Of all the ways in which psychology has influenced Americans during the past
half century, none has been more pervasive than the change it has brought about in how
they think of and deal with emotional and mental disorders. Many miseries, failures,
disabilities, dissatisfactions, and misbehaviors that their forefathers attributed to
weakness of character, wickedness, or Fate are now seen by most Americans as
psychological disorders than can be treated by mental health practitioners.
Acting on this conviction, each year some fifteen million Americans make 120
million visits to psychotherapists, and in-patients in mental hospitals and psychiatric
wards of general hospitals account for another several million sessions. Cumulatively,
nearly one out of three persons-eighty million or so-have had some experience with
About a third of these treatments are provided by psychologists, another third by
psychiatrists, and the rest by clinical mental health counselors, and pastoral counselors.
Psychotherapy can be defined as: any psychological technique used to facilitate positive
changes in personality, behavior, or adjustment. Psychotherapy most often refers to
verbal interaction between trained mental health professionals and their clients. One of
the biggest misconceptions about therapy is that seeing a therapist is a sign of weakness.
In fact, quite the opposite is true. Recognizing the need for help and seeking professional
therapy is a sign of both strength and your determination to live a productive and
Psychotherapists have many approaches to choose from: psychoanalysis,
desensitization, Gestalt therapy, logotherapy, client-centered therapy, reality therapy, and
behavioral therapy to name but a few. With so many therapies in use, some confusion
may exist about how they differ. To begin, it is helpful to recognize that psychotherapies
vary widely in emphasis. For this reason, the best approach for a particular person or
problem may also vary.
The terms listed here described basic aspects of various therapies. Notice that
more than one term may apply to a particular therapy. For example, it is possible to have
a directive, action-oriented group therapy or a nondirective, individual, insight-oriented
Individual therapy: A therapy involving one client and one therapist.
Group therapy: A therapy session in which several clients participate at the same
Insight therapy: Any psychotherapy whose goal is to lead clients to a deeper
understanding of their thoughts, emotions, and behavior.
Action therapy: Ant therapy designed to bring about direct changes in
troublesome thoughts, habits, feelings, or behavior, without seeking insight into their
origins or meanings.
Directive Therapy: Any approach in which the therapist provides strong
Nondirective therapy: A style of therapy in which clients assume responsibility
for solving their own problems; the therapist assists but does not guide or give advice.
Time-limited therapy: Any therapy begun with the expectation that it will last
only a limited number of sessions.
Supportive therapy: An approach in which the therapist’s goal is to offer
support, rather than to promote personal change. A person trying to get through an
emotional crisis or one who wants to solve day-to-day problems may benefit from
Therapy is not equally effective for all problems. Chances of improvement are
fairly good for phobias, low self-esteem, some sexual problems, and marital conflicts.
More complex problems, however, can be difficult to solve. Also, contrary to what many
people think, therapy usually does not bring about dramatic changes in behaviors or an
end to make constructive changes (Hellerstein et al., 1998)
In short, it is often unrealistic to expect psychotherapy to undo a person’s entire
past history. Yet even when problems are severe, therapy may help a person gain a new
perspective or learn behaviors to better cope with life. Psychotherapy can be hard work
for both clients and therapists. But when it succeeds, there are few activities more
It is also worth noting that psychotherapy is not always undertaken to solve
problems or end a crisis. Therapy can promote personal growth and enrichment for
people who are already doing well (Buck, 1990). The following lists some of the
elements of positive mental health that therapists seek to restore or promote (Bergin,
Personal autonomy and independence
A sense of identity
Feeling of personal worth
Skilled in interpersonal communication
Sensitivity, nurturance and trust
Genuine and honest with self and others
Self-control and personal responsibility
Committed and loving in personal relationships
Capacity to forgive others and oneself
Personal values and a purpose in life
Self-awareness and motivation for personal growth
Adaptive coping strategies for managing stresses and crises
Fulfillment and satisfaction in work
Good habits of physical health
Discuss the concept of a life coach
Invented by Freud, his system of therapy, called psychoanalysis has become the basic
model for most therapies since. Freud emphasized understanding the unconscious mind
as a central tenet of treating psychological disorders. Psychoanalysis is an intensive and
long-term therapy that may include several sessions per week over a period of several
years. There are several key features:
1. A comfortable physical environment. Freud felt that it was important to make the
patient comfortable. He had them lay down on a soft couch, and provided pillows and
comforters to wrap themselves in, if they should feel the need. He put tapestries up on his
walls to deaden the sound of downtown Vienna. He would pull the drapes closed and
provide soft lighting. His feeling was that, by providing a situation similar to sleep, he
would be giving his patients a chance to relax and get in touch with their deeper
2. An accepting social environment. Even more important was to make the patient feel
at ease socially. They were permitted to express their emotions freely, and Freud made it
clear to his patients that he was not there to judge them or scold them, no matter how odd
their behaviors or thoughts might appear. This is in marked contrast to most people’s day
to day life, in which we are afraid to mention our true feelings or odd thoughts, and try to
behave in a socially acceptable fashion. It is sometimes even difficult to talk to friends or
family – even they may judge us, and that is particularly hard to take!
