Psychodynamic and psychoanalytic psychotherapy

Psychoanalytically oriented psychotherapy (also called psychodynamic psychotherapy) encompasses psychotherapeutic approaches originally based upon the theories of Sigmund Freud and later expanded by a number of other therapists and theorists.  Psychoanalytically oriented therapists believe that early developmental experiences influence later behaviour and that such influences are outside of normal awareness.  The early experiences are retained in the unconscious mind as expectations about relationships, beliefs about ourselves and the world around us, and mechanisms to control uncomfortable feelings and thoughts and prevent them from coming into the conscious mind.  These unconscious processes determine present feelings and actions.  Thus the past shapes the present through forces that are sometimes known and sometimes unknown. This therapeutic model can be extremely useful for shaping explanations for behaviour when the person is anxious or depressed but has very little verbal capacity to explain their emotional world.  In such a case the therapist can help carers and others working and living with the client to understand some of the  basic principles of human anxiety and depression at a very primitive or early stage of human development.  With this understanding people working with the client can gain a broad comprehension of what the client may be experiencing and therefore approach the client in a more guided and compassionate manner.  This model makes very little distinction between how we all experience anxiety and depression and how our people with intellectual disability do so. Successful resolution of problems relies on obtaining insight into conscious and unconscious motivations which drive behaviour. The major difficulties of this model for use with people with an intellectual disability are: • It involves  a long period of treatment (in many cases in excess of 5 years), which means that there may be no immediate improvement observed in the client and for others they live with; • It is usually quite costly and may not be fully rebated by the medicare system; • It relies on one therapist for treatment for a protracted period of time, usually involving a minimum of weekly appointments. This can lead to very marked dependency issues for people who have few other resources for support; • The client requires good verbal skills and the ability to think about things from a psychological perspective. Again, a similar proviso holds as for other psychological therapies discussed in this unit; the therapist needs to be highly skilled and experienced in working with people with an intellectual disability. There may also be a more delayed response to treatment than is experienced for the general population.