The Evolution of Therapy as a Treatment Option
The description in this article of the evolution of psychotherapy is admittedly very brief and attempts to only cover the main points in the history of psychotherapy. It would be very easy to write an entire book on the history of psychotherapy and still come up short on all the details of its evolution. The information comes from the books History of Psychotherapy: Continuity and Change and A Short History of Psychotherapy. Readers interested in a more complete understanding of the history and development of psychotherapy can refer to these sources for more information.
The actual treatment of psychological or emotional issues goes back as far as recorded history. It is generally believed that the ancient Greeks were the first group to suspect that mental illness was a result of some medical condition as opposed to some supernatural explanation that included such things as demonic possession or being out of favor with the gods. The Greeks developed methods of treating mental illness based on the medical use of the time, such as using baths to treat depression and conceptualizing the psychological disorder of hysteria (a situation where an individual has a physical or neurological impairment, such as blindness or paralysis, with no evidence of physical damage) as occurring only in females and because of a wandering uterus. Nonetheless, the Greeks did recognize the value of using encouragement and consoling the individual in assisting to treat them.
Following the decline of the Roman Empire, the notions of mental illness and its causes returned to supernatural explanations and what today would be considered very barbaric treatments, including the use of torture to address possession by demons. As always in dark times, there are some individuals who advocated totally different approaches, such as the physician Paracelsus, who supported the use of talking to an individual to help them recover from insanity.
In the 19th century, several approaches foreshadowed the development of modern psychotherapy. One such occurrence was the development of mesmerism by the Frenchman Franz Anton Mesmer. Mesmer believed in the principle of animal magnetism and attempted to treat women with hysteria through the use of magnets and an impressive ceremony that involved him chanting and performing for the affected women. The anatomist Francis Joseph Gall developed the science of phrenology, which was the study of the shape of the skull as applied to certain personality traits and behaviors. Neither of these techniques were accepted by the medical establishments of the time; however, Mesmer’s technique foreshadowed the use of hypnosis, and even later, Freud’s approach and Gall’s principles foreshadowed the notion that certain parts of the brain were involved in specific functions.
A number of different approaches to talking cures were developed in the 1700s and included the notion of moral treatment that was associated with the changes in the approach to treating individuals that were institutionalized in asylums. The American physician Benjamin Rush, who is often referred to as the father of American psychiatry, was a notable figure in the use of moral treatment in American institutions.
While there were obvious references to talking cures for various emotional and psychological issues, the actual use of the term therapy is credited to an English psychiatrist who used talking cures in the 1850s. This person was Walter Cooper Dendy, and he introduced the term psycho-therapeia to describe his form of talking treatment. However, the actual birth of the use of a talking cure was popularized by the Viennese neurologist Sigmund Freud. Freud’s approach to therapy is still often referenced today in the popular media.
Freud was a neurologist who became influenced by the use of hypnosis in treating hysteria, which was popularized by French neurologist John Martin Charcot. Freud eventually abandoned the use of hypnosis exclusively and began using a form of talking therapy that developed into the school of psychoanalysis. Freud was a proponent of the use of free association in therapy where an individual would simply just speak what was on their mind at the moment. The therapist would attempt to understand what these thoughts meant. Freud’s theories included the notion that the unconscious mind was the dominant navigator of behavior and that the technique of free association, dream analysis, and analyzing slips of the tongue were methods to access the material in the unconscious mind.
Freud developed elaborate theories of behavior and development that still have relevance today and provide the basis for the psychodynamic school of psychotherapy, although many of his theoretical conceptualizations are no longer accepted by the majority of therapists. Nonetheless, it is important to understand that Sigmund Freud’s contributions to psychotherapy are insurmountable. Freud is responsible for the notions that experiences occurring in childhood can affect adult behavior, that sometimes individuals speak symbolically or are unaware of their intentions, and that many emotional issues can be addressed by a talking cure. These were radical assumptions for the time and remain relevant today.
An important divide from Freud’s notions came in the 1920s when the school of behaviorism began to exert its dominance in psychology and psychotherapy. Behaviorism did not give significant credence to unconscious mental processes but instead focused on observing and changing the observable behavior of individuals. A number of behavioral techniques were developed to address specific problems, including issues with anxiety, depression, overeating, etc. Perhaps the most well-known of the behaviorists is B. F. Skinner, the behaviorist who popularized operant conditioning and the use of reinforcement as a means to shape behavior.
While there are a number of offshoots from both Freudian and behaviorist principles, including very famous names such as Carl Jung, Victor Frankel, and Rollo May in the 1950s, two other important therapeutic paradigms were developed, both of which were reactions to Freudian psychoanalysis and strict behaviorist principles.
Carl Rogers was the son of a minister and impressed by the principles of individuals like Abraham Maslow. Maslow had developed a number of principles, the most popular being his theoretical hierarchy of human needs that traced the development of human motivation from basic survival instincts or needs to more deep-rooted spiritual and motivational needs. Maslow’s principles are often associated with the development of humanistic psychology, and Rogers developed the notion of client-centered therapy as a reaction to the deterministic viewpoints of behaviorism and Freudian thought.
