Case of the Week (CW) - N° 9 (The behavioral vs. the psychodynamic therapeutic approach: a real case)

Submitted by Joke on Nov 29, 2017 in Case of the Week

The divergence and convergence between behavioural and psychodynamic therapeutic approaches are very often discussed in philosophical or theoretical terms. In our case of the week, Stanley Messer (a senior psychodynamic therapist) reads through the case of a phobic patient treated by Lazarus (a senior behavioural therapist), and points to critical events during the therapy where he would have acted differently. In a unique dialogue, the therapeutic choices in this case are discussed from both theoretical points of view. The first impression from the paper is: these therapists will never find a common ground. However, both clinicians actually make valid points and could benefit from each other’s remarks (if they are ready to listen).

Messer tackles the symptomatic focus of the behavioural treatment (e.g., focusing on the compulsive handwashing and the agoraphobia), and proposes “not to be in hurry” concerning the symptom relief. He signals the important function of the symptoms as they can avoid a psychosis. Lazarus on the other hand points out to Messer’s labelling of the client as someone with an sadomasochistic or obsessive-compulsive disorder as problematic. He signals the importance of the secondary gains of the symptoms and the need to ally with the client’s needs regarding to the therapy. The therapists however agree on the hypothesis that the client is punishing herself for the abortion she had earlier, that the client has an extensive need for emotional support and that her social relationships (especially to men) need to be revaluated. The therapists differ in their use of the therapeutic relationship and disagree on how to work with the existing family relationships. They also have different interpretations on the patient’s increased sexual activities as either “acting out” or “improvement” and hence have different opinions on when and how to terminate the therapy.

Important to notice is that the therapists don’t break up their dispute, but try to follow up each argument and add nuance with several rebuttals and rejoinders.   

The case of the week underlines the values and shortcomings of both therapeutic approaches. After reading it, practitioners from different theoretical schools will rather feel the need to ask questions than consider their favourite doctrine confirmed.

This case of the week is very exciting as it shows how the theory behind a therapeutic approach is really acting out in therapeutic choices. 

 Here you can find the link to the case in our Archive (registration is required): 

http://singlecasearchive.com/archive/clinical-choice-points-behavioral-versus-psychoanalytic-interventions-1 

Warm greetings, 

The SCA team 

Behavioral therapy , Psychodynamic therapy, agoraphobia , compulsive disorder,