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Psychotherapy (also psychological therapy or talking therapy) is the use of
psychological Psychology is the scientific Science () is a systematic enterprise that Scientific method, builds and organizes knowledge in the form of Testability, testable explanations and predictions about the universe."... modern science is ...

psychological
methods, particularly when based on regular
personal interaction
personal interaction
, to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's
well-being Well-being, 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 the ...
and
mental health Mental health is "a state of well-being Well-being, 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 ultimatel ...

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 Interaction is a kind of action that occurs as two or more objects have an effect upon one another. The idea of a two-way effect is essential in the concept of interaction, as opposed t ...
. There are numerous types of psychotherapy 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 Scientific evidence is evidence Evidence for a proposition is what supports this proposition. It is usually understood as an indica ...
for treating some diagnosed
mental disorder A mental disorder, also called 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 In internal medici ...
s, and other types have been criticized as
pseudoscience Pseudoscience consists of statements, belief A belief is an attitude Attitude may refer to: Philosophy and psychology * Attitude (psychology) In psychology Psychology is the science of mind and behavior. Psychology include ...
. There are hundreds of psychotherapy techniques, some being minor variations, while 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 people 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 identi ...
, including
families In human society A society is a Social group, group of individuals involved in persistent Social relation, social interaction, or a large social group sharing the same spatial or social territory, typically subject to the same Politi ...
. 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 disorder A mental disorder, also called a m ...
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 Latin (, or , ) is a classical language A classical language is a language A language is a structured system of communication Communication (from Latin ''communicare'', meaning "to share" or "to be i ...
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 or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase happiness, and ove ...
'' is derived from
Ancient Greek Ancient Greek includes the forms of the Greek language Greek ( el, label=Modern Greek Modern Greek (, , or , ''Kiní Neoellinikí Glóssa''), generally referred to by speakers simply as Greek (, ), refers collectively to the diale ...
''
psyche Psyche (''Psyché'' in French) is the Greek term for "soul" or "spirit" (ψυχή). It may also refer to: Psychology * Psyche (psychology), the totality of the human mind, conscious and unconscious * Psyche (book), ''Psyche'' (book), an 1846 boo ...
'' ( ψυχή meaning "breath; spirit; soul") and ''therapeia'' (
θεραπεία Tarabya ( ota, Tarabiye, el, Θεραπειά, translit=Therapiá) is a neighbourhood in the Sarıyer Sarıyer () is the northernmost district of Istanbul, Turkey, on the European side of the city. The Sarıyer district is a huge area consisti ...
"healing; medical treatment"). The ''
Oxford English Dictionary The ''Oxford English Dictionary'' (''OED'') is the principal historical dictionary A historical dictionary or dictionary on historical principles is a dictionary which deals not only with the latterday meanings of words but also the historica ...
'' defines it as "The treatment of disorders of the mind or personality by psychological methods...", 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", particularly for a general audience, though not all forms of psychotherapy rely on
verbal communication Linguistics is the scientific Science (from the Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken in the area around Rome, know ...
. 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 psychologist A psychologist is a professional A professional is a member of a profession or any person who earns a living from a speci ...
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 Legal realism is a naturalism (philosophy), naturalistic approach to law. It is the view tha ...
defined psychotherapy as a healing relationship using socially authorized methods in a series of contacts primarily involving words, acts and rituals—regarded as forms of
persuasion Persuasion or persuasion arts is an umbrella term of influence Influence or influencer may refer to: *Social influence, in social psychology, influence in interpersonal relationships **Minority influence, when the minority affect the behavior ...

persuasion
and
rhetoric Rhetoric () is the Art (skill), art of persuasion, which along with grammar and logic (or dialectic – see Martianus Capella), is one of the Trivium, three ancient arts of discourse. Rhetoric aims to study the techniques writers or sp ...
. 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 Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia ''-logy'' is a suffix in the English l ...
) methods, namely
psychoanalysis Psychoanalysis (from Greek language, Greek: + ) is a set of Theory, theories and Therapy, 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 bo ...

psychoanalysis
, 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 ...

counseling
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, or psychosurgery) rather than psychotherapy. References {{Psychiatry-stub Psych ...
refers to the use of physical changes as injuries and illnesses, and
sociotherapySociotherapy is a social science and form of social work Social work is an academic discipline and practice-based profession that concerns itself with individuals, Family, families, social group, groups, communities and society as a whole in an ...
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 connotations can be found alongside each other. Traditionally, spirituality referred to a Religion, religious process of re-formation which "aims to recover the origin ...

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.


