1 The Origins of Psychotherapy
The origins of our modern form of âtalking cureâ are usually traced back to Sigmund Freud , beginning with his seminal publication on the origin of hysteria. This was co-authored with Joseph Breuer and published in 1895. In this, and his many subsequent publications, Freud laid out his proposals for the method of psychoanalysis . Key notions included the idea that much of human motivation operates at an unconscious level, and that different unconscious forces interact to determine our behaviour. This latter point was captured through the term âpsychodynamic â. These explanations of human behaviour and motivation put forward by Freud and his many successors remain influential in the field of psychotherapy . This is the profession which developed from Freudâs ideas and whose practitioners attempt to ameliorate psychological distress in clients through a process of dialogue.1
It is now a little over 120 years since Freud first began to put forward his ideas. In that time, there have been hundreds of other suggestions advanced around the nature of human distress and how to go about alleviating it. The American psychologist, Carl Ransom Rogers , put forward one early set of rival ideas. Rogers trained as a child psychologist in the 1920s and was initially schooled in Freudian thinking. However, in his early practice at the child guidance clinic in Rochester, New York, he began to question this approach. A particular stimulus appears to have been a visit by Otto Rank around 1936, who shared with Rogers some of his current writing (e.g. on âWill Therapyâ, first published in English in 1936). Rank was for many years a part of Freudâs inner circle, but the two split as it became obvious in the 1920s that many of Rankâs ideas were at odds with those of Freud. Rank felt, for example, that classic analysis neglected the emotional life of the client. Rogers seemed to have been heavily influenced by Rank, and published his key work, âClient Centred Therapyâ in 1951. In this highly influential book, Rogers argued that the primary aim of the therapist should be to offer a warm, accepting space for the client and to maintain a non-judgemental attitude. According to Rogers, clients needed space to explore their issues, without direction from the therapist. The therapistâs task in effect is to provide a safe therapeutic space, in which the client can feel fully accepted and understood.
Another American therapist who was also strongly influenced by Otto Rank was Rollo May . May is associated with the âexistential â school of psychotherapy . In acknowledging this influence, May wrote that Rank might be considered the first âexistentialâ therapist (May, 1994). According to this school of therapy, the best way for people to make sense of their own existence is through a consideration of their own experiences. It draws upon phenomenology and existential philosophy, with key themes around death, freedom, responsibility and the meaning of life (van Deurzen & Arnold-Baker, 2005).
At the same time that Rogers was developing his distinctive form of Client-Centred Therapy in the 1930s and 1940s, other psychologists, such as B. F. Skinner, were developing Behaviour Therapy , based upon the principles of classical and operant conditioning . The first published use of the term âBehaviour Therapyâ was probably in a report written by Lindsley, Skinner, and Solomon (1953). The approach was quickly picked up and developed by practitioners such as James Wolpe and Hans Eysenck (Clark, Fairburn, & Jones, 1997). Techniques such as relaxation training and systematic desensitization were found to be highly effective in helping people to deal with acquired phobias and anxieties . Alongside these developments, in the 1950s and 1960s, Albert Ellis and Aaron Beck were developing their approaches which focussed on peopleâs thought processes. Ellisâs version came to be known as Rational Emotive Behaviour Therapy , whilst Beckâs was called âCognitive Therapy â. These differed from the earlier pure behavioural approaches, which tended to focus on behaviour and the environment. By the 1970s, the two strands were being combined under the Cognitive Behaviour Therapy , which now included a focus on the environment, precipitating behaviour, thoughts and beliefs.
Thus, over the last 120 years of psychotherapy development, there have been four main strands of theoretical thinking. These begin with Freud âs psychodynamic ideas and then move on to client-centred, existential and cognitive behavioural therapies. It is interesting to reflect that the key personnel in each of the latter three strands were to some extent influenced by Freudâs original body of work. Rogers and May, however, came to be influenced by Otto Rank , who had broken away from Freudâs circle and espoused a different, more âauthenticâ and relationally present, view of therapy. Ellis and Beck were both initially trained in Freudian approaches, but became disillusioned and moved away from these, towards approaches rooted in a more immediate, here and now, cognitive phenomenology .
