What Constitutes Psychotherapy?
Psychotherapy is far more than just sitting around discussing one’s issues with another person. The term therapy is rather loosely defined; however, is generally accepted that therapy occurs when an individual seeks the assistance of a formally trained professional who uses various methods based on psychological principles to assist the person with their problems. The notion of the use of a professional therapist and methods based on established principles can be seen in the American Psychological Association’s formal definition of therapy, which basically states that psychotherapy is an intentional and formalized application of clinical methods that are derived from known psychological principles to assist individuals in changing their thoughts or thinking patterns, feelings, actions, or other characteristics.
Essentially then, groups like Alcoholics Anonymous that are not run by professionally trained therapists and do not operate according to identified psychological principles are not forms of therapy, even though some individuals may find them to be “therapeutic.”
The notion that something is “therapeutic” can range from individual subjective opinions of internal change to actual formal identified professional interventions, such as psychotherapy.
For instance, someone listening to a particular song that they are very fond of may find the experience of listening to the song as “therapeutic” on a number of levels; however, just listening to music is not an established type of therapy based on the formal definition of therapy.
The Major Schools of Psychotherapy
In order to list all the different forms of psychotherapy, one would need to write an entire volume with chapters devoted to the hundreds of different types and subtypes of psychotherapy interventions. However, there are several major founding paradigms or schools of thought under which the vast majority of all these different types of therapies are categorized. The major schools of psychological thought that contribute to psychotherapy are listed below.
- Psychodynamic Therapy: The psychodynamic form of therapy has its origins in the teachings of Sigmund Freud. There are a number of different types of psychodynamic therapy, and all of these approaches are based on the notion that a good deal of our thoughts, feelings, and actions are based on mental processes that we are not fully consciously aware of. Freud believed that the unconscious part of the mind accounted for the vast majority of one’s feelings, thoughts, and actions, and also believed that a good portion of an individual’s personality developed as a result of their experiences in early childhood. While individuals would still be able to change and alter their functioning as adults, the majority of their personality, including their fears, likes, dislikes, behavioral tendencies, etc., was the result of certain types of childhood experiences. While many of Freud’s original ideas have been modified or dropped altogether, most psychologists believe that experiences that occur during childhood are extremely important in many aspects of adult behavior.In addition, a number of other paradigms, such as the paradigm of social cognition, recognize that the majority of one’s behavior is done without consciously thinking about it. For example, most individuals go through their day performing a number of routines and behaviors that do not require conscious thought (e.g., reading, driving, eating, etc.). Freud’s emphasis on what most individuals think of as sexual attractions in early relationships based on the type of attractions that children have toward their parents is not emphasized as strongly as it once was. However, the psychodynamic school still retains the notion that many of the issues that individuals experience are the result of early conflicts that occur in childhood driving later behaviors.Freud’s original approach to therapy requires that an individual spend significant amounts of time with the therapist. In many cases, seeing a therapist several days a week for several years was required before the individual may see progress. Today’s psychodynamic therapists deliver therapy in a much quicker time period and are much more focused on changing specific problems as opposed to trying to alter individuals’ entire conceptualization of themselves. These briefer forms of psychodynamic therapy are used for a number of different issues, such as treating individuals with substance use disorders, depression, anxiety disorders, personality disorders, etc.
- Behavioral Psychology: Behaviorism is a paradigm in psychology that developed about the same time as Freud was developing his theories and took a vastly different approach to explaining behavior. Freud believed all behavior was based on unconscious motivations and drives, whereas behaviorists believed that these types of factors were unobservable and could not be used in a scientific study of behavior occurring in either humans or animals. Instead, behaviorism concentrated on the factors that could directly be associated with the behavior of a person, such as the factors occurring before the behavior that set up the actions and/or the results or consequences of one’s behavior (thus, the famous ABC acronym: Antecedents, Behavior, Consequences). Perhaps the most famous behaviorist is BF Skinner who developed an entire theory of behavior based on the specific consequences of one’s actions.Behavior psychology had a tremendous influence on psychotherapy even though there are very few pure behavioral psychologists that are therapists. Instead, many of the principles from behaviorism and techniques associated with behaviorism have been modified into very effective therapeutic techniques. These principles have even been applied in the medical treatment of individuals with substance use disorders, such as with the drug Antabuse. Antabuse operates on the principle of aversion therapy, which is a direct principle from behavioral psychology. Aversion therapy applies a noxious substance or experience as a motivator not to perform the behavior. In this case, individuals who take the drug and drink alcohol become violently ill. The association of becoming sick as a result of drinking alcohol will reduce the individual’s propensity to drink alcohol.Most behavioral principles are exceedingly effective if they include elements of cognition (helping the individual adjust their thoughts and beliefs). Other common behavioral techniques used in different types of therapy include exposure therapy (actually confronting someone with a situation or object that causes them anxiety or fear), relaxation training, and managing the results of one’s actions intentionally in order to implement change.
