Introduction to Psychotherapy

“Psychotherapy” is an umbrella term that describes the use of psychological methods to help a client
overcome distressing thoughts, feelings, and behaviors.

LEARNING OBJECTIVES

Discuss the history, goals, and types of psychotherapy

KEY TAKEAWAYS

Key Points

The purpose of psychotherapy is to explore thoughts, feelings, and behaviors with the goal of problem -
solving or achieving higher levels of functioning. Psychotherapy aims to increase the individual’s sense of
their own well-being.

One of the earliest forms of psychotherapy was psychoanalysis, created by Sigmund Freud in the late
19th century. Psychoanalysis aims to help clients gain insights about unresolved issues from the past.

The type of psychotherapy used is often dependent on the the individual, their particular situation, and
the problems from which they are suffering. Common types of psychotherapy include psychodynamic,
humanistic, behavioral, cognitive, cognitive-behavioral, group, and a number of others.

Large-scale international reviews of scientific studies have concluded that psychotherapy is effective for
numerous conditions; however, some criticize its effectiveness in favor of biomedical models.

Key Terms

classical conditioning: The use of a neutral stimulus, originally paired with one that invokes a response,
to generate a conditioned response.

determinism: The doctrine that all actions are determined by the current state and immutable laws of
the universe, with no possibility of choice.

free association: A technique used in psychoanalysis in which patients are invited to relate whatever
comes into their minds during the analytic session and to not censor their thoughts.

operant conditioning: A technique of behavior modification, developed by B. F. Skinner, that utilizes

positive and negative reinforcement and positive and negative punishment to alter behavior.

Defining Psychotherapy
“Psychotherapy” is an umbrella term that describes the use of psychological methods, particularly when
based on regular personal interaction, to help a person change and overcome problems in desired ways.
Other terms that can be used more or less interchangeably with the term “psychotherapy” include
“counseling” and “therapy.” Psychotherapy is defined by the interaction or treatment between a trained
professional and a client, patient, family, couple, or group. The problems addressed are psychological in
nature and can vary in terms of causes, influences, triggers, and resolutions.

History of Psychotherapy

It can be said that psychotherapy has been practiced through the ages, as medics, philosophers, spiritual
practitioners, and others used psychological methods to heal people. In the Western tradition, by the
19th century a mental-treatment movement (then referred to as “moral treatment”) developed based
on certain therapeutic methods. In 1853 Walter Cooper Dendy introduced the term “psycho-therapeia”
regarding how physicians might influence the mental states of sufferers and thus their bodily ailments.

In the late 1800s, Sigmund Freud (now known as the father of psychotherapy) developed
psychoanalysis, an early Western form of psychotherapy. Psychoanalysis is based on overcoming the
desires and negative influences of the unconscious mind. It encourages patients to use free association
as a way to come to insights about unresolved issues from the past that are resulting in emotional or
behavioral problems in the present.

Trained as a neurologist, Freud began focusing on problems that appeared to have no discernible
organic basis; he theorized that they had psychological causes originating in childhood experiences and
the unconscious mind. Techniques such as dream interpretation, free association, transference, and
analysis of the unconscious mind were developed. Many theorists, including Anna Freud, Carl Jung, and
Erik Erikson, built upon Freud’s fundamental ideas and developed their own systems of psychotherapy.
These were all later categorized as psychodynamic, meaning any approach that focused on the psyche’s
conscious and unconscious influences on the self and external relationships.

Behaviorism and behavioral therapy developed in the 1920s, relying on principles of operant
conditioning, classical conditioning, and social-learning theory to bring about therapeutic change in
observable symptoms. The approach became commonly used to treat phobias, as well as other
disorders.

