Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of
psychological
Psychology is the scientific study of mind and behavior. Psychology includes the study of conscious and unconscious phenomena, including feelings and thoughts. It is an academic discipline of immense scope, crossing the boundaries between t ...
methods, particularly when based on regular
personal interaction, to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's
well-being
Well-being, or wellbeing, also known as wellness, prudential value or quality of life, refers to what is intrinsically valuable relative ''to'' someone. So the well-being of a person is what is ultimately good ''for'' this person, what is in th ...
and
mental health
Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health ...
, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and
social skills
A social skill is any competence facilitating interaction and communication with others where social rules and relations are created, communicated, and changed in verbal and nonverbal ways. The process of learning these skills is called social ...
. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Certain types of psychotherapy are considered
evidence-based
Evidence-based practice (EBP) is the idea that occupational practices ought to be based on scientific evidence. While seemingly obviously desirable, the proposal has been controversial, with some arguing that results may not specialize to indivi ...
for treating some diagnosed
mental disorder
A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
s; other types have been criticized as
pseudoscience
Pseudoscience consists of statements, beliefs, or practices that claim to be both scientific and factual but are incompatible with the scientific method. Pseudoscience is often characterized by contradictory, exaggerated or falsifiability, unfa ...
.
There are hundreds of psychotherapy techniques, some being 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
A group is a number of persons or things that are located, gathered, or classed together.
Groups of people
* Cultural group, a group whose members share the same cultural identity
* Ethnic group, a group whose members share the same ethnic iden ...
, including
families
Family (from la, familia) is a group of people related either by consanguinity (by recognized birth) or affinity (by marriage or other relationship). The purpose of the family is to maintain the well-being of its members and of society. Ideall ...
.
Psychotherapists may be
mental health professionals
A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health or to treat mental disorders. This broad category was developed as a ...
such as psychiatrists, psychologists, mental health nurses, clinical social workers, marriage and family therapists, or professional counselors. Psychotherapists may also come from a variety of other backgrounds, and depending on the
jurisdiction
Jurisdiction (from Latin 'law' + 'declaration') is the legal term for the legal authority granted to a legal entity to enact justice. In federations like the United States, areas of jurisdiction apply to local, state, and federal levels.
Jur ...
may be legally regulated, voluntarily regulated or unregulated (and the term itself may be protected or not).
Definitions
The term ''
psychotherapy
Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome pro ...
'' is derived from
Ancient Greek
Ancient Greek includes the forms of the Greek language used in ancient Greece and the ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Dark Ages (), the Archaic peri ...
''
psyche
Psyche (''Psyché'' in French) is the Greek term for "soul" (ψυχή).
Psyche may also refer to:
Psychology
* Psyche (psychology), the totality of the human mind, conscious and unconscious
* ''Psyche'', an 1846 book about the unconscious by Car ...
'' (
ψυχή meaning "breath; spirit; soul") and ''therapeia'' (
θεραπεία "healing; medical treatment"). The ''
Oxford English Dictionary
The ''Oxford English Dictionary'' (''OED'') is the first and foundational historical dictionary of the English language, published by Oxford University Press (OUP). It traces the historical development of the English language, providing a com ...
'' defines it as "The treatment of disorders of the mind or personality by psychological means...", however, in earlier use it denoted the treatment of disease through hypnotic suggestion.
["psychotherapy, n.".]
OED Online. March 2015. Oxford University Press. (accessed 23 May 2015) Psychotherapy is often dubbed as a "talking therapy" or "talk therapy", particularly for a general audience, though not all forms of psychotherapy rely on
verbal communication
Linguistics is the scientific study of human language. It is called a scientific study because it entails a comprehensive, systematic, objective, and precise analysis of all aspects of language, particularly its nature and structure. Linguis ...
. 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
The American Psychological Association (APA) is the largest scientific and professional organization of psychologists in the United States, with over 133,000 members, including scientists, educators, clinicians, consultants, and students. It ha ...
adopted a resolution on the effectiveness of psychotherapy in 2012 based on a definition developed 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".
Influential editions of a work by psychiatrist
Jerome Frank
Jerome New Frank (September 10, 1889 – January 13, 1957) was an American legal philosopher and author who played a leading role in the legal realism movement. He was Chairman of the Securities and Exchange Commission, and a United States circu ...
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
Persuasion or persuasion arts is an umbrella term for Social influence, influence. Persuasion can influence a person's Belief, beliefs, Attitude (psychology), attitudes, Intention, intentions, Motivation, motivations, or Behavior, behaviours.
...
and
rhetoric
Rhetoric () is the art of persuasion, which along with grammar and logic (or dialectic), is one of the three ancient arts of discourse. Rhetoric aims to study the techniques writers or speakers utilize to inform, persuade, or motivate parti ...
. Historically, psychotherapy has sometimes meant "interpretative" (i.e.
Freudian
Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating pathologies explained as originating in conflicts i ...
) methods, namely
psychoanalysis
PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might b ...
, in contrast with other methods to treat psychiatric disorders such as behavior modification.
Some definitions of
counseling
Counseling is the professional guidance of the individual by utilizing psychological methods especially in collecting case history data, using various techniques of the personal interview, and testing interests and aptitudes.
This is a list of co ...
overlap with psychotherapy (particularly in non-directive client-centered approaches), or counseling may refer to guidance for everyday problems in specific areas, typically for shorter durations with a less medical or "professional" focus.
Somatotherapy
Psychiatric somatotherapy (or somatic therapy) is the treatment of mental illness by physical means (such as medication, electroconvulsive therapy
Electroconvulsive therapy (ECT) is a psychiatric treatment where a generalized seizure (witho ...
refers to the use of physical changes as injuries and illnesses, and
sociotherapy Sociotherapy is a social science and form of social work, and sociology that involves the study of groups of people, its constituent individuals, and their behavior, using learned information in case and care management towards holistic life enrich ...
to the use of a person's social environment to effect therapeutic change. Psychotherapy may address
spirituality
The meaning of ''spirituality'' has developed and expanded over time, and various meanings can be found alongside each other. Traditionally, spirituality referred to a religious process of re-formation which "aims to recover the original shape o ...
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.
Delivery
Psychotherapy may be delivered in person (one on one, or with couples, or in groups), over the phone, via
telephone counseling Telephone counseling refers to any type of psychological service performed over the telephone. Telephone counseling ranges from individual, couple or group psychotherapy with a professional therapist to psychological first aid provided by para-prof ...
, or
via the internet.
There have also been developments in computer-assisted therapy, such as
virtual reality therapy
Virtual reality therapy (VRT), also known as virtual reality immersion therapy (VRIT), simulation for therapy (SFT), virtual reality exposure therapy (VRET), and computerized CBT (CCBT), is the use of virtual reality technology for psychological o ...
for behavioral exposure, multimedia programs to each cognitive techniques, and handheld devices for improved monitoring or putting ideas into practice.
