↖ Homepage of the site 'What to do with your life?'
      

History and Overview of Psychotherapies

The goal of this text is to help answer the crucial question: In the case of psychological distress, are the chosen psychotherapies necessary, optimal, and sufficient?

A few key points to better understand the importance of psychotherapies

Psychology, as a field of study, is dominated by three major facts:

1. The human mind is composed of two subsystems: reason, and the cognitive-affective system. Psychopathologies arise when the cognitive-affective system becomes overbearing, overpowering reason, and psychotherapies aim to correct this imbalance.

2. Dominant psychopathologies are determined (caused) by social conventions, and therefore evolve as these conventions do.

3. There are two broad categories of therapeutic methods: those aiming to condition the cognitive-affective system to better face future challenges, and those aiming to free it from disturbances stemming from past experiences, often traumatic.

However, the history of psychology is shaped around two recurring errors:

4. Psychologists tend to confuse psychopathologies, as we have just defined them, with maladaptation to society. Thus, non-standard personality structures, which may not pose a problem in a society with different social conventions, tend to be diagnosed as pathological.
Indeed, psychologists often conflate helping the individual recover a satisfactory relationship with their cognitive-affective system with achieving satisfactory social integration, that is, enduring at all costs the arbitrary social conventions of the moment. Thus, they label as psychotherapies techniques that often amount to mere conditioning, while possibly meeting the patient's request, who in turn tends to confuse succeeding in life with succeeding in society.

5. There are many psychotherapies, and it is claimed that this diversity benefits the patient. However, in practice, this leads on the one hand to applying techniques that are not relevant to the patient, and on the other hand to favoring conditioning methods presented as psychotherapies (which offer a quick but superficial effect), as well as outright quackery that attempts to please the patient by relying on their beliefs and giving them the illusion of understanding their problem, without truly treating it.

Evolution of Psychopathologies

1880: Jean-Martin Charcot - Studies on Hysteria

The extreme rigidity of manners at the end of the 19th century, and more specifically those imposed on women, produced as the dominant pathology (among the more affluent social classes) hysteria, in individuals for whom this social straitjacket was unbearable.

1970: The end of strict education and the emergence of borderline pathologies

With the end of the strict education before 1968 and the physical punishments, and the rise of a more permissive education, we observe the massification of borderline pathologies (people who have difficulty accepting boundaries), particularly psychopathy. Thus, a rigid education favored the actualization of a tendency toward hysteria, but effectively protected against the actualization of a tendency toward psychopathy.

2008: Social media and the development of autism

The consequence of a society that has become hyper-connected has been the massification of mild autism. In the countryside at the beginning of the 20th century, a worker who did not drink was considered satisfactory, and labeled simply as 'quiet' if he communicated little and poorly. With the emergence of social media, the required level of communication, and the complexity of social relationships, has increased significantly, and a significant part of the population can no longer keep up, and will now be labeled as lacking social skills.

2016: Smartphones and the development of attention disorders

Hyper-stimulation by smartphones has led to the massification of attention disorders (ADHD).

Recall, as explained in the question Putting an End to the Misuse of Psychotropics and Psychotherapies, the need to not confuse psychopathology with a personality structure that is maladapted to the arbitrary social conventions of the moment, that is, to not attempt to treat with so-called psychotherapy what pertains to political struggle or education.

First class of psychotherapies
Conditioning oneself

Antiquity: Stoicism

Stoicism consists of training oneself to perceive the events of our existence in a specific way. It is therefore a form of self-conditioning.
However, it is not a conditioning as we criticized at point 4, since Stoicism is largely independent of the social conventions of the time.

1922: Emile Coué - Self-Mastery through Conscious Autosuggestion

The 'Coué method' is a corrupted version of Stoicism, based on the idea of self-hypnosis.

Positive thinking, a later development, is problematic from our point of view, due to the risk of denying problems, which are effectively addressed by the second class of psychotherapies that we will see later on.

1957: Burrhus Frederic Skinner - Radical Behaviorism

This is the most mechanical and scientific form of conditioning, following the work of Ivan Pavlov.
En étant communément associée aux TCC (Techniques Cognitivo Comportementales) qui regroupaient dans le sens commun tout ce qui était issu des neurosciences naissantes, cette forme extrême du conditionnement, proche de la robotisation, a conduit à renforcer l'opposition entre psychanalyse et TCC.

