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 What is Psychotherapy?

Psychotherapy has been called the “talking cure.”  In its essence, it must date back to the very distant time when human distress first found human language.  As a modern invention, perhaps it should be dated to the hypnotists of the 18th and 19th centuries with their marvelous cures and strange phenomena affected by mere language.  The sensational Anton Mesmer did not attribute the effects solely to words, however, thinking that surely some invisible “magnetic fluid” must be responsible (much like the “energy” healers of the current scene).  However, words are powerful all by themselves.  Sigmund Freud and his followers developed a rich, complex theory wedded with a rather simple technique of treatment featuring talking and listening and responding.  Emotional and physical symptoms often responded dramatically to his procedure of psychoanalysis. 

Psychoanalysis has provided the basis of all the contemporary developments in psychotherapy, although many of the current varieties may seem to bear little resemblance to it.  The sufferer tries to talk, the one who would help listens and tries to find useful responses.

There are many theories about the psychology of suffering, and what sorts of talk should be most helpful.

Psychodynamic approaches are the ones most closely related to Freudian theory and method.  Psychoanalysis itself split into a number of important factions that are still represented today.  Besides strict Freudians, there are Jungians, Adlerians, Ego-analysts, Object-Relations Analysts, Sullivanians, and practitioners of Psychosynthesis and Control-Mastery Theory, to name a few.  To one degree or another, all these points of view stress the importance of emotional conflicts in causing suffering and interpersonal trouble, all strive for self-understanding, and all of them assume that a lot of our mental life is unconscious (often the most important parts).  The kind of relationship one forms with the therapist (usually called the Transference) is assumed to be important for both  understanding and cure. 

Cognitive (or cognitive-behavioral) approaches all stress the importance of how we think.  To some extent, our thoughts cause our feelings, and they also structure our choices and our patterns of interactions with other people.  Sometimes these patterns lead us into unhappy places.  The cognitive therapies (there are many flavors) all help us understand our own thinking, and help us have more power over making useful changes in this wellspring of all our experience.

Experiential approaches stress the patterns of interaction going on in the therapy relationship itself, and try to use it to effect helpful changes.  Gestalt therapists explore here-and-now experiences, and are often very creative in crafting immediate changes that are instructive and freeing.  Client-centered therapists and Focusing therapists listen with exquisite sensitivity and help lead their clients to profound new understandings.  Other experiential approaches use guided imagery, or exploration of memories, or interpretation of dreams, or interpersonal encounter (authentic feedback). 

Group Therapy can be carried out by practitioners with any of the orientations just described.  Psychodynamic groups often stress the importance of understanding the emotional forces that implicitly structure relationships and interpersonal behavior.  Experiential groups often feature some very lively processes of sharing and developing feelings and shared meanings.  Cognitive groups are often more didactic than interactional, with an emphasis on learning and applying concepts and skills. The groups are usually made up of people who are initially strangers, but sometimes family members engage in therapy as a group.

There are other approaches that are sometimes referred to as psychotherapy, but they don’t rely on the curative power of communication, so they are actually quite different.  Purely Behavioral treatment controls the consequences of behavior in ways aimed to shape behavior in directions deemed more positive.  They are often applied to persons presumed to be unable or unwilling to respond to ordinary communication, such as those with profound developmental disability or criminals.  Psychopharmacological treatment also does not work primarily through communication, but instead alters experience by the use of drugs that effect the neurochemistry of the brain.