[
The Australian Victoria state Government's Health Agency has awarded no mental health app with scores greater than 3 stars out of 5 for effectiveness. One reason for this is that online ]cognitive behavioural therapy
Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (su ...
programs have poor "adherence" compared to face-to-face programs. That means that many users do not "stick to" the program as prescribed. They may uninstall the app or skip days, for instance.
Most forms of psychotherapy use spoken conversation
Conversation is interactive communication between two or more people. The development of conversational skills and etiquette is an important part of socialization. The development of conversational skills in a new language is a frequent focus ...
. Some also use various other forms of communication such as the written word, artwork
A work of art, artwork, art piece, piece of art or art object is an artistic creation of aesthetic value. Except for "work of art", which may be used of any work regarded as art in its widest sense, including works from literature ...
, drama
Drama is the specific mode of fiction represented in performance: a play, opera, mime, ballet, etc., performed in a theatre, or on radio or television.Elam (1980, 98). Considered as a genre of poetry in general, the dramatic mode has been ...
, narrative
A narrative, story, or tale is any account of a series of related events or experiences, whether nonfictional (memoir, biography, news report, documentary, travel literature, travelogue, etc.) or fictional (fairy tale, fable, legend, thriller (ge ...
story or music. Psychotherapy with children and their parents often involves play
Play most commonly refers to:
* Play (activity), an activity done for enjoyment
* Play (theatre), a work of drama
Play may refer also to:
Computers and technology
* Google Play, a digital content service
* Play Framework, a Java framework
* Pla ...
, dramatization (i.e. role-play), and drawing, with a co-constructed narrative from these non-verbal and displaced modes of interacting.
Regulation
Psychotherapists traditionally may be mental health professionals
A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health or to treat mental disorders. This broad category was developed as a ...
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
A psychiatrist is a physician who specializes in psychiatry, the branch of medicine devoted to the diagnosis, prevention, study, and treatment of mental disorders. Psychiatrists are physicians and evaluate patients to determine whether their sy ...
are trained first as physicians, and as such they may prescribe prescription medication
A prescription drug (also prescription medication or prescription medicine) is a pharmaceutical drug that legally requires a medical prescription to be dispensed. In contrast, over-the-counter drugs can be obtained without a prescription. The rea ...
; and specialist psychiatric training begins after medical school in psychiatric residencies: however, their specialty is in mental disorders or forms of mental illness. Clinical psychologists
Clinical psychology is an integration of social science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically based distress or dysfunction and to promote subjective well-being and personal ...
have specialist doctoral degrees in psychology with some clinical and research components. Other clinical practitioners, social workers
Social work is an academic discipline and practice-based profession concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being. Social work ...
, mental health counselors, pastoral counselors, and nurses with a specialization in mental health, also often 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.
A listing of the extensive professional competencies of a European psychotherapist was developed by the European Association of Psychotherapy (EAP) in 2013.
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
Client confidentiality is the principle that an institution or individual should not reveal information about their clients to a third party without the consent of the client or a clear legal reason. This concept, sometimes referred to as social s ...
—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.
Europe
As of 2015, there are still a lot of variations between different European countries about the regulation and delivery of psychotherapy. Several countries have no regulation of the practice or no protection of the title. Some have a system of voluntary registration, with independent professional organizations, while other countries attempt to restrict the practice of psychotherapy to 'mental health professionals' (psychologists and psychiatrists) with state-certified training. The titles that are protected also vary.[Psychotherapy for mental illness in Europe: An exploration on the evidence base and the status quo]
Eva Woelbert, 2015, Joint Research Centre, Publications Office of the European Union The European Association for Psychotherapy
The European Association for Psychotherapy (EAP) is a Vienna-based umbrella organisation for 128 Psychotherapy, psychotherapist organizations (including 28 national associations and 17 European associations) from 42 countries with a membership of m ...
(EAP) established the 1990 Strasbourg Declaration on Psychotherapy, which is dedicated to establishing an independent profession of psychotherapy in Europe, with pan-European standards. The EAP has already made significant contacts with the European Union & European Commission towards this end.
Given that the European Union
The European Union (EU) is a supranational political and economic union of member states that are located primarily in Europe. The union has a total area of and an estimated total population of about 447million. The EU has often been des ...
has a primary policy about the free movement of labor within Europe, European legislation can overrule national regulations that are, in essence, forms of restrictive practices.
In Germany, the practice of psychotherapy for adults is restricted to qualified psychologists and physicians (including psychiatrists) who have completed several years of specialist practical training and certification in psychotherapy. As psychoanalysis, psychodynamic therapy, and cognitive behavioral therapy meet the requirements of German health insurance companies, mental health professionals regularly opt for one of these three specializations in their postgraduate training. For psychologists, this includes three years of full-time practical training (4,200 hours), encompassing a year-long internship at an accredited psychiatric institution, six months of clinical work at an outpatient facility, 600 hours of supervised psychotherapy in an outpatient setting, and at least 600 hours of theoretical seminars. Social worker
Social work is an academic discipline and practice-based profession concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being. Social work ...
s may complete the specialist training for child and teenage clients. Similarly in Italy, the practice of psychotherapy is restricted to graduates in psychology or medicine who have completed four years of recognised specialist training. Sweden has a similar restriction on the title "psychotherapist", which may only be used by professionals who have gone through a post-graduate training in psychotherapy and then applied for a licence, issued by the National Board of Health and Welfare.
Legislation in France restricts the use of the title "psychotherapist" to professionals on the National Register of Psychotherapists, which requires a training in clinical psychopathology and a period of internship which is only open to physicians or titulars of a master's degree in psychology or psychoanalysis.
Austria and Switzerland (2011) have laws that recognize multi-disciplinary functional approaches.
In the United Kingdom, the government and Health and Care Professions Council
The Health and Care Professions Council (HCPC, formerly the Health Professions Council, HPC) is a statutory regulator of over 280,000 professionals from 15 health and care professions in the United Kingdom. The Council reports its main purpose i ...
considered mandatory legal registration but decided that it was best left to professional bodies to regulate themselves, so the Professional Standards Authority for Health and Social Care
The Professional Standards Authority for Health and Social Care (PSA) oversees the nine statutory bodies that regulate health professionals in the United Kingdom and social care in England. Where occupations are not subject to statutory regulation ...
(PSA) launched an Accredited Voluntary Registers scheme. Counseling and psychotherapy are not protected titles in the United Kingdom. Counsellors and psychotherapists who have trained and qualify to a certain standard (usually a level 4 Diploma) can apply to be members of the professional bodies who are listed on the PSA Accredited Registers.
United States
In some states, counselors or therapists must be licensed to use certain words and titles on self-identification or advertising. In some other states, the restrictions on practice are more closely associated with the charging of fees. Licensing and regulation are performed by various states. Presentation of practice as licensed, but without such a license, is generally illegal. Without a license, for example, a practitioner cannot bill insurance companies. Information about state licensure is provided by the American Psychological Association
The American Psychological Association (APA) is the largest scientific and professional organization of psychologists in the United States, with over 133,000 members, including scientists, educators, clinicians, consultants, and students. It ha ...