Albert Bandura a montré que ce type de conditionnement est aussi opérant par simple observation.

~2000: Mindfulness-Based Cognitive Therapy

The goal is to train one's awareness to not be preempted by the cognitive-affective system.
ACT, which we will see later, offers a more comprehensive approach.

Second class of psychotherapies
Revising one's history and beliefs

Antiquity: Buddhism

Compared to Stoicism, Buddhism adds the practice of meditation, which involves letting rise the thoughts spontaneously produced by the cognitive-affective system, in order to gradually dismiss them as irrelevant in the present context.
Buddhism seeks minimalism at the level of beliefs, to favor the present moment, and an objective and depersonalized consideration of facts, but it has not managed to get rid of some outlandish notions like reincarnation.

1896: Sigmund Freud - Psychoanalysis

The foundational concept of psychoanalysis is that of the unconscious, which can be compared to the cognitive-affective system, in contrast to reason. However, psychoanalysis produces many other concepts, to the great satisfaction of psychoanalysts who see themselves as initiates, especially in Latin countries. These other concepts are not scientifically validated.
At the therapeutic level, the psychoanalytic cure can be seen as a form of assisted meditation, not only in terms of form (the session ritual), but also in terms of content (the therapist accompanies the patient's thinking).
Compared to Stoicism and Buddhism, psychoanalysis removes the representation of the world and the affirmation of values, in favor of an interpretative folklore of non-scientific and unedifying concepts.

1954: Donald Winnicott - The 'Sufficiently Good' Environment

Observing and classifying young children's attachment styles allows to obtain information about the cognitive-affective system in individuals who do not have sufficient verbal abilities to perform assisted introspection (psychoanalysis or CBT by Aaron Beck). However, this is only an indicator, and not a psychotherapy itself.

1967: Aaron Beck - Cognitive Behavioral Therapy (CBT)

This is a pure cleaning of psychoanalysis: we keep the core of the therapeutic approach, and we remove the interpretative folklore. The advantage of this purified version is that its therapeutic principle can be scientifically explained. We treat only the overbearing aspect of the cognitive-affective system, although toward the end of his life, Aaron Beck supplemented his therapy with elements of ACT (see below).

1982: Steven Hayes - Acceptance and Commitment Therapy (ACT)

ACT can be seen as a cleanup of Buddhism.
Du Bouddhisme, ACT retire les quelques croyances subsistantes telles que la réincarnation, tout en spécifiant au patient qu'il doit réfléchir et prendre position sur ses valeurs et ses objectifs. Plus précisément, là où le Bouddhisme affirme que l'objectif de tout humain est l'éveil, c'est à dire la paix intérieure permanente, ACT nous invite à clarifier nos valeurs et la personne que nous souhaitons devenir, pour au final agir en conséquence. En ce sens ACT comporte une part de conditionnement qui la rattache aussi à la première classe de psychthérapies.
From Buddhism, ACT keeps the strong affirmation that spontaneous thoughts from the cognitive-affective system should be accepted and relativized, and not avoided, but this work does not take the form of meditation.
Finally, from Buddhism, ACT keeps the emphasis on the importance of the present moment, as in mindfulness therapies.

Differentiating the various forms of CBT

Under the label of CBT, one gathers things that have not much to do with each other:

   •   

Aaron Beck's CBT consists of cleaning up memory by re-examining and re-recording its content, and it approaches psychoanalysis.

   •   

The behaviorist branch relies on visualization techniques to pre-record an event and condition our cognitive-affective behavior in specific situations. This technique is largely used by athletes, and can be effective in fighting anxiety arising in well-defined situations, such as an exam.

   •   

Some CBT therapies resemble problem-solving, and more specifically the Gemba form of Lean, where the therapist helps the patient develop solutions to their problems. See below.