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 A telephone is a telecommunication Telecommunication is the transmission of information by various types of technologies over wire A wi ...
, 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 Virtual reality (VR) is ...
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 Psychosocial, psycho-social intervention that aims to improve mental health. CBT focuses on challenging and changing cognitive distortions (e.g. thoughts, beliefs, and attitudes) and behaviors, improving e ...
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 Communication (from Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken in the area ...

conversation
. 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 Art is a diverse range of (products of) hum ...

artwork
,
drama Drama is the specific Mode (literature), mode of fiction Mimesis, represented in performance: a Play (theatre), play, opera, mime, ballet, etc., performed in a theatre, or on Radio drama, radio or television.Elam (1980, 98). Considered as a ...

drama
,
narrative A narrative, story or tale is any account of a series of related events or experiences, whether nonfiction Nonfiction (also spelled non-fiction) is any document A document is a written Writing is a medium of human communication Comm ...

narrative
story or music. Psychotherapy with children and their parents often involves
play Play most commonly refers to: * Play (activity) Play is a range of Motivation#Incentive theories: intrinsic and extrinsic motivation, intrinsically motivated activities done for recreational pleasure and enjoyment. Play is commonly associated w ...
, 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 disorder A mental disorder, also called a m ...
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 A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simply doctor, is a professional who practices medicine, which is concern ...
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 ...

prescription medication
; 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 science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or Mental disorder, dysfunction and to promote subjective mental health, ...
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 A Profession is a disciplined group of individuals who adhere to ethical standards and who hold themselves out as, and are accepted by the public as possessing special kno ...
, 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 are all at a post-graduate level, often at a master's degree (or doctoral) level, over 4 years, with significant supervised practice and clinical placements. Such professionals doing specialized psychotherapeutic work also require a program of continuing professional education after basic professional training. There is a 2013 listing of the extensive professional competencies of a European psychotherapist, developed by the European Association of Psychotherapy (EAP). 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 Customer, clients to a third party without the consent of the client or a clear legal reason. This concept, sometimes referred to as ...
—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 en, Viennese , iso_code = AT-9 , registration_plate = Vehicle registration plates of Austria, W , postal_code_type = Postal co ...
(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 political and economic union of member states that are located primarily in Europe Europe is a which is also recognised as part of , located entirely in the and mostly in the . It comprises the wester ...

European Union
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 A Profession is a disciplined group of individuals who adhere to ethical standards and who hold themselves out as, and are accepted by the public as possessing special kn ...

Social worker
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 is t ...
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 psychologist A psychologist is a professional A professional is a member of a profession or any person who earns a living from a speci ...
. 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 Psychology is the science of mind and behavior. Psychology includes the study of consciousness, conscious and ...
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 ) , image_shield=Armoiries du Québec.svg , image_flag=Flag of Quebec.svg , coordinates= , AdmittanceDate=July 1, 1867 , AdmittanceOrder=1st, with New Brunswick ("Hope restored") , image_map = New Brunswick in Canada 2.svg , ...

Quebec
, 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 A Profession is a disciplined group of individuals who adhere to ethical standards and who hold themselves out as, and are accepted by the public as possessing special kno ...

social work
ers, couple and family therapists,
occupational therapists Occupational Therapists (OTs) are health care professionals specializing in occupational therapy Occupational therapy (OT) is a profession within healthcare Health care, health-care, or healthcare is the maintenance or improvement of health ...
, guidance counsellors,
criminologists Criminology (from Latin , "accusation", and Ancient Greek , ''-logia'', from λόγος ''logos'' meaning: "word, reason") is the study of crime and Deviance (sociology), deviant behaviour. Criminology is an interdisciplinary field in both t ...
,
sexologists Sexology is the scientific study of human sexuality Human sexuality is the way people experience and express themselves sexually. This involves biological Biology is the natural science Natural science is a branch of science ...
, 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.


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 A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such featur ...
movement (then meaning morale or mental) developed based on non-invasive non-restraint therapeutic methods. Another influential movement was started by
Franz Mesmer Franz Anton Mesmer (; ; 23 May 1734 – 5 March 1815) was a German physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simply doctor, is a ...

Franz Mesmer
(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 Attention is the behavioral and cognitive process Cognition () refers to "the mental action or process of acquiring knowledge and understanding through thought, experie ...

hypnosis
. 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 sufferers 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 Religious Society of Friends, Quakers from York who were interested in mental illness and concerned with t ...
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 the name given by German doctor Franz Mesmer Franz Anton Mesmer (; ; 23 May 1734 – 5 March 1815) was a doctor with an interest in astronomy Astronomy (from el, ἀστρονομί ...
.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 Neurology, neurologist, born at Mülhausen, Alsace. He is chiefly known for his theory of suggestibility in relation to Hypnosis, hypnotism. ...
and colleagues in the "
Nancy Nancy may refer to: Places France * Nancy, France, a city in the northeastern French department of Meurthe-et-Moselle and formerly the capital of the duchy of Lorraine ** Arrondissement of Nancy, surrounding and including the city of Nancy * ...

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 Attention is the behavioral and cognitive process Cognition () refers to "the mental action or process of acquiring knowledge and understanding through thought, experie ...
, 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 amo ...
and Albert Willem van Renterghem in
Amsterdam Amsterdam (, , ) is the Capital of the Netherlands, capital and Municipalities of the Netherlands, most populous city of the Netherlands with a population of 872,680 within the city proper, 1,558,755 in the City Region of Amsterdam, urban ar ...

Amsterdam
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 aud ...
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 Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is a branch of medicine M ...

