Psychotherapy

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Psychotherapy is an interpersonal, relational intervention used by trained psychotherapists to aid clients in problems of living. This usually includes increasing individual sense of well-being and reducing subjective discomforting experience. Psychotherapists employ a range of techniques based on experiential relationship building, dialogue, communication and behavior change and that are designed to improve the mental health of a client or patient, or to improve group relationships (such as in a family).

Contents 1 Forms 2 Systems of Psychotherapy 3 History 4 General Concerns 5 Specific schools and approaches 5.1 Scientific validation of different psychotherapeutic approaches 5.2 Psychoanalysis 5.3 Gestalt Therapy 5.4 Group Psychotherapy 5.5 Medical and non-medical models 5.6 Cognitive behavioral therapy 5.7 Behavior Therapy and Behavioral Counseling 5.8 Expressive therapy 5.9 Integrative Psychotherapy 5.10 Hypno-Psychotherapy 5.11 Adaptations for children 6 The therapeutic relationship 6.1 Confidentiality 7 Effectiveness and criticism 8 References 8.1 Psychodynamic schools 8.2 Humanistic schools 9 See also 9.1 Related topics 9.2 Related lists

[edit] Forms

Most forms of psychotherapy use only spoken conversation, though some also use various other forms of communication such as the written word, artwork, drama, narrative story, music, or therapeutic touch. Psychotherapy occurs within a structured encounter between a trained therapist and client(s). Purposeful, theoretically based psychotherapy began in the 19th century with psychoanalysis; since then, scores of other approaches have been developed and continue to be created.

Therapy is generally used to respond to a variety of specific or non-specific manifestations of clinically diagnosable crises. Treatment of everyday problems is more often referred to as counseling (a distinction originally adopted by Carl Rogers) but the term is sometimes used interchangeably with "psychotherapy".

Psychotherapeutic interventions are often designed to treat the patient in the medical model, although not all psychotherapeutic approaches follow the model of "illness/cure". Some practitioners, such as humanistic schools, see themselves in an educational or helper role. Because sensitive topics are often discussed during psychotherapy, therapists are expected, and usually legally bound, to respect client or patient confidentiality.

[edit] Systems of Psychotherapy

There are several main systems of psychotherapy:

• Cognitive behavioral
• Psychodynamic
• [[Existential Therapy|Existential]
• Humanistic/supportive
• Brief therapy (sometimes called "strategic" therapy, solution focused brief therapy)
• Systemic Therapy (including family therapy & marriage counseling)
• Integrative Psychotherapy
• Somatic Psychotherapy
• Transpersonal Psychotherapy
• Hypno-Psychotherapy
• Psychodrama/Dramatherapy
• On the way to a Fundamental Theory of Psychotherapy: "Periodic Table" of Tinbergen's four questions
• On the basis of Tinbergen's four questions a "periodic table" of all schools of psychotherapy can be established within a framework of reference of all fields of anthropological research and humanities.

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[edit] History

See also: History of psychotherapy and Timeline of psychotherapy

In an informal sense, psychotherapy can be said to have been practiced through the ages, as individuals received psychological counsel and reassurance from others. Purposeful, theoretically-based psychotherapy was probably first developed in the Middle East during the 9th century by the Persian physician and psychological thinker, Rhazes, who was at one time the chief physician of the Baghdad psychiatric hospital. In the West, however, serious mental disorders were generally treated as demonic or medical conditions requiring punishment and confinement until the advent of moral treatment approaches in the 18th Century. This brought about a focus on the possibility of psychosocial intervention - including reasoning, moral encouragement and group activities - to rehabilitate the "insane".

Psychoanalysis was perhaps the first specific school of psychotherapy, developed by Sigmund Freud and others through the early 1900s. Trained as a neurologist, Freud began focusing on problems that appeared to have no discernible organic basis, and theorized that they had psychological causes originating in childhood experiences and the unconscious mind. Techniques such as dream interpretation, free association, transference and analysis of the id, ego and superego were developed.

Many theorists, including Anna Freud, Alfred Adler, Carl Jung, Karen Horney, Otto Rank, Erik Erikson, Melanie Klein, and Heinz Kohut, built upon Freud's fundamental ideas and often formed their own differentiating systems of psychotherapy. These were all later termed under a more broad label of psychodynamic, meaning anything that involved the psyche's conscious/unconscious influence on external relationships and the self. Sessions tended to number into the hundreds over several years.