Rogers was more interested in Maslow’s notion of self-actualization and the need to strive to be more than one could be. Rogers therapeutic principles were in sharp contrast to the instinct-driven principles of Freud and the mechanistic approach of behaviorism. His approach was to be supportive, offer empathy, and provide positive regard to individuals with emotional and psychological problems. Rogers was also the first individual to actually research the formal effectiveness of psychotherapy. As it turns out, many principles related to Rogers’ notions are considered to be factors that contribute to the successful outcomes of all forms of different psychotherapeutic techniques today.
In contrast, a researcher Edward C. Tolman rejected the principles of Freud and behaviorism in favor of a paradigm that emphasized reasoning and thinking abilities. The principles of behaviorism supported the notion that learning occurred as a result of reinforcement. Tolman rejected this idea and developed a research paradigm that indicated that even rodents can learn without being reinforced for their choices. Tolman’s notion that rodents were able to develop “cognitive maps” of their environment and refer to these maps is often considered to be the beginnings of cognitive psychology.
The therapists Albert Ellis and Aaron Beck applied cognitive principles to therapeutic techniques that addressed the identification of irrational beliefs and thoughts, and techniques to change them. Beck’s approach was a much purer form of cognitive therapy. It was initially used in the treatment of clinical depression and later other psychological issues, whereas Ellis is often considered to be the first individual to form the principles of Cognitive Behavioral Therapy where cognitive techniques and behaviorism are combined. Both of these paradigms of therapy remain extremely popular today and form the basis of a number of different types of therapy.
Since the development of these four major paradigms of therapy, a number of other different perspectives have developed. Many of these are based on the principles of these four major paradigms, but Systems Therapy is a different type of therapy that focuses on the dynamics in families and groups, whereas Transpersonal Psychological Therapy goes back to Jungian notions of spirituality and focuses on the spiritual aspects of human existence. Other important perspectives have emerged, such as Feminist Therapy, existential therapy, Positive Psychology, etc.
Finally, it should be mentioned that the notion of group therapy is generally attributed to the English physician J.H. Pratt. In the early 1900s, Pratt began to use group sessions to instruct people affected with tuberculosis and their family members on how to engage in self-care for the disease. Pratt found that the groups benefited in ways he did not expect, such as via the sharing of experiences and emotionally supporting one another. Pratt formally began referring to his sessions as group psychotherapy.
Group psychotherapy gained popularity following World War II when groups of veterans were treated together. At this time, a number of different group psychotherapy paradigms exist. Group psychotherapy is an important component in the treatment of a number of different issues, including treatment for substance use disorders.
Therapy and Substance Abuse
- The principles of behavioral therapy, cognitive therapy, and Cognitive Behavioral Therapy were directly applied to issues that individuals with substance use disorders experience. Even the forerunners of these techniques, such as Skinner, Beck, and Ellis, developed modifications of their therapeutic techniques to address these issues. Continuing use of behavioral and cognitive behavioral principles to help individuals with all different types of substance use disorders in the 1950s and beyond helped solidify the use of therapy as important in the treatment of substance use disorders.
Ups and Downs
The saga of the development of psychotherapy is not without its ups and downs. For instance, English psychologist and researcher Hans Eysenck published a research study that supported the notion that psychotherapy was ineffective in the treatment of psychological problems. This study threatened to totally halt the progress of psychotherapy; however, subsequent research building on the inadequacies of Eysenck’s methodology indicated that his findings were not reliable and that psychotherapy is indeed effective for a number of different conditions. Current research in psychotherapy indicates that the use of psychotherapy is justified for a number of different conditions, and there are a number of different components to effective outcomes in psychotherapy.
The rise of biological psychiatry threatened to subjugate psychotherapy to the position of a supportive treatment; however, research studies have indicated that the use of psychotherapy is advantageous for a number of different conditions and produces longer lasting change. It also helps individuals to maintain their changes, whereas in many instances, once medication is discontinued, individuals begin to suffer the original problems they had. A large body of research advocates the combination of psychotherapy and psychotropic medications in the treatment of a number of different conditions.
Research has also indicated that the implementation of psychotherapy results in significant changes in the brain that may be associated with the development of change. This bolsters the use of psychotherapy for a number of conditions, including extremely hard to treat conditions like obsessive-compulsive disorder. Nonetheless, there are various disorders where it is considered appropriate to use psychotherapy as a frontline treatment. For example, schizophrenia and bipolar disorder are two mental health disorders that are most often effectively treated with medication. They are not responsive to psychotherapy except as a supportive treatment used to treat co-occurring issues.
The use of the “talking cure” can be found as far back as the earliest records of recorded history. Formal development of psychotherapeutic techniques is associated with various individuals, such as Sigmund Freud, B.F. Skinner, Carl Rogers, Albert Ellis, and Aaron Beck. Psychotherapy as an approach continues to evolve.