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History and overview of psychotherapies

The objective of this text is to help answer the following crucial question: faced with psychological distress, are the selected psychotherapy or psychotherapies necessary, optimal, and sufficient?

Some benchmarks for better understanding the stakes of psychotherapies

Current knowledge regarding the overall functioning of the mind is scant, in contrast to knowledge in neurology.

Psychology as a field of study is dominated by the following three main facts:

1. The human mind consists of two subsystems: reason, and the cognitive-affective system. Psychopathologies correspond to an invasive cognitive-affective system, which overwhelms reason, which psychotherapies seek to correct.

2. Dominant psychopathologies are determined (provoked) partly by social conventions, and therefore evolve along with them.

3. There are two major classes of therapeutic methods: those aiming to condition the cognitive-affective system, to better cope with future trials, and those aiming to free it from disturbances stemming from past experiences, usually traumatic.

However, the history of psychology revolves around 2 recurring errors:

4. Psychologists tend to confuse psychopathologies, as we have just defined them, with maladjustment to society. Thus, non-standard personality structures, which would not pose a problem in a society organized around different social conventions, tend to be diagnosed as pathological.
Indeed, psychologists tend to confuse enabling the individual to re-establish a satisfactory relationship with their cognitive-affective system with achieving satisfactory social integration, that is, managing at all costs with the arbitrary social conventions of the time. They thus qualify as psychotherapies techniques that often amount to mere conditioning, while possibly satisfying the patient's demand, who 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 to the patient that are not relevant to them. On the other hand, it tends to favor conditioning methods presented as psychotherapies (which have a rapid superficial effect), as well as outright quackery that seeks to please the patient by relying on their beliefs and giving them the illusion of understanding their distress, without truly treating it.

Evolution of psychopathologies

1880: Jean-Martin Charcot - Studies on hysteria

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

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

With the end of pre-1968 strict education and corporal punishment, and the emergence of a more permissive education, we observe the massification of borderline pathologies (individuals having difficulty accepting limits), particularly psychopathy. Thus, rigid education favored the realization of a tendency towards hysteria, but effectively protected against the realization of a tendency towards psychopathy.

2008: Social networks and the development of autism

The consequence of a society that has become hyper-communicative has been the massification of mild autism. In rural areas in the early 20th century, a working spouse who did not drink was considered satisfactory, and simply labeled taciturn if they communicated little and poorly. With the emergence of social networks, the level of communication required, and the complexity of social relationships, increases considerably, and a significant portion of the population can no longer keep up, and will now be labeled as lacking social skills.

2016: The smartphone and the development of attention disorders

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

Let us recall, as explained in the question Putting an end to the abusive use of psychotropics and psychotherapies, the necessity of not confusing psychopathology with a personality structure maladapted to the arbitrary social conventions of the time, that is, of not attempting to treat with so-called psychotherapy what belongs to the political struggle or education.

First class of psychotherapies
Self-conditioning

Antiquity: Stoicism

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

1922: Emile Coué - Self-Mastery through Conscious Autosuggestion

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

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

1957: Burrhus Frederic Skinner - Radical Behaviorism

This is the most mechanical and scientific version of conditioning, following the work of Ivan Pavlov.
Commonly associated with CBT (Cognitive Behavioral Therapies), which in common parlance grouped everything stemming from emerging neuroscience, this extreme form of conditioning, close to robotization, has led to strengthening the opposition between psychoanalysis and CBT.

Albert Bandura showed that this type of conditioning is also operative through simple observation.

~2000: Mindfulness meditation (Mindfulness-Based Cognitive Therapy)

The objective is to train consciousness not to be preempted by the cognitive-affective.
ACT, which we will see later, offers a more complete approach.

Second class of psychotherapies
Revising one's history and convictions

Antiquity: Buddhism

Compared to Stoicism, Buddhism adds the exercise of meditation, which consists of letting thoughts produced spontaneously by the cognitive-affective system rise to the surface, in order to gradually evacuate them as irrelevant here and now.
Buddhism seeks minimalism in beliefs, to favor the here and now, and the objective and de-dramatized consideration of facts, but fails to rid itself of some absurd notions like reincarnation.

