Behaviour therapy and psychodynamic psychotherapy: Basic conflict or reconciliation and integration?*

Abstract

As recently as 1970 the approaches of behaviour therapy and psychodynamic psychotherapy (especially in the form of psychoanalysis) to the explanation and treatment of disorders of behaviour were acknowledged by most psychologists to be fundamentally different and irreconcilable. Sporadic earlier suggestions that reconciliation between and even integration of the two approaches might be possible have received strong support in the last decade from a number of sources. The literature relating to these developments is reviewed and it is concluded that a strong case appears to have been made out for reconciliation and integration. These 'paths of convergence' have been produced by both general and specific forces. However, critical voices (mainly from sympathetic but unconvinced psychoanalytically oriented therapists) have not been wanting. Their criticisms are reviewed as well as the fundamental issue of the relationship between theory and therapy in the two approaches. It is concluded that the case for the reconciliation and integration of behaviour therapy and psychodynamic psychotherapy has not been satisfactorily established on empirical grounds and is very difficult, if not impossible, to establish on theoretical grounds.

The Impact of Research on the Practice of Psychotherapy

“…Prescriptive therapy aims to diminish or circumvent anxiety by teaching new coping skills; in contrast, exploratory therapy invites the client to`get in touch with' or`stay with' distressing feelings aroused in relationships. (For discussions of the difficulties in integrating the theory and practice of behavioural and dynamic therapies, see Messer &Winokur 1980, andYates 1983. ) Several clients who had prescriptive therapy first, and whose problems improved considerably during that phase, appeared to experience reluctance and even anguish in the first few exploratory sessions and the gains they made in prescriptive work were barely improved upon in the second phase.…”

Does psychoanalysis have a valuable place in modern mental health services? No

“…Secondly, theoretically: an approach that not only explicitly rejects but also opposes the use of treatments that deal with crippling symptoms such as anxiety and depression, obsessional rituals, and agoraphobic avoidance has no place in mental health services, which should by definition help service users to reduce distress and disability. 6 Finally, empirically: the development of an accountable healthcare culture by the National Institute for Health and Clinical Excellence and other mechanisms has resulted in real improvements in mental healthcare; an approach that rejects outcome measurement has no place in the rapidly evolving and empirically grounded field of psychological understanding and interventions in mental health.…”

On the Integration of Cognitive‐Behaviour Theory with Psychoanalysis

“…Critics of such`hybrid' 'integrated' approaches (Yates 1983, Haaga 1986) point to two flaws. The first and easily remediable one is the absence of empirical data indicating the superiority in terms of clinical efficacy of the integrated approach when compared to either approach used singly.…”