Goals of Psychotherapy
The purpose of psychotherapy is to explore thoughts, feelings, and behaviors with the goal of problem-
solving or achieving higher levels of functioning. Psychotherapy aims to increase the individual’s sense of
their own well-being. Psychotherapists employ a range of techniques based on experiential relationship-
building, dialogue, communication, and behavior change that are designed to improve the mental health
of a client or patient, or to improve group relationships (such as in a family). During psychotherapy, an
individual will often talk with a trained professional about how they feel, think, and react to challenges
in life, with the ultimate goal of resolving or reducing negative symptoms of an emotional or mental
health problem.

Types of Psychotherapy

Many forms of psychotherapy use spoken conversation; others use various other forms of
communication such as the written word, artwork, drama, storytelling, or music. Psychotherapy occurs
within a structured encounter between a trained therapist and a client. Depending on the individual and
the types of symptoms they are experiencing, a particular method of psychotherapy may be employed.
For instance, psychotherapy with children and their parents often involves play, role-play, and drawing,
with a co-constructed narrative from these non-verbal and displaced modes of interacting. Common
types of psychotherapy include the following.

Psychodynamic Therapy

The primary focus is to reveal the unconscious content of a client’s psyche in an effort to alleviate
psychic tension. Although its roots are in psychoanalysis, psychodynamic therapy tends to be briefer and
less intensive than traditional psychoanalysis.

Humanistic Therapy

This form is explicitly concerned with the human context of the development of the individual with an
emphasis on subjective meaning, a rejection of determinism, and a concern for positive growth rather
than pathology. It posits an inherent human capacity to maximize potential.

Behavioral Therapy

These methods focus exclusively on behaviors, or on behaviors in combination with thoughts and
feelings that might be causing them. Those who practice behavioral therapy tend to look more at
specific, learned behaviors and how the environment has an impact on those behaviors. Two primary
types include operant conditioning and classical conditioning.
Cognitive and Cognitive Behavioral Therapy (CBT)

Cognitive therapy seeks to identify maladaptive cognitions (thoughts), appraisals, beliefs, and reactions,
with the aim of influencing destructive negative emotions. CBT combines cognitive therapy and
behavioral therapy to address maladaptive cognitions as well as dysfunctional behaviors.

Group Therapy

In this type of therapy, one or more therapists treat a small group of clients together as a group.

Eclectic Therapy

Recently, many practitioners have begun to take what’s known as an eclectic approach, meaning they
combine aspects of multiple types 0f therapies. This approach can be useful in that is uses the
techniques and theories that work best in a specific patient’s scenario, rather than sticking solely to the
methods of one discipline.

Other Approaches to Therapy

There are a number of other approaches to psychotherapy as well. For instance, eye-movement
desensitization and reprocessing (EMDR) alleviates symptoms for individuals who have experienced
severe trauma. Body-centered therapies focus on the links between the mind and the body in order to
access greater awareness of the physical body and the emotions.

Medical vs. Humanistic Model

A distinction can be made between those psychotherapies that employ a medical model and those that
employ a humanistic model. In the medical model, the client is seen as unwell and the therapist employs
their skill to help the client regain health. The extensive use of the DSM-5 (the Diagnostic and Statistical
Manual of Mental Disorders) in the United States comes out of the medical model. The humanistic or
non-medical model, in contrast, strives to depathologize 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.
Efficacy

Large-scale international reviews of scientific studies have concluded that psychotherapy is effective for
numerous conditions. One line of research consistently finds that different forms of psychotherapy show
similar effectiveness. Further analyses seek to identify the factors that various psychotherapies have in
common that seem to account for this; for example, the quality of the therapeutic relationship, the
interpretation of the problem, and the confrontation of painful emotions. However, specific therapies
have been tested for use with specific disorders, and regulatory organizations in both the UK and the 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 after five years, long-term psychotherapy and
psychoanalysis gave greater benefits. Several patient and therapist factors appear to predict suitability
for different psychotherapies.

Some are skeptical of the healing power of a psychotherapeutic relationship. Some dismiss
psychotherapy altogether in favor of 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 people clients are in
relationships with—critics point out that people have, after all, been weathering crises long before
psychotherapy was introduced.