.
In addition to state laws, the American Psychological Association requires its members to adhere to its published ''Ethical Principles of Psychologists and Code of Conduct''. The American Board of Professional Psychology
The American Board of Professional Psychology (ABPP) is the primary organization for specialty board certification in psychology.
Mission statement
"The mission of the American Board of Professional Psychology is to increase consumer protectio ...
examines and certifies "psychologists who demonstrate competence in approved specialty areas in professional psychology".
Canada
Regulation of psychotherapy is in the jurisdiction of, and varies among, the provinces and territories.
In Quebec
Quebec ( ; )According to the Canadian government, ''Québec'' (with the acute accent) is the official name in Canadian French and ''Quebec'' (without the accent) is the province's official name in Canadian English is one of the thirtee ...
, psychotherapy is a regulated activity which is restricted to psychologists, medical doctors, and holders of a psychotherapy permit issued by the Ordre des psychologues du Québec, the Quebec order of psychologists. Members of certain specified professions, including social work
Social work is an academic discipline and practice-based profession concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being. Social work ...
ers, couple and family therapists, occupational therapists
Occupational therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use scientific bases and a holistic perspective to promote a person's abilit ...
, guidance counsellor
A school counselor is a professional who works in primary (elementary and middle) schools or secondary schools to provide academic, career, college access/affordability/admission, and social-emotional competencies to all students through a school ...
s, criminologists
Criminology (from Latin , "accusation", and Ancient Greek , ''-logia'', from λόγος ''logos'' meaning: "word, reason") is the study of crime and deviant behaviour. Criminology is an interdisciplinary field in both the behavioural and so ...
, sexologists
Sexology is the scientific study of human sexuality, including human sexual interests, behaviors, and functions. The term ''sexology'' does not generally refer to the non-scientific study of sexuality, such as social criticism.
Sexologists app ...
, psychoeducators, and registered nurses may obtain a psychotherapy permit by completing certain educational and practice requirements; their professional oversight is provided by their own professional orders. Some other professionals who were practising psychotherapy before the current system came into force continue to hold psychotherapy permits alone.
On 1 July 2019, Ontario's Missing Persons Act came into effect, with the purpose of giving police more power to investigate missing persons. It allows police to require (as opposed to permit) health professionals, including pyschotherapists, to share otherwise confidential documents about their client, if there is reason to believe their client is missing. Some have expressed concern that this legislation undermines psychotherapy confidentiality and could be abused maliciously by police, while others have praised the act for how it respects privacy and includes checks and balances.
History
Psychotherapy 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, by the 19th century, a moral treatment
Moral treatment was an approach to mental disorder based on humane psychosocial care or moral discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly fr ...
movement (then meaning morale or mental) developed based on non-invasive non-restraint therapetic methods. Another influential movement was started by Franz Mesmer
Franz Anton Mesmer (; ; 23 May 1734 – 5 March 1815) was a German physician with an interest in astronomy. He theorised the existence of a natural energy transference occurring between all animated and inanimate objects; this he called " ani ...
(1734–1815) and his student Armand-Marie-Jacques de Chastenet, Marquis of Puységur (1751–1825). Called Mesmerism or animal magnetism, it would have a strong influence on the rise of dynamic psychology and psychiatry as well as theories about hypnosis
Hypnosis is a human condition involving focused attention (the selective attention/selective inattention hypothesis, SASI), reduced peripheral awareness, and an enhanced capacity to respond to suggestion.In 2015, the American Psychologica ...
. In 1853, Walter Cooper Dendy
Walter Cooper Dendy (1 October 1794–10 December 1871) was an English surgeon and writer.
Career
Dendy was born in 1794 to Stephen Cooper Dendy and Marianne Dubbins at or near Horsham in Sussex. After an apprenticeship in that locality he came t ...
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
Daniel Hack Tuke (19 April 18275 March 1895) was an English physician and expert on mental illness.
Family
Tuke came from a long line of Quakers from York who were interested in mental illness and concerned with those afflicted. His great-gr ...
cited the term and wrote about "psycho-therapeutics" in 1872, in which he also proposed making a science of animal magnetism
Animal magnetism, also known as mesmerism, was a protoscientific theory developed by German doctor Franz Mesmer in the 18th century in relation to what he claimed to be an invisible natural force (''Lebensmagnetismus'') possessed by all livi ...
.[Shamdasani S. (2005]
'Psychotherapy': the invention of a word
History of the Human Sciences 18(1):1–22 Hippolyte Bernheim
Hippolyte Bernheim (17 April 1840, in Mulhouse – 2 February 1919, in Paris) was a French physician and neurologist. He is chiefly known for his theory of suggestibility in relation to hypnotism.
Life
Born into a Jewish family, Bernheim recei ...
and colleagues in the " Nancy School" developed the concept of "psychotherapy" in the sense of using the mind to heal the body through hypnotism
Hypnosis is a human condition involving focused attention (the selective attention/selective inattention hypothesis, SASI), reduced peripheral awareness, and an enhanced capacity to respond to suggestion.In 2015, the American Psychologica ...
, yet further.[ Charles Lloyd Tuckey's 1889 work, ''Psycho-therapeutics, or Treatment by Hypnotism and Suggestion'' 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
Frederik Willem van Eeden (3 April 1860, Haarlem – 16 June 1932, Bussum) was a late 19th-century and early 20th-century Dutch writer and psychiatrist. He was a leading member of the Tachtigers and the Significs Group, and had top billing a ...
and Albert Willem van Renterghem in Amsterdam
Amsterdam ( , , , lit. ''The Dam on the River Amstel'') is the Capital of the Netherlands, capital and Municipalities of the Netherlands, most populous city of the Netherlands, with The Hague being the seat of government. It has a population ...
renamed theirs "Clinique de Psycho-thérapeutique Suggestive" after visiting Nancy.[ During this time, travelling ]stage hypnosis
Stage hypnosis is hypnosis performed in front of an audience for the purposes of entertainment, usually in a theatre or club. A modern stage hypnosis performance typically delivers a comedic show rather than simply a demonstration to impress an au ...
became popular, and such activities added to the scientific controversies around the use of hypnosis in medicine.[ Also in 1892, at the second congress of experimental psychology, van Eeden attempted to take the credit for the term psychotherapy and to distance the term from hypnosis.][ In 1896, the German journal Zeitschrift für Hypnotismus, Suggestionstherapie, Suggestionslehre und verwandte psychologische Forschungen changed its name to Zeitschrift für Hypnotismus, Psychotherapie sowie andere psychophysiologische und psychopathologische Forschungen, which is probably the first journal to use the term.][ Thus psychotherapy initially meant "the treatment of disease by psychic or hypnotic influence, or by suggestion".][
]Sigmund Freud
Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating psychopathology, pathologies explained as originatin ...
visited the Nancy School and his early neurological
Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal ...
practice involved the use of hypnotism. However following the work of his mentor Josef Breuer
Josef Breuer ( , ; 15 January 1842 – 20 June 1925) was a distinguished physician who made key discoveries in neurophysiology, and whose work in the 1880s with his patient Bertha Pappenheim, known as Anna O., developed the talking cure (catharti ...
