My mind, my thoughts, my words

Two approaches, one goal

There are various different psychotherapies and I would say that they can be divided into two approaches: trying to make sense of the past, and not dealing with the past but focusing on the present/future.

A classic example for ‘past-oriented’ therapy, as I would coin it, is psychodynamic (“Freudian”) therapy. Freud suggested that many adult problems can be traced to unresolved conflicts during childhood and adolescence. Free associations, fantasies, and dreams are used to dig into the client’s unconscious in order to resolve any conflicts that stem from his past. The therapist tries to find out what caused the client’s symptoms. Therapy thus works as some sort of catharsis: The client finds out what’s wrong, talks about it to alleviate psychic tension, and then feels better.

On the other hand are ‘present-oriented’ therapies, such as Cognitive Behavioural Therapy (CBT). Therapy tries to identify maladaptive cognitions and false beliefs and teach the client to replace these with ‘healthy thoughts’. The client won’t delve into his past to figure out how and why he might have developed his problem.

What I am wondering is, what works better? Finding the cause of your troubles to make sense out of them and eventually be able to move past it? Or, forgetting about what happened –  à what lies in the past belongs to the past – and focusing on being in the present and making the best of it, as you’re not able to change what’s happened anyway?

For some problems, present-oriented therapies clearly seem like the way to go. For example if you have a phobia, it would be hard to determine what made you get it, or knowing what started it would very likely not make a difference in your fear. The best therapeutic approach in this case would be behavioural therapy, e.g. desensitisation in which the client would learn not to be scared of spiders step by step.

As for mental problems such as depression, eating disorders, etc.,  both psychdynamic therapy and CBT are a common choice for therapy. CBT focuses on thoughts which affect behaviours. Therapy is not concerned with the question why these dysfunctional thoughts exist. The goal is to identify and change dysfunctional thought patterns. Psychodynamic therapy tries to uncover the client’s unconscious (unresolved issues, unconscious feelings) in order to understand how these affect his behaviour. Sessions are more informal, open-ended, and based on free association which allows the client to talk freely about what’s on his mind so that feelings and behaviours from past experiences become apparent. Through the awareness about their effect on his present feelings and behaviours he can develop internal resources to help him deal with issues that have caused him to suffer.

Which ‘method’ suits a person better is also a personal matter. It depends on their situation, problem, and probably most of all whether they want to dig in their past or not. It has been found that psychodynamic therapy is at least as effective as other therapies and that the benefits may actually be longer lasting. I think it’s never wrong to think about your past because it makes you who you are today, so by doing so you would get to understand and know yourself better. However, in the end you do live in the present. For some people delving in the past might not make a difference, some might get stuck in the past, and for others it could give helpful insight. In brief, there’s no fix answer which method is right for someone, it depends on the circumstances. A bit of either would probably be great 🙂


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