The Evolution of Psychotherapy and Counseling (Fall 2012)
The practices of psychotherapy and counseling have been around for hundreds of years, since the antiquity period. However, the advancements of psychotherapy and counseling were slow until the late 1800s. The progression and growth since the 19th century has been momentous and very important to the treatment and theories we see today.
Sigmund Freud was a trained neurologist from Austria, but is often seen as the father of modern psychology and the developer of many psychological theories still used in the modern world. Until Freud entered the psychology scene, those who were unhappy were treated as seen fit by those around them instead of being listened to. Freud also discovered that dreams are symbolic and specific to the person having them. In 1900, he published his book Interpretation of Dreams, in which he uses his own dreams to prove that dreams are all about our unconscious thoughts and mind surfacing. He argues that our dreams are our wishes and our sub-thoughts. Although this book has been criticized from all perspectives and sides, it is still seen as valid by many today.
In 1923, Sigmund Freud developed the three theories of the Id, the Ego and the Superego. These are the three separate systems within humans. The Id, or it, is all the inherited components of our personalities. It’s the impulsive and unconscious part of us and does not take into account the logic and reality of the word. The Id is based on the pleasure principle, which means that it wants what it wants now and it doesn’t matter what the consequences are in order to get it. The Ego, or I, is the part that mediates between the Id and the real world around us, working by reason. It has no concept of right or wrong, something is only good if it attains the end with satisfaction but doesn’t damage the Id or itself. The Superego, or above I, consists of the conscious and the ideal self. It is mostly determined by childhood and how we were brought up. It controls the Id’s impulses and influences the Ego to focus on moralistic goals instead of just realistic ones. These three components balance and work with each other and help create our personalities.
In the late 1800s many important milestones in the history of psychotherapy and counseling were set. The American Psychological Association, otherwise known as the APA, was founded in 1892. It was headed by G. Stanley Hall. In 1879, Wilhelm Wundt opened the very first general psychological clinic with attempts to evaluate and approach mental distress. However, in 1896, the first scientifically clinical application of psychology began to help children with learning disabilities. This occurred at the University of Pennsylvania.
Although many developments were made in the 19th century regarding psychotherapy and counseling, the 20th century was the most developmental period of these practices. A number of psychologists from around the world visited Freud in Vienna during this time so that they could return to their native countries and promote his methods. A.A. Brill of the United States and Ernest Jones of the United Kingdom were two of the various psychologists that visited Freud. This resulted in many new theories and methods being introduced and experimented with during the 1900s, especially at the latter end of the century.
The three general types of therapies that were developed in the history of psychotherapy and counseling were behavioral, psychoanalytical/psychodynamic and humanistic. Behaviorism is concerned with stimulus responses and behavioral analysis. It is based on the understandings that people have no free will and all behavior is learned from the environment in which one grows up. The issue with this method was that it denied and ignored internal mental activity. Behaviorism’s main contributors were Joseph Wolpe, Hans Eysenck and B.F. Skinner. It was the dominant paradigm from the 1920s to the 1950s.
The methods of cognitive and existential therapy were evolved and developed during the 1950s in response to behaviorism. These techniques promoted positive change through the development of an authentic and understanding restorative group. Albert Ellis developed the first form of this called Rational Emotive Behavior Therapy. This system of cognitive behavioral therapy consisted of the belief that when humans become upset it is the beliefs that we hold that cause our anger, depression, or anxiety, not the actual event. This belief is also known as the ABC model. The ABC model is when something happens (A), one holds a belief about the situation (B), and one has an emotional response to that belief (C). The model presents that A does not cause B, but B causes C. Another aspect of the REBT method is that most humans want to be happy, whether alone or with others. Aaron T. Beck also contributed to the development of cognitive therapy by recognizing ten common patterns of faulty thinking; all or nothing, overgeneralization, a mental filter, disqualifying the positive, jumping to conclusions, magnification or minimization, emotional reasoning, “should” statement, labeling or mislabeling and personalization. These ideas were also established in the 1950s. However, both REBT and early forms of cognitive therapy were aimed at changing a person’s beliefs. In the 1970s cognitive and behavioral therapy approaches were combined which resulted in cognitive behavioral therapy. This strategy was intended to relieve symptoms and modify core beliefs. It has gained general acceptance around the world as treatment for many disorders today.
