Do psychoanalysis, cognitive behavioural therapies and person-centred approaches have fundamentally different ideas about how the human mind works? Do these reflect the historical period and culture from which they emerged?
Discussion
Modern psychotherapists sometimes draw on an eclectic range of models and techniques, adapting their approaches to the needs of the client. It is worth reflecting on the different ideas that these traditions developed about the mind’s structure and function. Psychoanalytic and psychodynamic approaches placed great emphasis on unconscious drivers and transference, whereas CBT and person-centred approaches emerged in contrast to these ideas, focusing more on conscious thoughts, feelings and behaviours. What might unite all of these different approaches? They all value the process of talking through the client’s experiences with a trained therapist, and all have a focus on trying to understand the mental obstacles and conflicts that may be causing an individual difficulties or impeding an authentic life. While psychodynamic approaches have the strongest focus on early childhood experiences and the way they shape later life, both CBT and humanistic approaches also ask how beliefs and ideas learnt in childhood can affect a person, especially if they cause difficulties in functioning or impede self-actualisation.
Historians have shown that Freud’s ideas emerged at a particular moment in late nineteenth-century Vienna, when European ideas about hypnosis and suggestion were popular and provided a basis for thinking about the unconscious. Psychoanalytic ideas have been more popular in some cultures than others, and have enjoyed a rise and fall in popularity. CBT emerged as a challenge to psychoanalysis at a time when economics and politics put an emphasis on the measurability of effectiveness, as they still do. Person-centred approaches reached the height of their popularity in the US in the 1960s and 1970s, when ideas about personal fulfilment and potential had widespread social currency. This may suggest that ideas about psychotherapy are specific to certain times and places rather than being universal and timeless truths, and that it is important to consider the wider social, cultural and economic reasons why some approaches become more influential in particular contexts.
Rogers had a number of allies who shared his general world view. In 1963, along with existential psychotherapist Rollo May and esteemed psychologist Abraham Maslow, he co-founded the Association for Humanistic Psychology. He also collaborated with colleagues of a communitarian and democratic orientation and began to experiment with and develop group therapies, including encounter groups. These became highly popular in the 1970s and remain a key tool in the psychotherapeutic toolbox to this day (Rogers, 1973).
One of Rogers’ own mentees, Nathaniel Raskin, reflected on the humanistic movement in the 1990s to account for its successes and failures. From the 1960s, Rogers benefited from operating outside of a university context, which gave him freedom to develop his practice without the restrictions of delivering teaching. Raskin argues that, as a result, person-centred approaches didn’t have the institutional support or respect that other traditions, particularly behavioural therapies, were able to mobilise. Organisationally, the movement was also unusual, holding regular meetings without hierarchical positions and elected officers. Instead it opted for a more volunteer-based system and the inclusion of egalitarian, unstructured ‘community meetings’ at conferences, in the spirit of Rogers’ anti-authoritarian approach (Raskin, 1996).
Despite this unorthodox approach, Rogers and others – notably G.T. Barrett-Lennard – had always been keen to make their approaches viable for academic psychology through measurement, testing and inventories, in order to provide sets of data for theory-building and evaluation. One such method was the Q-technique, developed by William Stephenson in the 1950s, to measure human subjectivity. This involved the client ordering statements about their personality from ‘least characteristic of me’ to ‘most characteristic of me’ at different points during the therapeutic process. Using this technique, Rogers showed that a person’s perceived sense of self changed as a consequence of therapy, and was more likely to become aligned with their ideal self (Rogers and Dymond, 1954; Raskin, 1996). That said, by the turn of the twenty-first century, the comparative lack of enthusiasm for empirical trials among the person-centred community had resulted in it being less influential in socialised healthcare and insurance-based services than cognitive and behavioural approaches.
There are, nonetheless, degrees to which psychotherapy, and counselling more broadly, have been shaped by Rogers’ philosophy, particularly in the move towards understanding service users as ‘clients’ rather than ‘patients’, and democratic ideas around collaboration between service users and service providers. The shift in focus away from concepts of medicalised illness towards the idea of ‘problems of living’ has also profoundly resonated with the rising well-being agenda. Rogerian language was arguably more accessible than psychoanalysis and behaviourism, as it relied less on jargon and complex theories of the mind and development. This vernacular approach facilitated the dissemination of humanistic psychology outside the clinic. The motifs and attitudes of the person-centred movement were taken up widely in late twentieth-century US and elsewhere, as they coincided with a wider cultural impetus for personal growth and self-improvement, and challenges to traditional social hierarchies and authority. These cultural themes are still prevalent, and humanistic psychology is a key part of the story of psychotherapy (Grogan, 2012).
Conclusion
This chapter has reconstructed some of the key moments and movements in the history of psychotherapy as a practice. It has examined the precursors to modern-day psychotherapy, including the widespread fascination with hypnosis and unconscious suggestion in the nineteenth century. Until Freud, psychotherapy was focused more on unconscious suggestions made by authority figures than on analysing the content of a patient’s own words. The birth of psychoanalysis saw a shift towards free association and the examination of unconscious transference from the patient’s early relationships towards the analyst, which forms the basic underlying idea for the psychodynamic tradition in psychotherapy.
Behavioural and cognitive therapies departed from psychoanalysis, rejecting the idea of an unconscious mind. In the 1950s, behaviour modification emerged to treat phobias and anxiety, drawing on learning and conditioning theories to change an individual’s associations and responses to stimuli. It was also deployed for unethical purposes including the ‘treatment’ of homosexuality. In the 1960s, CBT approaches began to emerge in the US, which focused on rationally challenging the automatic thoughts that contribute to negative patterns of thinking. CBT became successful worldwide, partly because it was amenable to randomised control trials that could provide an evidence base for its efficacy.
This chapter has traced the history of the humanistic approaches, which first emerged in response to the Second World War. It showed how Carl Rogers’ person-centred ideas developed through engagement with various influences, from religion and biology to democratic thought, and the impact that these ideas had on popular culture in post-war US and elsewhere.
Finally, this chapter discussed the types of evidence that different schools of psychotherapy have drawn on, both to build new theories and practices and to defend and popularise their approaches.
Further reading
This collection of chapters gives a brief overview of the development of a variety of different psychotherapeutic traditions:Dryden, W. (ed.) (1996) Developments in psychotherapy: historical perspectives. London: Sage.
This open-access article discusses debates about the history of psychotherapy and its meanings, and some of the recent literature published on the topic:Marks, S. (2017) ‘Psychotherapy in historical perspective’, History of the Human Sciences, 30(2), pp. 3–16. doi:10.1177/0952695117703243.
The following text provides an accessible introduction to psychoanalysis as a practice and theoretical framework.
