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Psychotherapy

Psychotherapy

PSYCHOANALYSIS

BEHAVIORAL THERAPY

COGNITIVE THERAPY

HUMANISTIC THERAPY

OTHER PSYCHOTHERAPIES

BIOLOGICAL CONSIDERATIONS AND RESEARCH

BIBLIOGRAPHY

Psychotherapy is the treatment of mental illness, emotional difficulties, or behavioral problems through usually non-invasive psychological means. It is based on the premise that human psychological suffering can be alleviated by speaking and listening. At its core, psychotherapy involves the interpersonal interaction between a trained professional and a suffering individual. Collectively, the varied forms of psychotherapy are often referred to as talking therapies. The specific techniques used in any psychotherapy depend largely on the theoretical orientation of the psychotherapist. Most approaches to psychotherapy can be traced in origin to one of the following schools: psychoanalytic, behavioral, cognitive, or humanistic. In practice, however, much of what is called psychotherapy today involves an evolving, fluid, and personalized use of techniques that depend on the specific problem, the professionals training, and the sufferers needs. The goals of all types of psychotherapy typically involve the reduction of symptoms (e.g., depression, anxiety), altering maladaptive patterns of living (e.g., alcohol abuse, compulsive gambling), and/or improvement in specific areas of life functioning (e.g., increased capacity for work, creativity, or relationships).

The advent of modern psychotherapy can arguably be attributed to the work of Franz Anton Mesmer (1734-1815). Though few, if any, of his ideas would be recognized today as sound practice, his work marked an important shift from religious theories and explanations of healing (i.e., exorcisms) to theories based on scientific understandings of the time. The trance-like state Mesmer induced in individuals (still known colloquially today as being mesmerized) was the precursor to hypnosis, a practice that French neurologist Jean-Martin Charcot (18251893) began using more specifically to treat patients with psychological difficulties. As a student of Charcots, Sigmund Freud (18561939) first began using hypnosis to treat patients before he abandoned it for what would later become his revolutionary method of psychoanalysis. Decades of theoretical evolution of psychoanalytic theory has spawned a vast array of psychotherapies.

Though a contemporary of Freuds, Ivan Pavlovs (18491936) work represents a different yet important developmental line in the understanding of human behavior and learning. Known for his work studying the reflexive behavior of dogs, Pavlov discovered how certain behavioral responses could be experimentally brought about, or conditioned, by pairing specific stimuli with other naturally occurring behaviors. This principle was used by American psychologists John B. Watson (18781958) and B. F. Skinner (19041990) in the clinical application of behaviorism, behavior therapy, and then to cognitive and cognitive-behavioral therapy. Historically, behavioral and cognitive psychotherapies have been viewed as an important counterargument to the earliest psychoanalytic ideas and techniques. In fact, the trailblazers of the behavior and cognitive psychotherapy movement, Albert Ellis (b. 1913) and Aaron Beck (b. 1921), both had early psychoanalytic training and interests.

PSYCHOANALYSIS

Developed by Sigmund Freud, psychoanalysis is often recognized as the first modern form of psychotherapy. It is based on the assumption that psychological symptoms are caused by unconscious conflict often rooted in ones early childhood experience. The aim of psychoanalysis is to bring unconscious conflicts into conscious awareness through the processes of introspection, insight, and interpretation. In a collaborative effort, the patient and therapist examine and try to resolve these conflicts, freeing the patient to live a more adaptive, healthy, and fulfilling life.

Freud discovered that examining the unconscious required some special tools. Foremost of these was the process of free association, the uncensored report of all thoughts and fantasies, regardless of content. What seemed potentially irrelevant, tangential, or embarrassing to the patient was seen by Freud to have disguised connections and meanings that once understood would help reveal unconscious conflicts and reduce suffering. To promote free association, an analytic couch was often used, with the analyst sitting behind the couch and listening to the patient. Freud also viewed dreams as disguised and symbolic representations of unconscious conflicts, which could be useful in the psychoanalytic process. The interpretation of these conflicts brought about change, according to Freud.

As Freuds understanding of psychoanalytic theory evolved he began incorporating such ideas as transference, resistance, and defensive mechanisms into his theory of cure. The practice of psychoanalysis continues to evolve today in ways that maintain, reject, and expand some of Freuds original principles. Although traditional psychoanalysis (usually four to five appointments per week for several years) is not as popular as it was in the first half of the twentieth century, at the beginning of the twenty-first century it remains a sought-after treatment modality for some people. A more popular variant of psychoanalysis is face-to-face psychoanalytic psychotherapy, which uses many of the same principles as psychoanalysis but is less frequent (usually one to two appointments per week). In the psychoanalytic community, psychoanalysis is viewed as the treatment of choice for a wide range of psychological difficulties, including depression, anxiety, and personality disorders. Though the cost and length of treatment has been criticized as being prohibitive for many individuals, proponents of psychoanalysis and psychoanalytic psychotherapy argue that benefits are more comprehensive and longer lasting than other forms of treatment.

BEHAVIORAL THERAPY

Behavior therapy emphasizes the scientific understanding of observable behaviors, rejecting the importance of self-awareness, insight, and the unconscious as valued in psychoanalytic techniques. The goal of most forms of behavior therapy is to increase desired behaviors and decrease undesired ones. It is a collective group of therapeutic techniques based on systematically researched theories of learning and behavior. For example, Pavlovs discovery of classical conditioning, or Pavlovian conditioning, led to an increased understanding of how certain behaviors could be learned. In his experiments with dogs, Pavlov found that the repeated pairing of a bell immediately proceeding the presentation of meat powder would eventually condition the dogs to salivate when the bell was later presented alone (without the meat powder). John B. Watsons (1878-1958) famous Little Albert experiment demonstrated how fear of a non fear-inducing white rat could be conditioned in a toddler boy by the repeated pairing of a loud noise with a the presentation of the rat. While the increase of salivation in dogs or the induction of fear in infants are hardly desired outcomes of modern psychotherapeutic techniques, these principles of classical conditioning have had a far reaching influence on subsequent developments of different forms of behavior therapy.

Systematic desensitization, for example, is a behavioral therapy technique that uses principles of classical conditioning to help gradually alleviate specific phobias (e.g., fear of flying) or reduce the symptoms of certain anxiety disorders. Flooding (also called exposure therapy) is another form of behavior therapy used to help reduce anxiety by exposing an individual to a feared stimulus until the anxiety is extinguished. Though not commonly used in modern day, aversion therapy is a controversial behavior therapy technique that pairs unwanted behaviors with unpleasant results in order to reduce the behavior (e.g., pairing alcoholic beverages with a chemical substance that causes nausea). Other behavioral approaches involve principles of operant conditioning that Skinner was most noted for. Operant conditioning relies heavily on ideas of reinforcement and punishment in the service of increasing desired behaviors and decreasing unwanted behaviors.