Behaviorism developed in the 1920s, and behavior modification as a therapy became popularized in the 1950s and 1960s. Notable contributors were Joseph Wolpe in South Africa, M.B. Shipiro and Hans Eysenck in Britain, and B.F. Skinner in the United States. Behavioral therapy approaches relied on principles of operant conditioning, classical conditioning and social learning theory to bring about therapeutic change in observable symptoms. The approach became commonly used for phobias, as well as other disorders.

Some therapeutic approaches developed out of the European school of existential philosophy. Concerned mainly with the individual's ability to develop and preserve a sense of meaning and purpose throughout life, major contributors to the field (e.g., Irvin Yalom, Rollo May) and Europe (Viktor Frankl, Ludwig Binswanger, Medard Boss, R.D.Laing, Emmy van Deurzen) attempted to create therapies sensitive to common 'life crises' springing from the essential bleakness of human self awareness, previously accessible only through the complex writings of existential philosophers (e.g., Søren Kierkegaard, Jean-Paul Sartre, Gabriel Marcel, Martin Heidegger, Friedrich Nietzsche). The uniqueness of the patient-therapist relationship thus also forms a vehicle for therapeutic enquiry.

A related body of thought in psychotherapy started in the 1950s with Carl Rogers. Based in existentialism and the works of Abraham Maslow and his hierarchy of human needs, Rogers brought person-centered psychotherapy into mainstream focus. Rogers' basic tenets were unconditional positive regard, genuineness, and empathic understanding, with each demonstrated by the counselor. The aim was to create a relationship conducive to enhancing the client's psychological well being, by enabling the client to fully experience and express themselves. Others developed the approach, like Fritz and Laura Perls in the creation of Gestalt therapy, as well as Marshall Rosenberg, founder of Nonviolent Communication, and Eric Berne, founder of Transactional Analysis. Later these fields of psychotherapy would become what is known as humanistic psychotherapy today. Self-help groups and books became widespread.

During the 1950s, Albert Ellis developed Rational Emotive Behavior Therapy (REBT). A few years later, psychiatrist Aaron T. Beck developed a form of psychotherapy known as cognitive therapy. Both of these included short, structured and present-focused therapy aimed at changing a person's distorted thinking, by contrast with the long-lasting insight-based approach of psychodynamic or humanistic therapies. Cognitive and behavioral therapy approaches were combined during the 1970s, resulting in Cognitive behavioral therapy. Being oriented towards symptom-relief, collaborative empiricism and modifying one's core beliefs, the approach gained widespread acceptance as a primary treatment for numerous disorders. A "third wave" of cognitive and behavioral therapies developed, including Acceptance and Commitment Therapy and Dialectical behavior therapy, which expanded the concepts to other disorders and/or added novel components.

Counseling methods developed, including solution-focused therapy and systemic coaching. Postmodern psychotherapies such as Narrative Therapy and coherence therapy did not impose definitions of mental health and illness, but rather saw the goal of therapy as something constructed by the client and therapist in a social context. Systems Therapy also developed, which focuses on family and group dynamics—and Transpersonal psychology, which focuses on the spiritual facet of human experience. Other important orientations developed in the last three decades include Feminist therapy, Brief therapy, Somatic Psychology, Expressive therapy, and applied Positive psychology.

A survey of over 2,500 US therapists in 2006 revealed the most utilised models of therapy and the ten most influential therapists of the previous quarter-century.^[1]

[edit] General Concerns

Psychotherapy can be seen as an interpersonal invitation offered by (often trained and regulated) psychotherapists to aid clients in reaching their full potential or to cope better with problems of life. Psychotherapists usually receive remuneration in some form in return for their time and skills. This is one way in which the relationship can be distinguished from an altruistic offer of assistance.

