What we currently understand as psychotherapy has existed since the beginning of time, although it has not always had the same form. However, the fundamental role of words and changing habits as methods to achieve mental health have been recognized by most human societies.
In this article we will briefly describe the history of psychotherapy and clinical psychology. To do this, we will take a journey that will go from ancient times to the appearance of cognitive-behavioral therapy, the predominant model today.
In ancient times our ancestors attributed unexplainable phenomena to the action of supernatural forces such as gods, demons and spirits. Psychic life and mental disorders were no exception.
The Egyptians viewed suggestion as a form of magic that could be used as a complement to medical treatments, and the Greeks believed that physical and mental illnesses depended on the body’s imbalance of four fluids or humors. Similarly, in China health was understood as the balance between vital forces.
It is believed that The first psychotherapies emerged in the Islamic world. Between the 10th and 12th centuries AD, thinkers and doctors such as Abu Zayd al-Balkhi, Zakariya al-Razi and Avicenna introduced the concepts of “mental health” and “psychotherapy” and described a large number of neuropsychological disorders.
The appearance of psychotherapy in Europe was delayed until the Renaissance, since in the Middle Ages the yoke of Christianity blocked advances in this field. For many centuries, mental health problems were linked to demonic influences. In reality, mesmerism and hypnotherapy, practiced by Mesmer, Puységur or Pussin, were some of the first properly European psychological treatments, in the 18th century.
Later the influence of rationalist and empiricist philosophers promoted the consolidation of psychology as a social science. The alienists Pinel and Esquirol were decisive in the development of moral treatment, which defended the rights of psychiatric patients against the abuses of religious “therapies.”
Psychoanalysis and scientific psychology
Charcot’s studies on hysteria and other neuroses, as well as Janet’s work on dissociation, influenced the emergence of Sigmund Freud’s psychoanalytic theory which postulated that human behavior is fundamentally determined by unconscious factors and experiences experienced in childhood.
At the same time, at the end of the 19th century, Granville Stanley Hall founded the American Psychological Association (or APA), which today continues to constitute the main organization of the profession. Clinical psychology also emerged in this period thanks to Witmer’s work with children with learning disabilities at the University of Pennsylvania.
While Freud’s disciples, such as Adler, Jung and Horney, expanded and revised the hypotheses of psychoanalysis, scientific psychology continued to develop through the founding of institutions, departments, clinics and publications on psychology. The United States established itself as the nucleus of these progress.
The rise of behaviorism
Although psychoanalysis continued to be strong during the first half of the 20th century, behaviorism became the predominant orientation in this period. The contributions of Thorndike, Watson, Pavlov and Skinner made observable behavior the focus of psychological analysis and promoted the development of brief behavioral therapies.
Skinner himself devised a number of techniques based on operant conditioning, mainly on reinforcement. Wolpe created systematic desensitization, the antecedent of modern exposure therapy, while Eysenck compiled the available evidence on the lack of effectiveness of psychoanalysis as a treatment.
Behaviorism was key in the evolution of psychotherapy, but in the 40s and 50s different perspectives that reacted to behaviorist reductionism which minimized the relevance of thought, emotion and will.
Existentialism, humanism and systemic therapy
The existential psychotherapies of Viktor Frankl, Otto Rank or RD Laing emerged from psychoanalysis. The same thing happened with Rogers’ client-centered therapy, which managed to focus psychotherapeutic interest on the existence of factors common to the different orientations that explain the effectiveness of therapy.
Carl Rogers and Abraham Maslow were the two pioneers of humanistic psychology. These authors believed that human beings have a natural tendency towards self-realization and personal growth, and defended psychotherapy as a method to help clients develop as people, based on their values. Gestalt therapy, created by Fritz Perls and Laura Perls in the middle of the century, is also found in this humanist current, although it appeared somewhat before Rogers and Maslow developed their ideas.
Later, in the 1960s and 1970s, authors such as Wilhelm Reich and Alexander Lowen popularized body psychotherapies, which reclaimed the body as the center of human experience. However, his theories were dismissed by the scientific community due to their lack of empirical solidity.
Systemic and family therapies They appeared in the 70s with the popularization of General Systems Theory and the contributions of the Milan School, the Structural School and the Mental Research Institute of Palo Alto. While existentialism and humanism were diluted, systemic therapy was consolidated during the following years.
Cognitivism: return to the mind
The cognitive orientation had as its predecessor George Kelly, who defended that people understand the world through idiosyncratic psychological constructs. However, the turning point was Ellis and Beck therapies, which emerged in the 50s and 60s.
Albert Ellis’s rational emotive behavioral therapy (REBT) focused on the technique that would later be known as “cognitive restructuring.” For his part, Aaron Beck developed Cognitive Therapy for depression, a highly structured and systematized procedure that served as a model for many other similar therapies.
Although cognitivist therapies emerged independently, in many cases hand in hand with authors trained in the psychoanalytic tradition, the truth is that behaviorism and scientific psychology also had a great influence on them. These complementary models ended up converging in cognitive-behavioral therapies.
Recent therapeutic developments
At least since the 1980s and 1990s, the focus of psychotherapy has been on demonstrating the effectiveness of treatments for specific disorders and problems. The American Psychological Association, with a predominantly cognitive-behavioral orientation, has had a great influence on this.
The turn of the century has also brought a rise of therapeutic eclecticism. Although cognitive-behavioral therapy has been consolidated as a global framework for action, a large number of professionals and interventions have popularized the use of techniques from various orientations to compensate for the limitations of cognitive-behavioral therapy.
In particular, the importance of emotions and language has been claimed. The combination of the cognitive-behavioral model with the theory of relational frameworks and mindfulness meditation, among other techniques, has promoted emergence of third generation therapies which are currently solidifying as the future of psychotherapy.