Sigmund Freud
visited the Nancy School and his early
neurological Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia ''-logy'' is a suffix in the English language, used with words originally adapted from Ancient Greek ending in (''-logia''). The earliest English exampl ...
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 A physician (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of ...
—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 Austrian may refer to: * Austrians, someone from Austria or of Austrian descent ** Someone who is considered an Austrian citizen, see Austrian nationality law * Something assoc ...
, dubbed a "
talking cure ''The Talking Cure'' and ''chimney sweeping'' were terms Bertha Pappenheim Bertha Pappenheim (27 February 1859 – 28 May 1936) was an Austrians, Austrian-Jewish feminist, a social pioneer, and the founder of the Jewish Women's Association (Germa ...
"—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 The mind is the set of faculties responsible for mental phenomena A phenomenon (; plural phenomena) is an observable fact or event. The term came into its mod ...
. He went on to develop techniques such as free association,
dream interpretation Dream interpretation is the process of assigning meaning to dream A dream is a succession of image An image (from la, imago) is an artifact that depicts visual perception Visual perception is the ability to interpret the s ...
,
transference Transference (german: Übertragung) is a phenomenon within psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of methods, particularly when based on regular , to help a person change behavior, increase ...
and analysis of the
id, ego and superego The id, ego, and super-ego are a set of three concepts in psychoanalytic theory Psychoanalytic theory is the theory A theory is a reason, rational type of abstraction, abstract thinking about a phenomenon, or the results of such thinking. The p ...
. His popular reputation as the father of psychotherapy was established by his use of the distinct term "
psychoanalysis Psychoanalysis (from Greek language, Greek: + ) is a set of Theory, theories and Therapy, 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 bo ...

psychoanalysis
", 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 Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regu ...

Alfred Adler
,
Carl Jung Carl Gustav Jung ( ; born Karl Gustav Jung, ; 26 July 1875 – 6 June 1961), was a Swiss psychiatrist A psychiatrist is a physician A physician (American English), medical practitioner (English in the Commonwealth of Nations ...

Carl Jung
,
Karen Horney Karen Horney (; ; 16 September 1885 – 4 December 1952) was a German psychoanalyst Psychoanalysis (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially ...
,
Anna Freud Anna Freud (3 December 1895 – 9 October 1982) was a British psychoanalyst of Austrian-Jewish descent. She was born in Vienna en, Viennese , iso_code = AT-9 , registration_plate = Vehicle registrat ...
,
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, e ...
,
Erik Erikson Erik Homburger Erikson (born Erik Salomonsen; 15 June 1902 – 12 May 1994) was a Danish-German-American developmental psychologist Developmental psychology is the science, scientific study of how and why human beings change over the cour ...

Erik Erikson
,
Melanie Klein Melanie Klein (née Reizes; 30 March 1882 – 22 September 1960) was an Austrian-British author and psychoanalyst Psychoanalysis (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, ...

Melanie Klein
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 that underlie human behavior, feelings, and emotions and how they might relate ...
'', meaning anything that involved the
psyche Psyche (''Psyché'' in French) is the Greek term for "soul" or "Spirit (animating force), spirit" (ψυχή). Psyche may also refer to: Psychology * Psyche (psychology), the totality of the human mind, conscious and unconscious * ''Psyche'', an ...
's
conscious Consciousness, at its simplest, is sentience or awareness of internal and external existence. Despite millennia of analyses, definitions, explanations and debates by philosophers and scientists, consciousness remains puzzling and controversial ...
/
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 other animals. It assumes that behavior is either a reflex In biology Biology is the natural science that studies life and living organisms, including thei ...
developed in the 1920s, and
behavior modification Behavior modification is a treatment approach that replaces undesirable behaviors with more desirable ones by using the principles of operant conditioning. Based on methodological behaviorism, overt behavior is modified with consequences, including ...
as a therapy became popularized in the 1950s and 1960s. Notable contributors were
Joseph Wolpe Joseph Wolpe (20 April 1915 in Johannesburg, South Africa Johannesburg ( , also ; ; Zulu and xh, eGoli), informally known as Jozi, Joburg, or "The City of Gold", is the largest city in South Africa South Africa, officially the R ...
in South Africa, M.B. Shipiro 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 Intelligence has been defined in many way ...
in Britain, and John B. Watson and
B.F. Skinner Burrhus Frederic Skinner (March 20, 1904 – August 18, 1990) was an American psychologist, behaviorist, author, inventor, and Social philosophy, social philosopher. He was a professor of psychology at Harvard University from 1958 until his retir ...

