In tribal societies the remedies to combat disease Mental illness involved not only the patient but the social group as a whole. There was a belief that the soul could leave the body (animism) and that people could be reincarnated into other beings (metempsychopsis). Therefore, there were different techniques to alleviate these supposed conditions, such as ceremonies for restoration, in which the “lost soul” is found, exorcist practices, confessions, healings by incubation, etc. Little by little these tribal thoughts became part of other paths such as organized religions in China, or Greek rational thought. Both thoughts They try to distance themselves from the immediacy of the present situation.
Roots of Psychotherapy
Psychotherapy has its roots in Greece, where rational thinking arises, with thinkers like Aristotle and Plato (know thyself). This tradition provides a rational conception and methods for the rational part to triumph over the animal (Stoic and Aristotelian tradition). In the Middle Ages, the Church considered mental disorders as a product of the devil, and methods ranging from prayer, the stake, torture and exorcism were used to cure them.
Although the ecclesiastical tradition provides relevant aspects for psychotherapy such as confession or resources to avoid sin (the “Treaty of Victory over Self” or spiritual exercises). In the Renaissance, exorcisms were performed according to Father J.Gassner due to two types of illnesses: natural and prenatural. The moral treatment introduced by Pinel constituted an important step towards the humanization of mental illness, with his reform of psychiatric care and an optimistic conception of mental illnesses. Psychotherapy appears in the last quarter of the 19th century. Hypnosis marks a bridge between prepsychological attitudes and the aspect of psychoanalysis. Mesmer provided a key impetus to psychotherapy with his theory of bodily fluid and its distribution.
He obtained therapeutic successes (group therapy, “rooms in crisis”). A split occurred among his followers. The fluidists who followed Mesmer (healing powers of the fluid) and the animists who followed the Marquis de Puysegur (healing had to do with faith). Braid coined the term hypnosis and attempted to give a scientific explanation using the neurophysiology of his time. Liebault began treating his patients with hypnosis, and Bernheim, an admirer of his, developed a research program into the therapeutic potential of hypnosis. Charcot studied hysteria and hypnotism, and Janet attempted the first cathartic cure with “the Lucile case” attempting to treat subconscious ideas through concentration through hypnosis.
At the end of the 19th century psychotherapy It referred to treatment by suggestion, and healing methods through the mind. The cathartic method was described by Breuer and from it Freud developed his psychoanalytic method. It represents a step from the old methods of hypnotic suggestion to the new psychoanalytic method (Breuer stopped insisting on hypnotic suggestion and limited himself to hypnotizing it to revive traumatic emotional memories. Freud started from the cathartic method because it could cure symptoms but not prevent them from reappearing. He highlighted the importance of defense, of the therapeutic relationship and proposed the method of free association.
Constitution of psychological therapy
In the 20th century, some experimental academic psychologists began to be interested in practical social problems, but academic-experimental psychology developed in Germany and represented mainly by Wundt and Tichener, so there is a clear disconnect between academic psychology and practice or applied to social problems.
Psychoanalysis develops autonomously and parallel to all this controversy. Lightmer Witner appears as the first clinical psychologist, although at that time clinical psychologists were mere test takers in hospitals, and psychoanalytic postulates were adopted for the treatment of patients. Many projective tests emerge and psychoanalysis and experimental psychology are approached through the Institute of Human Relations at Yale University by neobehavioral psychologists led by Hull in the 1940s (Dollard, Miller, Mower, Sears, Spence). The Second World War and due to the recruitment efforts, a greater therapeutic awareness emerged. There is a very important event for the step from the application of academic postulates to applied psychology and it is the Boulder Conference in 1949.
In this conference it is stated that the clinical psychologist must be trained in a scientific and applied manner, that they must be trained in diagnosis, research and therapy. Therefore, the appearance of behavior therapy is due to several main reasons: The cataclysm of the Second World War, which contributed to changing the spirit of the time (the zeigeist) by considering data from experimental psychology due to the great demand social The break with the methods of psychoanalysis because they were considered unrelated to the experimental method The confrontation with psychiatry that claimed psychotherapy as an exclusive competence of its discipline Therefore, alternative therapeutic approaches to psychoanalysis began to be developed.
