Those patients, who do not need to be hospitalized, are given outpatient therapy services, which reduce hospital costs, since there are no charges in the use of inpatient facilities, such as food and beds. There are two forms of outpatient therapy discussed in in connection with their efficacy. These are psychoanalysis therapy and client-centered or person-centered therapy. In psychoanalysis, the therapist does not play an active role, and he observes clients, when they try to make unconscious thoughts and emotions conscious. On the contrary, the client-centered approach makes use of the relationship built between the therapist and the client. The former creates a friendly environment for the latter to solve his or her problems. This approach is widely used despite such kind of relationships.
Efficacy of Treatment Approaches in Outpatient Therapy
Outpatient therapy is therapeutic treatment given to patients, who do not require hospitalization. Therapies given on an outpatient basis include physical therapy, psychological therapy, and surgical care. Outpatient therapy is preferred by most people, because it enables them to get required treatment enjoying the comfort of their homes. It also helps avoid bills.
Outpatient therapy can use psychoanalysis or client-centered approaches. Their effectiveness mostly depends on the events and the relationship between the client and the therapist.
Psychoanalysis (Freudian Therapy)
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This therapy was founded by Sigmund Freud. He believed that patients could be cured by means of making their unconscious thoughts and motivation conscious. The intention of this therapy is to let repressed experiences and emotions go. This method is normally used to treat anxiety disorders and depression. Psychoanalysis assumes that visible symptoms are a result of concealed disturbances. Their typical causes include issues that have not been resolved during development. Psychological problems are seen as such that originate in the unconscious mind. Their treatment aims at bringing the subdued conflict to unconsciousness, enabling the patient to deal with it.
There are three stages of psychoanalysis, which are as follows:
1) Assessment and diagnosis;
2) Working through the issues;
3) Reviewing the success of therapy or resolution.
The theory of psychoanalysis is based on the determinism of human personality. The structure of personality three elements, which are the superego, ego and id. The id is the foundation of instincts, which are in the unconscious mind. It the part, from which energy originates. The id is driven by the" pleasure principle". It decreases pain and tension reinstating pleasure. The ego regulates and controls personality, maintaining reality, while preparing plans to satisfy needs. The superego is the individuals' moral code that judges whether an action is bad or good. It also controls ideals and traditions that are inherited across generations.
Lazar (2010) analyzes psychoanalysis as “the study of unconscious” saying that it “focuses on behavior, dreams, slips of the tongue and the use of such a method as free associations. It provides the patient with a chance to search for links to different problems and issues in his or her thoughts”. This therapy uses unconscious processes and thoughts as the basis of behaviors and problem symptoms.
In psychoanalysis, anxiety is considered to be the key element. This concept can be explained as the state of tension, which urges people to take actions for the purpose of coping with it. There are defense mechanisms, namely denial and repression, which aid people in getting rid of tension.
Conducting a Therapy Session
Psychoanalysis is normally carried out in a setting, where the analyst is out of sight, and the patient is lying on the couch relaxed. It consists of numerous sessions over a comprehensive period. Besides, it promotes intensity, depth, and access to deeper unconscious needs, impulses and awareness. During a therapy session, the client should retell about what he thinks. Listening to him, the doctor focuses on the person’s slips of the tongue, seeking for connections between events. The patient may not know consciously that there are such ones.
The doctor should make the patient find connections himself or herself. He tells what conclusions he has made from the conversation. This process goes on with the aim of assisting the patient in gaining knowledge of how emotions and the mind work together. The analyst comprehends dreams as an expression of the inner life of the patient, both in the past and the present. In most cases, after having listened to dreams, the analyst asks the patient to associate a dream and its elements (Lazar, 2010). The dream material and associations help to uncover deeper fears and wishes of a person, and through the interpretation of the analyst, he or she can know what has been unconscious to him or her (Basavanthappa, 2007).
During the therapy session, there are two processes, which can be analyzed, namelyt ransference and countertransference, which lead to additional realization of the patient’s intuitive structure and familiarity. By interpreting and analyzing enactments, the analyst can assist the patient in understanding himself or herself. The former becomes self-aware and more skillful. The person is also assisted to adopt effective ways of dealing with anxiety. Psychoanalysis develops person’s ability to analyze his or her behaviour.
Efficacy of Therapy
There is the lack of persuasive and solid evidence on the efficacy of psychoanalysis, because it has self-imposed separation from empirical sciences. This approach has received support of psychotherapy studies. Evidence got from the reanalysis of tapes used during therapy at the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program shows that if the process of brief therapy resembles the psychodynamic approach, there are more chances of it being effective (Ablon & Jones, 1999).
There is evidence to support therapeutic interventions, which have come up as a result of psychoanalysis. However, most psychoanalysts argue that the goals and techniques of long-term and short-term psychotherapy cannot be compared. Long-term psychotherapy is seen to be more effective together with outpatient therapy, since patients do not experience any change in an environment.
Therapy is also cost-effective. There are savings in terms of bills to be paid and the time spent in hospital by an in-patient. Trials with the same patient groups using the assessment of outpatient psychoanalysis therapy with expanded baselines have given relatively satisfactory results. Patients with personality disorders showed substantial improvements after psychoanalysis therapy. A single case carried out in the group of children with chronical diabetes confirmed the relationship between the progress in diabetes control and interpretive work and physical growth (Basavanthappa, 2007).