1896: Sigmund Freud - Psychoanalysis

The founding concept of psychoanalysis is that of the unconscious, which can be compared to the cognitive-affective system, in opposition to reason. However, psychoanalysis produces many other concepts, to the great satisfaction of psychoanalysts who perceive themselves as initiates, particularly in Latin countries. These other concepts do not find scientific validation, and even end up obscuring the consideration of facts.
At the therapeutic level, the psychoanalytic cure can be seen as a form of assisted meditation not only at the level of form (ritual of the session), but also at the level of content (the therapist accompanies the patient's thought).
Compared to Stoicism and Buddhism, psychoanalysis removes the representation of the world and the affirmation of values, in favor of an invasive interpretative folklore of concepts that are neither scientific nor edifying.

1954: Donald Winnicott - The 'good enough' environment
Mary Ainsworth
John Bowlby

The observation and classification of attachment styles in young children allows obtaining information on the cognitive-affective content in individuals who do not have sufficient verbal capacities to perform assisted introspection (psychoanalysis or Aaron Beck's CBT). However, this is merely an indicator, and not a psychotherapy.

1967: Aaron Beck - Cognitive Behavioral Therapy (CBT)

This is a pure and simple cleanup of psychoanalysis: we keep the heart of the therapeutic approach, and remove the interpretative folklore. The advantage of this refined version is that its therapeutic principle is scientifically explained. We only treat the invasive side of the cognitive-affective system, even if towards the end of his life, Aaron Beck supplemented his therapy by adding elements of ACT (see below).

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

ACT can be seen as a cleanup ... of Buddhism.
From Buddhism, ACT removes the few remaining beliefs such as reincarnation, while specifying to the patient that they must reflect and take a stand on their values and goals. More precisely, where Buddhism asserts that the goal of every human isenlightenment, that is, permanent inner peace, ACT invites us to clarify our values and the person we wish to become, to ultimately act accordingly. In this sense, ACT contains a conditioning element that also links it to the first class of psychotherapies.
From Buddhism, ACT keeps the strong assertion that spontaneous thoughts stemming from the cognitive-affective system must 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 here and now, like mindfulness therapies.

Differentiating the various forms of CBT

Under the label CBT, we group things that have little in common:

At the end of the 20th century, psychoanalysis and CBTs engaged in a real influence war, particularly in France, while the latter, in the Aaron Beck and Steven Hayes versions, are merely the advanced version of the former. The direct opposition came largely from the inclusion under the term CBT, on the one hand, of behavioral conditioning methods (which relate to a caricature of Stoicism), and on the other hand, those aiming to conform the individual to the arbitrary expectations of society, which do not belong to therapy, but to a oppressive conditioning, as denounced at the beginning of this document.
Said more simply, psychoanalysis was not an advanced method, due to its too extensive interpretations not scientifically validated, and CBTs, on the one hand encompassed variants related to abusive conditioning, and on the other hand often used for validation metrics that were weakly relevant.

An important question remains the concept of values. CBT by Aaron Beck and especially ACT remove all that is arbitrary at this level, which should be praised, as it effectively protects them against the prejudices of the moment, and makes them true scientific therapies.
However, as ACT has understood, an individual needs values to construct themselves. Giving oneself one's own values is not so simple, and cognitive dissonance makes the task even more difficult. Therefore, this site comes as a complement by proposing more elaborate values, fully compatible with the advances of modern science during the last centuries.

Problem solving

We do not include 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. The primary importance we attribute to problem-solving appears in the article What is a successful education? and we consider good mastery of the cognitive-affective system, and thus psychotherapies, as a simple prerequisite to achieve it.
In other words, for us, problem solving is nothing less than the raison d'être of culture, which is much more than a simple therapy.

The placebo effect

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

However, it presents two major limitations:

All therapies seen previously involve a certain placebo effect. However, believing in them has little chance of placing us in a situation of cognitive dissonance vis-à-vis observed facts. On the contrary, based on the placebo effect, at all times, there have sprung up numerous therapies built on the prejudices and aspirations of the moment, with explanatory content designed to please. For example, astrology. Indeed, the content retained is of little importance for efficacy, since it is the placebo effect (the act of believing) that will ultimately be efficient. However, we will indeed be dealing with a drug, and not a true psychotherapy, since the confinement within the belief will be strong.

Overview of psychotherapies

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

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

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

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

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

To delve deeper

In the book Acceptance and Commitment Therapy - the process and practice of mindful change, chapter 1 'Foundations and the Model' exposes the largely mythical nature of psychiatric illnesses, and the primarily symptomatic effect sought by psychotherapies.
« 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. »