B.F. Skinner
in the United States.
Behavioral therapy Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regu ...
approaches relied on principles of
operant conditioning Operant conditioning (also called instrumental conditioning) is a type of associative learning process through which the strength of a behavior is modified by reinforcement or punishment. It is also a procedure that is used to bring about such lea ...
,
classical conditioning Classical conditioning (also known as Pavlovian or respondent conditioning) is a behavioral procedure in which a biologically potent stimulus A stimulus is something that causes a physiological response. It may refer to: *Stimulation Stimulat ...

classical conditioning
and
social learning theory Social learning theory is a theory of learning Learning is the process of acquiring new understanding Understanding is a psychological process related to an abstract or physical thing, such as a person, situation, or message whereby one is ...
to bring about therapeutic change in observable symptoms. The approach became commonly used for
phobias A phobia is a type of anxiety disorder Anxiety disorders are a cluster of mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or im ...
, as well as other disorders. Some therapeutic approaches developed out of the European school of
existential philosophy Existentialism ( ) is a form of philosophical Philosophy (from , ) is the study of general and fundamental questions, such as those about existence, reason Reason is the capacity of consciously applying logic Logic is an interdi ...
. 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 Irvin is both a given name and a surname. Notable people with the name include: Given name * Irvin J. Borowsky (born 1924), American publisher *Irvin Cobb Irvin Shrewsbury Cobb (June 23, 1876 – March 11, 1944) was an American author, humorist, ...

Irvin Yalom
,
Rollo May Rollo Reece May (April 21, 1909 – October 22, 1994) was an American Existential therapy, existential psychologist and author of the influential book ''Love and Will'' (1969). He is often associated with humanistic psychology and Existent ...
) and Europe (
Viktor Frankl Viktor Emil Frankl (26 March 1905 – 2 September 1997) was an Austrian neurologist Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is a branch of medicine Medicine is the Art (skil ...
,
Ludwig Binswanger Ludwig Binswanger (; ; 13 April 1881 – 5 February 1966) was a Swiss people, Swiss psychiatrist and pioneer in the field of existential psychology. His parents were Robert Johann Binswanger (1850–1910) and Bertha Hasenclever (1847–1896). ...
,
Medard Boss Medard Boss (October 4, 1903, St. Gallen , neighboring_municipalities = Eggersriet Eggersriet is a Municipalities of Switzerland, municipality in the ''Wahlkreis'' (constituency) of St. Gallen (Wahlkreis), St. Gallen in the Cantons of Switzerla ...
, R.D.Laing,
Emmy van Deurzen Emmy van Deurzen (born 13 December 1951 in The Hague, Netherlands) is an Existential therapy, existential therapist. She developed a philosophical therapy based in Existential phenomenology, existential-phenomenology. Biography van Deurzen was bor ...
) 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 Social criticism is a form of Academic or journalistic criticism focusing on sociological issues in contemporar ...
,
Jean-Paul Sartre Jean-Paul Charles Aymard Sartre (, ; ; 21 June 1905 – 15 April 1980) was a French philosopher A philosopher is someone who practices philosophy Philosophy (from , ) is the study of general and fundamental questions, such as tho ...

Jean-Paul Sartre
,
Gabriel Marcel Gabriel Honoré Marcel (7 December 1889 – 8 October 1973) was a French philosopher French philosophy, here taken to mean philosophy in the French language, has been extremely diverse and has influenced Western philosophy as a whole for centurie ...
,
Martin Heidegger Martin Heidegger (; ; 26 September 188926 May 1976) was a key German philosopher A philosopher is someone who practices philosophy Philosophy (from , ) is the study of general and fundamental questions, such as those about reason, ...
,
Friedrich Nietzsche Friedrich Wilhelm Nietzsche (; or ; 15 October 1844 – 25 August 1900) was a German philosopher A philosopher is someone who practices philosophy Philosophy (from , ) is the study of general and fundamental questions, such as thos ...

Friedrich Nietzsche
). 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 Carl Ransom Rogers (January 8, 1902 – February 4, 1987) was an American American(s) may refer to: * American, something of, from, or related to the United States of America, commonly known as the United States The United States of Ame ...

Carl Rogers
. Based also on the works of
Abraham Maslow Abraham Harold Maslow (; April 1, 1908 – June 8, 1970) was an American psychologist who was best known for creating Maslow's hierarchy of needs#REDIRECT Maslow's hierarchy of needs Maslow's hierarchy of needs is an idea in psychology ...
and his hierarchy of human needs, Rogers brought
person-centered psychotherapy Person-centered therapy, also known as person-centered psychotherapy, person-centered counseling, client-centered therapy and Rogerian psychotherapy, is a form of psychotherapy Psychotherapy (also psychological therapy or talking therapy) ...
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 uthenticity/genuineness/transparency and . 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 Fritz originated as a German nickname for FriedrichFriedrich may refer to: Names *Friedrich (surname), people with the surname ''Friedrich'' *Friedrich (given name), people with the given name ''Friedrich'' Other *Friedrich (board game), a boar ...

