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What Is Psychotherapy?

The History, Approaches and Criticisms of Psychotherapy

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Psychotherapy

Psychotherapy focuses on treating mental illness and psychological distress.

Photo by Brad Killer

Psychotherapy is a general term that is used to describe the process of treating psychological disorders and mental distress. During this process, a trained psychotherapist helps the client tackle a specific or general problem such as a particular mental illness or a source of life stress. Depending on the approach used by the therapist, a wide range of techniques and strategies can be used. However, almost all types of psychotherapy involve developing a therapeutic relationship, communicating and creating a dialogue and working to overcome problematic thoughts or behaviors.

Psychotherapy is increasingly viewed as a distinct profession in its own right, but many different types of professionals engage in psychotherapy regularly. Such individuals include clinical psychologists, psychiatrists, counselors, marriage and family therapists, social workers, mental health counselors, occupational therapists and psychiatric nurses.

Types of Psychotherapy

When many people hear the word psychotherapy, they immediately imagine a patient lying on a couch talking while a therapist sits in a nearby chair jotting down thoughts on a yellow notepad.

While many psychotherapists do use this classic type of talk therapy, there are actually a wide variety of techniques and practices used in psychotherapy. The exact approach used in each situation can vary based upon a variety of factors, including the training and background of the therapist, the preferences of the client and the exact nature of problem the client is experiencing.

Some of the major approaches to psychotherapy include:

  • Psychoanalytic: An approach to therapy that involved delving into a patients thoughts and past experiences to seek out unconscious desires or fantasies.

  • Cognitive-behavioral: A type of psychotherapy that involves cognitive and behavioral techniques to change negative thoughts and maladaptive behaviors.

  • Humanistic: A form of therapy that focuses on helping people maximize their potential.

A Brief History of Psychotherapy

While psychotherapy was practiced in various forms as far back as the time of the Ancient Greeks, it received its formal start when Sigmund Freud began using talk therapy to work with patients. Some of the techniques commonly used by Freud included transference, dream analysis and free association.

When behaviorism became a more prominent school of thought during the early part of the twentieth-century, techniques such as conditioning and association began to play an important role in psychotherapy. While behaviorism may not be as dominant as it once was, many of its methods are still very popular today. Behavioral therapy often uses classical conditioning, operant conditioning and social learning to help clients alter problematic behaviors.

Starting in the 1950s, the school of thought known as humanistic psychology began to have a major influence on psychotherapy. The humanist psychologist Carl Rogers developed an approach known as client-centered therapy, which focused on the therapist showing unconditional positive regard to the client. Today, this approach remains one of the most widely used models in psychotherapy.

The cognitive revolution of the 1960s also had a major impact on the practice of psychotherapy, as psychologists began to increasingly focus on how internal states influence behavior and functioning. The approach known as cognitive-behavioral therapy (CBT) emerged, a type of psychotherapeutic treatment that helps patients to understand the thoughts and feelings that influence behaviors. CBT is commonly used to treat a wide range of disorders, including phobias, addiction, depression and anxiety.

Issues in Psychotherapy

There are a number of issues or concerns for both therapists and clients. When selecting a therapist, clients need to consider whether they feel comfortable divulging personal information to their therapist. They also need to assess the therapist's qualifications, including the type of degree he or she holds as well as years of experience.

People who provide psychotherapy can hold a number of different titles or degrees. Some titles such as "psychologist" or "psychiatrist" are protected and carry specific educational and licensing requirements. Some of the individuals who are qualified to perform psychotherapy include psychiatrists, psychologists, counselors, licensed social workers and advanced psychiatric nurses.

When providing services to clients, psychotherapists need to consider issues such as informed consent, patient confidentiality and duty to warn. Informed consent involves notifying a client of all of the potentials risks and costs associated with treatment. This includes explaining the exact nature of the treatment, any possible risks and the available alternatives.

Because clients frequently discuss issues that are highly personal and sensitive in nature, psychotherapists have a legal obligation to protect a patients right to confidentiality. However, one instance where psychotherapists have a right to breach patient confidentiality is if clients pose an imminent threat to either themselves or others. Duty to warn gives counselors and therapists the right to breach confidentiality if a client poses a risk to another person.

Criticisms of Psychotherapy

One of the major criticisms leveled against psychotherapy is one that calls into question its effectiveness. In one early and frequently mentioned study, psychologist Hans Eysenck found that two-thirds of participants either improved or recovered on their own within two years, regardless of whether they had received psychotherapy.

In a meta-analysis that looked at 475 different studies, researchers found that psychotherapy was effective at enhancing the psychological well-being of clients. In his book The Great Psychotherapy Debate, statistician and psychologist Bruce Wampold reported that factors such as the therapist’s personality as well as his or her belief in the effectiveness of the treatment played a role in the outcome of psychotherapy. Surprisingly, Wampold suggests that the type of therapy used and the theoretical basis of the treatment do not have an effect on the outcome.

Learn More About Psychotherapy

References:

Eysenck, H. J. (1957). The effects of psychotherapy: An evaluation. Journal of Consulting Psychology, 16, 319-324.

Henrik, R. (1980). The Psychotherapy Handbook. The A-Z handbook to more than 250 psychotherapies as used today. New American Library.

Smith, M.L. What Research Says About the Effectiveness of Psychotherapy. Psychiatric Services. http://www.ps.psychiatryonline.org/cgi/content/abstract/33/6/457

Wampold, B. E. (2001). The Great Psychotherapy Debate: Models, Methods, and Findings. Routledge

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