Psychotherapy often includes techniques to increase awareness, for example, or to enable other choices of thought, feeling or action; to increase the sense of well-being and to better manage subjective discomfort or distress. Psychotherapy can be provided on a one-to-one basis or in group therapy. It can occur face to face, over the telephone, or, much less commonly, the Internet. Its time frame may be a matter of weeks or many years. Therapy may address specific forms of diagnosable mental illness, or everyday problems in managing or maintaining person relationships or meeting personal goals. Treatment of everyday problems is more often referred to as counseling (a distinction originally adopted by Carl Rogers) but the term is sometimes used interchangeably with "psychotherapy".

Psychotherapists employ a range of techniques to influence or persuade the client to adapt or change in the direction the client has chosen. These can be based on clear thinking about their options; experiential relationship building; dialogue, communication and adoption of behavior change strategies. Each is designed to improve the mental health of a client or patient, or to improve group relationships (as in a family). Most forms of psychotherapy use only spoken conversation, though some also use other forms of communication such as the written word, artwork, drama, narrative story, or therapeutic touch. Psychotherapy occurs within a structured encounter between a trained therapist and client(s). Because sensitive topics are often discussed during psychotherapy, therapists are expected, and usually legally bound, to respect client or patient confidentiality.

Psychotherapists are often trained, certified, and licensed, with a range of different certifications and licensing requirements depending on the jurisdiction. Psychotherapy may be undertaken by clinical psychologists,counseling psychologists, social workers, marriage-family therapists, expressive therapists, trained nurses, psychiatrists, psychoanalysts, mental health counselors, school counselors, or professionals of other mental health disciplines. Psychiatrists have medical qualifications and may also administer prescription medication. The primary training of a psychiatrist focuses on the biological aspects of mental health conditions, with some training in psychotherapy. Psychologists have more training in psychological assessment and research and, in addition, in-depth training in psychotherapy. Social workers have specialized training in linking patients to community and institutional resources, in addition to elements of psychological assessment and psychotherapy. Marriage-Family Therapists have specific training and experience working with relationships and family issues. A Licensed Professional Counselor (LPC) generally has special training in career, mental health, school, or rehabilitation counseling to include evaluation and assessments as well as psychotherapy. Many of the wide variety of training programs are multiprofessional, that is, psychiatrists, psychologists, mental health nurses, and social workers may be found in the same training group. Consequently, specialized psychotherapeutic training in most countries requires a program of continuing education after the basic degree, or involves multiple certifications attached to one specific degree.

[edit] Specific schools and approaches

Main article: list of psychotherapies

In practices of experienced psychotherapists, therapy will not represent pure types, but will draw aspects from a number of perspectives and schools.^[2][3]

[edit] Scientific validation of different psychotherapeutic approaches

In the psychotherapeutic community there has been discussion of evidence-based psychotherapy, e.g.^[4]

Virtually no comparisons of different psychotherapies with long follow-up times have been carried out.^[5] The Helsinki Psychotherapy Study^[6] is a randomized clinical trial, where patients are monitored for 12 months after the onset of study treatments, of which each lasted approximately 6 months. The assessments are to be completed at the baseline examination and during the follow-up after 3, 7, and 9 months and 1, 1.5, 2, 3, 4, 5, 6, and 7 years. The final results of this trial are yet to be published since follow-up evaluations will continue up to 2009.

[edit] Psychoanalysis

Main article: Psychoanalysis

Psychoanalysis was the earliest form of psychotherapy, but many other theories and techniques are also now used by psychotherapists, psychologists, psychiatrists, personal growth facilitators, occupational therapists and social workers. Techniques for group therapy have been developed.

While behaviour is often a target of the work, many approaches value working with feelings and thoughts. This is especially true of the psychodynamic schools of psychotherapy, which today include Jungian therapy and Psychodrama as well as the psychoanalytic schools. Other approaches focus on the link between the mind and body and try to access deeper levels of the psyche through manipulation of the physical body. Examples are Rolfing, Bioenergetic analysis and postural integration.^{[citation needed]}

[edit] Gestalt Therapy

Main article: Gestalt Therapy

Gestalt Therapy is a major overhaul of psychoanalysis. In its early development it was called "concentration therapy" by its founders, Frederick and Laura Perls. However, its mix of theoretical influences became most organized around the work of the gestalt psychologists; thus, by the time Gestalt Therapy, Excitement and Growth in the Human Personality (Perls, Hefferline, and Goodman) was written, the approach became known as "Gestalt Therapy."

