Psychotherapy

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Psychotherapy (also called psychological therapy, talk therapy, or just therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change their behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Certain types of psychotherapy are considered evidence-based for treating some diagnosed mental disorders; other types have been criticized as pseudoscience.

There are hundreds of psychotherapy techniques, some minor variations; others are based on very different conceptions of psychology. Most involve one-to-one sessions, between the client and therapist, but some are conducted with groups, including families.

Psychotherapists may be mental health professionals such as psychiatrists, psychologists, mental health nurses, clinical social workers, marriage and family therapists, or professional counselors. Regardless of their background, they have received training in techniques designed to help people overcome dysfunction due to their psychological problems and lead happy and meaningful lives.

Definitions

"Psychotherapy" is described as the "art of curing mental diseases," 1892, or "the treatment of mental or emotional disorder or of related bodily ills by psychological means. The word is derived from Ancient Greek psyche (ψυχή meaning "breath; spirit; soul") and therapeia (θεραπεία "healing; medical treatment").

Psychotherapy is often dubbed as a "talking therapy" or "talk therapy," referring to the way therapy sessions are often conducted by talking "with a trained therapist in a safe and confidential environment to explore and understand feelings and behaviors and gain coping skills." However, not all forms of psychotherapy rely on verbal communication. Children or adults who do not engage in verbal communication (or not in the usual way) are not excluded from psychotherapy; indeed some types are designed for such cases.

The American Psychological Association adopted a resolution on the effectiveness of psychotherapy in 2012 based on a definition developed in 1990 by American psychologist John C. Norcross:

Psychotherapy is the informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles for the purpose of assisting people to modify their behaviors, cognitions, emotions, and/or other personal characteristics in directions that the participants deem desirable.

Psychiatrist Jerome Frank defined psychotherapy as a healing relationship using socially authorized methods in a series of contacts primarily involving words, acts and rituals—which Frank regarded as forms of persuasion and rhetoric.

Historically, psychotherapy has sometimes meant "interpretative" (i.e. Freudian) methods, namely psychoanalysis, in contrast with other methods to treat psychiatric disorders such as behavior modification.

Some definitions of counseling overlap with psychotherapy, particularly in non-directive client-centered approaches.

Psychotherapy may address spirituality as a significant part of someone's mental / psychological life, and some forms are derived from spiritual philosophies, but practices based on treating the spiritual as a separate dimension are not necessarily considered as traditional or 'legitimate' forms of psychotherapy.

History

Baquet scene with many people sitting and standing around a large table for "animal magnetism" treatment

Psychotherapy in some form can be said to have been practiced through the ages, as medics, philosophers, spiritual practitioners, and people in general used psychological methods to heal others.

In the Western tradition, an influential movement was started by Franz Mesmer (1734–1815) and his student Armand-Marie-Jacques de Chastenet, Marquis of Puységur (1751–1825). Called Mesmerism or animal magnetism, it had a strong influence on the rise of dynamic psychology and psychiatry as well as theories about hypnosis.

In 1853, Walter Cooper Dendy introduced the term "psycho-therapeia" regarding how physicians might influence the mental states of patients and thus their bodily ailments, for example by creating opposing emotions to promote mental balance. Daniel Hack Tuke wrote about "psycho-therapeutics" in 1872, in which he also proposed making a science of animal magnetism.

Hippolyte Bernheim and colleagues in the "Nancy School" further developed the concept of "psychotherapy" in the sense of using the mind to heal the body through hypnotism. Charles Lloyd Tuckey's 1889 work popularized the work of the Nancy School in English. Also in 1889 a clinic used the word in its title for the first time, when Frederik van Eeden and Albert Willem van Renterghem in Amsterdam renamed theirs "Clinique de Psycho-thérapeutique Suggestive" after visiting Nancy.

Thus psychotherapy initially referred to "treatment of diseases by "psychic" methods (mainly hypnotism)."

Group photo 1909 in front of Clark University. Front row: Sigmund Freud, Granville Stanley Hall, Carl Jung; back row: Abraham Brill, Ernest Jones, Sandor Ferenczi

Sigmund Freud visited the Nancy School and his early neurological practice involved the use of hypnotism. However following the work of his mentor Josef Breuer—in particular a case where symptoms appeared partially resolved by what the patient, Bertha Pappenheim, dubbed a "talking cure"—Freud began focusing on conditions that appeared to have psychological causes originating in childhood experiences and the unconscious mind. He went on to develop techniques such as free association, dream interpretation, transference, and analysis of the ego, superego, and id. His popular reputation as the father of psychotherapy was established by his use of the distinct term "psychoanalysis," tied to an overarching system of theories and methods.