—in particular a case where symptoms appeared partially resolved by what the patient, Bertha Pappenheim
Bertha Pappenheim (27 February 1859 – 28 May 1936) was an Austrian-Jewish feminist, a social pioneer, and the founder of the Jewish Women's Association (''). Under the pseudonym Anna O., she was also one of Josef Breuer's best-documented pat ...
, dubbed a "talking cure
''The Talking Cure'' and ''chimney sweeping'' were terms Bertha Pappenheim, known in case studies by the alias Anna O., used for the verbal therapy given to her by Josef Breuer. They were first published in ''Studies on Hysteria'' (1895).
As Erne ...
"—Freud began focusing on conditions that appeared to have psychological causes originating in childhood experiences and the unconscious mind
The unconscious mind (or the unconscious) consists of the processes in the mind which occur automatically and are not available to introspection and include thought processes, memories, interests, and motivations.
Even though these processes exis ...
. He went on to develop techniques such as free association, dream interpretation
Dream interpretation is the process of assigning meaning to dreams. Although associated with some forms of psychotherapy, there is no reliable evidence that understanding or interpreting dreams has a positive impact on one's mental health.
In m ...
, transference
Transference (german: Übertragung) is a phenomenon within psychotherapy in which the "feelings, attitudes, or desires" a person had about one thing are subconsciously projected onto the here-and-now Other. It usually concerns feelings from a ...
and analysis of the id, ego and superego
The id, ego, and super-ego are a set of three concepts in psychoanalytic theory describing distinct, interacting agents in the psychic apparatus (defined in Sigmund Freud's structural model of the psyche). The three agents are theoretical const ...
. His popular reputation as the father of psychotherapy was established by his use of the distinct term "psychoanalysis
PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might b ...
", tied to an overarching system of theories and methods, and by the effective work of his followers in rewriting history.[ Many theorists, including ]Alfred Adler
Alfred Adler ( , ; 7 February 1870 – 28 May 1937) was an Austrian medical doctor, psychotherapist, and founder of the school of individual psychology. His emphasis on the importance of feelings of belonging, family constellation and birth order ...
, Carl Jung
Carl Gustav Jung ( ; ; 26 July 1875 – 6 June 1961) was a Swiss psychiatrist and psychoanalyst who founded analytical psychology. Jung's work has been influential in the fields of psychiatry, anthropology, archaeology, literature, philo ...
, Karen Horney
Karen Horney (; ; 16 September 1885 – 4 December 1952) was a German psychoanalyst who practised in the United States during her later career. Her theories questioned some traditional Freudian views. This was particularly true of her theories of ...
, Anna Freud
Anna Freud (3 December 1895 – 9 October 1982) was a British psychoanalyst of Austrian-Jewish descent. She was born in Vienna, the sixth and youngest child of Sigmund Freud and Martha Bernays. She followed the path of her father and contribu ...
, Otto Rank
Otto Rank (; ; né Rosenfeld; 22 April 1884 – 31 October 1939) was an Austrian psychoanalyst, writer, and philosopher. Born in Vienna, he was one of Sigmund Freud's closest colleagues for 20 years, a prolific writer on psychoanalytic themes, ...
, Erik Erikson
Erik Homburger Erikson (born Erik Salomonsen; 15 June 1902 – 12 May 1994) was a German-American developmental psychologist and psychoanalyst known for his theory on psychological development of human beings. He coined the phrase identity cr ...
, Melanie Klein
Melanie Klein (née Reizes; 30 March 1882 – 22 September 1960) was an Austrian-British author and psychoanalyst known for her work in child analysis. She was the primary figure in the development of object relations theory. Klein suggested tha ...
and Heinz Kohut
Heinz Kohut (3 May 1913 – 8 October 1981) was an Austrians, Austrian-born United States, American psychoanalyst best known for his development of self psychology, an influential school of thought within psychodynamics, psychodynamic/psychoanaly ...
, built upon Freud's fundamental ideas and often developed their own systems of psychotherapy. These were all later categorized as ''psychodynamic
Psychodynamics, also known as psychodynamic psychology, in its broadest sense, is an approach to psychology that emphasizes systematic study of the psychological forces underlying human behavior, feelings, and emotions and how they might relate t ...
'', meaning anything that involved the psyche
Psyche (''Psyché'' in French) is the Greek term for "soul" (ψυχή).
Psyche may also refer to:
Psychology
* Psyche (psychology), the totality of the human mind, conscious and unconscious
* ''Psyche'', an 1846 book about the unconscious by Car ...
's conscious
Consciousness, at its simplest, is sentience and awareness of internal and external existence. However, the lack of definitions has led to millennia of analyses, explanations and debates by philosophers, theologians, linguisticians, and scien ...
/unconscious
Unconscious may refer to:
Physiology
* Unconsciousness, the lack of consciousness or responsiveness to people and other environmental stimuli
Psychology
* Unconscious mind, the mind operating well outside the attention of the conscious mind a ...
influence on external relationships and the self. Sessions tended to number into the hundreds over several years.
Behaviorism
Behaviorism is a systematic approach to understanding the behavior of humans and animals. It assumes that behavior is either a reflex evoked by the pairing of certain antecedent (behavioral psychology), antecedent stimuli in the environment, o ...
developed in the 1920s, and behavior modification
Behavior modification is an early approach that used respondent and operant conditioning to change behavior. Based on methodological behaviorism, overt behavior was modified with consequences, including positive and negative reinforcement continge ...
as a therapy became popularized in the 1950s and 1960s. Notable contributors were Joseph Wolpe
Joseph Wolpe (20 April 1915 in Johannesburg, South Africa – 4 December 1997 in Los Angeles) was a South African psychiatrist and one of the most influential figures in behavior therapy.
Wolpe grew up in South Africa, attending Parktown Boys' ...
in South Africa, M.B. Shapiro and Hans Eysenck
Hans Jürgen Eysenck (; 4 March 1916 – 4 September 1997) was a German-born British psychologist who spent his professional career in Great Britain. He is best remembered for his work on intelligence and personality, although he worked on other ...
in Britain, and John B. Watson
John Broadus Watson (January 9, 1878 – September 25, 1958) was an American psychologist who popularized the scientific theory of behaviorism, establishing it as a psychological school.Cohn, Aaron S. 2014.Watson, John B." Pp. 1429–1430 in ''T ...
and B.F. Skinner
Burrhus Frederic Skinner (March 20, 1904 – August 18, 1990) was an American psychologist, behaviorist, author, inventor, and social philosopher. He was a professor of psychology at Harvard University from 1958 until his retirement in 1974.