Fritz
and
Laura Perls Laura Perls (née ''Lore Posner''; 15 August 1905 in Pforzheim – 13 July 1990 in Pforzheim) was a noted German-born psychologist and psychotherapist who helped establish the Gestalt Therapy, Gestalt school of psychotherapy. She was the wife o ...
in the creation of
Gestalt therapy Gestalt therapy is a form of psychotherapy which emphasizes Responsibility assumption, personal responsibility and focuses on the individual's experience in the present moment, the therapist–client relationship, the environmental and social co ...
, as well as Marshall Rosenberg, founder of
Nonviolent Communication Nonviolent communication (NVC) is an approach to communication based on principles of nonviolence Nonviolence is the personal practice of not causing harm to one's self and others under every condition. It may come from the belief that hurting ...
, and
Eric Berne Eric Berne (May 10, 1910 – July 15, 1970) was a Canadian-born psychiatrist A psychiatrist is a physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), me ...
, founder of
transactional analysis Transactional analysis (TA) is a psychoanalytic theory Psychoanalytic theory is the theory A theory is a reason, rational type of abstraction, abstract thinking about a phenomenon, or the results of such thinking. The process of contemplative ...
. Later these fields of psychotherapy would become what is known as
humanistic psychotherapy Humanism is a philosophy, philosophical stance that emphasizes the value and Agency (philosophy), agency of Human, human beings, individually and collectively. The meaning of the term ''humanism'' has fluctuated according to the successive i ...
today. Self-help groups and books became widespread. During the 1950s,
Albert Ellis Albert Ellis (September 27, 1913 – July 24, 2007) was an American psychologist and Psychotherapy, psychotherapist who founded Rational Emotive Behavior Therapy (REBT). He held MA and PhD degrees in clinical psychology from Columbia Universit ...
originated
rational emotive behavior therapy Rational emotive behavior therapy (REBT), previously called rational therapy and rational emotive therapy, is an active-directive, philosophically and empirical Empirical evidence for a proposition In logic and linguistics, a proposition is ...
(REBT). Independently a few years later, psychiatrist Aaron T. Beck developed a form of psychotherapy known as
cognitive therapy Cognitive therapy (CT) is a type of psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help ...
. 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 The Socratic method (also known as method of Elenchus, elenctic method, or Socratic debate) is a form of cooperative Argumentation, argumentative dialogue between individuals, based on asking and answering questions to stimulate critical thinking ...
, and links have been drawn between ancient
stoic Stoic may refer to: * An adherent of Stoicism; one whose moral quality is associated with that school of philosophy *STOIC, a programming language *Stoic (film), ''Stoic'' (film), a 2009 film by Uwe Boll *Stoic (mixtape), ''Stoic'' (mixtape), a 201 ...
philosophy and these cognitive therapies. Cognitive and behavioral therapy approaches were increasingly combined and grouped under the umbrella term
cognitive behavioral 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 (e. ...
(CBT) in the 1970s. Many approaches within CBT are oriented towards active/directive yet collaborative
empiricism In philosophy Philosophy (from , ) is the study of general and fundamental questions, such as those about Metaphysics, existence, reason, Epistemology, knowledge, Ethics, values, Philosophy of mind, mind, and Philosophy of language, l ...
(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 Acceptance and commitment therapy (ACT, typically pronounced as the word "act") is a form of psychotherapy and a branch of clinical behavior analysis. It is an empirically based psychological intervention (counseling), intervention that uses acce ...
and
dialectical behavior therapy Dialectical behavior therapy (DBT) is an evidence-based psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal ...
, which expanded the concepts to other disorders and/or added novel components and
mindfulness Mindfulness is the practice of purposely bringing one's attention in the present moment without evaluation,Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review, by Ruth A. Baer, available at http://www.wisebrain.or ...
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 therapy Solution-focused (brief) therapy (SFBT) is a goal-directed collaborative approach to Psychotherapy, psychotherapeutic change that is conducted through direct observation of clients' responses to a series of precisely constructed Question, question ...
and
systemic coaching Coaching is a form of development in which an experienced person, called a ''coach'', supports a learner or client in achieving a specific personal or professional goal by providing training and guidance. The learner is sometimes called a ''coa ...
.
Postmodern Postmodernism is an intellectual stance or mode of discourse defined by an attitude of skepticism Skepticism (American American(s) may refer to: * American, something of, from, or related to the United States of America, commonly known a ...
psychotherapies such as
narrative therapy Narrative therapy (or Narrative Practice) is a form of psychotherapy that seeks to help patients identify their values and the skills associated with them. It provides the patient with knowledge of their ability to live these values so they can ef ...
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 In psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of methods, particularly when based on regular , to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to i ...
also developed, which focuses on family and group dynamics—and
transpersonal psychology Transpersonal psychology, or spiritual psychology, is a sub-field or school of psychology that integrates the spirituality, spiritual and transcendence (philosophy), transcendent aspects of the human experience with the framework of modern psycho ...
, which focuses on the spiritual facet of human experience. Other orientations developed in the last three decades include
feminist therapy Feminist therapy is a set of related therapy, therapies arising from what proponents see as a disparity between the origin of most psychological theories and the majority of people seeking counseling being female. It focuses on society, societal, ...
,
brief therapy Brief psychotherapy (also brief therapy, planned short-term therapy) is an umbrella term for a variety of approaches to short-term, solution-oriented psychotherapy. Overview Brief therapy differs from other schools of therapy in that it emphasiz ...
,
somatic psychology Somatic psychology is a form of psychotherapy that focuses on somatics, somatic experience, including therapeutic and holistic approaches to the body. Body psychotherapy is a general branch of this subject, while somatherapy, eco-somatics and danc ...
,
expressive therapy The expressive therapies are the use of the creative arts The arts are a very wide range of human practices of creative expression, storytelling Storytelling describes the social and cultural activity of sharing narrative, stories, som ...
, applied
positive psychology Positive psychology is the scientific study of what makes life most worth living, focusing on both individual and societal well-being. It studies "positive subjective experience, positive individual traits, and positive institutions...it aims t ...
and the
human givens :''This is about psychotherapy. See Human condition for the general topic.'' Human Givens is the name of a theory in psychotherapy formulated in the United Kingdom, first outlined by Joe Griffin (psychologist), Joe Griffin and Ivan Tyrrell in the ...
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 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 or
eclectic Eclectic may refer to: Music * Eclectic (Eric Johnson and Mike Stern album), ''Eclectic'' (Eric Johnson and Mike Stern album), 2014 * Eclectic (Big Country album), ''Eclectic'' (Big Country album), 1996 * Eclectic Method, name of an audio-visual ...
approach. The importance of the
therapeutic relationship The therapeutic relationship refers to the relationship between a healthcare professional and a client or patient. It is the means by which a therapist and a client hope to engage with each other and effect beneficial change in the client. In psyc ...
, also known as therapeutic alliance, between client and therapist is often regarded as crucial to psychotherapy.
Common factors theory Common factors theory, a theory guiding some research in clinical psychology and counseling psychology, proposes that different approaches and evidence-based practices in psychotherapy and counseling share ''common factors'' that account for much o ...
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 Jean-Martin Charcot (; 29 November 1825 – 16 August 1893) was a French neurologist Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is a branch of medicine Medicine is the Art (skill), ...

