What is
Psychotherapy?
From a technical perspective, psychotherapy can be described as the use of specific therapeutic techniques along with a therapeutic relationship to bring about psychological and behavioural change. This article discusses the importance of the technique used in psychotherapy, the relationship between therapist and client, and the contribution of the client to psychotherapy results. The aims of psychotherapy are also discussed, with an emphasis on personal development.
Research has consistently demonstrated that the therapeutic technique is responsible for about 15% of the positive outcome experienced by clients who engage in psychotherapy. And in general, all therapies provide similar levels of benefit, with no one therapy proving to be significantly better than any other. Some caution is needed in interpreting this research however, as virtually all approaches investigated are 'talk' therapies, and not always easily differentiated from each other, even by expert therapists. An example of this bias in the research is reflected in the lack of representation of more experiential approaches like Reichian therapy and Gestalt therapy.
Some approaches have shown to be better suited to helping with some problems. For example, body-oriented approaches are considered very effective in addressing pre-verbal trauma and post-traumatic stress disorder (Rothschild, 2000) while talk therapies are not. Cognitive behaviour therapy (CBT) is considered a direct approach for changing dysfunctional belief systems. A person's character and values can also influence which technique they will respond best to. Psychotherapy approaches are commonly classified into categories of psycho-dynamic, humanistic/existential, cognitive/behavioural, and somatic/body-oriented. Although in clinical practice distinctions are less clear as therapists often integrate various approaches into their work.
Over the last few decades, psychotherapy research has also shown us that the therapeutic relationship between the client and their therapist contributes around 30% of the benefits of psychotherapy. So the relationship formed between client and therapist is twice as important, in terms of outcome, as the techniques used during therapy. This fact, which is the result of analysis of hundreds of studies into psychotherapy outcomes from all over the world, has changed the way we think about psychotherapy. In the case of depression, the relationship is particularly important as it is a much more reliable predictor of good outcomes regardless of the technique used. Carl Rogers was aware of the power of the therapeutic relationship when he developed the widely used and highly regarded person-centred approach to psychotherapy during the 1940's and 50's. This approach involves a relationship based on the therapist's empathy, unconditional positive regard and acceptance.
Regardless of the approach taken, helping clients with depression, anxiety and fear, relationship conflicts, jealousy, sexual issues, grief, stress, and so on, is the everyday reality of clinical practice for most psychotherapists.
Psychotherapy is not, however, just about providing relief from specific disorders and symptoms. Psychotherapy is used to both alleviate symptoms and enhance personal growth (Seligman, 1995). This can be seen in the popularity of psychotherapy among celebrities and creative people in general. Carl Rogers (1967) strongly believed psychotherapy to be a process fostering personality integration (in which symptoms are relieved) and growth toward wholeness and greater freedom to develop ones potential. And this is evident in the process of change you can see in clients. Karen Horney (1966), who also had a big impact on the evolution of psychotherapy, suggested the goal of therapy is to address those inner conflicts responsible for personal suffering and thereby helping the client discover their real feelings and wants, to evolve authentic values and to relate to others and the world on the basis of these. Psychotherapy could be described as a process of supporting the client in reducing both inner conflicts and relationship conflicts, and restoring or strengthening a sense of psychological and social harmony. All this results in increased self mastery.
Perhaps this quote from Abraham Maslow (1954) captures some elements of how our experience of ourselves and others can change as the process of psychotherapy and the growth of consciousness advances:
"One does not complain about water because it is wet, nor about rocks because they are hard ... As the child looks out upon the world with wide, uncritical and innocent eyes, simply noting and observing what is the case, without either arguing the matter or demanding that it be otherwise, so does the self-actualising person look upon human nature both in him or herself and in others."
It is no coincidence that Maslow's words have a Buddhist ring to them. Jung (1964) suggested that psychotherapy is the only movement within western culture that partly has, and should have, an understanding of the nature of Zen. And indeed in contemporary psychotherapy their is a strong movement toward recognising not just a psychological "self" that is often in need of restorative work, but also a more encompassing spiritual whole. At the forefront of this movement is transpersonal psychotherapy, which "seeks to find the sacred in the daily, ordinary life and consciousness in which most people live" (Cortright, 1997). From the transpersonal psychotherapy perspective, psychological work on the self is still important and necessary but is held within a broader context of spiritual unfolding.
The last few decades has also seen the increasing use of mindfulness meditation as part of psychotherapy approaches. Mindfulness meditation is traditionally associated with Buddhist meditation practice but its use in psychotherapy is showing us that it is effective in helping heal a wide range of problems including depression, anxiety, and borderline personality disorder, and more. Something meditators have suggested for a long time. However, despite this growing interest in the spiritual, the psychological realm is still a major focus of psychotherapy.
At the beginning of this article, I mentioned that research has shown us that the therapeutic technique accounts for 15% of the improvement you can expect from engaging in psychotherapy. And the relationship between the client and therapist for a further 30%. So where does the other 55% of change come from? 15% is placebo effect - the positive expectation that change is going to take place means some does (this means it is very important to find a therapist you have faith in). The rest, 40%, is entirely due to everything the client brings to therapy - life experience, motivation, social support, and so on. What this means is you, as the client, play a big part in your own healing. Psychotherapists simply use the expertise and wisdom they have gained to help you connect with your own inner wisdom and intrinsic drive for healing, growth and spiritual unfolding. In places where your developmental process has become stuck or derailed, psychotherapy gets it moving again.
References
Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7-18.
Horney, K. (1966). Our Inner Conflicts: A Constructive Theory of Neurosis. London: Norton.
Jorgensen, C. R. (2004). Active ingredients in individual psychotherapy: Searching for common factors. Psychoanalytic Psychology, 21, 4, 516-540.
Jung, C. (1964). In, D. T. Suzuki, An Introduction to Zen Buddhism. New York: Grove Press.
Maslow, A. H. ((1954). Motivation and Personality. New York: Harper.
Rogers, C. R. (1967). On Becoming a Person. London: Constable.
Roth, A,. & Fonagy, P. (2005). What Works For Whom? A Critical Review of Psychotherapy Research (2nd ed). New York: The Guilford Press.
Rothschild, B. (2000). The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. New York: W. W. Norton & Co.
Seligman, M. (1995). The effectiveness of psychotherapy: The Consumer Reports study. American Psychologist, 50, 965-97