- The Cognitive School: Cognitive psychology was concerned with understanding how individuals think. This involved understanding various patterns of thinking, developing explanations, anticipating events, explaining emotions, and understanding how all of these thinking processes relate to actual behavior. The cognitive paradigm was a type of response to the perceived limitations that the Freudian and behaviorist schools of psychology failed to address, even though cognitive psychology describes a number of ingrained or unconscious processes that drive thinking feeling and behaving. Cognitive therapy based on the principles of cognitive psychology has been demonstrated to be an effective treatment approach for a number of issues, particularly issues with anxiety, depression, and even substance use disorders. The cognitive paradigm has branched out into a number of different sub-paradigms, and the most relevant of these applications in therapy is the notion of Cognitive Behavioral Therapy (CBT). CBT applies the principles of cognitive psychology and behaviorism to develop specific types of therapeutic approaches to treating a number of different issues. CBT is not considered to be a separate paradigm in psychology, but instead a combination of two paradigms applied to psychotherapy. Different manifestations of CBT are often considered to be the preferred approaches for psychotherapy. A number of different therapeutic paradigms based on CBT principles have been developed, and these types of interventions are typically considered to be effective for a number of different issues.
A number of these approaches based on CBT include:
- Humanistic Psychology: Humanistic psychology developed as a reaction to rather mechanistic approaches of Freudian psychology and the behaviorist school of psychology. Many of the early humanistic psychologists developed principles that would eventually lead to applications in psychotherapy. These include individuals such as Abraham Maslow (the famous hierarchy of needs) and Carl Rogers (the most famous of all the humanist psychologists).
Carl Rogers’s application of humanistic principles to psychology is particularly noteworthy. Rogers believed that the principles of Freudian psychology and behavioral psychology lacked an understanding of what it meant to be human. Instead, he believed that individuals were motivated to try and reach their maximum potential, but were often blocked by external perceptions of how they “should” be based on misunderstandings of what really made a person a functional and worthy human being. Rogers believed that many of us develop unrealistic notions of how we “should” behave or be as opposed to what is realistic. For example, many individuals develop the unrealistic notion that they must be approved by everyone, everything they do must be without flaws, and that if they are not capable of living up to such unrealistic standards, they are somehow defective. Rogers’s ideas included the notion that individuals should be realistic, genuine, and care about one another without these unrealistic specified conditions of worth.
Rogers was the first individual to actually perform research on the effectiveness of psychotherapy. Many of his ideas are responsible for what are often referred to as the common factors of psychotherapy, which represent overarching principles of psychotherapy that drive its effectiveness regardless of what approach is used.
Individual or Group?
Psychotherapy can be performed on a one-on-one basis where there is just the therapist and one client (individual therapy) or on a group basis where there is at least one therapist and several clients being treated at the same time. In general, individual therapy and group therapy are equivalent in their effectiveness, although there are specific instances where certain individuals may find that they prefer one over the other.
Advantages to individual treatment include being the sole focus of the therapist’s attention, having no worries that someone else will disclose one’s innermost feelings to other people outside the therapeutic relationship (this is known as confidentiality), feeling more comfortable discussing issues of a very personal nature, and being able to work very intensely on specific issues.
Group therapy offers a person a chance to learn from others with similar problems who may be at different levels of development, develop strong social support, and may help individuals who are initially reluctant to discuss things that are distressing for them.
Psychotherapy can be practiced in either an individual or group setting despite the paradigm involved. In addition, there are number of different types of group therapy that can occur, including family therapy where the members of the group are family members, substance abuse group therapy where all the members of the group have substance use issues, group therapy for depression or individuals have issues with depression, etc. In some cases, individuals will attend both group and individual therapy sessions, and in other cases, they may just attend one form of therapy.
Is Psychotherapy Effective?
The bottom line is that psychotherapy is an effective form of intervention. This is not to imply that psychotherapy is a panacea and will help everyone in every instance. Volumes of research on the effectiveness of psychotherapy have been performed, and there are several important factors that may contribute to outcomes in psychotherapy. For example, according to the book The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work, a number of different factors contribute to outcomes in psychotherapy. Some of the more general factors include principles emphasized by Carl Rogers and humanistic psychology, such as genuineness (the therapist and client are both honest and open), the therapist’s ability to be empathetic (the therapist’s ability to actually understand the client and feel for the client based on the client’s actual perceptions and view), and maintaining an unconditional positive regard for the client, such that no matter what is going in the client’s life, the therapist views the client as a valuable human being.
Other factors that can contribute to therapy outcomes include the specific motivations of the client, the ability of both client and therapist to effectively communicate with one another, and some of the features of specific therapies that are directed at helping the individual change. For example, a number of types of CBT appear to be very efficacious at working with individuals with very difficult problems, such as borderline personality disorder, whereas certain types of psychodynamic therapy can be useful in uncovering issues associated with past trauma.
There really is no “one-size-fits-all” approach to therapy. Often, an important factor in determining the actual effectiveness of psychotherapy in a specific case is the fit between the therapist and client, the client’s motivation to work on the issues, and the therapist’s ability to identify and target the specific problems that need to be addressed.
However, psychotherapy will not work for everyone, will not solve every problem, and requires that individuals in therapy actively participate. An important factor in trying to improve or change is the motivation of the individual. Even though there are various forms of psychotherapy that attempt to increase an individual’s motivation to change, unless the person actually participates in the therapeutic process, one cannot expect significant positive results.