Gestalt Therapy stands on top of essentially four load bearing theoretical walls: phenomenological method, dialogical relationship, field-theoretical strategies, and experimental freedom. Some have considered it an existential phenomenology while others have described it as a phenomenological behaviorism. Gestalt therapy is a humanistic, holistic, and experiential approach that does not rely on talking alone, but facilitates awareness in the various contexts of life by moving from talking about situations relatively remote to action and direct, current experience.

[edit] Group Psychotherapy

Main article: Group psychotherapy

The therapeutic use of groups in modern clinical practice can be traced to the early years of the 20th century, when the American chest physician Pratt, working in Boston, described forming 'classes' of fifteen to twenty patients with tuberculosis who had been rejected for sanatorium treatment.^{[citation needed]} The term group therapy, however, was first used around 1920 by Jacob L. Moreno, whose main contribution was the development of psychodrama, in which groups were used as both cast and audience for the exploration of individual problems by reenactment under the direction of the leader. The more analytic and exploratory use of groups in both hospital and out-patient settings was pioneered by a few European psychoanalysts who emigrated to the USA, such as Paul Schilder, who treated severely neurotic and mildly psychotic out-patients in small groups at Bellevue Hospital, New York. The power of groups was most influentially demonstrated in Britain during the Second World War, when several psychoanalysts and psychiatrists proved the value of group methods for officer selection in the War Office Selection Boards. A chance to run an Army psychiatric unit on group lines was then given to several of these pioneers, notably Wilfred Bion and Rickman, followed by S. H. Foulkes, Main, and Bridger. The Northfield Hospital in Birmingham gave its name to what came to be called the two 'Northfield Experiments', which provided the impetus for the development since the war of both social therapy, that is, the therapeutic community movement, and the use of small groups for the treatment of neurotic and personality disorders.

[edit] Medical and non-medical models

A distinction can also be made between those psychotherapies that employ a medical model and those that employ a humanistic model. In the medical model the client is seen as unwell and the therapist employs their skill to help the client back to health. The extensive use of the DSM-IV, the diagnostic and statistical manual of mental disorders in the United States, is an example of a medically-exclusive model.

In the humanistic model, the therapist facilitates learning in the individual and the client's own natural process draws them to a fuller understanding of themselves. An example would be gestalt therapy.

Some psychodynamic practitioners distinguish between more uncovering and more supportive psychotherapy. Uncovering psychotherapy emphasizes facilitating the client's insight into the roots of their difficulties. The best-known example of an uncovering psychotherapy is classical psychoanalysis. Supportive psychotherapy by contrast stresses strengthening the client's defenses and often providing encouragement and advice. Depending on the client's personality, a more supportive or more uncovering approach may be optimal. Most psychotherapists use a combination of uncovering and supportive approaches.

[edit] Cognitive behavioral therapy

Main article: Cognitive behavioral therapy

Cognitive behavioral therapy focuses on modifying everyday thoughts and behaviors, with the aim of positively influencing emotions. The therapist helps clients recognise distorted thinking and learn to replace unhealthy thoughts with more realistic substitute ideas. This approach includes Dialectical behavior therapy.

[edit] Behavior Therapy and Behavioral Counseling

Main article: Behavior Therapy

Behavior Therapy focuses on modifying overt behavior and helping clients to achieve goals. This approach is built on the principles of learning theory including operant and respondent conditioning, which makes up the area of applied behavior analysis or behavior modification. This approach includes Acceptance and Commitment Therapy, Functional Analytic Psychotherapy, and Dialectical behavior therapy. Sometimes it is integrated with cognitive therapy to make cognitive behavior therapy

[edit] Expressive therapy

Main article: Expressive therapy

Expressive therapy is a form of therapy that utilizes artistic expression as its core means of treating clients. Expressive therapists use the different disciplines of the creative arts as therapeutic interventions. This includes the modalities dance therapy, drama therapy, art therapy, music therapy, writing therapy, among others. Expressive therapists believe that often the most effective way of treating a client is through the expression of imagination in a creative work and integrating and processing what issues are raised in the act.