Many others, including Alfred Adler, Carl Jung, Karen Horney, Anna Freud, Otto Rank, Erik Erikson, Melanie Klein, and Heinz Kohut, built upon Freud's fundamental ideas, often developing their own systems of psychotherapy. These were all later categorized as psychodynamic, meaning anything that involved the psyche's conscious/unconscious influence on external relationships and the self.

Behaviorism developed in the 1920s, and behavior modification as a therapy became popular in the 1950s and 1960s. Notable contributors were Joseph Wolpe in South Africa, M.B. Shapiro and Hans Eysenck in Britain, and John B. Watson and B.F. Skinner in the United States. Behavioral therapy approaches relied on principles of operant conditioning, classical conditioning, and social learning theory to bring about therapeutic change in observable symptoms. The approach became commonly used for phobiass, as well as other disorders.

Some therapeutic approaches developed out of the European school of existential philosophy. Concerned mainly with the individual's ability to develop and preserve a sense of meaning and purpose throughout life, major contributors to the field, including Rollo May), Viktor Frankl, and R.D.Laing, attempted to create therapies sensitive to common "life crises" springing from the essential bleakness of human self-awareness, previously accessible only through the complex writings of existential philosophers such as Søren Kierkegaard, Jean-Paul Sartre, Gabriel Marcel, Martin Heidegger, and Friedrich Nietzsche.

A related body of thought in psychotherapy started in the 1950s with Carl Rogers. Based on the works of Abraham Maslow and his hierarchy of human needs, Rogers brought person-centered psychotherapy into the mainstream. The primary requirement was that the client receive three core "conditions" from his counselor or therapist: unconditional positive regard, sometimes described as "prizing" the client's humanity; congruence [authenticity/genuineness/transparency]; and empathic understanding. This type of interaction was thought to enable clients to fully experience and express themselves, and thus develop according to their innate potential. Others developed this approach: Fritz and Laura Perls created Gestalt therapy and Eric Berne founded transactional analysis. Later these fields of psychotherapy would become what is known as humanistic psychotherapy.

During the 1950s, Albert Ellis originated rational emotive behavior therapy (REBT). Independently a few years later, psychiatrist Aaron T. Beck developed a form of psychotherapy known as cognitive therapy. Both of these included relatively short, structured, and present-focused techniques aimed at identifying and changing a person's beliefs, appraisals, and reaction-patterns, in contrast to the more long-lasting insight-based approach of psychodynamic or humanistic therapies. Beck's approach used primarily the socratic method, and both Beck and Ellis cited aspects of the ancient philosophical system of Stoicism as a forerunner of their ideas.

Cognitive and behavioral therapy approaches were increasingly combined and grouped under the umbrella term cognitive behavioral therapy (CBT) in the 1970s. Many approaches within CBT are oriented towards active/directive yet collaborative empiricism (a form of reality-testing), and assessing and modifying core beliefs and dysfunctional schemas. These approaches gained widespread acceptance as a primary treatment for numerous disorders.

Delivery

Psychotherapy may be delivered in person (one on one, or with couples, or in groups) or via telephone counseling or online counseling.

Most forms of psychotherapy use spoken conversation. Some also use various other forms of communication such as the written word, artwork, drama, narrative story, or music. Psychotherapy with children and their parents often involves play, dramatization (role-playing), and drawing, with a co-constructed narrative from these non-verbal and displaced modes of interacting.

Developments in computer-assisted therapy include as virtual reality therapy for behavioral exposure, multimedia programs to teach cognitive techniques, and handheld devices for improved monitoring or putting ideas into practice.

Regulation

Psychotherapists include mental health professionals like psychologists and psychiatrists; professionals from other backgrounds (family therapists, social workers, nurses, etc.) who have trained in a specific psychotherapy; or (in some cases) academic or scientifically trained professionals.

Psychiatrists are trained first as physicians, and as such they may prescribe prescription medication. Specialist psychiatric training begins after medical school in psychiatric residencies: however, their specialty is in mental disorders or forms of mental illness. Clinical psychologists have specialist doctoral degrees in psychology with some clinical and research components. Other clinical practitioners, social workers, mental health counselors, pastoral counselors, and nurses with a specialization in mental health, also conduct psychotherapy. Many of the wide variety of psychotherapy training programs and institutional settings are multi-professional. In most countries, psychotherapy training is completed at a postgraduate level, often at a master's degree (or doctoral) level, over four years, with significant supervised practice and clinical placements. Mental health professionals that choose to specialize in psychotherapeutic work also require a program of continuing professional education after basic professional training, such as psychoanalytic training.

As sensitive and deeply personal topics are often discussed during psychotherapy, therapists are expected, and usually legally bound, to respect client or patient confidentiality. The critical importance of client confidentiality—and the limited circumstances in which it may need to be broken for the protection of clients or others—is enshrined in the regulatory psychotherapeutic organizations' codes of ethical practice. Examples of when it is typically accepted to break confidentiality include when the therapist has knowledge that a child or elder is being physically abused; when there is a direct, clear and imminent threat of serious physical harm to self or to a specific individual.