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 disorders 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 A mental disorder, also called 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 In internal medici ...
, or everyday problems in managing or maintaining
interpersonal relationships The concept of interpersonal relationship involves social associations, connections, or affiliations between two or more people. Interpersonal relationships vary in their degree of intimacy or self-disclosure, but also in their duration, in t ...
or meeting personal goals. A course of therapy may happen before, during or after
pharmacotherapy Pharmacotherapy is therapy A therapy or medical treatment (often abbreviated tx, Tx, or Tx) is the attempted remediation of a health Health, according to the , is "a state of complete physical, and social and not merely the absence of ...
(e.g. taking
psychiatric medication A psychiatric or psychotropic medication is a psychoactive drug A psychoactive drug, psychopharmaceutical, psychoactive agent, or psychotropic drug, is a chemical substance that changes nervous system function and results in alterations in p ...
). Psychotherapies are categorized in several different ways. A distinction can be made between those based on a
medical model ''Medical model'' is the term coined by psychiatrist A psychiatrist is a physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simply doct ...
and those based on a 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'' (DSM; latest edition: DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of ...
, 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 Group psychotherapy or group therapy is a form of psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interact ...
, including
couples therapy Couples therapy (also couples' counseling, marriage counseling, or marriage therapy) attempts to improve romantic relationships and resolve interpersonal conflicts. History Marriage counseling originated in Germany in the 1920s as part of the eu ...
and
family therapy Family therapy (also referred to as family counseling, family systems therapy, marriage and family therapy, couple and family therapy) is a branch of psychology that works with family, families and couples in intimate relationships to nurture cha ...
. 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 Brief psychotherapy (also brief therapy, planned short-term therapy) is an umbrella term for a variety of approaches to short-term, solution-oriented psychotherapy. Overview Brief therapy differs from other schools of therapy in that it emphasiz ...
(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 Depth(s) may refer to: Science * Three-dimensional space * Depth (ring theory), an important invariant of rings and modules in commutative and homological algebra * Depth in a well, the measurement between two points in an oil well * Color 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", are based on
humanistic psychology Humanistic Psychology is a psychological perspective that arose in the mid-20th century in answer to two theories: Sigmund Freud Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian and the foun ...
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 Subjective may refer to: * Subjectivity, a subject's personal perspective, feelings, beliefs, desires or discovery, as opposed to those made from an independent, objective, point of view ** Subjective experience, the subjective quality of consciou ...
meaning, a rejection of
determinism Determinism is the philosophical Philosophy (from , ) is the study of general and fundamental questions, such as those about existence Existence is the ability of an entity to interact with physical or mental reality Reality is the ...
, and a concern for positive growth rather than
pathology Pathology is the study of the causesCauses, or causality, is the relationship between one event and another. It may also refer to: * Causes (band), an indie band based in the Netherlands * Causes (company), an online company See also * Cau ...
. Some posit an inherent human capacity to maximize potential, "the 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 Existentialism ( ) is a form of philosophy, philosophical inquiry that explores the problem of human existence and centres on the experience of thinking, feeling, and acting. In the view of the existentialist, the individual's starting point ha ...
—the belief that human beings can only find meaning by creating it. This is the goal of
existential therapy Existential psychotherapy is a form of psychotherapy based on the model of human nature and experience developed by the Existentialism, existential tradition of European philosophy. It focuses on concepts that are universally applicable to human ...
. Existential therapy is in turn philosophically associated with
phenomenology Phenomenology may refer to: Art * Phenomenology (architecture) Phenomenology in architecture upright=1.45, alt=Plan d'exécution du second étage de l'hôtel de Brionne (dessin) De Cotte 2503c – Gallica 2011 (adjusted), Plan of the secon ...
.
Person-centered therapy Person-centered therapy, also known as person-centered psychotherapy, person-centered counseling, client-centered therapy and Rogerian psychotherapy, is a form of psychotherapy developed by psychologist Carl Rogers beginning in the 1940s and ex ...
, 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 The self is an individual person as the object of its own reflective consciousness Consciousness, at its simplest, is or of internal and external existence. Despite millennia of analyses, definitions, explanations and debates by philosoph ...

