5. Counselling

Counselling refers to a confidential relationship between a client and an individual who is trained to listen attentively and who will try and help you to improve things through support and understanding. ‘Counselling’ outlines some recognizable and useful differences between counselling and psychotherapy. Overall, counselling is less formal than psychotherapy, and the relationship between counsellor and client more equal. Most counselling draws on Carl Rogers’ client-centred approach, whose three core conditions for successful counselling and psychotherapy are congruence or genuineness, empathy, and respect. The specific counselling approaches considered here are: existential therapy, transactional analysis, drug and alcohol counselling, psychodynamic counselling, and telephone counselling.

6. Cognitive behaviour therapy

Cognitive behaviour therapy (CBT) brings together the strengths of behaviour therapy and cognitive therapy. ‘Cognitive behaviour therapy’ identifies three layers of thinking in CBT theory: negative automatic thoughts, underlying assumptions, and core beliefs (often called schemas). CBT is very structured and pretty prescriptive. Once negative automatic thoughts have been identified they need to be tested and examined. This is referred to as collaborative empiricism. Collaborative empiricism has two functions. The first, and most obvious, is to identify, test, and modify negative automatic thoughts. The second is to teach the patient to become her own therapist. Specialized CBT—mindfulness-based cognitive therapy and dialectical behaviour therapy—is also described.

2. Freud and psychoanalysis

Almost all modern psychotherapies owe their origins to Freud and psychoanalysis. ‘Freud and psychoanalysis’ shows that although psychoanalysis is no longer the dominant psychotherapy, it has influenced virtually all subsequent therapies. Sigmund Freud (1856–1939), a neurologist based in Vienna, started it all. He used hypnosis for many years with his neurotic patients, but moved on to free association and dream interpretation. His psychoanalysis involved gaining an understanding of a person’s mental structures: the ego, id, super-ego, and defence mechanisms. The spread of psychoanalysis to the US, the UK, and South America was a result of the rise of Nazism in the 1930s, which forced many early analysts to leave Austria.

8. Psychotherapy now and in the future

Psychotherapy has reached into almost every aspect of our lives—how we treat the mentally ill, how we understand our relationships, our appreciation of art and artists, and even how we manage our schools, prisons, and workplaces. ‘Psychotherapy now and in the future’ reviews the current state of psychotherapy in the Western world as well as in non-Western societies, and considers what the future holds for psychotherapy. How we judge psychotherapy’s future will probably reflect what we think of it now: as a profound breakthrough in understanding ourselves and a step forward in social evolution, or as simply one among many technical procedures to reduce distress and improve human well-being.

7. Family, group, and interactive therapies

‘Family, group, and interactive therapies’ considers and describes the widely established practice of systemic family therapy, couples therapy, and group therapy, and also introduces psychodrama, art therapy, and music therapy, which are interactive therapies. Family therapy is often used when the referred patient is a child or adolescent. When families are struggling to find a healthy balance, systemic family therapy offers them an opportunity to take a step back and think together. Group therapy is traditionally composed of individuals with a range of problems—anxiety, depression, phobias, relationship difficulties. This range of problems and individuals makes the group a microcosm of ordinary life.

4. Time-limited psychotherapy

For many therapists and patients, short-term therapies are now the treatments of choice. ‘Time-limited psychotherapy’ describes three time-limited psychotherapies that have emerged with increasing evidence for their effectiveness: interpersonal psychotherapy (IPT, devised specifically for depression), cognitive analytic therapy (CAT, an integrative approach combining cognitive understandings and techniques within a more analytic framework), and solution-focused therapy (SFT, an active approach that engages people’s inbuilt ability to find solutions). In all of these therapies, both parties have to make active use of the time available to them. A focus is created at a very early stage, and the patient or client plays an active role in addressing their difficulties, both within and between sessions.

3. Post-Freudians: moving towards the interpersonal

Many of Freud’s followers began to develop their own ideas, the most influential being Carl Gustav Jung. ‘Post-Freudians: moving towards the interpersonal’ describes Jung as a romantic individual who believed that analysis had the potential to bring patients to an emotionally richer, more spiritual state. He introduced the concepts of introvert and extrovert, but is best known for his ideas on symbolism. Jungian psychotherapy is called analytical psychology to distinguish it from psychoanalysis. Analytical psychology aims for integration of the personality, aspiring to a harmony that accepts inherent contradictions rather than striving to reduce or eradicate them. The work of other neo-Freudians—Alfred Aldler, Erik Erikson, and John Bowlby’s attachment theory—are also described.

1. What is psychotherapy and who is it for?

Psychotherapy involves using an agreed relationship between a trained practitioner and a patient to obtain relief from emotional suffering. Most Western psychotherapies are based on talking and discussion that aim for a very personal understanding of the origins and meaning of problems in order to remove symptoms and obtain relief. ‘What is psychotherapy and who is it for?’ explains that present-day psychotherapy is available to a wide range of individuals in many settings. Different therapies include counselling, cognitive behaviour therapy, group and family therapies, and interactive therapies such as music and art therapy. It also shows that psychotherapy is not risk free; good psychotherapists carefully assess patients’ character strengths and their problems before embarking on treatment.