3. Free association. Free association is the central “technique” of psychoanalysis. It is a
matter of the patient talking about whatever comes to mind. It’s another way of getting a
person to relax: Just move towards the things that trouble you the most. If you can
imagine a therapist who pushes you to face things you would rather not face, you can see
how many people would begin to back off, get angry, and probably leave the therapist!
Unfortunately, for this reason, many forms of therapy are not exactly “efficient” and can
take many months, even years. Contrary to popular belief, though, Freud felt that therapy
should only last a month or two.
4. Resistance. The therapist, in the meantime, looks for clues to the patient’s problems in
their conversations. One of these clues is resistance. When you do get close to some
difficult area, you might begin to become uncomfortable. You might change the topic
suddenly, or forget what you were talking about. You might even begin coming in late, or
missing an appointment altogether! In a way, this is a good sign: You are getting close to
5. Slips of the tongue. A slip of the tongue is technically called a parapraxis, and is
commonly called a Freudian slip. Sometimes, we say things we didn’t intend to say, and
a little bit of what we are thinking about comes by accident. Freud considered these clues
very significant, but nowadays, we think that most slips are just accidents and little more.
But a colleague of mine once referred to the cervix when he meant to say cortex, and may
well have had an attractive student in mind when he made the slip, so….
6. Dream interpretation. Freud is, of course, famous for his views on dream
interpretation. According to Freud, dreams reflect symbolic or unconscious desires.
Basically, he believed that when we dream, our defenses are down, and things that we are
deeply concerned about rise to the surface. You may have noticed that things happen in
your dreams that you wouldn’t even consider in the daytime, such as vicious acts of
aggression, uncharacteristic sexual adventures, and horrible humiliations.
But people who are truly repressed may, even in their dreams, hide behind symbols rather
than face such things directly. Freud’s patients often had problems involving sexually
repression – a commonplace thing in his very conservative times – and would dream
about things that only hinted at their true desires. Things like snakes and swan necks
might symbolize the penis, entering into a cave might represent the sex act, a burning fire
might be sexual desire, and a floor collapsing underneath you might really refer to
orgasm. Psychologists today don’t consider dreams quite as important as Freud did, and
are more likely to ask the patient what the or she thinks the dream means than try to
interpret it for them. But dreams will always be an interesting part of life and therapy!
7. Transference. Transference is when the patient begins to feel feelings towards the
therapist. It can be anger, it can be affection; it can even be sexual desire. Freud believed
that these feelings were actually being transferred from their true object – some important
person in the patient’s life – onto the therapist Transference is therefore an important
clue. Freud also believed that transference was necessary to progress in therapy, in that it
takes what is going on in the patient’s unconscious and brings it out into the real world. It
is only a matter of time until the patient comes to realize what those feelings truly
Most therapists today don’t make a very big deal about transference. Mind you, it
happens a lot, but it makes pretty simple sense: Sometimes you get frustrated at your
therapist, who, after all, represents your failures at life. Sometimes you begin to feel real
affection (even a bit of physical attraction) to this person who is so patient and
understanding, especially while you are so confused and miserable. One thing should be
clear, though: nearly everyone in psychology considers it a major breech of ethics for a
therapist to take advantage of a patient who has these feelings. If you therapist makes
sexual advances, it is time to get another therapist.
8. Catharsis. Catharsis is an outpouring of “pent-up” emotions. When the client makes a
breakthrough, they may become very emotional – whether it be ranting and raving and
storming around the office, or the much more common outburst of crying. Freud
considered this a very good sign indeed. He thought of our problems as being like an
infection that has swollen way out of proportion, and that catharsis was like draining an
infection to relieve the pain.
9. Insight. Ultimately, a patient will achieve insight into their problems. They will, as
Freud put it, “make the unconscious conscious.” This is the goal of therapy. Once a
person can see the original trauma face-to-face, recognize it for what it is, come to
understand it as an adult, and lay it back to rest, their symptoms should disappear, and
they are on the road to recovery.
Although most psychologists today no longer see it as so important to find out what
originally started your psychological problems – or even that psychological problems
necessarily have traumatic origins – the idea of insight is a part of most approaches to
therapy. Sometimes we refer to therapy as a kind of education, where you learn about
how you as an individual actually work. Like you need to know how a car works before
you can fix it, you need to know how you work before you can start to deal with your
problems in a rational fashion, instead of suffering with a lot of useless and painful
symptoms that get you nowhere.