...
in the United States. Behavioral therapy
Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or o ...
approaches relied on principles of operant conditioning
Operant conditioning, also called instrumental conditioning, is a learning process where behaviors are modified through the association of stimuli with reinforcement or punishment. In it, operants—behaviors that affect one's environment—are c ...
, classical conditioning
Classical conditioning (also known as Pavlovian or respondent conditioning) is a behavioral procedure in which a biologically potent stimulus (e.g. food) is paired with a previously neutral stimulus (e.g. a triangle). It also refers to the learni ...
and social learning theory
Social learning is a theory of learning process social behavior which proposes that new behaviors can be acquired by observing and imitating others. It states that learning is a cognitive process that takes place in a social context and can occur p ...
to bring about therapeutic change in observable symptoms. The approach became commonly used for phobias
A phobia is an anxiety disorder defined by a persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avoi ...
, as well as other disorders.
Some therapeutic approaches developed out of the European school of existential philosophy
Existentialism ( ) is a form of philosophical inquiry that explores the problem of human existence and centers on human thinking, feeling, and acting. Existentialist thinkers frequently explore issues related to the meaning, purpose, and value ...
. Concerned mainly with the individual's ability to develop and preserve a sense of meaning and purpose throughout life, major contributors to the field (e.g., Irvin Yalom, Rollo May
Rollo Reece May (April 21, 1909 – October 22, 1994) was an American existential psychologist and author of the influential book '' Love and Will'' (1969). He is often associated with humanistic psychology and existentialist philosophy, ...
) and Europe (Viktor Frankl
Viktor Emil Frankl (26 March 1905 – 2 September 1997)
was an Austrian psychiatrist who founded logotherapy, a school of psychotherapy that describes a search for a life's meaning as the central human motivational force. Logotherapy is part ...
, Ludwig Binswanger
Ludwig Binswanger (; ; 13 April 1881 – 5 February 1966) was a Swiss psychiatrist and pioneer in the field of existential psychology. His parents were Robert Johann Binswanger (1850–1910) and Bertha Hasenclever (1847–1896). Robert's Germ ...
, Medard Boss
Medard Boss (October 4, 1903, St. Gallen – December 21, 1990, Zollikon) was a Swiss psychoanalytic psychiatrist who developed a form of psychotherapy known as Daseinsanalysis, which united the psychotherapeutic practice of psychoanalysis with t ...
, R.D.Laing, Emmy van Deurzen
Emmy van Deurzen (born 13 December 1951 in The Hague, Netherlands) is an existential therapist. She developed a philosophical therapy based in existential-phenomenology.
Biography
van Deurzen was born and raised in The Hague, in The Netherlands ...
) 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 (e.g., Søren Kierkegaard
Søren Aabye Kierkegaard ( , , ; 5 May 1813 – 11 November 1855) was a Danish theologian, philosopher, poet, social critic, and religious author who is widely considered to be the first existentialist philosopher. He wrote critical texts on ...
, Jean-Paul Sartre
Jean-Paul Charles Aymard Sartre (, ; ; 21 June 1905 – 15 April 1980) was one of the key figures in the philosophy of existentialism (and phenomenology), a French playwright, novelist, screenwriter, political activist, biographer, and litera ...
, Gabriel Marcel
Gabriel Honoré Marcel (7 December 1889 – 8 October 1973) was a French philosopher, playwright, music critic and leading Christian existentialist. The author of over a dozen books and at least thirty plays, Marcel's work focused on the modern ...
, Martin Heidegger
Martin Heidegger (; ; 26 September 188926 May 1976) was a German philosopher who is best known for contributions to phenomenology, hermeneutics, and existentialism. He is among the most important and influential philosophers of the 20th centur ...
, Friedrich Nietzsche
Friedrich Wilhelm Nietzsche (; or ; 15 October 1844 – 25 August 1900) was a German philosopher, prose poet, cultural critic, philologist, and composer whose work has exerted a profound influence on contemporary philosophy. He began his ...
). The uniqueness of the patient-therapist relationship thus also forms a vehicle for therapeutic inquiry. A related body of thought in psychotherapy started in the 1950s with Carl Rogers. Based also on the works of Abraham Maslow and his hierarchy of human needs, Rogers brought person-centered psychotherapy into mainstream focus. 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 empathy, 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 the approach, like Fritz Perls, Fritz and Laura Perls in the creation of Gestalt therapy, as well as Marshall Rosenberg, founder of Nonviolent Communication, and Eric Berne, founder of transactional analysis. Later these fields of psychotherapy would become what is known as humanistic psychology, humanistic psychotherapy today. Self-help groups and books became widespread.
During the 1950s, Albert Ellis (psychologist), 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, by contrast with the more long-lasting insight-based approach of psychodynamic or humanistic therapies. Beck's approach used primarily the socratic method, and links have been drawn between ancient stoicism, stoic philosophy and these cognitive therapies.
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. A "third wave" of cognitive and behavioral therapies developed, including acceptance and commitment therapy and dialectical behavior therapy, which expanded the concepts to other disorders and/or added novel components and mindfulness (psychology), mindfulness exercises. However the "third wave" concept has been criticized as not essentially different from other therapies and having roots in earlier ones as well. Counseling methods developed include solution focused brief therapy, solution-focused therapy and systemic coaching.
Postmodern psychotherapies such as narrative therapy and coherence therapy do not impose definitions of mental health and illness, but rather see the goal of therapy as something constructed by the client and therapist in a social context. Systemic therapy also developed, which focuses on family and group dynamics—and transpersonal psychology, which focuses on the spiritual facet of human experience. Other orientations developed in the last three decades include feminist therapy, brief therapy, somatic psychology, expressive therapy, applied positive psychology and the human givens approach. A survey of over 2,500 US therapists in 2006 revealed the most utilized models of therapy and the ten most influential therapists of the previous quarter-century.
Types
There are hundreds of psychotherapy approaches or schools of thought. By 1980 there were more than 250; by 1996 more than 450; and at the start of the 21st century there were over a thousand different named psychotherapies—some being minor variations while others are based on very different conceptions of psychology, ethics (how to live) or technique.[Twenty-First Century Psychotherapies: Contemporary Approaches to Theory and Practice]
Jay Lebow, Jay L. Lebow, John Wiley & Sons, 2012. Introduction. Citing Garfield 2006 In practice therapy is often not of one pure type but draws from a number of perspectives and schools—known as an Integrative psychotherapy, integrative or Eclectic psychotherapy, eclectic approach. The importance of the therapeutic relationship, also known as therapeutic alliance, between client and therapist is often regarded as crucial to psychotherapy. Common factors theory addresses this and other core aspects thought to be responsible for effective psychotherapy.