   •   

Finally, CBT contains social conditioning techniques that raise ethical questions. Indeed, one attempts to pass off forms of social normalization as therapies. Take for example the training of mildly autistic individuals to better decode facial expressions. In a group that practices problem-solving, mildly autistic individuals do not encounter particular difficulties, and this mode is the most satisfying for all individuals. It is only when moving to a relational mode corresponding to what Eric Berne (inventor of transactional analysis) calls psychological games that relational difficulties arise for mildly autistic individuals.

During the second half of the 20th century, psychoanalysis and CBT waged a real influence war, especially in France, although the latter, in the versions of Aaron Beck and Steven Hayes, are merely the culmination of the former. The frontal opposition largely came from the inclusion under the CBT label, on the one hand, of behaviorist conditioning methods (which belong to a caricature of Stoicism), and on the other hand of those aiming to conform the individual to the arbitrary expectations of society, which do not belong to therapy, but to an oppressive conditioning, as denounced at the beginning of this document.
To put it more simply, psychoanalysis was not a completed method due to its overly extensive interpretations lacking scientific validation, and CBT encompassed variants involving abusive conditioning.

An important question remains the notion of values. Aaron Beck's CBT and especially ACT remove everything arbitrary at this level, which should be noted, as it effectively protects them from the prejudices of the moment and makes them genuine scientific therapies.
However, as ACT understood, an individual, to construct themselves, needs values. Establishing one's own values is not so simple, and cognitive dissonance makes the task even more difficult. That is why this site comes as a complement, proposing more elaborated values fully compatible with the advances of modern science during the last few centuries.

Problem Solving

We do not feature Thomas J. D’Zurilla and Arthur M. Nezu (PST Problem-Solving Therapy) in this history of psychotherapies, due to the distinction we make between the cognitive-affective system and reason. Our primary emphasis on problem solving is evident in the article What is a successful education? and we consider good mastery of the cognitive-affective system, and thus psychotherapies, as merely a prerequisite for achieving it.
Put simply, for us, problem solving is nothing less than the raison d'être of culture, that is to say much more than a simple therapy.

The Placebo Effect

The placebo effect is something very powerful: believing in something produces quite significant effects.

However, it presents two major limitations:

   •   

It is quite difficult to predict which belief will be efficient for which individual.

   •   

It cages as much as it cures, because belief becomes necessary, and the consideration of objective facts becomes compromised. The placebo effect must therefore be more closely associated with a drug than a psychotherapy in this sense, as it creates a dependency on belief.

All the therapies previously mentioned contain a part of placebo effect. Nevertheless, believing in them has little chance of placing us in a situation of cognitive dissonance in the face of observed facts. Conversely, based on the placebo effect, throughout history there have proliferated multiple therapies built on the prejudices and aspirations of the time, with an explanatory content created to please. For example, Astrology. Indeed, the content chosen is of little importance to the effectiveness, since the placebo effect (the act of believing) will ultimately be the efficient factor. On the other hand, one will indeed be dealing with a drug, and not a genuine psychotherapy, since the entrapment in belief will be strong.

Overview of Psychotherapies

This diagram aims to illustrate the influences linking the main psychotherapies, without however claiming to be exhaustive.

The horizontal axis represents time. We note that the majority of the most well-known figures were born around 1910.

On the left column, we find the various issues they addressed, or the elements they prioritized in their approach.

The main psychotherapies used today are represented on a yellow background.

The numerous concepts of psychoanalysis have proven impossible to validate on scientific grounds (topologies, etc.). Nevertheless, it remains widely disseminated, perhaps because the main figures of the 20th century often began with psychoanalysis.

Dive Deeper

In the book Acceptance and Commitment Therapy - the process and practice of mindful change, le chapitre 1 'Foundations and the Model' expose l'aspect largement mythique des maladies psychiatriques, et l'effet principalement sympthomatique recherché par les psychothérapies.
« Often, the generalized effects of psychotherapy on functional status and quality of life are small, and the largest effects tend to be observed with symptom severity measures. Reductions in symptom frequency and severity are only moderately correlated with improvements in social functioning or broader measures of life quality.
Yet, students of psychopathology are dutifully trained to know nearly every characteristic of nearly every syndrome category. Research journals in clinical psychology and psychiatry contain little else but research on syndromes; in most countries that fund mental health science, funding is almost entirely dedicated to the study of these syndromes. »