self
. Humanistic
Psychodrama Psychodrama is an action method, often used as a psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal inter ...
(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 Gestalt therapy is a form of psychotherapy which emphasizes Responsibility assumption, personal responsibility and focuses on the individual's experience in the present moment, the therapist–client relationship, the environmental and social co ...
, 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: phenomenological method, dialogical relationship, field-theoretical strategies, and experimental freedom. A briefer form of humanistic therapy is the
human givens :''This is about psychotherapy. See Human condition for the general topic.'' Human Givens is the name of a theory in psychotherapy formulated in the United Kingdom, first outlined by Joe Griffin (psychologist), Joe Griffin and Ivan Tyrrell in the ...
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 psychotherapies focus on revealing or interpreting
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 ...

unconscious
processes. Most commonly referring to
psychodynamic therapy Psychodynamic psychotherapy or psychoanalytic psychotherapy is a form of psychoanalysis and/or depth psychology, the primary focus of which is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension, which ...
, of which
psychoanalysis Psychoanalysis (from Greek language, Greek: + ) is a set of Theory, theories and Therapy, 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 bo ...

psychoanalysis
is the oldest and most intensive form, these applications of
depth psychology Depth psychology (from the German term ''Tiefenpsychologie'') refers to the practice and research of the science of the unconscious, covering both psychoanalysis Psychoanalysis (from Greek language, Greek: + ) is a set of Theory, theories and ...
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 Ego psychology is a school of psychoanalysis rooted in Sigmund Freud's structural Id, ego, and super-ego, id-ego-superego model of the mind. An individual interacts with the external world as well as responds to internal forces. Many psychoana ...
,
object relations theory Object relations theory in psychoanalytic psychology is the process of developing a psyche Psyche (''Psyché'' in French) is the Greek term for "soul" or "spirit" (ψυχή). It may also refer to: Psychology * Psyche (psychology), the totali ...
,
self psychology Self psychology, a modern psychoanalytic theory Psychoanalytic theory is the theory A theory is a rational Rationality is the quality or state of being rational – that is, being based on or agreeable to reason Reason is the capacity o ...
,
interpersonal psychoanalysis Interpersonal psychoanalysis is based on the theories of American psychiatrist Harry Stack Sullivan (1892–1949). Sullivan believed that the details of a patient's interpersonal interactions with others can provide insight into the causes and cure ...
, and
relational psychoanalysis Relational psychoanalysis is a school of psychoanalysis in the United States that emphasizes the role of real and imagined relationships with others in mental disorder and psychotherapy. 'Relational psychoanalysis is a relatively new and evolving ...
. Techniques for analytic
group therapy Group psychotherapy or group therapy is a form of psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interact ...
have also developed.


Cognitive-behavioral

Behavior therapies use
behavioral Behavior (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of variety (linguistics), varieties of the English language native to the United States. Cur ...
techniques, including
applied behavior analysis Applied Behavior Analysis (ABA), also called behavioral engineering Behavioral engineering, also called applied behavior analysis, is intended to identify issues associated with the interface of technology and the human operators in a system ...
(also known as
behavior modification Behavior modification is a treatment approach that replaces undesirable behaviors with more desirable ones by using the principles of operant conditioning. Based on methodological behaviorism, overt behavior is modified with consequences, including ...
), to change maladaptive patterns of behavior to improve emotional responses, cognitions, and interactions with others.
Functional analytic psychotherapy Functional analytic psychotherapy (FAP) is a psychotherapeutic approach based on clinical behavior analysis Clinical behavior analysis (CBA; also called clinical behaviour analysis or third-generation behavior therapy) is the clinical applied beh ...
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 Monism attributes oneness or singleness (Greek: μόνος) to a concept e.g., existence. Various kinds of monism can be distinguished: * Priority monism states that all existing things go back to a source that is distinct from them; e.g., ...
(rejecting mind-body dualism and treating the person as a unit), and relational (analyzing bidirectional interactions).
Cognitive therapy Cognitive therapy (CT) is a type of psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help ...
focuses directly on changing the thoughts, in order to improve the emotions and behaviors.
Cognitive behavioral 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 (e. ...
attempts to combine the above two approaches, focused on the construction and reconstruction of people's
cognition Cognition () refers to "the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses many aspects of intellectual function Intellectual functioning refers to the "general men ...
s,
emotions Emotions are psychological state A mental state is a state of mind that an agent is in. Most simplistically, a mental state is a mental condition. It is a relation that connects the agent with a proposition. Several of these states are a comb ...