Sigmund Freud (1856–1939), a Viennese neurologist who studied with Jean-Martin Charcot in 1885, is often considered the father of modern psychotherapy. His methods included analyzing his patient's dreams in search of important hidden insights into their unconscious minds. Other major elements of his methods, which changed throughout the years, included identification of childhood sexuality, the role of anxiety as a manifestation of inner conflict, the differentiation of parts of the psyche (id, ego, superego), transference and countertransference (the patient's projections onto the therapist, and the therapist's emotional responses to that). Some of his concepts were too broad to be amenable to empirical testing and invalidation, and he was critiqued for this by Jaspers. Numerous major figures elaborated and refined Freud's therapeutic techniques including Melanie Klein, Donald Winnicott, and others. Since the 1960s, however, the use of Freudian-based analysis for the treatment of mental disorder
A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
s has declined substantially. Different types of psychotherapy have been created along with the advent of clinical trials to test them scientifically. These incorporate subjective treatments (after Beck), behavioral treatments (after Skinner and Wolpe) and additional time-constrained and centered structures, for example, interpersonal psychotherapy. In youth issue and in schizophrenia, the systems of family treatment hold esteem. A portion of the thoughts emerging from therapy are presently pervasive and some are a piece of the tool set of ordinary clinical practice. They are not just medications, they additionally help to understand complex conduct.
Therapy may address specific forms of diagnosable mental illness, or everyday problems in managing or maintaining interpersonal relationships or meeting personal goals. A course of therapy may happen before, during or after pharmacotherapy (e.g. taking psychiatric medication).
Psychotherapies are categorized in several different ways. A distinction can be made between those based on a medical model and those based on a Humanistic psychology, humanistic model. In the medical model, the client is seen as unwell and the therapist employs their skill to help the client back to health. The extensive use of the DSM-IV, the diagnostic and statistical manual of mental disorders in the United States is an example of a medically exclusive model. The humanistic or non-medical model in contrast strives to depathologise the human condition. The therapist attempts to create a relational environment conducive to experiential learning and help build the client's confidence in their own natural process resulting in a deeper understanding of themselves. The therapist may see themselves as a facilitator/helper.
Another distinction is between individual one-to-one therapy sessions, and group psychotherapy, including couples therapy and family therapy.
Therapies are sometimes 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.
Some practitioners distinguish between more "uncovering" (or "Depth psychology, depth") approaches and more "supportive" psychotherapy. Uncovering psychotherapy emphasizes facilitating the client's insight into the roots of their difficulties. The best-known example is classical psychoanalysis. Supportive psychotherapy by contrast stresses strengthening the client's coping mechanisms and often providing encouragement and advice, as well as reality-testing and limit-setting where necessary. Depending on the client's issues and situation, a more supportive or more uncovering approach may be optimal.
Humanistic
These psychotherapies, also known as "Experiential knowledge, 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 subjectivity, subjective meaning, a rejection of determinism, and a concern for positive growth rather than pathology. Some posit an inherent human capacity to maximize potential, "the Self-actualization, self-actualizing tendency"; the task of therapy is to create a relational environment where this tendency might flourish. Humanistic psychology can, in turn, be rooted in existentialism—the belief that human beings can only find meaning by creating it. This is the goal of existential therapy. Existential therapy is in turn philosophically associated with Phenomenology (philosophy), phenomenology.
Person-centered therapy, also known as client-centered, focuses on the therapist showing openness, empathy and "unconditional positive regard", to help clients express and develop their own self.
Humanistic Psychodrama (HPD) is based on the human image of humanistic psychology. So all rules and methods follow the axioms of humanistic psychology. The HPD sees itself as development-oriented psychotherapy and has completely moved away from the psychoanalytic catharsis theory.
Self-awareness and self-realization are essential aspects in the therapeutic process. Subjective experiences, feelings and thoughts and one's own experiences are the starting point for a change or reorientation in experience and behavior in the direction of more self-acceptance and satisfaction. Dealing with the biography of the individual is closely related to the sociometry of the group.
Gestalt therapy, originally called "concentration therapy", is an existential/experiential form that facilitates awareness in the various contexts of life, by moving from talking about relatively remote situations to action and direct current experience. Derived from various influences, including an overhaul of psychoanalysis, it stands on top of essentially four load-bearing theoretical walls: phenomenology (psychology), phenomenological method, dialogical relationship, field-theoretical strategies, and experimental freedom.
A briefer form of humanistic therapy is the human givens approach, introduced in 199899. It is a solution-focused intervention based on identifying emotional needs—such as for security, autonomy and social connection—and using various educational and psychological methods to help people meet those needs more fully or appropriately.
Insight-oriented
Insight-oriented psychotherapy, Insight-oriented psychotherapies focus on revealing or interpreting unconsciousness, unconscious processes. Most commonly referring to psychodynamic therapy, of which psychoanalysis
PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might b ...
is the oldest and most intensive form, these applications of depth psychology encourage the verbalization of all the patient's thoughts, including Free association (psychology), 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. Techniques for analytic group therapy have also developed.
Cognitive-behavioral
Behavior therapy, Behavior therapies use Behaviorism, behavioral techniques, including applied behavior analysis (also known as behavior modification
Behavior modification is an early approach that used respondent and operant conditioning to change behavior. Based on methodological behaviorism, overt behavior was modified with consequences, including positive and negative reinforcement continge ...
), to change maladaptive patterns of behavior to improve emotional responses, cognitions, and interactions with others. Functional analytic psychotherapy is one form of this approach. 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 thoughts, in order to improve the emotions and behaviors.
Cognitive behavioral therapy 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.
The concept of "third wave" psychotherapies reflects an influence of Eastern philosophy in clinical psychology, incorporating principles such as meditation into interventions such as mindfulness-based cognitive therapy, acceptance and commitment therapy, and dialectical behavior therapy for borderline personality disorder.[
Interpersonal psychotherapy (IPT) is a relatively brief form of psychotherapy (deriving from both CBT and Psychodynamic psychotherapy, psychodynamic approaches) that has been increasingly studied and endorsed by guidelines for some conditions. It focuses on the links between mood (psychology), mood and social circumstances, helping to build social skills and social support. It aims to foster adaptation to current interpersonal roles and situations.
Exposure and response prevention (ERP) is primarily deployed by therapists in the treatment of Obsessive–compulsive disorder, OCD. The American Psychiatric Association (APA) state that CBT drawing primarily on behavioral techniques (such as ERP) has the "strongest evidence base" among psychosocial interventions. By confronting feared scenarios (i.e., exposure) and refraining from performing rituals (i.e., responsive prevention), patients may gradually feel less distress in confronting feared stimuli, while also feeling less inclination to use rituals to relieve that distress. Typically, ERP is delivered in "hierarchical fashion", meaning patients confront increasingly anxiety-provoking stimuli as they progress through a course of treatment.