Behavior psychotherapies tend to be directive, specific, and symptom focused. They are most popularly associated with the treatment of specific phobias, various anxiety disorders, or maladaptive behaviors (e.g., addictions, pedophilia). While research suggests that these techniques can be highly effective, especially in the short term, there is some debate as to how lasting the effects can be. A criticism of a strict behavioral approach to treatment is that it does not address underlying causes of the behaviors. The principles of behaviorism and behavioral psychotherapy are often used most successfully in conjunction with other theoretical approaches.

COGNITIVE THERAPY

Since the 1960s cognitive psychotherapy has been the predominant force in the treatment of many psychological difficulties. The basic assumption of all forms of cognitive therapy is that thinking impacts feeling. For example, cognitive therapists posit that an individual may be feeling depressed because of certain thoughts the person has (e.g., I am not good enough). In contrast to behaviorisms focus on observable behaviors, the aim of cognitive therapy is to address, challenge, and alter maladaptive thoughts and cognitions. This can be done in many ways.

Developed by Ellis, Rational Emotive Therapy, also known as Rational Emotive Behavior Therapy, is a confrontational form of cognitive therapy that involves active and direct confrontation of an individuals irrational beliefs. This type of intervention was intended by Ellis to be somewhat jarring to patients so as to highlight how individuals thoughts and beliefs were irrational appraisals of events that led to self-imposed suffering (e.g., depression, anxiety). As such, alleviation of symptoms came about by attacking these irrational thoughts directly.

Beck is known for developing a less confrontational, gentler approach to cognitive psychotherapy. Becks work, and many approaches that follow, focuses on correcting errors of reasoning called cognitive distortions. These distortions are said to create and maintain negative feelings such as anxiety or depression. For example, a young man engages in the cognitive distortion of catastrophizing (e.g., assuming the worst case scenario) when he believes that his public speaking will provoke unbearable anxiety and illicit embarrassing ridicule. In reality, however, the experience may just be uncomfortable. A cognitive therapist would address with this young man the distortions of his thinking. Other cognitive distortions include overgeneralization, all-or-nothing thinking, and jumping to conclusions. All of these distortions are automatic in nature and the process of cognitive psychotherapy works to reprogram these thoughts into more adaptive ones. Technically, cognitive psychotherapy tends to be directive with an emphasis on self-monitoring, problem solving skills, behavioral experiments, and improved decision making. Many cognitive therapists utilize homework assignments to encourage patients to continue monitoring their thoughts and feelings when outside the consulting room.

The term cognitive-behavioral psychotherapy is often used to describe the natural and practical mix of many of the cognitive and behavioral techniques described. In general, cognitive and cognitive-behavioral therapy utilize a much more structured and guided approach. It has proven to be a highly effective, efficient, and often time-limited treatment of many psychological disorders. Its structure also lends itself well to empirical investigation. Cognitive and cognitive-behavioral psychotherapy is the predominate form of psychotherapy being practiced in the United States today.

HUMANISTIC THERAPY

Having its roots in existential philosophy, humanistic psychotherapy is based on the ideas and practice of Abraham Maslow (19081970) and Carl Rogers (19021987). Often referred to as a third force of modern psychology and psychotherapeutic technique, humanistic psychotherapy represents an alternative to the larger psychoanalytic and cognitive-behavioral approaches. Both Maslow and Rogers focused on the ideas of psychological growth and deemphasized the notion of mental illness. Developed in the 1960s, humanistic psychotherapy posits that humans have an innate desire to maximizing personal growth and fulfillment, a goal termed by humanistic thinkers as self-actualization. The blocking of self-actualization is viewed by humanistic therapists as the source of psychological suffering.

Perhaps more than any other clinician, Rogerss person-centered therapy illuminated the more universally practical components of psychotherapy, regardless of orientation. His focus on a genuine, empathic, and honest relationship between therapist and sufferer has been viewed as instrumental across many therapeutic disciplines. Humanistic psychotherapy tends to be non-directive. The humanistic psychotherapist focuses on the patients current feelings and experiences. The goal of Rogerss type of psychotherapy is to listen in an empathic way that allows the patient to feel heard and understood. It was this understanding, Rogers believed, that helped patients navigate personal roadblocks and live more fulfilled and meaningful lives. Other important variants of humanistic psychotherapy were practiced by Rollo May (1909-1994), Victor Frankl (19051997) and James Bugental (b. 1915).

OTHER PSYCHOTHERAPIES

The various practices described share in common the most traditionally recognized form of psychotherapy: one trained professional listening and speaking with a suffering individual. There are, however, other forms of psychotherapy that deserve mention. As early as the 1940s, psychotherapy in a group setting was an accepted form of treatment.

The unique benefits of the interpersonal experience coupled with the increased patient-to-therapist ratio maintains group psychotherapy as a popular alternative to individual psychotherapy. Support groups led by lay persons or fellow suffers, such as Alcoholics Anonymous, remain a popular treatment choice for individuals. Specific psychotherapies have been designed to work with families, couples, or even in industrial settings. Play therapy is often a method used by practitioners working with children. There are also different forms of psychotherapy that involve the use of music or art. The variety of problems, populations, theoretical orientations, and modalities, coupled with each psychotherapists individual style, makes the number of different types of psychotherapy virtually endless.

BIOLOGICAL CONSIDERATIONS AND RESEARCH

The biological treatment of psychological distress has become inextricably linked to current ideas about psychotherapy. The 1950s marked an explosion of scientific research that led to new understandings about the connection between brain chemistry and psychological disorders. Most notably, the advent of psychotropic medication demonstrated that medicines could influence individuals thinking, feelings, and behaviors in ways that brought about relief of symptoms. This development has drastically changed the way people suffering from mental health issues receive treatment. Though it has not supplanted psychotherapy as a treatment modality, psychopharmacology has proven to be an important aspect of treating many disorders. Findings suggest that for most mental health issues, a combination of psychotherapy and medication is often more effective than either alone or none at all.

Critics of the biological approach often state that medication alone treats only symptoms and does not address underlying, more psychological causes, often leaving individuals dependent on medications to maintain a sense of mental health. The effectiveness and efficiency of symptom relief that some medication has demonstrated, however, solidifies the medical treatment of mental illness as an important modality that is here to stay. That said, new developments in neuroscience, brain imaging, and research techniques are beginning to demonstrate how psychotherapy alone can alter brain chemistry. This nascent line of research has begun focusing the historically fuzzy distinction between mind and body that has puzzled philosophers and scientists for thousands of years.

