There are a large number of competing theories influencing contemporary psychotherapeutic thinking. Psychotherapies derived from psychoanalytic, cognitive, and behavior theory are the most widely used. Cognitive and behavioral interventions have the strongest empirical verification; little empirical evidence supports the efficacy of analytiddynamic therapies.

Psychoanalytic/Psychodynamic theory

The principal theorist responsible for launching psychoanalysis as a technique and psychodynamic theory in general is Sigmund Freud. Freud’s theories proposed that unconscious motivations and early developmental influences were essential to understanding behavior. Freud’s original theories have proven quite controversial and have led to the creation of various alternative or derivative theories.

Twentieth-Century Schools of Psychodynamic Psychology
There are three major twentieth-century psychodynamic schools: drive psychology, ego psychology, and object relations theory.

Drive Psychology
Drive psychology posits that infants have sexual (and other) drives. This theory proposes that sexual and aggressive instincts are present in each individual and that each individual passes sequentially through psychosexual developmental stages (oral, anal, phallic, latency, and genital). Included in drive psychology is conflict theory, which proposes to explain how character and personality development are influenced by the interaction of drives with the conscience and reality.

Ego Psychology
Freud eventually developed a tripartite theory of the mind in which the psychic structure was composed of the id, ego, and superego. Under this theory, the id is the compartment of the mind containing the drives and instincts. The superego contains the sense of right and wrong, largely derived from parental and societal morality. The ego is responsible for adaptation to the environment and for the resolution of conflict. A major function of the ego is the reduction of anxiety. Ego defenses (Table 17-1) are proposed as psychic mechanisms that protect the ego from anxiety. Some ego defenses (e.g., sublimation) are more functional to the individual than others (e.g.,
denial).

Object Relations Theory
Object relations theory (objects refers to important people in one’s life) departs from drive theory in that the relationship to an object is motivated by the primacy of the relationship rather than the object being a means of satisfying a drive. Child observation furthered object relations theory, emphasizing concepts of attachment and separation.

The interpersonal school arose as an outgrowth of object relations theory. The interpersonal theorists emphasize that intrapsychic conflicts are less important than one’s relationship to one’s sense of self and to others. In other words, the relationships in a person’s life are given primary importance in producing happiness or misery.

Erikson’s Life Cycle Theory

Erik Erikson made major contributions to the concept of ego development. Erikson theorized that ego development persists throughout one’s life.
Erikson conceptualized that psychosocial events drive change, leading to a developmental crisis.
According to Erikson’s model, individuals pass through a series of life cycle stages (Table 17-2).

Each stage presents core conflicts produced by the interaction of developmental possibility with the external world. Individual progress and associated ego development occur with successful resolution of the developmental crisis inherent in each stage. This model allows for continued ego development until death.

Cognitive Theory

Cognitive theory recognizes the importance of the subjective experience of oneself, others, and the world. It posits that irrational beliefs and thoughts about oneself, the world, and one’s future can lead to psychopathology.

In cognitive theory, thoughts or cognitions regarding an experience determine the emotions that are evoked by the experience. For example, the perception of danger in a situation naturally leads to anxiety.
When danger is truly present, anxiety can be adaptive, leading to hypervigilance and self-protection.

When the situation is only perceived as dangerous (such as in fear of public speaking), the resulting anxiety can be psychologically paralyzing. A person may fear public speaking because of an irrational fear that something disastrous will occur in public. A principal type of irrational belief is a cognitive distortion (Table 17-3).

Behavioral Theory

Behavioral theory posits that behaviors are fashioned through various forms of learning, including modeling, classical conditioning, and operant conditioning (Table 17-4). A behaviorist might propose that through operant conditioning, depression is caused by a lack of positive reinforcement (as may occur after the death of a spouse), resulting in a general lack of interest in behaviors that were once pleasurable (or reinforced).

Cognitive - Behavioral Therapy (CBT)

Cognitive and behavioral theories form part of the bases of CBT. CBT involves the examination of cognitive distortions and the use of behavioral techniques to treat common disorders such as major depression.