It is the treatment of psychological distress through talking with a specially trained therapist and learning new ways to cope rather than merely using medication to alleviate the distress.
It is done with the immediate goal of aiding the person in increasing self-knowledge and awareness of relationships with others. Psychotherapy is carried out to assist people in becoming more conscious of their unconscious thoughts, feelings, and motives.
Psychotherapy’s longer-term goal is making it possible for people to exchange destructive patterns of behavior for healthier, more successful ones.
Different approaches to psychotherapy
The psychodynamic approach was derived from principles and methods of psychoanalysis, and it encompasses psychoanalysis, Jungian analysis, Gestalt therapy, client-centered therapy, and somatic or body therapies, among other forms of sychotherapy.
Psychoanalysis is therapy based upon the work of Austrian physician Sigmund Freud (1856–1939), and those who followed, Carl Jung, Alfred Adler, Erich Fromm, Karen Horney, and Erik Erikson. The basis of psychoanalytic therapy is the belief that behavior and personality develop in relation to unconscious wishes and conflicts from childhood.
Gestalt therapy, developed by Frederick (Fritz) Perls, emphasizes the principles of self-centered awareness and accepting responsibility of one’s own behavior. Client-centered therapy was formulated by Carl Rogers, and it introduced the idea that individuals have the resources within themselves for self-understanding and for change.
Part of this concept is that the therapist exposes his or her own true feelings and does not adopt a professional posture, keeping personal feelings unclear. Somatic or body therapies include: dance therapy, holotropic breathwork, and Reichian therapy.
The behavioral approach encompasses various behavior modification techniques and theories, including assertiveness training/social skills training, operant conditioning, hypnosis/hypnotherapy, sex therapy, systematic desensitization, and others.
Systematic desensitization was pioneered by Joseph Wolpe, after he became frustrated with psychoanalysis. This therapy is a combination of deep muscular relaxation and emotive imagery exercises, in which the client relaxes and the therapist verbally sets scenes for the client to imagine.
These scenes include elements of the client’s fears, building from the smallest fear toward the largest fear, and the therapist monitors the client and introduces the scenes, working to maintain the client’s relaxed state.
The cognitive approach stresses the role that thoughts play in influencing behavior. Rational-emotive therapy and reality therapy are both examples of the cognitive approach. Rational-emotive therapy was pioneered by Albert Ellis in the mid-1950s.
This therapy is based on the belief that events in and of themselves don’t upset people, but people get upset about events because of their attitudes towards the events. Ellis’s therapy set out to change people’s attitudes about events through objective, firm direction from the therapist and talk therapy.
Reality therapy, developed by William Glasser, is based upon the idea that humans seek to satisfy their complex needs, and the behaviors they adopt are to accomplish that satisfaction. In Glasser’s theory, some people usually fulfill themselves and are generally happy, while others are unable to fulfill themselves and get angry or depressed.
The family systems approach includes family therapy in several forms and is the attempt to modify relationships within the family. Family therapy views behaviors and problems as the result of family interactions, rather than as belonging to a family member.
One theory, developed by Murray Bowen, has become its own integrated system with eight basic concepts, including differentiation of self and sibling position. This system attempts to help an individual become differentiated from the family, while remaining in touch with the family system.
In the practical application of these approaches, psychotherapy can take many forms. Some of the most commonly practiced forms include:
- Counseling, the provision of both advice and psychological support, is the most elemental form of psychotherapy. Counseling can be short-term therapy done to assist a person in dealing with an immediate problem such as marital problems or family planning, substance abuse, bereavement, or terminal illness. Or it can be longer-term, more extensive treatment that addresses feelings and attitudes that impair success.
- Group psychotherapy requires less therapist time, and is thus less expensive. In fact, the interactions that occur between members of the group are expected to provide the change and healing each member receives. The therapist functions as a facilitator, or one who encourages and controls the group interchanges. Group therapy provides each member with the additional benefit of sharing and feedback from others experiencing similar emotional problems. This sharing and feedback has been found to be therapeutic, and the group can actually function as a trial social setting, allowing people to try out newly-learned behaviors.
- Family therapy began in the 1930s, when Freudian analyst Alfred Adler used it in working with his patients’ entire families. Since the 1950s, it has been a widely used and highly respected means of therapy based upon the belief that the relationships and interactions within a family have a profound impact upon the patient’s mental difficulties. Family therapy generally does not deal with internal conflicts, but rather encourages positive interactions between the various family members.
All forms of psychotherapy require an atmosphere of absolute mutual trust and confidentiality. Without this total safety, no form of therapy will be successful.
Origins
Psychotherapy had its beginnings in the ministrations of some of the earliest psychologists, priests, magicians, and shamans of the ancient world. They attempted to determine the causes of the person’s emotional distress by talking, counseling, and educating, and interpreting both behavior and dreams.
Many of these practices became suspect as the work of charlatans, and fell into disrepute over the centuries. There was little change or progress in the treatment of mental illness over the centuries that followed.
Austrian physician Franz Anton Mesmer (1734–1815) began using what he termed magnetism and both the power of suggestion and hypnosis in 1772. Mesmer’s treatments, too, fell into disrepute after his theories were rejected by a medical board of inquiry in 1784.
Then, nearly a century later, Mesmer’s ideas were rediscovered by French neurologist Jean-Martin Charcot (1825–1893). Dr. Charcot used suggestion and hypnosis for treating psychological difficulties at Salpêtrière Hospital in Paris in the late nineteenth century. Mesmer is now known as the Father of Hypnosis.