These four main approaches to therapy remain influential to this day. People wishing to train in counselling or psychotherapy could choose to enter a training organization which is guided by one or other of these theories. Counselling psychologists are typically trained in two of the four. This leads to a potentially confusing situation for aspiring trainees, of having to decide which school or schools of therapy they wish to train in. On what basis should such people make their decision? Equally, people in psychological distress who decide they might benefit from psychotherapy might be faced with different practitioners who espouse different approaches. On what basis should they choose a therapist? This situation becomes even more complicated when we consider that there are myriad ways in which people have attempted to bring aspects of these different approaches together into some kind of âintegratedâ approach, which may or may not have their own label. For example, schema therapy (Young, Klosko, & Weishaar, 2003) could be seen as a combination of cognitive and psychodynamic ingredients (see Chapter 4 for more on this approach).
The aim of this book is to argue the case that cognitive science can be put forward as a strong basis in which to ground a unified, comprehensive account of therapy. To develop this argument, it will be useful to consider in a little more depth the key insights from these four different strands of therapy. This will enable us to consider what is unique to each and where they overlap. From this overview, we will suggest what some of the essential ingredients of effective psychotherapy might be. Having reached this vantage point, we can then go on to consider the extent to which cognitive science can offer a convincing framework for psychotherapy.
2 Key Elements of Psychodynamic ThoughtâThe Importance of Early Experience, Unconscious Phenomena and Defence Processes
A key feature of psychodynamic thinking is the importance placed on the role of our early experience in influencing and shaping our later adult lives. In their early years , human infants experience a massive amount of growth and development. In the first few months, they are totally dependent upon their parents or guardians for all of their needs. They rely on adults to feed, clean and soothe them. At this early stage, when they have not yet mastered the ability to control their muscles and move around, they have limited means in which to influence their environment. However, right from the moment of birth they are able to signal their distress through crying. Research has also shown that infants are able, from a very early stage, to distinguish human faces within their environment. This is illustrated through the observation that they will preferentially direct their gaze towards such stimuli (Bushnell, 2001; Haan, Pascalis, & Johnson, 2002). During the act of feeding, they will look towards their motherâs face and seek eye contact. It is believed that these early interactions between mothers and their infants are important in building up the early bond between them (Bowlby, 2008). This is then linked to the infantâs development of a later sense of attachment âin other words how secure the infant feels in their relationship with their parents, and the extent to which they can tolerate their parents being absent for short periods. The sense of attachment has been shown to be important in shaping childrenâs early relationships and behaviour. Its influence, however, extends much further than this, into adulthood and our adult relationships (Sroufe, 2005).
Given how important our early years are in setting us up for our future adult lives, it is interesting to note that as adults we have very little recollection of this period. When people are asked to give details of their earliest memories, people often struggle to think of anything much before the age of around four years. For many people, this memory blank for their earliest experiences can extend for much longer, often up to the age of around seven years. Before the age of four, memories tend to be extremely fleeting and brief. This phenomenon whereby people can recall very little detail of the earliest years is referred to as âinfantile amnesia â (West & Bauer, 1999). Various theories have been put forward as to why we have such little recall of this early phase of our lives. For example, it has been suggested that as adults much of our memory recall is verbally mediated. In our early years, our language skills are just developing, and thus, the rich linguistic tapestry may not yet exist in which memories can be embedded and thus made available for future recall. As is well known, Freud himself explained childhood amnesia by powerful mechanisms of repression defence, a fundamental notion for psychodynamic thought (see Bauer, 2015; Erdelyi, 2006).
Despite the fact that much of our early experience is inaccessible to future conscious recall, a considerable amount of this experience does remain with us and be...