Psychiatry itself is a biologically oriented field. As compared to other mental health fields such as clinical psychology, counseling psychology, and social work, modern psychiatric training involves relatively little instruction or experience in the practice of psychotherapy. This has not always been the case. At the height of its popularity in the United States, psychoanalysis was practiced almost exclusively by psychiatrists. It was only in the late 1980s that psychologists, social workers, and counselors were first accepted into American psychoanalytic training institutes. Although some psychiatrists practice various types of psychotherapy as part of their profession, most do not and the balance of psychotherapy practice has shifted to non-medically trained professionals. As a medical profession with prescription privileges, however, psychiatrists are the most knowledgeable and well-trained in the area of psychotropic medication and the biological treatment of mental illness.

In the study of mental health treatment there is a growing call for the introduction and dissemination of psychotherapy approaches to be scientifically sound and have evidence-based proof of effectiveness. This comes from a social value of consumer protection as well as the financial pressures inherent in increasing health care costs. The structured nature of cognitive and behavioral psychotherapy techniques have made these forms of treatment better suited to traditional experimental designs and standardization, whereas the less structured and more individualized psychoanalytic and humanistic treatments present more complicated research challenges. This makes comparing the effectiveness of one type of therapy versus another understandably problematic. What constitutes proof is also a matter of debate among researchers, practitioners, and patients alike. While the scientific study of psychotherapy process and outcome likely will continue to illuminate and inform the public about treatment options, it is important to always consider the limitations of such research.

Debates between theoretical camps of psychotherapy have had a history of contention, each, at times, extolling the virtues of their own techniques and criticizing the deficits of the others. This debate has also been informative, propelling the understanding of what helps troubled people feel better. In some ways the debate is like the fable of the six blind men asked to describe an elephant to one another. Having only the sense of touch, one man described the smooth coolness of the ivory tusk, another the furrowed curve of the trunk; a third the wispy tuft of the tail, and so on. Each man could hardly believe that he was describing the same thing as the other.

SEE ALSO Anxiety; Classical Conditioning; Depression, Psychological; Emotion; Existentialism; Freud, Sigmund; Maslow, Abraham; Medicine; Mental Illness; Operant Conditioning; Pavlov, Ivan; Psychoanalytic Theory; Psychology; Psychoneuroendocrinology; Skinner, B. F.

BIBLIOGRAPHY

Beck, Aaron T. Cognitive Therapy and the Emotional Disorders. 1976. New York: International Universities Press.

Beck, Judith S. Cognitive Therapy: Basics and Beyond. 1995. New York: Guilford Press.

Frank, Jerome D., and Julia B. Frank. Persuasion and Healing: A Comparative Study of Psychotherapy, 3rd ed. 1993. Baltimore, MD: Johns Hopkins University Press.

Freud, Sigmund. New Introductory Lectures on Psycho-Analysis. 1933. New York: W. W. Norton.

McWilliams, Nancy. Psychoanalytic Psychotherapy: A Practitioners Guide. 2004. New York: Guilford Press.

Prochaska, James O., and John C. Norcross. 2006. Systems of Psychotherapy: A Transtheoretical Analysis, 6th ed. Pacifica Grove, CA: Thomson Brooks/Cole.

Rogers, Carl. On Becoming a Person. 1961. Boston: Houghton Mifflin.

Skinner, B. F. Science and Human Behavior. 1953. New York: Macmillan.

Yalom, Irivin D., and Molyn Leszcz. 2005. The Theory and Practice of Group Psychotherapy, 5th ed. New York: Basic Books.

Steven J. Hanley

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Psychotherapy

Psychotherapy

Definition

Psychotherapy can be defined as a means of treating psychological or emotional problems such as neurosis or personality disorder through verbal and nonverbal communication. 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

TYPES OF PSYCHOTHERAPY
Type Description Disciplines Proponents
Psychodynamic Based on psychoanalysis, the psychodynamic approach believes behavior and personality stem from the unconscious wishes and conflicts from childhood. Psychoanalysis, Jungian analysis, Gestalt therapy Client-centered therapy, and somatic or body therapies Sigmund Freud, Carl Jung, Alfred Adler, Erich Fromm, Karen Horney, Erik Erikson, and Frederick (Fritz) Perls
Behavioral Encompasses various behavior modification techniques and theories Assertiveness training/social skills training, operant conditioning, hypnosis/hypnotherapy, sex therapy, systematic desensitization, etc. Joseph Wolpe
Cognitive Focuses on the influence thoughts have on behavior Rational-emotive therapy and reality therapy Albert Ellis, William Glasser
Family systems Believes behavior in influenced by family dynamics and attempts to modify relationships within the family Family therapy Murray Bowen

other forms of psychotherapy. Psychoanalysis is therapy based upon the work of Austrian physician Sigmund Freud (18561939), 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 (17341815) 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 (18251893). 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, un-known mindthe 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 sexbased 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 psychotherapyto 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 & 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.

Training & certification

Though the actual clinical practice of psychotherapy is very much the same among disciplines, therapists come from a variety of different fields, including medicine, psychology, social work, and nursing.

Psychiatrists are required to complete four years of medical school and one year of internship, followed by a three-year residency in psychiatry. In order to be a psychoanalyst, a minimum of three years further training at a psychoanalytic institute is necessary, along with personal ongoing analysis.

Psychologists earn a Ph.D. in clinical psychology followed by a year of supervised practice, and additionally may take specialized training at a specific psychotherapeutic school, including therapy for themselves.

Social workers who specialize in mental health must earn a master's degree or doctorate before being allowed to practice.

Psychiatric nurses generally earn a master's degree and practice in hospitals or community mental health centers.

Most states in the United States require a license to practice as a psychotherapist, and by law in the majority of the states, they are accountable only to the other members of their profession.

Resources

BOOKS

Clayman, Charles B., M.D. American Medical Association Home Medical Encyclopedia. New York: Random House, 1989.

Coleman, James C. Abnormal Psychology and Modern Life. Glenview, Illinois: Scott, Foresman and Company, 1972.

Engler, Jack, and Daniel Goleman. The Consumer's Guide to Psychotherapy. New York: Simon & Schuster, 1992.

Taber, Clarence Wilbur. Taber's Cyclopedic Medical Dictionary. F. A. Davis Co., 1997.

OTHER

American Group Psychotherapy Association. "About Group Psychotherapy." http://www.agpa.org (1999).

CNN. "A Century Later, Science Still Grapples with Freud." http://www.cnn.com.

Electric Library. "Group Psychotherapy." http://www.encyclopedia.com (1999).

Lucidcafe. "Sigmund Freud, Austrian Originator of Psycho-Analysis." http://www.lucidcafe.com.

Joan Schonbeck

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Psychotherapy

PSYCHOTHERAPY

Psychotherapy involves individual or group meetings with a therapist trained to use various techniques to treat psychopathology. Psychiatrists, psychologists, nurses, social workers, and counselors can provide psychotherapy interventions to older adults with psychiatric disorders. Review of the literature suggests that psychotherapy is an effective treatment intervention, either alone or in conjunction with medication, for many psychological disorders in older adults.