[edit] Integrative Psychotherapy

Main article: Integrative Psychotherapy

Integrative Psychotherapy represents an attempt to combine ideas and strategies from more than one theoretical approach.^[7] These approaches include mixing core beliefs and combining proven techniques. Forms of integrative psychotherapy include Multimodal Therapy, the Transtheoretical Model, Cyclical Psychodynamics, Systematic Treatment Selection, Cognitive Analytic Therapy, Internal Family Systems Model, and Multitheoretical Psychotherapy. In practice, most experienced psychotherapists develop their own integrative approach over time.

[edit] Hypno-Psychotherapy

It has been suggested that this article or section be merged into Hypnotherapy. (Discuss)

Unlike the majority of comparable therapies, hypno psychotherapy measures its history not in years or decades but centuries. Therefore, if the provenance of a therapy is to be determined by its longevity, hypno psychotherapy has stood the test of time. Throughout much of that history, the discipline has been hampered by the absence of a single theory to explain the medium through which it works - hypnosis. The usually acknowledged forerunner of modern hypno psychotherapy, Franz Anton Mesmer (1734-1815)[1], believed in the existence of a universal fluid - animal magnetism - an imbalance of which in the human body caused illness. He, and others trained by him, sought to control the distribution of this fluid, restoring balance, and health, to those who sought his help. Mesmer was careful to confirm whether any given presenting problem were organic or functional, and worked with the latter, functional psychosomatic illnesses. (This same caution is observed by competent practitioners today.) Mesmer was convinced that a cure might only be achieved when a patient experienced a crisis, typified by convulsions and related phenomena. In 1784, a Royal Commission in France, where Mesmer was then resident, decided against the existence of magnetic fluid. The Commission attributed Mesmer's undoubted successes to his manipulation of a patient's imagination; that is, by suggestion.

In an age not familiar with the power of suggestion alone, outside of a religious context, the significance of the Commission's findings was overlooked. But if there were no universal fluid, with nothing physical being transmitted between Mesmerist and subject, related phenomena must be psychological in origin. The blind regained their sight, for instance, through the power of imagination and suggestion, rather than animal magnetism. Since Mesmer would not allow his theory to be displaced by such a concept, and the Commission discounted it, the emergence of modern psychology and hypno psychotherapy was postponed. Discredited by the findings of the Commission and other enquiries, and the bizarre nature in which he chose to conduct therapy sessions, Mesmer eventually returned to his native Austria. These events, along with the convulsions of the French Revolution, Napoleonic and post-Napoleonic Europe, scattered Mesmer's followers throughout Europe and abroad. Attempts to carry forward Mesmer's medical applications met with considerable opposition. British doctors who advocated the use of Mesmerism, for instance, made little progress because of the attitude of the medical and scientific establishments. John Elliotson (1791-1868)[2] was obliged to resign his post as Professor of Surgery at University College, London. James Braid (1795-1860)[3], who substituted the word "Hypnotism" * for Mesmerism, was refused permission to read a paper on the subject to the British Association for the Advancement of Science. James Esdaile (1808-1859)[4], who performed over 300 major surgical operations in India using hypnosis as the anaesthetic, was denied access to the medical press to publish his findings. (* From Hypnos, Ancient Greek god of sleep, since Braid thought a form of sleep was involved. The name persists, though the sleep theory has been discarded.)

The often legitimate suspicions aroused by the extravagant claims and behaviour of mesmerists and hypnotists - some of whom exploited, and continue to exploit, related phenomena for "entertainment" - relegated the legitimate applications of hypnosis to the fringe of respectability. The advent of chemical anaesthetics and growth of the drugs industry impeded the study and use of hypnosis in medicine. In much the same way as chemical agents had served to displace hypnosis in the practice of medicine, so Freudian psychoanalysis tended to displace it in psychotherapy. Despite sporadic revivals of interest, such as after and during the First and Second World Wars when short term psychotherapy was needed, its present popularity is comparatively recent. Mesmer's student, de Puysegur (1751-1825), had quietly relegated the importance of the crisis in favour of the trance-like state typical of his therapeutic practice. Modern therapy, too, recognises the significance of the trance and, when we speak of somebody being "mesmerised", we do not suppose that person to be convulsed. Although emotion may be released - most particularly when the technique of hypno-analysis is used, based on the Freudian view that repressed material may be recovered from the unconscious mind - it is a sense of calm detachment, rather than crisis, which typifies the great majority of hypnotherapy sessions.

