the dreams created, rather than the actual
• For example- anorexics are asked to talk about early
memories to uncover unconscious conflicts that may
be causing their disorder.
• This allows them to deal with it on a conscious level
Strengths of this approach
• Heaton et al (1988) found that clients who
had therapists interpreting their dreams felt
they got more insight and depth that way than
trying to interpret their own.
• 88% of clients said they proffered therapists to
interpret their dreams- seems to offer clients
• Dream analysis is subjective , with the
interpretation of the dream dependent on the
analyst. Different analysts may have different
• Client may not tell the analyst the whole
dream! May have forgotten bits or might edit
certain areas of the dream. May therefore not
actually reflect the unconscious mind.
***EYSENECK 1952 **** ESPOSTIO ET AL 1999
• CBT- cognitive behavioural therapy
• Combines cognitive and
behavioural approaches
• Cognitive assumption that
our beliefs about the world
affect how we see the world
and ourselves.
• Behavioural part is what
changes our behaviour
• Focuses on the present behaviour and
thoughts instead of how they are developed
• The therapist has to accept the patients
perception of reality and then use this
misperception to help the patient manage
• To make adaptive decisions instead of
• Until recently it was thought that CBT would
not be effective for people as their whole
perception of reality is different. –making it
difficult to get them to challenge their beliefs.
• HOWEVER… Chadwick 2000 studied 22
schizophrenics who heard voices. All got 8 hrs
of CBT and all had reduce negative
• Gould et al 2001 carried out a meta-analysis of
studies that looked at the effectiveness of CBT in
conjunction with taking anti psychotics.
• He found that there wad a large reduction in
positive symptoms in most cases, with drop out
rates of about 12 %, considerably lower than
amongst those who stop taking anti psychotics
Biological approach
• Use of drugs…
• Are also known as neuroleptics, were first
developed in the 1950s…
• Helped to sedate person also reduce the
intensity and frequency of hallucinations and
• Further anti psychotic drugs have since been
What happens in the brain?
• Anti psychotic drugs fit into dopamine
receptors …
• Blocking dopamine and stopping it being
picked up…
• Most effective when given at the onset of
Clozapine 
• Developed in the 1970s, also reduce the
negative symptoms, though some debate
remains as the evidence is inconclusive..
• Some studies found it affective whilst others
Strengths of the biological approachuse of drugs
• Drugs allow the patient to live in society, so
avoiding being institutionalised...
• Allows them to access other therapies that
may also help to cure them
• Pickar et al 1992• Compared the effectiveness of clozapine with
other neuroleptics and a placebo drug. He
found that clozapine was the most effective of
treating symptoms, even in patients who did
not respond to previous drugs
• Placebo was least effective
Emsley 2008
• Studied the effects of injecting the anti psychotic drug
• Found that those who had the injection early in the
course of their disorder had high remission rates and
low relapse
• In 84% of patients there was at least a 50% reduction in
positive and negative symptoms
• Over the 2 years of the study-64% went into remission
• One problems with all the drugs is the side
• Constipation; coughing; diarrhea; drowsiness;
dryness of mouth; headache; heartburn;
increased dream activity; increased length of
sleep; nausea; sore throat; stuffy or runny nose;
unusual tiredness or weakness; weight gain;
absence of menstrual periods; breast growth in
males; tiredness; increased appetite; sexual
problems in both men and women
• Non compliance or partial compliance when it
comes to taking the drugs is a major barrier to
the treatment of schizophrenia and can lead
to relapses.
• After several relapses, patients are at an
increased risk of never getting back to a
functional level they were at before
developing the disorder
Rosa et al
• Found that only 50% of the patients comply
with their drug therapy.
• Even if patients do comply and take their
drugs, it has been found that 50% of them still
have distressing symptoms.
• Can never been seen as a cure… as you will
always have to take their drugs
• Use of drugs may be unethical as it may create
a dependency to them and think that u can
treat any problem with drugs…
• The use of drugs was shown not to ever ‘cure’
patients and this may be a misleading .
• However, taking the drugs allows for sufferers
to socialise with people ‘normally’ in every
day life 
Learning approach
A system of behaviour modification based on the systematic
positive reinforcement of target behaviour.
The reinforces are symbols or tokens that can be exchanged
for other reinforces.
Token economy is based on the principles of operant
conditioning and can be situated within applied behaviour
analysis (behaviourism). Token economies are applied with
children and adults.
Token economy and anorexia
• reward patients for eating regular meals, and
ensuring that they do not purge afterwards,
with additional hospital privileges or rewards
then being granted.
• A rewards may be, seeing their families….
• Although no specialist
training is needed to
implement a TEP, most
experts recommend
training for all staff…
makes the programmes
• Gives anorexics a sense of
control over their own life
and focuses the attention
off controlling the idea of
being thin to putting on
• Some people could argue that the
programmes can lead to learned helplessness,
where anorexics feel they have no choice but
to comply otherwise basic privileges are
withheld from them. This may be unethical
• 
• May violate human rights? And at the very
least is patronising
Social approach
• FAMILY THERAPY• Families are usually involved in therapy and
recovery from anorexia in various ways.
Underlying relationship issues must be dealt
with between the anorexic patient and family
• Maudsley Family Therapy, also known as
Family-Based Treatment or the Maudsley
Approach, is a family therapy for the
treatment of anorexia nervosa devised by
Christopher Dare and colleagues at the
Maudsley Hospital in London in 1985
• Also
• ****Lock and Le Grange
Family therapy….
• A comparison of family to individual therapy was conducted
with eighty anorexia patients.
The study showed family therapy to be the more effective
approach in patients under 18 and within 3 years of the onset
of their illness.
• Subsequent research confirmed the efficacy of family-based
treatment for teens with anorexia nervosa.
• Family-based treatment has been adapted for bulimia nervosa
and showed promising results in a randomized controlled trial
comparing it to supportive individual therapy.
Strengths 
• FBT encourages parents to take an active role
in restoring their adolescent's weight and, for
now, seems to have some advantages over the
more "routine" advice to parents, which is to
involve them in a way that is supportive and
understanding of their child, but encourages
them to step back from the eating problem.
• Engaging these families in treatment can be a
challenge and this may be particularly true
when the family is seen together in session.
This challenge around engagement might be
associated with parental guilt and blame that
increase as a consequence of criticisms or
confrontations occurring during family

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