Advanced age can be accompanied by bereavement, relationship conflicts (either marital or with adult children), or chronic or acute illness. Although such difficulties are more common among older adults than younger adults, the development of psychiatric symptoms as a response to life stress is never normal, and most older adults remain psychologically healthy in the face of difficult circumstances.

The normal aging process does provide challenges for therapists in adapting psychotherapy to older patients. Some types of cognitive function decrease in elderly persons, although the distribution of function is widely varied. Therapists may need to proceed through material at a slower pace, or in smaller units with more repetition. Memory aids, such as tape recordings of sessions, written notes, and reminders, can help patients recall information. Clearly defined goals and strategies, plus an agenda and structure for each session, are beneficial. Also, elderly patients are more likely to have loss in visual or auditory acuity or have coexisting medical problems, requiring adaptation of standard techniques.

Many elderly persons with medical problems take multiple medications, making it difficult for a psychiatrist to prescribe and manage additional medications. This makes psychotherapy an appealing option for older adults. Though research suggests the most promising treatment for late-life psychological disorders is combined medication and psychotherapy, psychotherapy alone is also an effective treatment option. Just as there is a myriad of medications for treating psychological disorders, psychotherapy options are quite varied as well, and depend upon structure, goals, and suitability to the problem of depression, anxiety, or dementia.

Depression

Antidepressants have traditionally been regarded as a primary treatment, yet psychotherapy has been shown by several studies to be at least equally effective in treating depression in elderly persons. Psychodynamic psychotherapy, life review and reminiscence therapy, interpersonal therapy, cognitive-behavioral therapy, and group therapy are commonly used treatments of late-life depression.

Psychodynamic therapy. This therapy is rooted in psychoanalytic theory, viewing current interpersonal and emotional experience as influenced by childhood experience. According to this theory, early childhood molds a complex inner world forged by unconscious and conscious mental processes. Relationships, such as that with one's mother, are internalized and create a sense of self. A life event, such as a loss, may initiate conflict within that inner world, and unresolved conflict manifests as depressive symptoms. In therapy, these conflicts are explored and resolved.

Life review and life reminiscence therapy. These therapies are also psychodynamically oriented. Life review revisits and resolves past conflicts and reintegrates life events through a review of life experiences. Reminiscence differs from life review by focusing on social intimacy and self-esteem through past experiences, instead of directly resolving past conflicts. The process includes autobiographies, visits to childhood locations, photographs, reunions, and scrapbooks.

Interpersonal psychotherapy (IPT). This time-limited outpatient therapy focuses on four problem areas of current interpersonal issues: interpersonal disputes, role transitions, interpersonal deficits, and abnormal grief. The therapist and client decide in which direction to focus. The immediate therapeutic objective is to alleviate depressive symptoms; however, the future goal is to improve social functioning and interpersonal relationships. Role-playing, communication analysis, clarification of wants and needs, and links between affect and environmental events are some of the techniques used. Suggested adaptations of IPT to elderly patients by clinicians include flexibility of session length, focusing on long-standing role disputes, and the need to help patients with practical problems. IPT has been proven to be as effective in treating elderly patients as specific medications, with longer-lasting effects when combined with antidepressant medication.

Cognitive-behavioral therapy (CBT). The cognitive model of depression is based on the idea that, due to early learning, depressed individuals develop stable, albeit distorted, cognitive schemas that predispose them to negatively interpret life events. CBT usually consists of three components: First, the patient is pressed to increase reinforcing activities and pleasurable experiences through behavioral activation. Then, automatic dysfunctional thoughts are exposed, challenged, and substituted with more accurate cognition. Finally, the cognitive schemas driving these automatic thoughts are explored and changed to accurately fit the patient's experiences. Behavioral activation and automatic-thought modification have been shown to be effective either individually or in conjunction with each other.

Social problem-solving therapy (PST) falls within the realm of cognitive and behavioral interventions and is anchored in a model in which ineffective coping skills under stress leads to deterioration of problem-solving abilities and subsequent depression. PST approaches involve recognizing and altering maladaptive attitudes linked to ineffective problem-solving while increasing motivation to generate alternative solutions, make decisions, and assess solution utility.

Group therapy. Group therapy consists of a group of patients meeting regularly with a therapist or therapist team that leads the discussion. Some group therapy emphasizes the teaching of coping skills or social skills, while other groups may focus on supportive and expressive resolution of individual difficulties in a group setting. Older patients may prefer group therapy because it can provide a social network of support, as well as decrease the cost of care.

Anxiety disorders

There are three central cognitive-behavioral techniques in the treatment of anxiety: relaxation training, cognitive restructuring, and exposure. Relaxation training consists of tension-relaxation exercises involving different muscle groups and adaptations of the progressive relaxation techniques of Bernstein and Berkovec. Cognitive restructuring involves identifying cognitions associated with fear and modifying them into alternative, less distressing cognitions, as well as teaching coping strategies. Patients are also required to monitor thoughts and practice strategies outside therapy sessions. Exposure helps to manage phobias and consists of gradual real-life exposure or imagined exposure to the phobic situation. For example, a person with a phobia of the dentist, will, gradually and with therapist support, look at pictures of dentists, be in an examination room with a dentist and patient, and then have dental work performed. The patient is thus safely exposed to her or his fear.

There is virtually no research on psychotherapeutic treatment effectiveness in elderly anxious patients. However, Sheikh and Cassidy recommend that treatment strategies can be based on the research with younger populations and modified for older patients. The literature has demonstrated effectiveness of CBT for different anxiety disorders in adults, including generalized anxiety disorder (GAD), panic disorder, phobias, and obsessive-compulsive disorder. CBT interventions have been found successful, either alone or with medication for all of these disorders. Also, research suggests that post-traumatic stress disorder (PTSD) can be chronic, continuing into old age from an earlier event. Snell and Padin-Rivera have reported that group psychotherapy is effective in treating elderly veterans with PTSD.

Dementia

Patients with dementia have worsening memory impairment in addition to compromised functioning in at least one other cognitive domain. Alzheimer's disease constitutes the most frequent cause of late-life dementia. Psychotherapy with clients with dementia is made difficult by the loss of language, which complicates communication between client and therapist. The relative success of psychotherapy correlates with the level of connection and communication achieved between the therapist and client. When that client suffers from dementia, the therapist's job becomes more challenging. Subtler subvocal and paralinguistic cues of communication must be utilized in an effort to avoid clinical detachment.

Considerable debate exists on the prospect of memory interventions and the proposed success for patients with Alzheimer's disease. However, techniques using environmental adaptations and external memory aids have been used to help patients with dementia. Reality orientation programs have implemented the use of signs, diaries, memory wallets, and recordings to help patients recall personal information. Cognitive stimulation programs have also been increasingly advocated. Validation therapy acknowledges the truth of feelings behind acting-out behaviors in an effort to decrease these behaviors.

