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The Nature of Psychotherapy

 What is the goal of psychotherapy?

When adults become dissatisfied or distraught with life and suspect that the reason lies within themselves, they are likely to seek help from someone with training and experience in such matters. These people seek therapy, which refers to treatment of behavioral, bodily, or psychological disorders. Mental health professionals who have been trained to deal with the psychological problems of others include clinical, counseling, and school psychologists, and psychiatrists. The special kind of help they provide is called psychotherapy. Psychotherapy involves three things: Verbal interaction between a therapist and client; the development of a supportive and trusting relationship; and an analysis by the therapist of the client’s problems, including suggestions for overcoming those problems.

Psychotherapy literally means “healing of the soul.” In early times, people often thought that psychological disturbances represented some sort of moral or religious shortcoming. People with personal problems were sometimes viewed as being inhabited by demons, and treatment consisted of exorcism—the driving out of these demons by religious ceremonies or physical punishment. Within the past 200 years, however, views of psychological disorders have changed. Psychological disorders slowly came to be thought of as diseases, and the term mental illness was applied to many psychological problems.

One of the earliest reformers was Philippe Pinel (1745–1826) who, in 1792, became the chief physician at the Paris asylum Bicêtre. His unprecedented step of unchaining mental patients who were shackled to the walls changed society’s view of people with psychological disturbances. Society began to see that the psychologically disturbed were not possessed by demons, but rather needed care and treatment for their illnesses. Pinel believed that extreme social and psychological stresses were a major cause of psychological disorders. He encouraged close contact with patients and encouraged them to discuss their personal problems.

Nevertheless, many psychotherapists feel that the term mental illness has outlived its usefulness and that, in fact, it may now be doing more harm than good. The trouble with letting a person think of himself as mentally ill is that he sees himself in a passive, helpless position. He sees his troubles as being caused by forces over which he has no control. By thinking of himself in this way, the person can avoid taking responsibility for his own situation and for helping himself change.

Development of Psychotherapy

Different types of psychotherapy developed over the years. Sigmund Freud, who created psychoanalysis, began his career in the late 1800s as a neurologist. A neurologist is a physician who studies the physical structure and function of the neurons and brain. Freud became interested in hypnosis, which led him to explore the unconscious mind. Ultimately his education in medicine led him to develop psychoanalysis, the first “talk” therapy in the Western world. For many years, psychoanalysis was the primary method of therapy for individuals with psychological disorders. In psychoanalysis, power revolves around the physician. The physician tells the patient what is wrong with him or her. Patients are expected to follow the psychoanalyst’s instructions on how to improve their lives.

Following World War II, the number of psychologists in the United States increased dramatically. In the mid-1900s, people were less willing to rely on authority. The 1960s saw a boom in the “human potential” movement—people believed they were in charge of their own destinies. They would not be controlled by some aloof authority such as a remote psychotherapist. This led to the creation of humanistic therapy, which believed that, under the right circumstances, individuals could heal themselves. During this time, a number of philosophers, including Jean-Paul Sartre, wrote about the meaning of life for the individual. Humanistic therapy, with its emphasis on self, drew on this thinking. Carl Rogers’s client-centered therapy, which worked to help people reach their full potential, was the most influential form of humanistic therapy. The introduction of humanistic therapy had long-term effects. No longer was the therapist in complete control of treatment. From this point forward, dealing with psychological disorders was seen as a team effort between the professional and the individual.

While humanistic therapy could help people make important changes, some psychologists thought the results were not measurable and that humanistic therapies focused too much on people’s feelings and not enough on correcting illogical thought processes. This led to the development of cognitive therapy. The word cognition means “reason” or “intellect.” These techniques focus on helping individuals to think, and then behave, in ways that can help them reach their goals. The late 1960s saw the introduction of behavior therapy. This method focused on changing people’s actual behavior, rather than delving into its causes. Many therapists combined cognitive and behavior therapy methods. This led to cognitive-behavior therapy, which is widely used today.

Mental health professionals began to realize that many individuals with psychological challenges needed practice with interpersonal skills. This led to the beginning of group therapy. Another reason for the increasing use of group therapy is the high cost of individual therapy. Today, many people find group therapy helpful. In self-help groups, such as Alcoholics Anonymous, members with similar challenges work together, often with a leader, to provide support for one another.

As medicine advanced, many diseases and conditions that used to be untreatable could be treated with drug therapy. Epilepsy, for example, is an example of such a condition. Scientists also developed drugs that helped control psychological disorders. While these drugs are not cures, they can control symptoms. They are often used in conjunction with psychotherapy. The use of drugs has greatly changed the treatment of psychological disorders.

Today’s psychotherapy has benefited from all of the methods discussed here. No one method of therapy has convincingly proven to be better than the others. However, several factors have been shown to be important. These factors include identifying the issue to be addressed, the relationship between the individual and the therapist, and the importance of focusing on changing the individual’s behavior.