Other types include reality therapy/Glasser's choice theory, choice theory, multimodal therapy, and therapies for specific disorders including Posttraumatic stress disorder, PTSD therapies such as cognitive processing therapy and Eye movement desensitization and reprocessing, EMDR; Substance use disorder, substance abuse therapies such as relapse prevention and contingency management; and co-occurring disorders therapies such as Seeking Safety.
]
Systemic
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 (includes family therapy and marriage counseling). Community psychology is a type of systemic psychology.
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. The power of groups was most influentially demonstrated in Britain during the Second World War, when several psychoanalysts and psychiatrists proved the value of group methods for officer selection in the War Office Selection Boards. A chance to run an Army psychiatric unit on group lines was then given to several of these pioneers, notably Wilfred Bion and Rickman, followed by S. H. Foulkes, Main, and Bridger. The Northfield Hospital in Birmingham gave its name to what came to be called the two "Northfield Experiments", which provided the impetus for the development since the war of both social therapy, that is, the therapeutic community movement, and the use of small groups for the treatment of neurotic and personality disorders. Today group therapy is used in clinical settings and in private practice settings.
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. This may include techniques such as affect labeling. 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.
Postmodernist
Also known as post-structuralist or Constructivism (psychological school), constructivist. Narrative therapy gives attention to each person's "dominant story" through therapeutic conversations, which also may involve exploring unhelpful ideas and how they came to prominence. Possible social and cultural influences may be explored if the client deems it helpful. Coherence therapy posits multiple levels of mental constructs that create symptoms as a way to strive for self-protection or self-realization. Feminist therapy does not accept that there is one single or correct way of looking at reality and therefore is considered a postmodernist approach.
Other
Transpersonal psychology addresses the client in the context of a spiritual understanding of consciousness. Positive psychotherapy (PPT) (since 1968) is a method in the field of humanistic and psychodynamic psychotherapy and is based on a positive image of humans, with a health-promoting, resource-oriented and conflict-centered approach.
Hypnotherapy is undertaken while a subject is in a state of hypnosis
Hypnosis is a human condition involving focused attention (the selective attention/selective inattention hypothesis, SASI), reduced peripheral awareness, and an enhanced capacity to respond to suggestion.In 2015, the American Psychologica ...
. Hypnotherapy is often applied in order to modify a subject's behavior, emotional content, and attitudes, as well as a wide range of conditions including: dysfunctional habits, anxiety, stress-related illness, pain management, and personal development.
Psychedelic therapy are therapeutic practices involving psychedelic drugs, such as LSD, Psilocybe mushrooms, psilocybin, Dimethyltryptamine, DMT, and MDMA. In psychedelic therapy, in contrast to conventional psychiatric medication taken by the patient regularly or as needed, patients generally remain in an extended psychotherapy session during the acute psychedelic activity with additional sessions both before and after in order to help integrate experiences with the psychedelics. Psychedelic therapy has been compared with the shamanic healing rituals of indigenous people. Researchers identified two main differences: the first is the shamanic belief that multiple realities exist and can be explored through altered states of consciousness, and second the belief that spirits encountered in dreams and visions are real. The charitable initiative Founders Pledge has written a research report on cost-effective giving opportunities for funding psychedelic-assisted mental health treatments.
Body psychotherapy, part of the field of somatic psychology, focuses on the link between the mind and the body and tries to access deeper levels of the psyche through greater awareness of the physical body and emotions. There are various ''body-oriented'' approaches, such as Reichian (Wilhelm Reich) character-analytic vegetotherapy and orgonomy; neo-Reichian bioenergetic analysis; somatic experiencing; integrative body psychotherapy; Ron Kurtz's Hakomi psychotherapy; sensorimotor psychotherapy; Biosynthesis psychotherapy; and Biodynamic psychotherapy. These approaches are not to be confused with Bodywork (alternative medicine), body work or body-therapies that seek to improve primarily physical health through direct work (touch and manipulation) on the body, rather than through directly psychological methods.
Some non-Western indigenous peoples, indigenous therapies have been developed. In African countries this includes harmony restoration therapy, meseron therapy and systemic therapies based on the Ubuntu (philosophy), Ubuntu philosophy.
Integrative psychotherapy is an attempt to combine ideas and strategies from more than one theoretical 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, internal family systems model, multitheoretical psychotherapy and conceptual interaction. In practice, most experienced psychotherapists develop their own integrative approach over time.
Child
Psychotherapy needs to be adapted to meet the developmental needs of children. Depending on age, it is generally held to be one part of an effective strategy to help the needs of a child within the family setting. Child psychotherapy training programs necessarily include courses in Developmental psychology, human development. Since children often do not have the ability to articulate thoughts and feelings, psychotherapists will use a variety of media such as musical instruments, sand and toys, crayons, paint, clay, puppets, bibliocounseling (books), or board games. The use of play therapy is often rooted in psychodynamics, psychodynamic theory, but other approaches also exist.
In addition to therapy for the child, sometimes instead of it, children may benefit if their parents work with a therapist, take parenting classes, attend grief counseling, or take other action to resolve stressful situations that affect the child. Parent management training is a highly effective form of psychotherapy that teaches parenting skills to reduce their child's behavior problems.
In many cases a different psychotherapist will work with the care taker of the child, while a colleague works with the child. Therefore, contemporary thinking on working with the younger age group has leaned towards working with parent and child simultaneously, as well as individually as needed.
Computer-supported
Research on computer-supported and computer-based interventions has increased significantly over the course of the last two decades. The following applications frequently have been investigated:
* Tele-therapy / tele-mental health: In teletherapy classical psychotherapy is provided via modern communication devices, such as via videoconferencing.
* Virtual reality: Virtual reality, VR is a computer-generated scenario that simulates experience. The immersive environment, used for simulated Exposure therapy, 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. The feasibility of such interventions has been investigated for individual and group therapy.
Effects
Evaluation
There is considerable controversy about whether, or when, psychotherapy efficacy is best evaluated by randomized controlled trials or more individualized idiographic methods.
One issue with trials is what to use as a placebo treatment group or non-treatment control group. Often, this group includes patients on a waiting list, or those receiving some kind of regular non-specific contact or support. Researchers must consider how best to match the use of inert tablets or sham treatments in Placebo-controlled study, placebo-controlled studies in pharmaceutical trials. Several interpretations and differing assumptions and language remain. Another issue is the attempt to standardize and manualize therapies and link them to specific symptoms of diagnostic categories, making them more amenable to research. Some report that this may reduce efficacy or gloss over individual needs. Fonagy and Roth's opinion is that the benefits of the evidence-based approach outweighs the difficulties.
There are several formal frameworks for evaluating whether a psychotherapist is a good fit for a patient. One example is the Scarsdale Psychotherapy Self-Evaluation (SPSE). However, some scales, such as the SPS, elicit information specific to certain schools of psychotherapy alone (e.g. the superego).