Barriers to treatment

The present body of research in geropsychology supports psychotherapy as a treatment option for older persons with psychological disorders. However, several limitations curb its effectiveness. Older adults are less likely to report psychological problems and to seek help from mental health professionals or physicians than are younger adults. This may be due to social stigma associated with treatment for psychological problems. Psychological problems in elderly persons may also be underdiagnosed because they may pass off psychiatric symptoms as signs of physical illness. The responsibility for the diagnosis of psychiatric disorders in older adults is often left to primary care physicians, who have a limited amount of time with their patients. Also, mental health professionals with expertise in geriatric psychology are quite few, and therefore may not be available for referral.

Even when diagnosed, not all late-life psychological problems are treated adequately. Ageism still pervades American health policy and the minds of many health care providers. Research by Ford and Sbordone found that psychiatrists viewed elderly patients as less likely to respond to treatment than their younger counterparts. Only since 1989 has Medicare covered outpatient mental health care, and it still only covers 50 percent of the cost, compared with 80 percent coverage of physical health care costs.

Despite these barriers, there is convincing evidence that older adults respond as well to psychotherapy as do younger adults. It is important to begin to address the individual, physician, and policy barriers that prevent older adults with psychiatric disorders from receiving aggressive treatment.

Christine M. Vitt Autumn Edenfield Thomas R. Lynch

See also Anxiety; Cognitive-Behavioral Therapy; Dementia; Depression; Geriatric Psychiatry; Interpersonal Therapy; Life Review; Problem Solving Therapy; Psychological Assessment.

BIBLIOGRAPHY

Allen, R.; Walker, Z.; Shergill, P.; Dath, P.; and Katona C. "Attitudes to Depression in Hospital Inpatients: A Comparison Between Older and Younger Subjects." Aging and Mental Health 2 (1998): 3639.

Arean, P. A.; Perri, M. G.; Nezu, A. M.; Schein, R. L.; Christopher, F., and Joseph, T. X. "Comparative Effectiveness of Social Problem-Solving Therapy and Reminiscence Therapy as Treatments for Depression in Older Adults." Journal of Consulting and Clinical Psychology 61 (1993): 10031010.

Beck, A. T. Depression: Clinical, Experimental and Theoretical Aspects. New York: Harper and Row, 1967.

Bernstein, D. A., and Borkovec, T. D. Progressive Relaxation: A Manual for the Helping Professions. Champaign, Ill.: Research Press, 1973.

Beutler, L. E.; Scogin, F.; Kirkish, P.; Schretlen, D.; et al. "Group Cognitive Therapy and Alprazolam in the Treatment of Depression in Older Adults." Journal of Consulting and Clinical Psychology 55 (1987): 550556.

Butler, R. N. "The Life Review: An Interpretation of Reminiscence in the Aged." Psychiatry 26 (1974): 6576.

Duffy, M., ed. Handbook of Counseling and Psychotherapy with Older Adults. New York: John Wiley & Sons, 1999.

Ford, C. V., and Sbordone, R. J. "Attitudes of Psychiatrists toward Elderly Patients." American Journal of Psychiatry 137 (1980): 571575.

Frank, E.; Frank, N.; Cornes, C.; Imber, S. D.; Miller, M. D.; Morris, S. M.; and Reynolds, C. F., III "Interpersonal Psychotherapy in the Treatment of Late-Life Depression." In New Applications of Interpersonal Psychotherapy. Edited by G. L. Klerman and M. M. Weissman. Washington D.C.: American Psychiatric Press, 1983. Pages 167198.

Hirschfeld, R.; Keller, M.; Panico, S.; Arons, B.; Barlow, D.; Davidoff, F.; et al. "The National Depressive and Manic Depressive Association Consensus Statement on the Undertreatment of Depression." Journal of the American Medical Association 277 (1997): 333340.

Reynolds, C. F., III; Frank, E.; Perel, J. M.; Imber, S. D.; Cornes C.; et al. "Nortriptyline and Interpersonal Therapy as Maintenance Therapies for Recurrent Major Depression: A Randomized Controlled Trial In Patients Older Than 59 Years." Journal of the American Medical Association 281 (1999): 3945.

Scogin, F., and McElreath, L. "Efficacy of Psychosocial Treatments for Geriatric Depression: A Quantitative Review." Journal of Consulting and Clinical Psychology 62 (1994): 6974.

Sheikh, J. I., and Cassidy, E. L. "Treatment of Anxiety Disorders in the Elderly: Issues and Strategies." Journal of Anxiety Disorders 14 (2000): 173190.

Snell, F. I., and Padin-Rivera, E. "Group Treatment for Older Veterans with Post-Traumatic Stress Disorder." Journal of Psychosocial Nursing and Mental Health 35 (1997): 1016.

Teri, L., and McCurry, S. M. "Psychosocial Therapies." In The American Psychiatric Press Textbook of Geriatric Neuropsychiatry. Edited by C. D. Coffey, J. L. Cummings, et al. Washington, D.C.: American Psychiatric Press, 1994. Pages 662682.

Zarit, S. H., and Knight, B. G., eds. A Guide to Psychotherapy and Aging: Effective Clinical Interventions in a Life-Stage Context. Washington, D.C.: American Psychological Association, 1976.

Zeiss, A. M., and Breckenridge, J. S. "Treatment of Late-Life Depression: A Response to the NIH Consensus Statement." Behavior Therapy 28 (1997): 321.

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Psychotherapy

PSYCHOTHERAPY

Psychotherapy is a method for the treatment of psychological problems, which are often expressed somatically.

Therapies can be classified following various models. In the cathartic model, the patient is urged to speak, in order to expel or get rid of his suffering. The therapist favors the act of communication over the content of what is expressed. In the reparative model, the therapist tries to help the patient by bringing love and understanding to cancel out the prejudice he has been victim of or to make up for some internal deficit. With the educational model, the therapist guides the patient in the "right" direction, advising him as to his life choices. He "corrects" the mistakes of nature, parental education, or social environment.

Freud demarcated himself dramatically from hypnosis and cathartic post-traumatic abreaction in developing an original psychotherapeutic dimension, centered on the exploration of the unconscious, the study of psychic functioning and intrapsychic conflicts, and transference-counter-transference relation (Ellenberger, 1970). He emphasized psychic reality understood through the reality of narrative. Accordingly, the psychotherapy to be discussed here is psychoanalytic psychotherapy, situated within the context of the theory, technique, and framework of psychoanalysis.

