A Brief History of Psychotherapy

A Brief History of Psychotherapy – Additional ReadingA Brief History of Psychotherapy – Additional ReadingIntroductionAlthough modern, scientific psychology is often dated at the 1879 opening of the first psychological clinic by Wilhelm Wundt, attempts to create methods for assessing
and treating mental distress existed long before. The earliest recorded approaches were a combination of religious, magical and/or medical perspectives.[1] Early
examples of such psychological thinkers included Patañjali, Padmasambhava,[2] Rhazes, Avicenna[3] and Rumi[4] (see Islamic psychology and Eastern philosophy and
clinical psychology).In an informal sense, psychotherapy can be said to have been practiced through the ages, as individuals received psychological counsel and reassurance from others.
Purposeful, theoretically-based psychotherapy was probably first developed in the Middle East during the 9th century by the Persian physician and psychological
thinker, Rhazes, who was at one time the chief physician of the Baghdad psychiatric hospital. In the West, however, serious mental disorders were generally treated as
demonic or medical conditions requiring punishment and confinement until the advent of moral treatment approaches in the 18th Century. This brought about a focus on
the possibility of psychosocial intervention – including reasoning, moral encouragement and group activities – to rehabilitate the “insane”.In the 19th century, one could have his or her head examined, literally, using phrenology, the study of the shape of the skull developed by respected anatomist Franz
Joseph Gall. Other popular treatments included physiognomy—the study of the shape of the face—and mesmerism, developed by Franz Anton Mesmer—designed to relieve
psychological distress by the use of magnets. Spiritualism and Phineas Quimby’s “mental healing” technique that was very like modern concept of “positive
visualization” were also popular.While the scientific community eventually came to reject all of these methods, academic psychologists also were not concerned with serious forms of mental illness.
That area was already being addressed by the developing fields of psychiatry and neurology within the asylum movement and the use of moral therapy.[1] It wasn’t until
the end of the 19th century, around the time when Sigmund Freud was first developing his “talking cure” in Vienna, that the first scientifically clinical application
of psychology began—at the University of Pennsylvania, to help children with learning disabilities.Although clinical psychologists originally focused on psychological assessment, the practice of psychotherapy, once the sole domain of psychiatrists, became integrated
into the profession after the Second World War. Psychotherapy began with the practice of psychoanalysis, the “talking cure” developed by Sigmund Freud. Soon
afterwards, theorists such as Alfred Adler and Carl Jung began to introduce new conceptions about psychological functioning and change. These and many other theorists
helped to develop the general orientation now called psychodynamic therapy, which includes the various therapies based on Freud’s essential principle of making the
unconscious conscious.Modern Psychotherapy: The BeginningsCounselling and Psychotherapy theories were being developed during the beginning of the 20th century, however it is thought that the roots of this subject originated a
long time before this. The most renowned work is that of Sigmund Freud (left) whose research into the human mind began in Vienna in 1881. He received training to
become a neurologist and began working with patients who were classed as hysterical. Freud named his method psychoanalysis and continued to practice his theories until
the 1930’s.Although Freud is thought of as the oldest psychological theorist, it was Franz Anton Mesmer, an 18th century physician who discovered animal magnetism (also known as
mesmerism) and James Braid who developed hypnotherapy using inspiration from Mesmer’s ideas. Hypnosis was a technique Freud adopted in his early work to treat mind
disorders but then concentrated on developing his own theories after recognising that hypnotherapy was only a useful technique with certain problems. However Freud’s
work remains the most well known in recent times. Freud proposed the division of the mind into ego, superego and id. He also believed that infants pass through oral,
anal and phallic stages and becoming ‘stuck’ in one of the phases could lead to disastrous consequences.Carl Jung was a close colleague of Freud, but eventually split from Freud to pursue his own school of analytical psychology. His ideas are also widely recognised in
recent times. Alfred Adler, Sandor Ferenczi, Karl Abraham and Otto Rank are other influential theorists who worked closely with Freud. Carl Jung, and other descendants
of Freud’s approach, focused heavily on psychodynamic theories.The 1940’s and 1950’s marked an important expansion in the field of counselling. The US psychologist Carl Rogers (influenced by Alfred Adler and Otto Rank) established
the person centred approach, which is at the heart of most current practice. The person centred approach is now listed under the ‘humanistic’ branch of psychotherapy.