In the 1950s humanistic psychology, the core of the “human potential
movement”—whose leading spokesman was Maslow—emerged as a “Third Force” or
alternative to Freudian psychoanalysis on the one hand and behaviorist psychology on the
The humanists, more philosophic than scientific, objected to the psychoanalytic
doctrine that the individual’s personality and behavior are totally determined by his or her
life experiences, especially those of childhood, and also to the behaviorist view that the
individual’s behavior is only a set of conditioned responses to stimuli. Humanistic
psychology stressed the individual’s power to choose how to behave and the right to
fulfill oneself in one’s own way; it held that behavior should be judged not in terms of
supposedly objective scientific standards but in terms of the individual’s own frame of
reference. If a person considered an easygoing, noncompetitive, “laid-back” life ideal,
that was a valid goal for him or her, not a symptom of a character flaw; so, too, with
singleness rather than marriage, sexual freedom rather than monogamy, and other
departures from social norms. Humanist psychology therefore had great appeal,
especially for the young, during the individualistic, rebellious 1960s.
Out of this psychology emerged a crop of therapies. Though widely disparate,
they are all based on the doctrine that everyone possesses inner resources for growth and
self-healing and that the goal of therapy is not to change the client but to remove
obstacles, such as poor self-image or the denial of feelings, to the client’s use of these
inner resources. The therapist does not guide clients toward a scientific ideal of mental
health but helps them grow toward their own best selves. Instead of calling the person a
“patient” as a psychoanalyst might, the humanistic-oriented therapist would call the
person a “client.” The client and the therapist are more equal in the therapeutic
Rogers believed that effective therapists maintain four basic conditions. First, the
therapist offers the client unconditional positive regard (unshakable personal
acceptance). The therapist refuses to react with shock, dismay, or disapproval to anything
the client says or feels. Total acceptance by the therapists is the first step to self-
acceptance by the client. As an example, sometimes clients do things to please others.
Unconditional positive regard suggests that the client does not have to please the
Second, the therapist attempts to achieve genuine empathy by trying to see the
world through the client’s eyes and feeling some part of what the client is feeling.
Third, the therapist strives to be authentic (genuine and honest). The therapist
must not hide behind a professional role. Rogers believed that phony fronts destroy the
growth atmosphere sought in client-centered therapy. In essence, therapists model the
type of openness they expect from their clients.
Fourth, the therapist does not make interpretations, propose solutions, or offer
advice. Instead, the therapist reflects (rephrases, summarizes, or repeats) the client’s
thoughts and feelings. This allows the therapist to act as a psychological “mirror” so
clients can see themselves more clearly. Rogers believed that a person armed with a
realistic self-image and greater self-acceptance will gradually discover solutions to life’s
In short, if the client can understand or develop insight into his or her problems of
living, then the client can choose to change his or her behavior.
Gestalt therapy, developed by Fritz Perls (1969), emphasizes the importance of
client’s fully experiencing, in the present moment, their feelings, thoughts, and actions
and then taking responsibility for them. The goal of Gestalt therapy is to help clients
achieve a more integrated self and become more authentic and self-accepting. In addition,
they learn to assume personal responsibility for their behavior rather than blaming
society, past experiences, parents, or others.
Gestalt therapy is a directive therapy, one in which the therapist takes an active
role in determining the course of therapy sessions and provides answers and suggestions
to the client. The well-known phrase “getting in touch with your feelings” is a major
objective of Gestalt therapy. Perls suggested that those of us who are in need of therapy
carry around a heavy load of unfinished business, which may be in the form of
resentment toward or conflicts with parents, siblings, lovers, employers, or others. If not
resolved, these conflicts are carried forward into our present relationships. One method
for dealing with unfinished business is the “empty chair” technique. The client sits facing
an empty chair and imagines, for example, that a wife, husband, father, or mother sits
there. The client proceeds to tell the chair what he or she truly feels about that person.
Then, the client moves to the empty chair and role-plays what the imagined person’s
response would be to what was said.
Behavior therapies sharply contrast with insight-oriented in several important
ways. First, behavior therapies are more active than insight therapies: second, they
concentrate on changing people’s behavior rather than in increasing their insight into
their thoughts and feelings: and finally, they typically operate within an even shorter time
frame. Behavior therapies are based on the belief that all behavior, both normal and
abnormal, is learned.
Some institutions use token economies that reward appropriate behavior with
tokens such as poker chips, play money, gold stars, or the like. The tokens can later be
exchanged for desired goods (candy, gum, cigarettes) and/or privileges (weekend passes,
free time, participation is desirable activities). Sometimes, individuals are fined a certain
number of tokens for undesirable behavior. Mental hospitals have successfully used token
economies with chronic schizophrenics for decades to improve their self-care skills and
Desensitization, Extinction, and flooding systematic desensitization, a method for
gradually reducing fear and anxiety, is one of the oldest behavior therapy techniques
(Wolpe, 1990). The method works by gradually associating a new response (relaxation)
with stimuli that have been causing anxiety. For example, an aspiring politician might
seek therapy because he is anxious about speaking to crowds. The therapist looks for
more details, asking whether the man feels more threatened by an audience of 500 than
by an audience of 50, more tense when addressing men than when speaking to both men
and women, and so on. The first step is for the therapist and client to develop a hierarchy
of fears-a list of situations from the least to the most anxiety-provoking for the client.