The term psychotherapy surfaced for the first time in 1872, while the term psychoanalysis came to be known only in 1896. But it wasn't until 1905, in his article "On Psychotherapy" (1905a [1904]) that Freud clearly distanced himself from hypnosis by opposing the cathartic method to the analytic method. For a number of decades, he had used the terms psychoanalysis and psychotherapy interchangeably, but shortly before 1920 he abandoned the term psychotherapy definitively, qualifying his method from then on as psychoanalysis. This abandonment occurred after the defections of Alfred Adler, Wilhelm Steckel, and Carl G. Jung and, in a second stage, his differences with Otto Rank and Sàndor Ferenczi. In effect, some of those in Freud's circle were advocating a more active attitude on the part of the psychoanalyst to accelerate the psychoanalytic process as well as to shorten its duration. A reaction was not long in coming: Ernest Jones and Edward Glover emphatically denounced any deviation from a traditional treatment, and any psychotherapeutic approach, such as a return to pure suggestion of the preanalytic period (Robert Wallerstein). This traditional position was the "official" one of the psychoanalytic movement for a very long time. Nevertheless, in the 1950s the term psychoanalytic psychotherapy gained currency among psychoanalysts themselves, who came to believe that certain changes had to be made in the framework of the classical psychoanalytic model, which was not appropriate for the psychopathology of some patients.

As of 2005, questions about the differences between psychoanalytic psychotherapy and psychoanalysis are still posed in terms of process: how, for example, could the psychoanalytical process be influenced by reworking the framework? The face-to-face position implies seeing the analyst, being able to observe his gestures and unconscious corporal reactions, to hang onto his every word and look into his eyes. Likewise, not being seen by the analyst can result in the patient's feeling lost, cast into the abyss, or on the contrary allow him to feel emotions that would be blocked by a face-to-face expression. However, these differences in formal framework (frequency of sessions, face-to-face or couch-armchair, more or less active position of the psychoanalyst, etc.) are insufficient, in themselves, to characterize the type of process underway. In any event, according to René Roussillon (1986), a psychoanalytic approach can only explore certain portions of the psyche. Even where the choice of the framework (psychotherapy or psychoanalysis) favors a psychoanalytical approach, this is not always necessarily the same one. Finally, the psychotherapeutic process is characterized by a transference of partial objects to the psychoanalyst while, in the psychoanalytical process, these partial transferences would be worked through until there was a full development of the transference neurosis.

Other authors have brought out differences in therapeutic aims. Ideally, in psychoanalysis the framework should allow exploration of the patient's unconscious with the psychoanalyst following the patient as far as he is able to go. According to this very strict definition, psychoanalysis does not, a priori, aim at a therapeutic goal. Instead, the therapeutic result emerges from the psychoanalytic process. By contrast, psychotherapy does imply a goal: to diminish the suffering of the patient, allowing him to return to work, and so on. However, these differences are not always so clear-cut in the reality of practice among psychoanalysts and psychotherapists. Whatever technique is chosen, standard treatment or face-to-face, the psychoanalyst has a "psychoanalytic function," so that any psychotherapeutic approach undertaken by the psychoanalyst involves psychoanalytical work.

Psychotherapy cannot be isolated from its social context. After the Second World War, the development of social health care programs allowed compensation for psychiatric care and the establishment of a variety of facilities for the treatment of specific pathologies. Many of the professionals practicing in these institutional settings were trained in psychoanalytic psychotherapy by psychoanalysts working in the field, or else were educated in teaching institutes that structured their curricula in accordance with psychoanalytic psychotherapy. These professionals engaged in personal psychoanalytic work without, necessarily, matriculating in the training courses of psychoanalytic societies; but very often a veritable analytical process developed with patients that they were treating in their institutions.

Accordingly, the wish of Freud (1919a [1918]) has been fulfilled, "to alloy the pure gold of analysis freely with the copper of direct suggestion" (p. 168) to create "a psychotherapy for the people" (p. 168), and to alleviate a greater portion of "the vast amount of neurotic misery which there is in the world" (p. 166), which the small number of psychoanalysts cannot greatly affect. Clearly Freud wanted to see the traditional treatment adapted to treat a greater number of patients as soon as "the conscience of society will awake" (p. 167). The concern to preserve psychoanalytic thought in some institutional form has led national societies of psychoanalytic therapy to create organizations like the European Federation for Psychoanalytic Psychotherapy (EFPP).

Psychoanalysis and psychoanalytic psychotherapy, and their particular adaptations (child psychoanalysis, group psychoanalysis, analytical psychodrama, psychoanalytical couple or family therapy, etc.) constitute a "psychoanalytic field," very different in nature from therapeutic techniques. The latter, basically anti-analytic, may be considered as "an ensemble of ready-made counter-transference approaches meant to function as institutional defenses, as a system of alleviating anxieties prompted by the relation to the other," representing "group-oriented ideologies" (Roussillon, 1986).

The psychoanalytical approach often requires much time since it favors the process rather than the suppression of symptoms, which is the case with non-analytical therapeutic techniques. In the interest of budgetary considerations, social agencies that reimburse psychic treatment try to limit its duration or the amount of compensated sessions, or else to favor approaches that aim to eliminate symptoms very quickly, without taking account of their function in the overall psychic economy of the patient. The psychoanalytical approach runs the risk of losing its liberty and revolutionary quality in submitting overly to social constraints. Countries that seek to integrate the psychoanalytic approach in the master plan of their treatment policies risk making it shed its special and irreverent identity, becoming increasingly therapeutic, in the sense of "suppressing symptoms" (Frisch, 1998). The notion of conflict, central in psychoanalysis, has consequently been introduced in the psychoanalytic movement on issues relating to its future and its identity: it must either evolve toward isolation to maintain its purity (psychoanalysis), or adapt to social constraints to survive (psychoanalytical psychotherapy), but at the risk of losing its soul.

Serge Frisch

See also: Analyzability; Cathartic method; Deutsches Institut für Psychologische Forschung und Psychotherapie (Institut Göring); Directed daydream (R. Desoille); Face-to-face situation; Group psychotherapies; Hypnosis; Initial interview(s); "Lines of Advance in Psycho-Analytic Therapy"; Narco-analysis; Psychodrama; Psychoanalytic family therapy; Relaxation psychotherapy; Suggestion; Symbolic realization.

Bibliography

Ellenberger, Henri F. (1970). The discovery of the unconscious. The history and evolution of dynamic psychiatry. New York: Basic Books.

Freud, Sigmund. (1919a [1918]). Lines of advance in psycho-analytic therapy. SE, 17: 157-168.

Roussillon, René. (1986). Préface, in M. Berger (Ed.), Entretiens familiaux et champ transitionnel. Paris: Presses Universitaires de France.

Wallerstein, Robert S. (1995). The talking cures. New Haven, CT, and London: Yale University Press.

Further Reading

Bergman, Anni. (2002). Changing psychoanalytic psychotherapy into psychoanalysis. International Journal of Psychoanalysis, 83, 245-248.

Kernberg, Otto. (1999). Psychoanalysis, psychoanalytic psychotherapy and supportive psychotherapy. International Journal of Psychoanalysis, 80, 1075-1092.