There are now thought to be three general types of psychological therapies; behavioural therapies, psychoanalytical and psychodynamic therapies and humanistic
therapies.1. Behavioural TherapiesBehavioural Therapy is effective for individuals who require treatment for some sort of behaviour change, such as addictions, phobias and anxiety disorders. Based on
the principle that behaviour is learnt, and can therefore be unlearnt, or reconditioned, Behavioural Therapy concentrates on the ‘here and now’ without focusing on the
past to find a reason for the behaviour.The most famous examples of conditioning are those of Ivan Pavlov and B.F Skinner.An experiment conducted by Pavlov demonstrated how ringing a bell close to dinner time caused dogs to associate the ringing of the bell with the expectation of food,
which made them salivate even if no food appeared. The importance of this experiment is that the conditioned response (the dogs salivating) decreased in intensity the
more times the conditioned stimulus (ringing of the bell) occurred without the appearance of food.A similar technique can be used to treat phobias, for example, where an individual can gradually be exposed to the stimuli that triggers the phobia, and recondition
their behavioural response to it.B.F Skinner conducted an experiment that associated reconditioning with rewards. The experiment involved feeding a rat via an automatic dispenser until the rat leant
to associate the noise of the dispenser with the arrival of food. Once the rat had learnt this behaviour, a lever in the wall was raised so that when the rat touched
it (accidently) with its paw, the food was dispensed. The rat then learnt to associate the lever with the arrival of food and continually pressed it.A similar technique can be applied to individuals by reinforcing desired behaviour, or not reinforcing undesired behaviour.Cognitive TherapyCognitive Therapy involves learning how to identify and replace distorted thoughts and beliefs, ultimately changing the associated habitual behaviour towards them. It
is usually focused on the present and is a problem-solving orientated treatment. Cognitive Therapy is based on the principle that the way we perceive situations
influences how we feel about them.When individuals are distressed they often can’t recognise that their thoughts are distorted, so Cognitive Therapy helps them to identify these thoughts and reassess
them. For example, if an individual makes a small mistake they may think “I’m useless, I can’t do anything right”. Strongly believing this may cause them to avoid the
activity where they made a mistake and confirm this belief deeper. Addressing these thoughts, and reassessing them can lead to more flexible ways of thinking, allowing
the individual to feel more positive, be less likely to avoid situations and be able to challenge their negative belief.Cognitive Therapy was first developed in the 20th century by American psychiatrist Aaron Beck who realised what usually held his clients back most were negative
thoughts and beliefs such as “I’m stupid” or “I can’t do that”. Beck initially focused on depression and developed a ‘list of errors’ in thinking, that he believed
could maintain depression. The list included errors such as magnification (of negatives), minimisation (of positives) and over-generalisation.Albert Ellis, another therapist, came to similar conclusions about his clients’ negative beliefs and their tendencies to ‘catastrophise’ or ‘awfulise’. Ellis’s work
also became known as a form of Cognitive Therapy, now referred to as Rational Emotive Behaviour Therapy (REBT).The cognitive approach came into conflict with the behavioural approach at the time, which focused solely on assessing stimuli and behavioural responses to it.
However, during the 1970’s behavioural techniques and cognitive techniques joined forces to create Cognitive Behavioural Therapy.
Cognitive Behavioural TherapyCognitive Behavioural Therapy (CBT) combines cognitive and behavioural therapies, and involves changing the way you think (cognitive) and how you respond to these
thoughts (behaviour). CBT focuses on the ‘here and now’ instead of focusing on the cause of the issue, and breaks overwhelming problems into smaller parts to make them
easier to deal with. These smaller parts can be described as thoughts, emotions, physical feelings and actions. Each of these has the ability to affect the other, e.g.
the way you think about things can affect how you feel emotionally and physically, and ultimately how you behave.CBT is based on the principle that individuals learn unhelpful ways of thinking and behaving over a long period of time. However, identifying these thoughts and how
they can be problematic to feelings and behaviours can enable individuals to challenge negative ways of thinking, leading to positive feelings and behavioural changes.
It is possible for the therapy to take place on a one-to-one basis, with family members or even as a group depending on the issue and how the individual feels most
comfortable.CBT can be useful for dealing with issues such as:• anger• anxiety• depression• drug or alcohol problems• eating disorders• obsessive-compulsive disorder• phobias• post-traumatic stress disorder• Sexual and relationship problemsThe emphasis on cognitive or behaviour aspects of therapy can vary depending on the issue. For example, the emphasis may be more towards cognitive therapy when
treating depression, or the emphasis may be more towards behaviour therapy when treating obsessive compulsive disorder.CBT is a practical therapy, which is likely to work best treating a specific issue as it focuses on particular problems and how to overcome them.CBT sessions may consist of a number of activities, including:• Coping skills• Assessments• Relaxation• Challenging certain thoughts• Thought stopping• Homework projects• Training in communicationUseful Websites• www.babcp.com• www.beckinstitute.org2. Psychoanalytic and Psychodynamic TherapiesFreud is widely regarded as being the founder of modern psychology, developing the therapy known as psychoanalysis. This therapy is based on the idea that a great deal
of an individual’s behaviour and thoughts are not within their conscious control. Psychoanalysis attempts to help clients develop insight into deep-rooted problems
that are often thought to stem from childhood.Psychoanalysis is based on the principle that our childhood experiences have created our current behaviour patterns and thinking process. These thoughts and feelings
can become repressed and may manifest themselves as depression or other negative symptoms.By talking freely about thoughts entering their mind, the client reveals unconscious thoughts and memories that the analyst will seek to interpret and make sense of.