Functions of Psychotherapy

One of the functions of psychotherapy is to help people realize that they are responsible for their own problems and that, even more importantly, they are the only ones who can really solve these problems. This approach does not imply that people become disturbed on purpose or that no one should need outside help. People often adopt certain techniques for getting along in life that seem appropriate at the time but lead to trouble in the long run. Such patterns can be difficult for the individual to recognize or change. The major task of the therapist, therefore, is to help people examine their way of living, to understand how their present way of living causes problems, and to start living in new, more beneficial ways. The therapist can be thought of as a professional hired by the individual to help him find the source of his problems and investigate appropriate solutions.

Approaches to Psychotherapy

There are many different kinds of therapy. However, only a few of them will be described in this chapter, including psychoanalysis, humanistic, cognitive, behavioral, and biological approaches to treatment (see table, Types of Psychotherapies). Each one is based on different theories about how human personality works, and each one is carried out in a different style. Some psychotherapists stick primarily to one style and consider the other styles less useful. Other psychotherapists use an eclectic approach to therapy, choosing methods from many different kinds of therapy and using the ones that work best. Whatever the style or philosophy, all types of psychotherapy have certain characteristics in common.

The primary goal of psychotherapy is to strengthen the patient’s control over his or her life. People seeking psychotherapy need to change their thoughts, feelings, and behaviors. Over the years, they have developed not only certain feelings about themselves but also behaviors that strengthen those feelings. Their behaviors and feelings make it difficult, if not impossible for them to reach their goals.

One of the most important factors in effective treatment is the patient’s belief or hope that he can change. The influence that a patient’s hopes and expectations have on his improvement is often called the placebo effect. This name comes from giving medical patients placebos, inert sugar pills, when they complain of ailments that do not seem to have any physiological basis. The patients take the tablets, and their symptoms disappear.

The placebo effect does not imply that problems can be solved simply by fooling the patient. It does demonstrate, however, the tremendous importance of the patient’s attitude in finding ways to change. A patient who does not believe he can be helped probably cannot be. A patient who believes he can change and that he has the power to change will find a way. Therapy goes beyond the placebo effect. It combines the patient’s belief that he can change with hard work and professional guidance.

Qualities of a Therapist

In American society, there are many practitioners of psychotherapy. Some, like clinical psychologists, are trained in psychological testing, assessment, and diagnosis. Counseling psychologists have been trained to deal with problems of adjustment. Various kinds of therapists and the training that each goes through before practicing psychotherapy are shown in the table, Kinds of Therapists.

Before going to a professional therapist, most people first turn to a friend or other nonprofessional for help and advice. Sometimes, this is exactly what’s needed. Professional therapists, however, are likely to be more skillful in encouraging the person to examine uncomfortable feelings and problems.

There are three characteristics found in effective therapists. First, a therapist needs to be psychologically healthy. A therapist who is anxious, defensive, and withdrawn will not be able to see the patient’s problems clearly nor able to aid in the development of solutions. A second important characteristic is empathy. Empathy is the capacity for warmth and understanding. Troubled people are usually fearful and confused about explaining their problems. The therapist needs to be able to give the patient confidence that he is capable of caring and understanding. Finally, a good therapist must be experienced in dealing with people and understanding their complexities. Only by having worked with many people can a therapist learn when to give support, when to insist that the patient stand on his own feet, and how to make sense of the things people say.

Group Therapies

 What are the advantages of group therapy?

In some forms of therapy, the patient is alone with the therapist. In group therapy, however, she is in the company of other patients. There are several advantages to this situation. Sometimes individuals with psychological challenges think they are somehow strange or abnormal. A person in group therapy has the chance to see other people struggling with problems similar to her own. She discovers what other people think of her, and, in turn, can express what she thinks of them. In this exchange she discovers where she is mistaken in her views of herself and of other people and where she is correct. Within the group, the patient can practice different ways of interacting with others in a safe environment. In this way, she can see which techniques work for her and which ones do not. She also can see other people with similar problems recovering, giving her the hope of recovery.

Another advantage to group therapy is that one therapist can help a large number of people at a reduced cost. Most group-therapy sessions are led by a trained therapist who makes suggestions, clarifies points, and keeps activities from getting out of hand. In this way, her training and experience are used to help as many as 20 people at once, although 8–10 is a more comfortable number. It is possible to use psychoanalytical, cognitive, and behavioral techniques in a group setting. What is discussed in group therapy is confidential. To safeguard this confidentiality, members agree not to disclose names of group members or topics of group discussion outside of session meetings.

Family Therapy

Therapists often suggest, after talking to a patient, that the entire family unit should work at group therapy. In family therapy, the focus is on the interactions among the family members. This method is particularly useful because it untangles the twisted web of relationships that has led one or more members of the family to experience emotional suffering.