Stone, Leo. (1954). The widening scope of indications for psychoanalysis. Journal of the American Psychoanalytic Association, 2, 567-594.

Wallerstein, Robert S. (1989). Psychoanalysis and psychotherapy: An historical perspective. International Journal of Psychoanalysis, 70, 563-592.

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Psychotherapy

Psychotherapy

Definition

The treatment of mental or emotional disorders and adjustment problems through the use of psychological techniques rather than through physical or biological means.

Description

Psychoanalysis , the first modern form of psychotherapy, was called the "talking cure," and the many varieties of therapy practiced today are still characterized by their common dependence on a verbal exchange between the counselor or therapist and the person seeking help. The therapeutic interaction is characterized by mutual trust, with the goal of helping individuals change destructive or unhealthy behaviors, thoughts, and emotions. It is common for experienced therapists to combine several different approaches or techniques.

Psychodynamic approach

Freudian psychoanalysis places emphasis on uncovering unconscious motivations and breaking down defenses. Therapy sessions may be scheduled once or even twice a week for a year or more. This type of therapy is appropriate when internal conflicts contribute significantly to a person's problems.

Behavioral techniques

In contrast to the psychodynamic approach, behavior-oriented therapy is geared toward helping people see their problems as learned behaviors that can be modified, without looking for unconscious motivations or hidden meanings. According to the theory behind this approach, once behavior is changed, feelings will change as well. Probably the best-known type of behavioral therapy is behavior modification , which focuses on eliminating undesirable habits by providing positive reinforcement for the more desirable behaviors.

Another behavioral technique is systematic desensitization , in which people are deliberately and gradually exposed to a feared object or experience to help them overcome their fears. A person who is afraid of dogs may first be told to visualize a dog, then is given a stuffed toy dog, then exposed to a real dog seen at a distance, and eventually forced to interact with a dog at close range. Relaxation training is another popular form of behavior therapy. Through such techniques as deep breathing, visualization, and progressive muscle relaxation, clients learn to control fear and anxiety.

Cognitive methods

Some behavior-oriented therapy methods are used to alter not only overt behavior, but also the thought patterns that drive it. This type of treatment is known as cognitive-behavioral therapy (or just cognitive therapy). Its goal is to help people break out of distorted, harmful patterns of thinking and replace them with healthier ones. Common examples of negative thought patterns include magnifying or minimizing the extent of a problem; "all or nothing" thinking (i.e., a person regards himself as either perfect or worthless); overgeneralization (arriving at broad conclusions based on one incident, for example); and personalization (continually seeing oneself as the cause or focus of events).

In cognitive-behavioral therapy, a therapist may talk to the client, pointing out illogical thought patterns, or use a variety of techniques, such as thought substitution, in which a frightening or otherwise negative thought is driven out by substituting a pleasant thought in its place. Clients may also be taught to use positive self-talk, a repetition of positive affirmations. Cognitive therapy usually takes a longer amount of time as it treats more serious problems.

Couples therapy

Couples therapy focuses on the relationship between two people, typically who have a romantic or sexual connection. The therapy aims to concentrate on the problems of the relationship and make each partner feel that they have an equal role. The therapy can be administered by either a male or female therapist, but many couples feel that having both a male and female therapist in the session is beneficial.

Family and group therapy

Family therapy has proven effective in treating a number of emotional and adjustment problems. While the client's immediate complaint is the initial focus of attention, the ultimate goal of family therapy is to improve the interaction between all family members and enhance communication and coping skills on a long-term basis (although therapy itself need not cover an extended time period). Group therapy , which is often combined with individual therapy, offers the support and companionship of other people experiencing the same or similar problems and issues.

Therapy is terminated when the treatment goals have been met or if the client and/or therapist conclude that it is not working. It can be effective to phase out treatment by gradually reducing the frequency of therapy sessions. Even after regular therapy has ended, the client may return for periodic follow-up and reassessment sessions.

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Psychotherapy

Psychotherapy

The treatment of mental or emotional disorders and adjustment problems through the use of psychological techniques rather than through physical or biological means.

Psychoanalysis , the first modern form of psychotherapy, was called the "talking cure," and the many varieties of therapy practiced today are still characterized by their common dependence on a verbal exchange between the counselor or therapist and the person seeking help. The therapeutic interaction is characterized by mutual trust, with the goal of helping individuals change destructive or unhealthy behaviors, thoughts, and emotions. It is common for experienced therapists to combine several different approaches or techniques. The most common approaches are discussed below.

Psychodynamic approach

Freudian psychoanalysis places emphasis on uncovering unconscious motivations and breaking down defenses. Therapy sessions may be scheduled once or even twice a week for a year or more. This type of therapy is appropriate when internal conflicts contribute significantly to a personís problems. (For more information, see entry on Psychoanalysis).

Behavioral techniques

In contrast to the psychodynamic approach, behavior-oriented therapy is geared toward helping people see their problems as learned behaviors that can be modified, without looking for unconscious motivations or hidden meanings. According to the theory behind this approach, once behavior is changed, feelings will change as well. Probably the best-known type of behavioral therapy is behavior modification , which focuses on eliminating undesirable habits by providing positive reinforcement for the more desirable behaviors.

Another behavioral technique is systematic desensitization , in which people are deliberately and gradually exposed to a feared object or experience to help them overcome their fears. A person who is afraid of dogs may first be given a stuffed toy dog, then be exposed to a real dog seen at a distance, and eventually forced to interact with a dog at close range. Relaxation training is another popular form of behavior therapy . Through such techniques as deep breathing, visualization, and progressive muscle relaxation, clients learn to control fear and anxiety.

Cognitive methods

Some behavior-oriented therapy methods are used to alter not only overt behavior, but also the thought patterns that drive it. This type of treatment is known as cognitive-behavior therapy (or just cognitive therapy ). Its goal is to help people break out of distorted, harmful patterns of thinking and replace them with healthier ones. Common examples of negative thought patterns include magnifying or minimizing the extent of a problem; "all or nothing" thinking (i.e., a person regards himself as either perfect or worthless); overgeneralization (arriving at broad conclusions based on one incident, for example); and personalization (continually seeing oneself as the cause or focus of events).

In cognitive-behavioral therapy, a therapist may talk to the client, pointing out illogical thought patterns, or use a variety of techniques, such as thought substitution, in which a frightening or otherwise negative thought is driven out by substituting a pleasant thought in its place. Clients may also be taught to use positive self-talk, a repetition of positive affirmations. Cognitive therapy is usually provided on a short-term basis (generally 10-20 sessions).