Deeply buried memories and experiences are often expressed during this time and the opportunity to share these thoughts and feelings can help clients to work through
these problems. These thoughts can be analysed through free associations (the client says whatever comes to mind during the session, without censoring their thoughts),
dreams and fantasies, which all allow the analyst to clarify the client’s unconscious thoughts.Clients are encouraged to “transfer” feelings they have toward important people in their life onto the analyst in a process called “transference”. Success of
psychoanalysis often depends on both analyst and client and how they work together.Psychoanalysis is an intensive process and usually clients attend four or five sessions a week for several years. The regular sessions provide a setting to explore
these unconscious patterns, and try to make sense of them. Psychoanalysis is mostly used by clients suffering high levels of distress, and can be arduous for both
client and analyst. However, if successful, the therapy can be life-changing.Psychoanalytic TherapyPsychoanalytic therapy is based upon psychoanalysis but is less intensive, with clients only attending between one and three sessions a week. Psychoanalytic therapy is
often beneficial for individuals who want to understand more about themselves. It is particularly helpful for those who feel their difficulties have affected them for
a long period of time and need relieving of mental and emotional distress.Together, the therapist and the client try to understand the inner life of the client through deep exploration. Uncovering an individual’s unconscious needs and
thoughts may help them to understand how past experiences have affected them, and how they can work through these to live a more fulfilling life.Psychodynamic TherapyPsychodynamic counselling or psychotherapy evolved from psychoanalytic theory, however it tends to focus on more immediate problems, be more practically based and
shorter term than psychoanalytic therapy. Carl Jung, Alfred Adler, Otto Rank and Melanie Klein are all widely recognised for further developing the concept and
application of psychodynamics.Psychodynamic therapy focuses on unconscious thought processes which manifest themselves in a client’s behaviour. The approach seeks to increase a client’s self-
awareness and understanding of how the past has influenced present thoughts and behaviours, by exploring their unconscious patterns.Clients are encouraged to explore unresolved issues and conflicts, and to talk about important people and relationships in their life. Transference (when clients
transfer feelings they have toward important people in their life onto the therapist) is encouraged during sessions.Compared to psychoanalytic therapy, psychodynamic therapy seeks to provide a quicker solution for more immediate problems.3. Humanistic TherapiesHumanistic therapy emerged in the 1950’s, and although behavioural therapy and psychoanalytic methods were available, a humanistic approach offered individuals another
alternative. This approach focuses on recognising human capabilities in areas such as creativity, personal growth and choice. Two major theorists associated with this
approach are Carl Rogers and Abraham Maslow.The main goals of humanistic psychology are to find out how individuals perceive themselves here and now and to recognise growth, self-direction and responsibilities.
This method is optimistic and attempts to help individuals recognise their strengths by offering a non-judgemental, understanding experience.Person-Centred Counselling (also known as “Client-Centred” or Rogerian” counselling)This approach to counselling and psychotherapy sees human beings as having an innate tendency to develop towards their full potential. But this is inevitably blocked
or distorted by our life experiences, in particular those who tell us we are only loved or valued if we behave in certain ways and not others, or have certain feelings
and not others. As a result, because we have a deep need to feel valued, we tend to distort or deny to our awareness those of our inner experiences that we believe
will not be acceptable.The counsellor or psychotherapist in this approach aims to provide an environment in which the client does not feel under threat or judgement. This enables the client
to experience and accept more of who they are as a person, and reconnect with their own values and sense of self-worth. This reconnection with their inner resources
enables them to find their own way to move forward.The counsellor or psychotherapist works to understand the client’s experience from the client’s point of view, and to positively value the client as a person in all
aspects of their humanity, while aiming to be open and genuine as another human being. These attitudes of the therapist towards the client will only be helpful if the
client experiences them as real within the relationship, and so the nature of the relationship that the counsellor and client create between themselves is crucial for
the success of therapy.Gestalt TherapyGestalt Therapy focuses on the whole of an individual’s experience; their thoughts, feelings and actions, and concentrates on the ‘here and now’ – what is happening
from one moment to the next. Roughly translated from German, Gestalt means ‘whole’ and was developed in the 1940’s by Fritz Perls. The main goal of this approach is
for the individual to become more self-aware, taking into account their mind, body and soul.A therapist will constantly promote the client’s awareness of themselves and often uses experiments that are created by the therapist and client. These experiments can
be anything from creating patterns with objects and writing to role-playing. Promoting self-awareness is the main objective of gestalt therapy but other areas such as
improving the ability to support ones emotional feelings are also important. Gestalt therapy is influenced by psychoanalytic theory and therapists will concentrate on
‘here and now’ experiences to remove obstacles created by past experiences.Transactional AnalysisTransactional Analysis is a theory that involves an individual’s growth and development. It is also a theory related to communication and child development explaining
the connections to our past and how this influences decisions we make. Transactional Analysis was developed during the late 1950’s by psychiatrist Eric Berne.Berne recognised three key “ego-states” – Parent, Adult and Child. The Parent ego state is a set of thoughts, feelings and behaviours we leant from our parents and
other important people. The Adult ego state relates to direct responses to the ‘here and now’ that are not influenced by our past. The Child ego state is a set of
thoughts, feelings and behaviours learnt from our childhood. The ego-states are useful for analysing unconscious scripts and “games” people play.Transactional Analysis seeks to identify what goes wrong in communication and provide opportunities for individuals to change repetitive patterns that limit their
potential. It encourages individuals to analyse previous decisions they have made to understand the direction and patterns of their life for themselves. It also helps
clients to trust their decisions and think/act as an individual improving the way they feel about themselves. TA is a humanistic approach and like Person-Centred
Counselling focuses on the here and now concept.