A typical modern hypno psychotherapy session, influenced by research and refinement in numerous countries since Mesmer's day, comprises induction, treatment strategy, and termination. In the induction, the therapist may, for example, speak slowly to the subject about the subject's becoming imaginatively involved in an experience of focussed awareness, whilst peripheral distractions fade - hence the subject may, with eyes closed, concentrate upon the progressive relaxation of his/her muscles to the exclusion of external events and stimuli. A good subject, well-motivated, optimistic about the therapy and confident in the therapist (criteria in which he/she may be educated in and out of hypnosis) is then ready to engage in any therapy intended to change inappropriate behaviour, thought or feeling. This means that virtually all, if not all, psychological techniques may be delivered via the medium of hypnosis. Because imaginative involvement, selective attention, and suspension of the critical process are all characteristic of the hypnotic state, hypno psychotherapy may often be the treatment of choice. The subject may move forward or backward in time, rehearse coping techniques, learn to correct types of thinking and feeling prejudicial to emotional well-being, and behaviour prejudicial to physical health, confront, but not exaggerate, life's problems whilst reappraising its potential, develop the ability to use self-hypnosis and perform "homework" tasks emphasising modern hypno psychotherapy's stress upon a subject's active involvement in the desired therapeutic outcome. At the termination, cues for subsequent positive thoughts, feelings or behaviour (post-hypnotic suggestions) may be introduced or re-iterated. Finally, the subject is gently returned from what has been described as an altered state of consciousness - the hypnotic state - to the everyday state of consciousness with its diffuse and distracting stimuli. Now discussion takes place (possibly an extension of dialogue whilst the subject was in hypnosis) and the hypnotic experience is examined in order to inform and enhance future therapy sessions i.e. the therapist defers to the source of expertise and control which lies not with the therapist, but with the subject.

Given a comfortable environment, a sympathetic and empathetic therapist who inspires confidence, and the subject's optimism about a realistic outcome, that outcome may be achieved. Because hypnosis is so fundamental, and universal, even if not recognised as such, it should not be withdrawn from the public domain, either in terms of training or availability as therapy. Rather, we should be aiming to widen such training and availability. Whilst hypnosis can stand alone as a form of therapy or form an adjunct to any other profession, it should become the property of no single profession. Virtually any book on the subject deals with the numerous theories of hypnosis. Essentially, the debate centres upon whether or not hypnosis is a special state. "State" theorists might argue that the subject's appearance and subjective reports of the hypnotic experience alone would support their theory. "Non-state" theorists might argue that hypnotic behaviour is the result of motivation, attitude and expectancy resulting in the subject's willingness to follow the therapist's suggestions. Perhaps the outcome will be some sort of compromise: 'Hypnosis is an altered state of consciousness, the achievement of which is greatly influenced by factors such as the subject's motivation, attitude and expectancy promoting a willingness to follow the therapist's suggestions'

[edit] Adaptations for children

Counseling and psychotherapy must be adapted to meet the developmental needs of children. Many counseling preparation programs include courses in human development. Since children often do not have the ability to articulate thoughts and feelings, counselors will use a variety of media such as crayons, paint, clay, puppets, bibliocounseling (books), toys, et cetera. The use of play therapy is often rooted in psychodynamic theory, but other approaches such as Solution Focused Brief Counseling may also employ the use of play in counseling. In many cases the counselor may prefer to work with the care taker of the child, especially if the child is younger than age four.

[edit] The therapeutic relationship

Research has shown that the quality of the relationship between the therapist and the client has a greater influence on client outcomes than the specific type of psychotherapy used by the therapist (this was first suggested by Saul Rosenzweig in 1936 ^[8]). Accordingly, most contemporary schools of psychotherapy focus on the healing power of the therapeutic relationship.

This research is extensively discussed (with many references) in Hubble, Duncan and Miller (1999)^[9] (quotes in this section are from this book) and in Wampold (2001).^[10]

A literature review by M. J. Lambert (1992)^[11] estimated that 40% of client changes are due to extratherapeutic influences, 30% are due to the quality of the therapeutic relationship, 15% are due to expectancy (placebo) effects, and 15% are due to specific techniques. Extratherapeutic influences include client motivation and the severity of the problem:

For example, a withdrawn, alcoholic client, who is "dragged into therapy" by his or her spouse, possesses poor motivation for therapy, regards mental health professionals with suspicion, and harbors hostility toward others, is not nearly as likely to find relief as the client who is eager to discover how he or she has contributed to a failing marriage and expresses determination to make personal changes.