Types

Numerous types of psychotherapy have been designed for individual adults, families, or children and adolescents. There are hundreds of psychotherapy techniques, some being minor variations; others are based on very different conceptions of psychology.

There are many types of psychotherapy, but generally they fall into four major categories: psychodynamic psychotherapy, cognitive therapy or behavior therapy, humanistic therapy, and integrative psychotherapy.

Psychotherapies can also be categorized by whether they involve individual one-to-one therapy sessions, or group psychotherapy, including couples therapy and family therapy.

Therapies may also classified according to their duration; a small number of sessions over a few weeks or months may be classified as brief therapy (or short-term therapy), others, where regular sessions take place for years, may be classified as long-term.

Psychodynamic

Psychodynamic therapy, or Insight-oriented psychotherapy, focuses on revealing or interpreting unconscious processes. These applications of depth psychology, of which Psychoanalysis is the oldest and most intensive form, encourage the verbalization of all the patient's thoughts, including free associations, fantasies, and dreams, from which the analyst formulates the nature of the past and present unconscious conflicts which are causing the patient's symptoms and character problems.

There are six main schools of psychoanalysis, which all influenced psychodynamic theory: Freudian, ego psychology, object relations theory, self psychology, interpersonal psychoanalysis, and relational psychoanalysis.

Cognitive-behavioral

Behavior therapies use behavioral techniques, including applied behavior analysis (also known as behavior modification), to change maladaptive patterns of behavior to improve emotional responses, cognitions, and interactions with others. By nature, behavioral therapies are empirical (data-driven), contextual (focused on the environment and context), functional (interested in the effect or consequence a behavior ultimately has), probabilistic (viewing behavior as statistically predictable), monistic (rejecting mind-body dualism and treating the person as a unit), and relational (analyzing bidirectional interactions).

Cognitive therapy focuses directly on changing the person's thoughts, in order to improve their emotions and behaviors.

Cognitive behavioral therapy (CBT) attempts to combine the above two approaches, focused on the construction and reconstruction of people's cognitions, emotions, and behaviors. Generally in CBT, the therapist, through a wide array of modalities, helps clients assess, recognize and deal with problematic and dysfunctional ways of thinking, emoting, and behaving.

Humanistic

Humanistic psychotherapies, also known as "experiential," are based on humanistic psychology and emerged in reaction to both behaviorism and psychoanalysis, being dubbed the "third force." They are primarily concerned with the human development and needs of the individual, with an emphasis on subjective meaning, a rejection of determinism, and a concern for positive growth rather than pathology.

Such therapy also seeks an integration of the whole person, referred to as self-actualization by Abraham Maslow. Each person is understood as already having inbuilt potentials and resources that might help them to build a stronger personality and self-concept; the mission of the therapist is to point the individual in the direction of these resources. However, in order to actualize hidden potentials the person might have to give up the safety of a particular stage of the personality in order to embrace a new and more integrated stage. This is not a simple or easy process, as it might include confronting new life-choices or redefining one's view of life. Thus, psychological instability and anxiety are viewed as as normal features of human life and development that can be worked through in therapy.

Humanistic psychology has led to several approaches to counseling and therapy. These include the existential psychology of Rollo May, person-centered or client-centered therapy developed by Carl Rogers, Gestalt therapy developed by Fritz Perls, transactional analysis developed by Eric Berne, marital counseling, and family therapy.

Integrative

In practice therapy is often not of one pure type but draws from a number of perspectives and schools—known as an integrative or eclectic approach. These approaches include mixing core beliefs and combining proven techniques. Forms of integrative psychotherapy include multimodal therapy, the transtheoretical model, cyclical psychodynamics, systematic treatment selection, cognitive analytic therapy, internal family systems model, multitheoretical psychotherapy, and conceptual interaction. In practice, most experienced psychotherapists develop their own integrative approach over time, based on the needs of their individual clients seeking treatement.

Integrative psychotherapy is sometimes referred to as "holistic therapy" because it considers the client's mental, physical, and emotional health in a unified way.

Other

Beyond those four major categories there are many other forms of therapy. Some of the more popular types are included here.

Systemic

A group therapy session

Systemic therapy seeks to address people not just individually, as is often the focus of other forms of therapy, but in relationship, dealing with the interactions of groups, their patterns and dynamics. This includes family therapy and marriage counseling.

The term group therapy was first used around 1920 by Jacob L. Moreno, whose main contribution was the development of psychodrama, in which groups were used as both cast and audience for the exploration of individual problems by reenactment under the direction of the leader. The more analytic and exploratory use of groups in both hospital and out-patient settings was pioneered by a few European psychoanalysts who emigrated to the US, such as Paul Schilder, who treated severely neurotic and mildly psychotic out-patients in small groups at Bellevue Hospital, New York. Today group therapy is used both in clinical settings and in private practice.