Next, the therapist teaches the person how to relax: to clear his or her mind, to release
tense muscles, and to be able to produce this relaxation response readily.
Once the client has mastered the technique of deep relaxation, he or she begins
work at the bottom of the hierarchy of fears. The person is told to imagine the least
threatening situation on the list and to signal when he feels the least bit tense. At the
signal, the therapist tells the person to forget the scene and to concentrate on relaxing.
After a short time, the therapist instructs the client to imagine the scene again. This
process is repeated until the person feels completely relaxed when imagining that scene.
Then the therapist moves on to the next situation in the client’s hierarchy of fears and
trains the person to be completely relaxed when imagining that situation as well.
Therapist and client advance up the hierarchy in this way until finally the person can
imagine the most fearful situation at the top of the hierarchy without experiencing any
Numerous studies indicate that systematic desensitization helps many people
overcome their fears and phobias. Research suggest, however, that the key to
desensitization’s success may not be the learning of a new conditioned relaxation
response but rather the extinction of the old fear response through mere exposure: If a
person repeatedly imagines a frightening situation without actually encountering danger,
the fear or anxiety associated with that situation should gradually decline.
Flooding is a less familiar, and more aggressive, method of desensitization
through exposure. For example, someone with a powerful fear of snakes might be forced
immediately to handle dozens of snakes; or someone with an overwhelming fear of
spiders might be forced to stroked a tarantula and allow it to crawl up his or her arm.
Couples Therapy was originally known as marriage counseling but today often
proceeds at a deeper level than old-time counseling and is offered not only to married
couples but to premarital, extramarital, and homosexual couples, all of whom have
somewhat similar relationship problems.
The therapist’s role in couples therapy is a tightrope act: If he or she is perceived
by either member of the couple as siding with the other member, the therapy may be
abruptly broken off. The therapist therefore seeks to avoid transferences that would
generate strong feelings by either client, acts as interpreter, adviser, and teacher, and
stresses that the troubled relationship, not either individual, is the client.
The therapist solicits information and makes interpretations; teaches
communications skills and problem solving; plays back to the couple how they sound and
look in their interaction (“Are you aware that you sat as far apart as possible?”); brings up
sensitive issues that they avoid discussing with each other but can safely fight about in
the relative safety of the therapist’s office; and assigns homework to teach them new and
more satisfying patterns of behavior. Couples therapy is usually conducted on a weekly
basis, and most problems can be resolved in a year or less. In some cases, the partners in
couples therapy recognize that what one or both really want is the end of the relationship.
In that case, the therapist sometimes is able to help them separate cooperatively rather
than combatively and minimize the damage to themselves and to the children, if there are
Family therapy was developed almost simultaneously in several different places
in the United States in the 1950s, most notably in Palo Alto and New York. Its basic
assumption is that psychological symptoms and difficulties of all sorts stem from faulty
relationships within the family rather than from individual intrapsychic mechanisms
(although these are not ruled out).
Even though the family may come in with an “identified patient”—a scapegoat or
supposedly sick member on whom the family blames its troubles—the therapist regards
the family as the patient, or, to be more precise, the family’s interactions, rules, roles,
relationships, and organization. All these make up the “family system”; family therapy
draws heavily on systems theory, which was borrowed and adapted from biology. In
systems theory terms, the family members may be either overly or insufficiently involved
with one another; cut off from outside influences by rigid family boundaries; conversely,
lacking in a sense of familial belonging because of vague family boundaries; and so on.
The therapist diagnoses the family’s problems in systems theory terms by means
of genograms (diagrams of family patterns over three generations), by determining what
the alliances are within the family, and by using other methods special to family therapy.
For example, the therapist pays attention to the dynamics of the family unit – how family
members communicate, how they act toward one another, and how they view each other.
The goal of the therapist is to help family members reach agreement on certain changes
that will help heal the wounds of the family unit, improve communication patterns, and
create more understanding and harmony within the group.
The American Association for Marriage and Family Therapy has some ten
thousand members, who come from various disciplines and have met the association’s
requirement of two years of supervised postgraduate experience as marriage and family
therapists. Many other thousands of psychotherapists, who may or may not have had
extensive training in marital and family therapy, call themselves marital and family
therapists—the term is not controlled by law in most states—to indicate that they deal
with couples and family problems as well as individual ones.