In one study, some highly motivated clients showed measurable improvement before their first session with the therapist, suggesting that just making the appointment can be an indicator of readiness to change. Tallman and Bohart (1999)^[12] note that:

Outside of therapy people rarely have a friend who will truly listen to them for more than 20 minutes (Stiles, 1995)^[13]... Further, friends and relatives often are involved in the problem and therefore do not provide a "safe outside perspective" which may be required. Nonetheless, as noted above, people often solve their problems by talking to friends, relatives, co-workers, religious leaders, or some other confidant in their lives, or by thinking and exploring themselves.

[edit] Confidentiality

Further information: client confidentiality, and physician-patient privilege

Confidentiality is an integral part of the therapeutic relationship and psychotherapy in general.

[edit] Effectiveness and criticism

There is considerable controversy over which form of psychotherapy is most effective, and more specifically, which types of therapy are optimal for treating which sorts of problems.^[14]

The dropout level is quite high, one meta-analysis of 125 studies concluded that mean dropout rate was 46.86%.^[15] The high level of dropout has raised some criticism about the relevance and efficacy of psychotherapy.

Psychotherapy outcome research—in which the effectiveness of psychotherapy is measured by questionnaires given to patients before, during, and after treatment—has had difficulty distinguishing between the success or failure of the different approaches to therapy. Not surprisingly, those who stay with their therapist for longer periods are more likely to report positively on what develops into a longer term relationship. Of course, this might mean that "treatment" is open-ended and related concerns regarding the total financial costs.

As early as 1952, in one of the earliest studies of psychotherapy treatment, Hans Eysenck reported that two thirds of therapy patients improved significantly or recovered on their own within two years, whether or not they received psychotherapy.^[16]

Many psychotherapists believe that the nuances of psychotherapy cannot be captured by questionnaire-style observation, and prefer to rely on their own clinical experiences and conceptual arguments to support the type of treatment they practice. This means that "if you believe you are doing some good, you are," a conception of dubious merit.

In 2001 Bruce Wampold, Ph.D. of the University of Wisconsin published "The Great Psychotherapy Debate"^[17]. In it Wampold, a former statistician who went on to train as a counselling psychologist, reported that

1. psychotherapy can be more effective than placebo,
2. no single treatment modality has the edge in efficacy,
3. factors common to different psychotherapies, such as whether or not the therapist has established a positive working alliance with the client/patient, account for much more of the variance in outcomes than specific techniques or modalities.

Although the Great Psychotherapy Debate dealt primarily with data on depressed patients, subsequent articles have made similar findings for post-traumatic stress disorder ^[18], and youth disorders ^[19]

Some report that by attempting to program or manualize treatment psychotherapists may actually be reducing efficacy, although the unstructured approach of many psychotherapists cannot appeal to patients motived to solve their difficulties through the application of specific techniques different from their past "mistakes."

Critics of psychotherapy are skeptical of the healing power of a psychotherapeutic relationship.^[20] Since any intervention takes time, critics note that the passage of time, without therapeutic intervention, can frequently result in psycho-social healing.^[21]

Many resources available to a person experiencing emotional distress—the friendly support of friends, peers, family members, clergy contacts, personal reading, research, and independent coping—present considerable value, indicating that psychotherapy is frequently inappropriate or unneeded by many. Critics note that humans have been dealing with crises, navigating severe social problems and finding solutions long before the advent of psychotherapy.^[22]

Some psychotherapeutics have answered to scientific critique saying that psychotherapy is not a science since it is a craft.^[23]

Further critiques have emerged from feminist, constructionist and discursive sources. Key to these is the issue of power. In this regard there is a concern that clients are persuaded—both inside and outside of the consulting room—to understand themselves and their difficulties in ways that are consistent with therapeutic ideas. This means that alternative ideas (e.g., feminist, economic, spiritual) are sometimes implicitly undermined. Critics suggest that we idealise the situation when we think of therapy only as a helping relation. It is also fundamentally a political practice, in that some cultural ideas and practices are supported while others are undermined or disqualified. So, while it is seldom intended, the therapist-client relationship always participates in society's power relations and political dynamics.^[24]