Rogers begins to record therapeutic interviews to subject them to systematic analysis. Behaviorism emerges strongly after the hegemony of psychoanalysis and emerges behavior therapy, with representatives such as Eysenck (studies on the effectiveness of psychotherapy), Skinner (“Science and human behavior”) Wolpe (systematic desensitization) In the 1950s, therefore, psychotherapy basically existed and was reduced to two options: psychoanalytically oriented psychotherapies and modification behavior (inspired by scientific psychology). But these two alternatives were insufficient: a somewhat dehumanized image of man, difficulty in understanding complex human phenomena, and an effectiveness that was not devastating.
Therefore, other important psychotherapeutic approaches emerge: Humanistic psychology or third force, as a philosophical and social movement rather than as a therapeutic approach. Techniques and therapies that aim to achieve self-realization and the development of human potential (Gestalt therapy, transactional analysis) Systemic model: That understands the family as an open system, as the nucleus of conceptualization and treatment (Bateson, Weakland, Haley) Cognitive models: They propose cognitions and other mental processes as the main object of study. Very significant impact on psychotherapy. Cognitive approach (Ellis, Beck) and behavioral-cognitive approach (Mahoney, Meichenbaum).
Current situation of psychotherapy
There is a conceptual, methodological and technical dispersion, or “several” behavioral modifications due to parallel developments rather than due to ruptures or overcomings of paradigms. We mainly find the following paradigms:
- Applied Behavior Analysis (Skinner)
- Radical neobehaviorism (Hull-Spencer, Eysenck, Wolpe.
- Social learning theory (Bandura)
- Cognitive behavior modification
- Cognitive approach
- Behavioral-cognitive approach (Mahoney, Meichenbaum)
Mahoney precisely summarizes the most notable trends and their changes Increase in eclecticism in the 60s with a moderate decrease in the 80s Decrease in the psychoanalytic tendency with an increase in the late 80s Consolidation of humanistic therapy in the 60s that declines in the 80s Paper moderate but constant behaviorism, and constant but more moderate evolution of the systemic orientation.
In practice, eclecticism is the most used option: Intuitive and atheoretical eclecticism:
They choose techniques based on their subjective attractiveness
- Technical eclecticism: They choose techniques according to systematic criteria without the need to approve the theoretical framework to which they belong.
- Synthetic eclecticism: Assimilative integration (reformulation of the concepts of one theory based on another) and accommodative integration (articulation of compatible theoretical elements)
Eysenck’s studies on the effectiveness of psychotherapy have profoundly influenced current trends, because it is taken into account that: The therapeutic model that each one defends is not definitive, but limited. It is necessary to achieve a deeper understanding of the mechanisms of change, which encourages openness to new approaches in research
Development of an integrative movement.
In recent years, there has also been a trend towards the adoption of brief therapy, considering that a number of fewer than 25 sessions is appropriate. This is due to the fact that the longer duration of the experimental studies does not show clear differential efficacy effects.
MOMENTS OF THE THERAPEUTIC PROCESS
- Answer: Reduction of symptoms by at least 50% of those presented at the beginning of treatment
- Remission: Complete disappearance of symptoms with return to a normal level of functioning
- Recovery: Remission maintained for at least a period of 6 months
- Relapse: Appearance of symptoms during remission or recovery
- Recurrence: Appearance of symptoms after recovery. This phenomenon frequently appears in chronic diseases
- Efficacy: Achievement of therapeutic objectives in optimal and ideal conditions (laboratory)
- Effectiveness: Degree to which a treatment achieves its therapeutic objectives in routine clinical practice.
Therapeutic efficiency: Achievement of clinical objectives at the lowest possible cost. In 1986 Lambert identified that a total of the change that the patient experiences in psychotherapy: 40% is due to extratherapeutic effects 30% to common factors 15%techniques applied in therapy 15% Placebo effect. THE TASK FORCE REPORT aims to evaluate psychotherapeutic treatments. The report distinguishes 2 categories of treatments:
- Well-established or effective treatments
- Treatments probably effective or experimental
For a treatment to be well established, three conditions must be met:
- There must be at least 2 experimental studies where the treatment has been shown to be superior to placebo
- That the treatment is manualized.
- That the characteristics of the sample are well specified.
Criticisms Manualization only occurs in behavioral therapies Different therapies show the same effectiveness Patient variability is inevitable
This article is merely informative, at Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.