Family and group therapy

Family therapy has proven effective in treating a number of emotional and adjustment problems. While the clientís immediate complaint is the initial focus of attention , the ultimate goal of family therapy is to improve the interaction between all family members and enhance communication and coping skills on a long-term basis (although therapy itself need not cover an extended time period). Group therapy , which is often combined with individual therapy, offers the support and companionship of other people experiencing the same problems and issues.

Therapy is terminated when the treatment goals have been met or if the client and/or therapist conclude that it isn't working. It can be effective to phase out treatment by gradually reducing the frequency of therapy sessions. Even after regular therapy has ended, the client may return for periodic follow-up and reassessment sessions.

Further Reading

Engler, Jack and Daniel Goleman. The Consumer's Guide to Psychotherapy. New York: Fireside, 1992.

Kanfer, Frederick H. and Arnold P. Goldstein, eds. Helping People Change: A Textbook of Methods. New York: Pergamon Press, 1991.

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psychotherapy

psychotherapy, treatment of mental and emotional disorders using psychological methods. Psychotherapy, thus, does not include physiological interventions, such as drug therapy or electroconvulsive therapy, although it may be used in combination with such methods. This type of treatment has been used in one form or another through the ages in many societies, but it was not until the late 19th cent. that it received scientific impetus, primarily under the leadership of Sigmund Freud. Although Freud's theoretical formulations have come sharply into question, his treatment method involving individualized client-psychologist sessions has been used in modified forms for years (see psychoanalysis).

Behavior therapy aims to help the patient eliminate undesirable habits or irrational fears through conditioning. Techniques include systematic desensitization, particularly for the treatment of clients with irrational anxieties or fears, and aversive conditioning, which uses negative stimuli to end bad habits. Humanistic therapy tends to be more optimistic, basing its treatment on the theory that individuals have a natural inclination to strive toward self-fulfillment. Therapists such as Carl Rogers and Abraham Maslow used a highly interactive client-therapist relationship, compelling clients to realize exactly what they are saying or how they are behaving, in order to foster a sense of self-awareness. Cognitive therapies try to show the client that certain, usually negative, thoughts are irrational, with the goal of restructuring such thoughts into positive, constructive ideas. Such methods include Albert Ellis's rational-emotive therapy, where the therapist argues with the client about his negative ideas; and Aaron Beck's cognitive restructuring therapy, in which the therapist works with the client to set attainable goals. Other forms of therapy stress helping patients to examine their own ideas about themselves.

Psychotherapy may be brief, lasting just a few sessions, or it may extend over many years. More than one client may be involved, as in marriage or family counseling, or a number of individuals, as in group psychotherapy.

See S. L. Garfield and A. E. Bergin, ed., Handbook of Psychotherapy and Behavior Change (4th ed. 1993); A. Roth et al., What Works for Whom?: A Critical Review of Psychotherapy Research (1996); W. Gaylin, Talk Is Not Enough: How Psychotherapy Really Works (2000).

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"psychotherapy." The Columbia Encyclopedia, 6th ed.. 2016. Retrieved June 28, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1E1-psychoth.html

psychotherapy

psychotherapy An imprecise term that may embrace a wide variety of psychological methods of treatment, group or individual, provided by specialist therapists for the treatment of mental and behavioural problems (usually non-psychotic). Psychotherapy may include directive therapies involving suggestion, such as hypnosis, as well as non-directive, behavioural, and psycho-dynamic therapies. Narrowly defined, it denotes psychoanalytic therapies, excluding full psychoanalysis.

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GORDON MARSHALL. "psychotherapy." A Dictionary of Sociology. 1998. Encyclopedia.com. 28 Jun. 2016 <http://www.encyclopedia.com>.

GORDON MARSHALL. "psychotherapy." A Dictionary of Sociology. 1998. Encyclopedia.com. (June 28, 2016). http://www.encyclopedia.com/doc/1O88-psychotherapy.html

GORDON MARSHALL. "psychotherapy." A Dictionary of Sociology. 1998. Retrieved June 28, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O88-psychotherapy.html

psychotherapy

psychotherapy (sy-koh-th'e-răpi) n. psychological (as opposed to physical) methods for the treatment of mental disorders and psychological problems. There are many different approaches to psychotherapy, including psychoanalysis, client-centred therapy, group therapy, and family therapy. See also behaviour therapy, cognitive behavioural therapy, counselling.
psychotherapeutic (sy-koh-th'e-ră-pew-tik) adj. —psychotherapist n.

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"psychotherapy." A Dictionary of Nursing. 2008. Encyclopedia.com. 28 Jun. 2016 <http://www.encyclopedia.com>.

"psychotherapy." A Dictionary of Nursing. 2008. Encyclopedia.com. (June 28, 2016). http://www.encyclopedia.com/doc/1O62-psychotherapy.html

"psychotherapy." A Dictionary of Nursing. 2008. Retrieved June 28, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O62-psychotherapy.html

psychotherapy

psy·cho·ther·a·py / ˌsīkōˈ[unvoicedth]erəpē/ • n. the treatment of mental disorder by psychological rather than medical means. DERIVATIVES: psy·cho·ther·a·peu·tic / -ˌ[unvoicedth]erəˈpyoōtik/ adj. psy·cho·ther·a·pist / -ˈ[unvoicedth]erəpist/ n.

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"psychotherapy." The Oxford Pocket Dictionary of Current English. 2009. Encyclopedia.com. 28 Jun. 2016 <http://www.encyclopedia.com>.

"psychotherapy." The Oxford Pocket Dictionary of Current English. 2009. Encyclopedia.com. (June 28, 2016). http://www.encyclopedia.com/doc/1O999-psychotherapy.html

"psychotherapy." The Oxford Pocket Dictionary of Current English. 2009. Retrieved June 28, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O999-psychotherapy.html

psychotherapy

psychotherapy Treatment of a psychological disorder by nonphysical methods. It is carried out either with an individual or group, and usually involves some sort of ‘talking cure’ and the development of a rapport between patient and therapist. Psychotherapy is often based on psychoanalysis, but also sometimes on behaviour therapy or other theories.

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"psychotherapy." World Encyclopedia. 2005. Encyclopedia.com. 28 Jun. 2016 <http://www.encyclopedia.com>.

"psychotherapy." World Encyclopedia. 2005. Encyclopedia.com. (June 28, 2016). http://www.encyclopedia.com/doc/1O142-psychotherapy.html

"psychotherapy." World Encyclopedia. 2005. Retrieved June 28, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O142-psychotherapy.html

psychotherapy

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"psychotherapy." Oxford Dictionary of Rhymes. 2007. Encyclopedia.com. 28 Jun. 2016 <http://www.encyclopedia.com>.

"psychotherapy." Oxford Dictionary of Rhymes. 2007. Encyclopedia.com. (June 28, 2016). http://www.encyclopedia.com/doc/1O233-psychotherapy.html

"psychotherapy." Oxford Dictionary of Rhymes. 2007. Retrieved June 28, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O233-psychotherapy.html

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