Many psychotherapists believe that the nuances of psychotherapy cannot be captured by questionnaire-style observation, and prefer to rely on their own clinical experiences and conceptual arguments to support the type of treatment they practice. Psychodynamic therapists increasingly believe that evidence-based approaches are appropriate to their methods and assumptions, and have increasingly accepted the challenge to implement evidence-based approaches in their methods.
A pioneer in investigating the results of different psychological therapies was psychologist Hans Eysenck
Hans Jürgen Eysenck (; 4 March 1916 – 4 September 1997) was a German-born British psychologist who spent his professional career in Great Britain. He is best remembered for his work on intelligence and personality, although he worked on other ...
, who argued that psychotherapy does not produce any improvement in patients. He held that behavior therapy is the only effective one. However, it was revealed that Eysenck (who died in 1997) falsified data in his studies about this subject, fabricating data that would indicate that behavioral therapy enables achievements that are impossible to believe. Fourteen of his papers were retracted by journals in 2020, and journals issued 64 statements of concern about publications by him. Rod Buchanan, a biographer of Eysenck, has argued that 87 publications by Eysenck should be retracted.
Outcomes in relation with selected kinds of treatment
Large-scale international reviews of scientific studies have concluded that psychotherapy is effective for numerous conditions.[
One line of research consistently finds that supposedly different forms of psychotherapy show similar effectiveness. According to The Handbook of Counseling Psychology: "Meta-analyses of psychotherapy studies have consistently demonstrated that there are no substantial differences in outcomes among treatments". The handbook states that there is "little evidence to suggest that any one psychological therapy consistently outperforms any other for any specific psychological disorders. This is sometimes called the Dodo bird verdict after a scene/section in Alice in Wonderland where every competitor in a race was called a winner and is given prizes".
Further analyses seek to identify the factors that the psychotherapies have in common that seem to account for this, known as common factors theory; for example the quality of the therapeutic relationship, interpretation of problem, and the confrontation of painful emotions.]
Outcome studies have been critiqued for being too removed from real-world practice in that they use carefully selected therapists who have been extensively trained and monitored, and patients who may be non-representative of typical patients by virtue of strict inclusionary/exclusionary criteria. Such concerns impact the Replication crisis, replication of research results and the ability to generalize from them to practicing therapists.[
However, specific therapies have been tested for use with specific disorders, and regulatory organizations in both the UK and US make recommendations for different conditions.
The Helsinki Psychotherapy Study was one of several large long-term clinical trials of psychotherapies that have taken place. Anxious and depressed patients in two short-term therapies (solution-focused and brief psychodynamic) improved faster, but five years long-term psychotherapy and psychoanalysis gave greater benefits. Several patient and therapist factors appear to predict suitability for different psychotherapies.
Meta-analyses have established that ]cognitive behavioural therapy
Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (su ...
(CBT) and psychodynamic psychotherapy are equally effective in treating depression.
A 2014 meta analysis over 11,000 patients reveals that Interpersonal Psychotherapy (IPT) is of comparable effectiveness to CBT for depression but is inferior to the latter for eating disorders. For children and adolescents, interpersonal psychotherapy and CBT are the best methods according to a 2014 meta analysis of almost 4000 patients.
Mechanisms of change
It is not yet understood how psychotherapies can succeed in treating mental illnesses. Different therapeutic approaches may be associated with particular theories about what needs to change in a person for a successful therapeutic outcome.
In general, processes of Arousal, emotional arousal and memory have long been held to play an important role. One theory combining these aspects proposes that permanent change occurs to the extent that the neuropsychological mechanism of Memory consolidation#Reconsolidation, memory reconsolidation is triggered and is able to incorporate new emotional experiences.
Adherence
Patient Compliance (medicine), adherence to a course of psychotherapy—continuing to attend sessions or complete tasks—is a major issue.
The dropout level—early termination—ranges from around 30% to 60%, depending partly on how it is defined. The range is lower for research settings for various reasons, such as the selection of clients and how they are inducted. Early termination is associated on average with various demographic and clinical characteristics of clients, therapists and treatment interactions.[Jennifer L. Strauss, Vito S. Guerra, Christine E. Marx, A. Meade Eggleston Ph.D, Patrick S. Calhoun Ph.]
Chapter 9: Improving Patient Treatment Adherence: A Clinician's Guide
In: Improving Patient Treatment Adherence: A Clinician's Guide. Edited by Hayden Bosworth. Springer Science & Business Media, 3 July 2010 The high level of dropout has raised some criticism about the relevance and efficacy of psychotherapy.
Most psychologists use between-session tasks in their general therapy work, and cognitive behavioral therapies in particular use and see them as an "active ingredient". It is not clear how often clients do not complete them, but it is thought to be a pervasive phenomenon.[
From the other side, the adherence of therapists to therapy protocols and techniques—known as "treatment integrity" or "fidelity"—has also been studied, with complex mixed results. In general, however, it is a hallmark of evidence-based psychotherapy to use fidelity monitoring as part of therapy outcome trials and ongoing quality assurance in clinical implementation.
]
Adverse effects
Research on adverse effects of psychotherapy has been limited, yet worsening of symptoms may be expected to occur in 3% to 15% of patients, with variability across patient and therapist characteristics. Potential problems include deterioration of symptoms or developing new symptoms, strains in other relationships, social stigma, and therapy dependence.[ Some techniques or therapists may carry more risks than others, and some client characteristics may make them more vulnerable.][ Side-effects from properly conducted therapy should be distinguished from harms caused by malpractice.]
General critiques
Some critics are skeptical of the healing power of psychotherapeutic relationships. Some dismiss psychotherapy altogether in the sense of a scientific discipline requiring professional practitioners, instead favoring either nonprofessional help or biomedical treatments. Others have pointed out ways in which the values and techniques of therapists can be harmful as well as helpful to clients (or indirectly to other people in a client's life).
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. Critics note that humans have been dealing with crises, navigating severe social problems and finding solutions to life problems long before the advent of psychotherapy.
On the other hand, some argue psychotherapy is under-utilized and under-researched by contemporary psychiatry despite offering more promise than stagnant medication development. In 2015, the US National Institute of Mental Health allocated only 5.4% of its budget to new clinical trials of psychotherapies (medication trials are largely funded by pharmaceutical companies), despite plentiful evidence they can work and that patients are more likely to prefer them.
Some Christians, such as theologian Thomas C. Oden, have argued that successful therapeutic relationships, based on true acceptance of the client as a human being without contingency, require a theological assumption, an ontological acceptance of God.
Further critiques have emerged from feminist, Social constructionism, constructionist and Discourse analysis, discourse-analytical sources. Key to these is the issue of Power (social and political), 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 (e.g., feminist, economic, 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, and that while it is seldom intended, the therapist–client relationship always participates in society's power relations and political dynamics. A noted academic who espoused this criticism was Michel Foucault.
See also
* Improving Access to Psychological Therapies
* List of psychotherapy journals
* Other-centred therapy
* Physical therapy
* Psychosomatic medicine
References
Further reading
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Psychotherapy,