Often family members are unhappy because they are mistreating or are being mistreated by other family members in ways no one understands or wants to talk about. Each one also has a subjective viewpoint. The family therapist can point out what is happening from an objective viewpoint and can suggest ways of improving communication and fairness in the family. An important goal for the therapist is to help the members create an alliance in which they all work together to achieve common goals. One way that the therapist can do this is by making certain that each family member receives his or her turn to be heard. This encourages the family members to be respectful toward one another and ensures that everyone has an opportunity to share their viewpoint. While the therapist avoids directly telling members how to change their behavior, the therapist encourages the family members to see events from each other’s point of view. The therapist may also suggest several ways of improving communication and fairness within the family. For example, if a child is angry because her sister borrows her clothes or other personal items without asking her permission, the family can work together on a solution. By working together, they strengthen their ability to communicate, which will help them resolve future, and possibility more difficult, challenges.

Self-Help Groups

Not all group therapies are run by professional therapists. Some of the most successful examples are provided in nonprofessional organizations, such as self-help groups. An increasing number of self-help groups have emerged in recent years. These voluntary groups, composed of people who share a particular problem, are often conducted without the active involvement of a professional therapist. During regularly scheduled meetings, members of the group come together to discuss their difficulties and to provide one another with support and possible solutions. Self-help groups have been formed to deal with problems ranging from alcoholism, overeating, and drug addiction to child abuse, widowhood, single parenting, adjusting to cancer, and gambling.

The best-known self-help group is Alcoholics Anonymous (AA), which was founded in 1935. Far more people find treatment for their drinking problems through AA than in psychotherapy or treatment centers.

The purpose of Alcoholics Anonymous is “to carry the AA message to the sick alcoholic who wants it.” The only requirement to join is “a desire to stop drinking.” According to AA, the only way for alcoholics to change is to admit that they are powerless over alcohol and that their lives have become unmanageable. Those who think they can battle the problem alone will not be successful. There
are also AA-based groups, such as Al-Anon and Alateen, for family members for mutual support.

Members of AA usually meet at least once a week to discuss the meaning of this message, to talk about their experiences with alcohol, and to describe the new hope they have found with AA. Mutual encouragement, friendship, and an emphasis on personal responsibility are used to keep an individual sober.

Many self-help groups, such as Narcotics Anonymous and Overeaters Anonymous, base their organizations on the AA model. Together, these organizations are referred to as “twelve-step” programs because members abide by twelve steps to reach recovery. These steps are fundamentally the same for all the organizations. In Overeaters Anonymous, for example, the first step is” We admitted we were powerless over food—that our lives had become unmanageable.”

National and community organizations such as NAMI (National Alliance on Mental Illness) strive to improve the lives of individuals with psychological difficulties. All of these organizations work to aid those with challenges they are working to overcome.

Comparing How is traditional group therapy different from self-help groups?

Does Psychotherapy Work?

 What are the arguments against psychotherapy?

In 1952 Hans Eysenck published a review of 24 different studies on the effectiveness of psychoanalytic treatment and eclectic psychotherapy, treatment in which several different therapeutic approaches are combined. Eysenck concluded that psychotherapy was no more effective than no treatment at all. According to his interpretation of these 24 studies, only 44 percent of the psychoanalytic patients improved with treatment, while 64 percent of those given eclectic psychotherapy had improved. Most startling, Eysenck argued that even this 64 percent improvement rate did not demonstrate the effectiveness of psychotherapy, since it has been reported that 72 percent of a group of hospitalized neurotics improved without treatment. If no treatment at all leads to as much improvement as psychotherapy, the obvious conclusion is that psychotherapy is not effective.

In 1970, Allen Bergin wrote a carefully reasoned review that leads one to question the validity of Eysenck’s sweeping generalization. Much of Bergin’s argument is based on how patients should be classified. Precise criteria for improvement are difficult to define and apply. Some people may experience spontaneous remission, or the sudden, unaccountable disappearance of symptoms without any therapy at all. However, it is important to realize that these people may have received help from unacknowledged sources. If the prime ingredient in therapy is to establish a close relationship, then spontaneous remission in people who have received continuing help from such sources is not spontaneous at all.

An analysis of nearly 400 studies on the effectiveness of psychotherapy, conducted by Mary Lee Smith and Gene V. Glass, used elaborate statistical procedures to estimate the effects of psychotherapy. They found that therapy is generally more effective than no treatment and on the average most forms of therapy have similar effects; that is, therapy may improve the quality of life for the patients. Smith and Glass were able to show that for some specific clients and situations, some forms of therapy would be expected to result in a greater improvement than others. As a result, the psychologist and client may work together to discuss the appropriate form of psychotherapy to achieve a cure.