emotions
and
behavior Behavior (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of variety (linguistics), varieties of the English language native to the United States. Cur ...
s. 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 Meditation is a practice where an individual uses a technique – such as mindfulness Mindfulness is the practice of purposely bringing one's attention in the present moment without evaluation,Mindfulness Training as a Clinical Interventio ...

meditation
into interventions such as
mindfulness-based cognitive therapy Mindfulness-based cognitive therapy (MBCT) is an approach to psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, persona ...
,
acceptance and commitment therapy Acceptance and commitment therapy (ACT, typically pronounced as the word "act") is a form of psychotherapy and a branch of clinical behavior analysis. It is an empirically based psychological intervention (counseling), intervention that uses acce ...
, and
dialectical behavior therapy Dialectical behavior therapy (DBT) is an evidence-based psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal ...
for
borderline personality disorder Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a mental illness A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that ...
.
Interpersonal psychotherapy Interpersonal psychotherapy (IPT) is a brief, attachment-focused psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, pers ...
(IPT) is a relatively brief form of psychotherapy (deriving from both CBT and
psychodynamic Psychodynamics, also known as psychodynamic psychology, in its broadest sense, is an approach to psychology that emphasizes systematic study of the psychological forces that underlie human behavior, feelings, and emotions and how they might relate ...
approaches) that has been increasingly studied and endorsed by guidelines for some conditions. It focuses on the links between 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 Exposure therapy is a technique in behavior therapy Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviorism, behaviourism and/or cognitive therapy, cognitive ...
(ERP) is primarily deployed by therapists in the treatment of OCD. The
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest Psychiatry, psychiatric organization in the world. Its some 38,800 members are main ...
(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 #REDIRECT Reality therapy Reality therapy (RT) is an approach to psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction with ad ...
/ choice theory,
multimodal therapy Multimodal therapy (MMT) is an approach to psychotherapy devised by psychologist Arnold Lazarus, who originated the term ''behavior therapy'' in psychotherapy. It is based on the idea that humans are biological beings that think, feel, act, sense, ...
, and therapies for specific disorders including
PTSD Post-traumatic stress disorder (PTSD)Acceptable variants of this term exist; see the '' Terminology'' section in this article. is a mental disorder that one can develop after exposure to a traumatic event, such as sexual assault, warfare, ...
therapies such as
cognitive processing therapy Cognitive processing therapy (CPT) is a manualized therapy used by clinicians to help people recover from posttraumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental Mental may refer to: * of or relating to the mind Fi ...
and EMDR;
substance abuse Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods which are harmful to the individual or others. It is a form of substance-related disorder Substance-related disorders, also known as substance use disord ...
therapies such as
relapse prevention Relapse prevention (RP) is a cognitive-behavioral therapy, cognitive-behavioral approach to relapse with the goal of identifying and preventing high-risk situations such as Substance use disorder, unhealthy substance use, obsessive-compulsive behav ...
and
contingency management Contingency management (CM) is the application of the three-term contingency The three-term contingency (also known as the ABC contingency) in operant conditioning—or contingency management—describes the relationship between a behavior, its con ...
; and co-occurring disorders therapies such as Seeking Safety.


Systemic

Systemic therapy In psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of methods, particularly when based on regular , to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to i ...
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 Family therapy (also referred to as family counseling, family systems therapy, marriage and family therapy, couple and family therapy) is a branch of psychology that works with family, families and couples in intimate relationships to nurture cha ...
and marriage counseling). Community psychology is a type of systemic psychology. The term
group therapy Group psychotherapy or group therapy is a form of psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interact ...
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 Attention is the behavioral and cognitive process Cognition () refers to "the mental action or process of acquiring knowledge and understanding through thought, experie ...

hypnosis
. 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 A psychiatric or psychotropic medication is a psychoactive drug A psychoactive drug, psychopharmaceutical, psychoactive agent, or psychotropic drug, is a chemical substance that changes nervous system function and results in alterations in p ...
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 Somatic psychology is a form of psychotherapy that focuses on somatics, somatic experience, including therapeutic and holistic approaches to the body. Body psychotherapy is a general branch of this subject, while somatherapy, eco-somatics and danc ...
, 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 Emotions are psychological state A mental state is a state of mind that an agent is in. Most simplistically, a mental state is a mental condition. It is a relation that connects the agent with a proposition. Several of these states are a comb ...

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 Multimodal therapy (MMT) is an approach to psychotherapy devised by psychologist Arnold Lazarus, who originated the term ''behavior therapy'' in psychotherapy. It is based on the idea that humans are biological beings that think, feel, act, sense, ...
, 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 in particular believe that evidence-based approaches are not appropriate to their methods or assumptions, though some 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 Intelligence has been defined in many way ...
, 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 on this, 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 Psychosocial, psycho-social intervention that aims to improve mental health. CBT focuses on challenging and changing cognitive distortions (e.g. thoughts, beliefs, and attitudes) and behaviors, improving e ...
(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 * Physical therapy * Psychosomatic medicine


References


Further reading

* * * Two volumes. * * * * * * * * * * {{Authority control Psychotherapy,