Modern psychotherapy is relatively new, established only at the end of the 19th century. Sigmund Freud (1856-1939) is considered by many to be the first person who in a systematic way used talking therapy in order to help his clients resolve their emotional issues.

1. Psychodynamic approaches

Freud was inspired by the work of Franz Mesmer (1734-1814), an Austrian physician who pioneered hypnotherapy as a cure for psychosomatic problems and other disorders of the mind. Freud also worked under Jean-Martin Charcot (1825-1893), a French neurologist who used hypnosis to treat hysteria in his patients. Although Freud was later to question the value of hypnosis as a treatment strategy, it helped him to understand the importance of the unconscious mind and the way in which feelings and behaviours can be influenced to create psychopathological symptoms.

Many of Freud’s contributions have been a mainstay of psychoanalytic thought, such as his emphasis on the importance of unconscious processes in human motivation and his concepts of personality (id, ego, and superego). Contemporary psychodynamic therapy (as opposed to classical psychoanalytic therapy) continues to draw heavily on the early principles and ideas of psychoanalysis, although the early work of Freud has been significantly developed and much of current psychodynamic thinking draws on the work of other theorists, including Jung, Adler, Klein and Bowlby.

All psychodynamic approaches work on the premise that much of human experience takes place beyond awareness in the unconscious part of the mind. These methods also emphasise early childhood relationships with caregivers as a prime contributor of emotional wellbeing in adult life. It is worth noting, however, that early psychoanalytic thinking was focused mainly on person’s intra-psychic conflicts between their id, ego and superego. In contrast, contemporary psychodynamic thought, influenced by such theories as attachment and object relations, places more emphasis on a relational, social and environmental context of an individual.

2. Cognitive-behavioural approaches

Behaviourism

Behaviourism emerged in the early 20th century as a reaction to psychodynamic psychology, which often had difficulty making predictions that could be tested using rigorous experimental methods. The primary tenet of behaviourism, as expressed in the writings of John B. Watson (1878-1958) and B. F. Skinner (1904-1990), is that psychology should concern itself with the observable behaviour of people and animals, not with unobservable events that take place in their minds. The behaviourist school of thought maintains that behaviours as such can be described scientifically without recourse either to internal physiological events or to hypothetical constructs such as thoughts and beliefs. It is important to note that behaviourists did not claim that mental phenomena were non-existent. They did, however, believe that they had no scientific significance and that overt behaviour could be explained without considering them.

Behaviourism assumes that all behaviour is learnt from the environment and symptoms are acquired through classical conditioning and operant conditioning. Classical conditioning involves learning by association and is usually the cause of most phobias. Operant conditioning involves learning by reinforcement and punishment, and can explain abnormal behaviour such as eating disorders.

Behavioural therapies focus on maladaptive behaviours which are viewed as a problem that needs to be addressed rather than merely a symptom of deeper underlying issues. As such, behavioural therapy stands in sharp contrast to other approaches that value insight and exploration of one’s emotions and cognitions.

Cognitive-behavioural therapy

Traditional behaviour therapy rejected any explanation of behaviour based on the working of the inner mind. By early 1970s, however, research confirmed that behaviour was mediated not only by rewards and punishments but perceptions and beliefs as well. As a consequence, the theoretical model of behaviour therapy evolved to include cognitive component. The two principal writers in the development of cognitive therapy were Aaron T. Beck (b.1921) and Albert Ellis (1913-2007).

The development of cognitive approach to understanding human behaviour aimed at looking at thinking processes that were believed to influence behaviour and emotional responses. Cognitive therapy is based on the assumption that individuals interact with the environment through the process of thinking. These thoughts, in turn are linked to feelings and behaviour, as well as physical well-being. Cognitive behaviour therapists postulate that people can achieve change by working directly on their own patterns of thinking and behaviour. Due to negative lifetime experiences many individuals have learned distorted patterns of thought which need to be challenged and transformed into more adaptive thought patterns.

Cognitive therapists are interested in the conscious mind of a person, in the way they think, interpret and evaluate their environment. In that respect, cognitive therapy differs from psychodynamic approach which focuses on the unconscious mind.

3. Humanistic approaches

Humanistic movement started in the late 1950s when a group of US psychologists (incl. Abraham Maslow, George Kelly, Carl Rogers, & Gordon Allport) set up the Association for Humanistic Psychology. It was called the ‘third force’ because it was a reaction against the two dominant perspectives in psychology at the time, namely behaviourism and psychoanalysis. Humanistic psychologists wanted a perspective that accounted for people’s capacity to be self-aware and to be responsible for directing their own lives.

Humanistic psychology is characterised by a phenomenological (subjective) emphasis on conscious experience, the assumption that people have the potential to achieve their full potential, a holistic approach (one which encompasses the whole person - mind, spirit and body), and utilising a wide range of methods for facilitating personal growth.

The most prominent schools of humanistic therapies include person-centred approach, gestalt, and transactional analysis.

Person-centred approach

For an American psychologist, Carl Rogers (1902-1987), both psychoanalysis and behaviourism represented a reductionist approach to human personality. Psychoanalysis viewed people as always driven by basic biological drives, never free from these primitive instincts and behaviours, whereas behaviourism focused only on observable and measurable sides to human functioning. In contrast, Rogers claimed that individuals, given the right conditions, had the capacity to change and move towards a position of health and growth.

Rogers’ theory rests on the assumption that the conscious awareness of a person is their most important source of knowledge. He believes that clients have the capacity for self-direction and constructive personal change. According to Rogers, the nature of the relationship between client and therapist is fundamental to the therapeutic change. He identified therapeutic core conditions of congruence, unconditional positive regard and empathy that are both necessary and sufficient for therapeutic change to occur.

Rogers’ foundational ideas, especially the central role of the client-therapist relationship as a means for growth and change, have been incorporated by many other theoretical approaches. He contributed to developing a theory of psychotherapy that de-emphasized pathology and focused instead on the strengths and resources of individuals.

Conclusion

Each of the three main forces in modern psychotherapy described above (psychoanalysis, behaviourism and humanistic therapies) brought a different perspective on human mental distress and the ways to alleviate it. Psychoanalysis, and psychodynamic approaches in general, brought unconscious conflicts into focus. Cognitive behavioural therapies studied the importance of the way we interpret events and how these cognitions influence the way we feel. Humanistic therapies shifted their focus from the emphasis on technique and reliance on therapist’s authority to the importance of the therapeutic relationship. Each perspective is valuable but I personally believe in the worth of a therapist who is able to integrate several approaches in order to tailor specific interventions to the unique needs of his or her clients.

References

Boyne, E (ed.) 1995, Psychotherapy in Ireland, the Columba Press, Dublin.

Corey, G 2013, Theory and practice of counselling and psychotherapy, Brooks/Cole Cengage Learning, International edition.

Fancher, R 1996, Pioneers of psychology, W.W. Norton & Company, New York, London.

Mautner, T (ed.) 2005, Dictionary of philosophy, Penguin Books, London

Morris, C & Maisto, A 1999, Understanding psychology, Prentice Hall, Upper Sadle River, New Jersey.

Reber, A & Reber, E (eds.) 2001, Dictionary of psychology, Penguin Books, London.

Reeves, A 2013, An introduction to counselling and psychotherapy, Sage, London.

Image of Sigmun Freud by skeeze from Pixabay