In the late nineteenth and early twentieth century, Austrian physician Sigmund Freud studied Charcot’s work, and came to believe that hypnosis was less a treatment for mental illness than a means of determining its underlying cause.
Freud used hypnosis as one means of uncovering the often traumatic, not consciously recalled memories of his neurotic patients just as he used their dreams to evaluate their mental conflicts. He later abandoned hypnosis because he did not induce successful trances in his neurology patients.
His The Interpretation of Dreams, published in 1899, made the point that a person’s dreams were actually a window into the inner, unknown mind—the royal road to the unconscious. He used the information he obtained not only to help his patients, but also to collect data that eventually helped verify some of his psychodynamic assumptions.
Sigmund Freud theorized that the human personality is composed of three basic parts, the id, the ego, and the superego. The id is defined as the most elemental part, the one that unconsciously motivates people toward fulfilling instinctive urges. The ego is more related to intellect and judegment.
It arbitrates between the internal, usually unrecognized desires all human beings have and the reality of the external world. The superego, unconscious controls dictated by moral or social standards outside of ourselves, is probably most easily described as another name for the conscience.
Freud believed that mental illness was the result of people being unable to resolve conflict, or inadequate settlement of disharmony among the ego, superego, and id. To deal with these internal psychic conflicts, people develop defense mechanisms, which is normally a healthy response.
The defense mechanisms become harmful to mental health when overused, or used inappropriately. Freud further postulated that childhood psychic development is primarily based upon sexuality; he divided the first eighteen months of life into three sex-based phases: oral, anal, and genital.
Freud’s earliest students, including Carl Jung and Alfred Adler, came to believe that Freud had overestimated the influence sexuality had on psychic development, and found other influences that helped to shape the personality.
In the late 1800s and into the twentieth century, 1904 Nobel Prize winner Ivan Petrovich Pavlov pioneered the research that would later result in behavioral therapies, such as the work of American behaviorist Burrhus Frederic Skinner.
And in the 1930s, American psychologist Carl Ransom Rogers began his school of psychology that emphasized the importance of the relationship between the patient (or client, according to Rogers) and the therapist in bringing about positive psychic change.
Primal therapy, developed by Arthur Janov in the 1960s, is based upon the assumption that people must relive early life experiences with all the acuity of feeling that was somehow suppressed at the time in order to free themselves of compulsive or neurotic behavior.
Primal therapy was a cathartic approach that many therapists now believe can impede progress because a person can become addicted to the release (even “high”) associated with the catharsis and seek to keep repeating it for the momentary satisfaction.
Transactional analysis, based on Eric Berne’s work, came into favor in the 1970s, and supposes that all people function as either parent or child at various times, and teaches the person to identify which role he or she is filling at any given time and to evaluate whether this role is appropriate.
Benefits
The generally accepted aims of psychotherapy are:
- Increased insight or improved understanding of one’s own mental state. This can range from simply knowing one’s strengths and weaknesses to understanding that symptoms are signs of a mental illness and to deep awareness and acceptance of inner feelings.
- The resolution of disabling conflicts, or working to create a peaceful and positive settlement of emotional struggles that stop a person from living a reasonably happy and productive life.
- Increasing acceptance of self by developing a more realistic and positive appraisal of the person’s strengths and abilities.
- Development of improved and more efficient and successful means of dealing with problems so that the patient can find solutions or means of coping with them.
- An overall strengthening of ego structure, or sense of self, so that normal, healthy means of coping with life situations can be called upon and used as needed.
Though there are no definitive studies proving that all five of these goals are consistently realized, psychotherapy in one form or other is a component of nearly all of both in-patient and community based psychiatric treatment programs.
Description
Classic Freudian psychotherapy is usually carried out in 50-minute sessions three to five times per week. The patient lies on a couch while he or she talks with the therapist. Freudian therapy characteristically requires ongoing treatment for several years, though in Freud’s era it did not.
Most other forms of individual psychotherapy, including Jungian, counseling, humanistic, Gestalt, or behavioral therapies, are carried out on a weekly basis (or more frequently, if necessary), in which the person meets with his or her therapist in the therapist’s office, and may or may not continue for longer than a year.
Group therapy is held in a variety of settings. A trained group therapist chooses the people that presumably would benefit and learn from interactions with each other.
The size of a group is usually five to 10 people, plus a specially trained therapist who guides the group discussion and provides examination of issues and concerns raised.
Child psychotherapy is done for the same reasons as adult psychotherapy—to treat emotional problems through communication. The obvious difference is that child psychotherapy must acknowledge the child’s stage of development. This means that the therapist may use different techniques, including play, rather than only talking to the patient.
A newer direction in the treatment of mental disorders is the use of brief psychotherapy sessions, often combined with medication, to treat neurotic conditions.
Another short-term psychotherapy is often termed crisis intervention, and is used to aid people in dealing with specific crises in their lives, such as the death of a loved one.
Research and general acceptance
Psychotherapy, in its many forms, has been accepted and used throughout the world for more than one hundred years. It is normally covered as a valid treatment of mental disorder by both public and private health insurers.
Because the various types of psychotherapy have different aims, and mental illnesses usually do not have absolute measurable signs of recovery, evaluating psychotherapy’s effectiveness is difficult.
As a general rule, the majority of people who undergo treatment with psychotherapy can expect to make appreciable gains. Studies have revealed, however, that not everyone who goes into therapy will be helped, or helped as much as others, and some will even be harmed.
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