The Evolution of Psychotherapy: A Brief History
Updated: May 28, 2020
Psychotherapy as we know it today has a long and fascinating history. I provide a snippet here, but if you are interested in knowing more, I suggest Lewis Aron’s A Meeting of Minds: Mutuality in Psychoanalysis.
Sigmund Freud is generally regarded as the pioneer in this field. An Austrian doctor. Freud proposed that we store all kinds of memories, behaviour patterns and desires in our unconscious, of which we are unaware, and we make decisions based on these hidden aspects of self.
Psychoanalysis, which Freud developed, was a “one person” therapy in the sense that patients lay on a couch with the psychoanalyst behind them, asking them to free-associate whatever came into their minds as a way to gain entry into the unconscious. Once a patient provided the necessary material which led to an insight - an aha! moment – Freud believed the patient would then change their behaviour, beliefs and ways of feeling about things. The psychoanalyst was meant to be out of sight and say as little as possible so as to not interrupt the process of free association.
Freud had many students that at first agreed with him completely, but then broke from the master to come up with their own theories of how the mind works. Carl Jung, for instance, said we have a “collective unconscious” meaning that we all recognize certain motifs in human behaviour which repeat in cultures separated by space or time. He named these “archetypes.” He also named those hidden aspects of self as “the shadow”. Jung was a great believer in the importance and meaning of dreams as a way to gain entry into the unconscious mind. He said dreams contain symbols and hidden meanings about how we really think and feel about things. Analyzing these can lead to insight and change.
A transition occurred in the field with the dawn of the “two person” therapies: psychoanalysts began to believe that the therapist is just as important to the process of therapy as is the patient, and that it is the relationship between them that is the driving factor in creating change. One of Freud’s former students, Sandor Ferenczi, was actually the first to propose this. However, his methods were deemed too unorthodox and his findings were largely ignored.
Donald Winnicott and John Bowlby in England both came up with what is known as attachment theory – they studied children and adolescents and came to the conclusion that as human beings we form attachment bonds with those we love, such as parents and partners, and that human relationships are feedback loops – what I do affects you which then affects what you do to me, which then affects me, etc.
The Interpersonalists and Relationalists in America started to focus on the relationship between therapist and patient as well. Self psychology was created by Heinz Kohut, and Carl Rogers posited that the more genuine and warm the therapist, the better the chances of change in the patient. The first family therapy, known as systems theory, was introduced by Murray Bowen, and focused on the dynamics between people as the driving force of behaviour.
As time passed, the word patient was changed to client. It is now taken for granted that the fit between client and therapist is of utmost importance. Modern therapies tend to be shorter in duration than those of the past. CBT, DBT, ACT, Solution Focused, Narrative and body centered therapy such as Sensorimotor psychotherapy have risen in popularity. The process of therapy itself has changed – it is more collaborative, more equal, with the client as the expert on their own life.
But what is the underlying, core goal of all psychotherapies, old or new? I would argue it is integration – of cut off feelings and thoughts, of those aspects of ourselves we are afraid or ashamed of. As we integrate, we grow, mature, flourish and bloom.