[edit] References

• Asay, Ted P., and Michael J. Lambert (1999). The Empirical Case for the Common Factors in Therapy: Quantitative Findings. In Hubble, Duncan, Miller (Eds), The Heart and Soul of Change (pp. 23-55)
• Field, Nathan Breakdown and Breakthrough: Psychotherapy in a New Dimension[5] (1996) Publisher: Routledge ISBN 0-415-10958-2.

[edit] Psychodynamic schools

• Aziz, Robert, C.G. Jung’s Psychology of Religion and Synchronicity (1990), currently in its 10th printing, a refereed publication of The State University of New York Press. ISBN 0-7914-0166-9.
• Aziz, Robert, Synchronicity and the Transformation of the Ethical in Jungian Psychology in Carl B. Becker, ed. Asian and Jungian Views of Ethics. Westport, CT: Greenwood, 1999. ISBN 0-313-30452-1.
• Aziz, Robert, The Syndetic Paradigm: The Untrodden Path Beyond Freud and Jung (2007), a refereed publication of The State University of New York Press. ISBN 13:978-0-7914-6982-8.
• Bateman, Anthony; Brown, Dennis and Pedder, Jonathan (2000). Introduction to Psychotherapy: An Outline of Psychodynamic Principles and Practice. Routledge. ISBN 0-415-20569-7. 
• Bateman, A.; and Holmes, J. (1995). Introduction to Psychoanalysis: Contemporary Theory and Practice. Routledge. ISBN 0-415-10739-3. 
• Oberst, U. E. and Stewart, A. E. (2003). Adlerian Psychotherapy: An Advanced Approach to Individual Psychology. New York: Brunner-Routledge. ISBN 1-58391-122-7
• Ellenberger, Henri F. (1970). The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry. Basic Books. 

[edit] Humanistic schools

• Schneider (et al), Kirk (2001). The Handbook of Humanistic Psychology. SAGE Publications. ISBN 0-7619-2121-4. 

• Rowan, John (2001). Ordinary Ecstasy. Brunner-Routledge. ISBN 0-415-23632-0. 

• Ansel Woldt, Sarah Toman (eds) (2005). Gestalt Therapy History, Theory, and Practice. Gestalt Press. ISBN 0-7619-2791-3 (pbk.). 

• Crocker, Sylvia (1999). A Well-Lived Life, Essays in Gestalt Therapy. SAGE Publications. ISBN 0-88163-287-2 (pbk.). 

• Yontef, Gary (1993). Awareness, Dialogue, and Process. The Gestalt Journal Press, Inc.. ISBN 0-939266-20-2 (pbk.). 

[edit] See also

[edit] Related topics

Counseling Main article Counselling psychology Clinical psychology Anti-psychiatry Psychiatry Psychology Defence mechanism

Mental health Mental health professional Neurosis Psychosis Social work Integrative Psychotherapy Gestalt Therapy

[edit] Related lists

• List of psychotherapies
• List of counseling topics
• Important publications in psychoanalysis and psychotherapy
• Timeline of psychotherapy
• Special:Whatlinkshere/Counselling psychology Links into Counseling Psychology
• Special:Whatlinkshere/Clinical psychology Links into Clinical Psychology

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v • d • e Medicine > Psychiatry Subspecialties Behavioral medicine • Biological psychiatry • Child and adolescent psychiatry • Cross-cultural psychiatry • Emergency psychiatry • Forensic psychiatry • Geriatric psychiatry • Liaison psychiatry • Military psychiatry • Neuropsychiatry • Social psychiatry Societies American Board of Psychiatry and Neurology • American Psychiatric Association • Royal College of Psychiatrists Related topics Neuroimaging • Neurophysiology • Psychiatrist • Psychopharmacology • Psychosurgery • Psychotherapy Lists List of psychiatrists • List of figures in psychiatry • List of physicians • List of psychiatric medications • List of psychiatric medications by condition treated • List of neurological disorders • List of psychotherapies• List of counseling topics