Transpersonal Psychology and PsychosynthesisTranspersonal psychology began within humanistic therapies, however today it is gaining recognition by many psychologists and a number of professional organisations,
and is now often seen as its own separate psychological theory (along with the other three main categories: behavioural, psychoanalytical and psychodynamic and
humanistic).Transpersonal psychology literally means “beyond the personal” and involves encouraging the individual to discover the deep core of who they really are (the real
person that transcends an individual’s body, age, gender, physical space, culture, appearance etc.) It involves building and expanding on an individual’s qualities,
their spirituality and self development.Abraham Maslow’s research on self-actualisation was a key factor in the development of Transpersonal Psychology, which has since been refined by the work of many
others. Transpersonal Psychology encompasses three major areas: Beyond-Ego Psychology, Integrative/Holistic Psychology, and Transformative Psychology.Psychosynthesis was developed by psychiatrist Roberto Assagioli and involves an integration of the psychological and transpersonal elements. Psychosynthesis accepts
the idea of a higher, spiritual level of consciousness, sometimes referred to as the “higher self”. Techniques such as meditation and visualisation are often used for
self-exploration and personal growth.Existential TherapyExistential Therapy focuses on exploring the meaning of certain issues through a philosophical perspective, instead of a technique-based approach. It is appropriate
for those wishing to increase their self-awareness and broaden their views on their surrounding world.The principles of existential therapy are based on the theories of 19th and 20th century influential philosophers, such as Soren Kierkegaard and Friedrich Nietzsche,
who were in conflict with the predominant ideologies of their time and committed to exploring human existence in a personal manner. Existential therapy favours the
idea that we are all directly responsible for our own lives, over the idea of meaningful existence and predetermined destiny. Many other philosophers, including Jean-
Paul Sartre, Gabriel Marcel and Ludwig Binswanger, also contributed to the exploration of these ideas and the therapy is aimed at making sense of human existence.Existential Therapy is generally not concerned with the client’s past, but emphasises the choices to be made in the present and future.

Facts & FiguresMental health affects an estimated 450 million people world wide, yet despite this figure many still feel ashamed to seek diagnosis and support. Current figures state
that each year in Britain an estimated 1 in 4 adults will experience at least one diagnosable mental health problem, though only 230 of every 300 who need help will
actually visit their GP.Mental illness is an extremely common form of distress and exists in many different forms of facets, each of which can have a debilitating effect on both your mental
and physical well-being. This section of the site features information, facts, figures and studies which provide an insight into the various aspects of mental health.Go to: http://www.counselling-directory.org.uk/stats.html (for a list of related statistics)
History of Psychotherapy: Continuity and Change [Hardcover] PhD John C Norcross (Editor), Gary R Vandenbos (Editor), Donald K Freedheim (Editor) Publisher: American Psychological Association; 2nd edition (15 July 2010)
History of Psychotherapy: A Century of ChangeEdited by Donald K. Freedheim, Herbert J. Freudenberger, Donald R. Peterson, Jane W. Kessler, Hans H. Strupp, Stanley B. Messer, and Paul L. Wachtel1992
A Brief History of Psychotherapy in Graphic Display James R. Phelps Academic Psychiatry 1996;20:99-100.
Approaching Psychoanalysis: An Introductory CourseDavid Livingston Smith 1992 Karnac BooksA comprehensive user-friendly introductory account of Freudian theory and other major currents in psychoanalytic thought. It also includes biographical material on the
major theorists. It helps to clear up many misconceptions about psychoanalytic theory and will be useful for students and professionals alike.

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