Expressive

Expressive psychotherapy is a form of therapy that utilizes artistic expression (via improvisational, compositional, re-creative, and receptive experiences) as its core means of treating clients. Expressive psychotherapists use the different disciplines of the creative arts as therapeutic interventions. This includes the modalities dance therapy, drama therapy, art therapy, music therapy, writing therapy, among others. Expressive psychotherapists believe that often the most effective way of treating a client is through the expression of imagination in creative work and integrating and processing what issues are raised in the act.

Hypnotherapy

Hypnotherapy is undertaken while a subject is in a state of hypnosis. Proponoents view hypnotherapy as a helpful adjunct therapy, having additive effects when treating psychological disorders, such as depression, anxiety, eating disorders, sleep disorders, compulsive gambling, phobias and post-traumatic stress, along with cognitive therapies.

Computer-supported

Research on computer-supported and computer-based interventions increased significantly in the early twenty-first century. Common applications include:

• Virtual reality: VR is a computer-generated scenario that simulates experience. The immersive environment, used for simulated exposure, can be similar to the real world or it can be fantastical, creating a new experience.
• Computer-based interventions (or online interventions or internet interventions): These interventions can be described as interactive self-help. They usually entail a combination of text, audio, or video elements.
• Computer-supported therapy (or blended therapy): Classical psychotherapy is supported by means of online or software application elements. Such interventions have been implemented for individual and group therapy.

Telepsychotherapy

Telepsychiatry or telemental health refers to the use of telecommunications technology (mostly videoconferencing and phone calls) to deliver psychiatric care remotely for people with mental health conditions. It is a branch of telemedicine. During the COVID-19 pandemic mental health services were adapted to telemental health.

While telepsychiatry can improve access to mental health services for some it might also represent a barrier for those lacking access to a suitable device, the internet or the necessary digital skills. Factors such as poverty that are associated with lack of internet access are also associated with greater risk of mental health problems, making digital exclusion an important problem of telemental health services.

Evaluation

Large-scale international reviews of scientific studies have concluded that psychotherapy is effective for numerous conditions, leading the American Psychological Association to adopt their 2012 resolution recognizing its effectiveness.

Research consistently finds that supposedly different forms of psychotherapy show similar effectiveness:

Meta-analyses of psychotherapy studies have consistently demonstrated that there are no substantial differences in outcomes among treatments. ... little evidence to suggest that any one psychological therapy consistently outperforms any other for any specific psychological disorders.

It is not clearly understood how psychotherapies succeed in treating mental illnesses. Studies show that psychotherapies have a number of factors in common that may account for their similar levels of success. This common factors theory suggest that the effectiveness of any therapy depends on such factors as the quality of the therapeutic relationship, interpretation of problems, and the confrontation of painful emotions.

However, specific therapies have been found most effective with specific disorders, especially when adapted to best fit the patient's characteristics. Thus, regulatory organizations make different treatment recommendations for different conditions.

Criticisms

Certain types of psychotherapy are considered evidence-based for treating some diagnosed mental disorders; other types have been criticized as pseudoscience.

Critics are skeptical of the healing power of professional psychotherapeutic relationships. They point out that many resources available to a person experiencing emotional distress—the friendly support of friends, peers, family members, clergy contacts, personal reading, healthy exercise, research, and independent coping—all present considerable value. Human beings have been dealing with crises, navigating severe social problems, and finding solutions to life problems long before the advent of psychotherapy.

A further criticism is the issue of power. In this regard there is a concern that clients are persuaded—both inside and outside the consulting room—to understand themselves and their difficulties in ways that are consistent with therapeutic ideas. This means that alternative ideas (such as, feminist, economic, or spiritual) are sometimes implicitly undermined. Critics suggest that we idealize the situation when we think of therapy only as a helping relationship—arguing instead that it is fundamentally a political practice, in that some cultural ideas and practices are supported while others are undermined or disqualified.

References

ISBN links support NWE through referral fees

• Alladin, Assen. Cognitive Hypnotherapy: An Integrated Approach to the Treatment of Emotional Disorders. Wiley, 2008. ISBN 978-0470032473
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• Furedi, Frank. Therapy Culture: Cultivating Vulnerability in an Uncertain Age. Routledge, 2003. ISBN 978-0415321594
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External links

All links retrieved February 23, 2024.

• Psychotherapies National Institute of Mental Health (NAMI)
• Psychotherapy Mayo Clinic
• What is Psychotherapy? American Psychiatric Association
• Psychotherapy Cleveland Clinic
• What Is Therapy? Psychology Today
• Understanding psychotherapy and how it works American Psychological Association
• Psychotherapy American Psychological Association
• Psychotherapy Types and Techniques Verywell Mind

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