Psychoanalytic or psychodynamic therapy, developed by Sigmund Freud, is based on the idea that a person’s behaviors and thoughts are not within their conscious control. This form of therapy focuses on childhood and past events that have shaped one’s behavior patterns and thought processes. Psychoanalysis is known as the “talking cure,” or “talk therapy”. It is described as “making the unconscious conscious” (Freud, 1916/1917). It is believed that if the patient talks freely during a session, with no worries of censoring themselves, thoughts and memories will be revealed that the psychologist can then interpret and make sense of for the patient. It is meant to bring underlying problems to the surface so they can be addressed and dealt with in a healthy way. Psychoanalysis is a very intense style of psychotherapy that requires ample commitment from both the patient and psychologist. The success of this method depends greatly on the ability of the two to work together and achieve the patient’s goals. Karen Horney contributed to this theory with her book Feminine Psychology in 1936. Other psychologists such as Alfred Adler and Carl Jung further developed Freud’s psychoanalytical theory and developed psychodynamic therapy. This method is very similar to psychoanalytic therapy, the only difference being that the psychodynamic approach is a shorter and less intense form, focusing on more immediate problems.
The “third wave” of therapeutic development was the humanistic approach that was introduced in the early 1940s by Carl Rogers, a psychologist from the U.S. He suggested that therapy be ‘person/client-centered’. With this strategy, the experience of the person was the core focus, instead of the psychoanalytical and behaviorist traditions of applying theoretical constructs and ignoring the internal world of the person. In 1942 Rogers published his book Counseling and Psychotherapy, which explained that a non-judgmental approach to treating mental health issues was the most effective way. He explained that in a non-judgmental setting the client is more likely to accept who they are and reconnect with themselves. Nine years later Carl Rogers published his most well known work, Client-Centered Therapy. In this piece he explained the concept of person-centered therapy. Although the humanistic method is accepted world wide, it is a greatly American approach.
In addition to Carl Rogers, Abraham Maslow also helped to found the humanistic psychological approach. He also developed his famous “Maslow’s Hierarchy of Needs”, a five-stage model that is still used to today for understanding human motivation and personal development. The five stages, beginning at the bottom, are biological and physiological needs, safety needs, belongingness and love needs, esteem needs, and self-actualization. It begins with the basic needs of life; air, food, water, shelter, sleep, warmth and sex. Safety needs include protection, security, law and order, stability, and limits. Safety and biological needs trump everything else and only when these needs are met can one focus on the rest of the model. Belongingness and love needs include family, affection, relationships and work groups. This is followed by esteem needs; status, achievement, responsibility and reputation. When all four of these subgroup needs are met and in order, we attain self-actualization, which is personal growth and fulfillment. The model declares that the needs must be met in the given order to reach the greatest form of happiness.
Even though the majority of psychotherapy is emotional and has to do mostly with the mind, both unconscious and conscious, the repression of feelings corresponds to hindrance of the body. Wilhelm Reich, first a student and later a colleague of Freud, began developing body psychotherapy in the 1920s. It uses various techniques, collaborating with psychoanalysis, to enhance one’s recovery. Reich also instigated the concept of “character armor”, which is how human beings develop fixed, rigid postures and patterns of relating in order to protect themselves against emotional pain. The patterns humans develop penetrate their whole bodies, affecting their biological mechanisms such as breathing, metabolism, and the nervous system. Reich originated several approaches within the method of body psychotherapy including various forms of touch, movement, and breathing. These techniques are used on or with the body. Body psychotherapy is largely based on the belief that the body and mind work in sync; one cannot function properly without the other.
There have been many disagreements between psychologists themselves and others regarding theories and psychological practices. In the 1900s, many people believed that lay analysts, therapists with no medical training, should not be permitted to practice psychology. A.A. Brill was one of the most avid supporters of making the practice of lay analysis illegal and in 1926 succeeded with that belief. It became illegal in New York to practice lay analysis, so one who wished to practice psychology had to be medically trained in order to do so. Brill’s thoughts were also supported by the American Medical Association, who warned it members not to cooperate with lay analysts. However, Ernest Jones disagreed with Brill and supported lay analysts, as did Sigmund Freud. Freud and Jones argued that medicine and the practice of analysis are two very different things. This has become the common belief of society today.
Most believe that counseling is short-term work and psychotherapy is long-term work. Psychotherapy goes back to a person’s past and childhood, therefore uncovering lot that a person might not have realized about themselves, while counseling is more current and focuses on the present and future. Both forms of therapy are effective and are catered to the needs of the patient.
The history of psychotherapy and counseling is extensive but the greatest steps forward have been taken during the past 150 years. The advances made in the 19th and 20th centuries have made colossal differences in the practices of the present world, and the theories and practices of the fathers of psychology are still in effect and taken seriously today.
The history forces within the topic the evolution of psychotherapy and counseling are new ideas and roles of specific individuals. These two history forces go hand in hand. Roles of specific individuals were a great force because these individuals had these new ideas. Prominent people such as Sigmund Freud, Carl Rogers and Abraham Maslow introduced many new ideas that were crucial to the advancement of these theories and practices. New ideas were the main fuel for the evolution and progression of therapy because they helped form new approaches and more effective treatments for those with mental illnesses. These new ideas include behaviorism, the three separate systems within humans, and talk therapy. The combination of these history forces influenced the worldwide views and attitudes towards psychotherapy and counseling in a positive way.
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