Most researches done on the efficacy of psychoanalysis therapy do not clearly show that this approach is better than others. However, there is compelling evidence that psychoanalysis is much more effective when treating outpatients, especially those with milder disorders, and less effective for those with severe cases. Various poorly controlled studies, mostly those carried out in Europe, showed that long intensive therapies were more effective than short non-intensive ones. The results of psychoanalysis are noticeable outside symptomatology in terms of health care costs reduction and work functioning.
Benefits of Psychoanalysis
Effective psychoanalysis therapy can only be achieved, if the match between the psychoanalyst and the patient is perfect. Those patients, who are capable and interested in searching deeply into their personality, and have the ability to come up with logical connections and to depict causes and conclusions, also benefit a lot from this therapy. However, psychoanalysis can assist most people. It can help to those patients, whose capacity for psychoanalysis work is impaired adjustment of methods (Ablon & Jones, 1999).
Client-Centered Therapy (Rogerian Therapy)
Client-centered therapy was introduced by psychologist Carl Rodgers. It focuses on the client and avoids making diagnosis, asking questions, or providing assurance to him or her during interaction (Basavanthappa, 2007).
The importance of this approach consists on the fact that the patient may trust the analyst, because the latter does not judge him or her. In such a situation, the client may find answers to the problems himself or herself. The efficacy of client-centered therapy is linked with an unconditional and empathetic relationship between the patient and the therapist. Where there is an optimal environment for this therapy, the patient becomes skilled to take an active position in his or her recovery. He or she also learns to take accountability for making decisions and discoveries, which will make it possible to achieve the highest level of progress and growth (Høglend, 1993). This approach can be used to cure any disorder. It can be achieved through the use of long-established talk therapy. This therapeutic approach has a lot of value in many treatment milieus.
Client-Centered Therapy Principles
The client-centered therapist allows clients to picture their own stories in the way they want. He infrequently asks questions, disagrees or agrees with the client, or offers reassurance. The therapist does not provide solutions in client-centered therapy. He has a role of providing an environment, in which the client can talk about his or her feelings with confidence without being judged (Basavanthappa, 2007). It makes the client be aware of his or her own features, which he or she has been denying. The goal of this permissive indirect method is to make people feel that they are free and are not influenced by any force. However, client-centered therapy may not work well with conservative people or those, whose insights of reality have been distorted by mental illness (Høglend, 1993).
Efficacy of Client-Centered Therapy
According to Rogers, for the success of therapy, some requirements should be met. These are as follows:
- The way, in which the therapist and the patient interact is very important.
- The therapist should not judge the client and should accept him or her unconditionally. Therefore, the former should have unconditional positive regard (UPR). It helps the client improve self-regard, since he or she becomes aware of occurrences, where in the patient’s view, his or her self-esteem has been misrepresented by others.
- The perception of the client through empathetic understanding and UPR of the therapist also influence the efficacy of therapy (Basavanthappa, 2007).
- The ability of the therapist to use his or her experience to help the client open up also affects efficacy. The former must be able to portray that he or she is genuine in what he or she is doing (Basavanthappa, 2007). The client must be motivated to support the relationship open.
The therapist should be able to experience an empathetic comprehension of the inner frame of reference of the client. When the former shows empathy to the latter, the patient believes that the doctor loves him or her unconditionally and can understand instead of judging.
For therapy to be efficient, therapists' attitude plays a crucial role. He or she must have empathy, congruence and unconditional positive regard (URP). Besides, the therapist must be able and willing to be genuine to the client without acting. He or she must also accept patients unconditionally. It encourages clients to talk, since they believe that the therapist will understand and appreciate them. The efficacy of the client-centered approach is conditioned by the relationships between the therapist and the patient (Høglend, 1993).
Benefit of Therapy
Client-centered therapy has been established to be used when treating addictions, low self-esteem in depressed clients, and dual diagnosis. By letting the client connect with the inner self, he or she is better provided to go beyond the boundaries of addictions and other coercions. This therapy can help patients suffering from tension, stress and alcohol abuse, panic, eating disorders and other problems.
The efficacy of both approaches is affected by the relationship between the client and the therapist. In psychoanalysis, the ability of the patient to search deeply into his or her personality and his or her interest affect the efficacy of the approach. However, this approach can assist most people, and many researches have been done, in which its efficacy has been confirmed. Psychanalysis is effective when administered with other approaches.
The efficacy of the client-centered approach is conditioned by the relationships between the client and the doctor. The environment during the therapy session influences the response of the patient. The idea of such conditional relationship is important for determining the efficacy of this method (Basavanthappa, 2007).
Psychoanalysis is uniquely effective, since it uses unconscious motivation in an active way. When the patient recognizes the unconscious pattern, there are higher chances that he or she will never repeat them. Psychoanalysis provides new ways of looking at oneself, and this makes the patient feel control over his or her life. Therefore, psychoanalysis is more efficient than client-centered therapy.
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