CHAPTER 1
INTRODUCTION
The field of psychotherapy and counseling is continuously evolving. Approaches to treatment change in the wake of the addition of new information, opportunities to test the impact of treatments over time, and the zeitgeist of the place and time where psychotherapy/counseling is practiced. The time has long passed when one method, psychoanalytic psychotherapy as described by Freud (Freud, 1966), dominated the scene. Even during Freud’s era, Jung (1935), Adler (Adler, Glueck, & Lind, 2006), and several other analysts offered competing visions of the core aspects of personality and psychopathology and the conduct of treatment. There has been an explosion in the number of psychotherapies over the past few decades with that number now reaching more than 1,000 different named therapies (Garfield, 2006). Moreover, although some of these treatments are only slight variations of others, many approaches have their foundations in an array of diverse philosophies concerned with the understanding of personality, ethical questions (e.g., how to live life well), and notions of how to most helpfully improve problems in living and psychopathology.
DEFINING PSYCHOTHERAPY
Orlinsky and Howard (1987) define psychotherapy as “(1) a relation among persons, engaged in by (2) one or more individuals defined as needing special assistance to (3) improve their functioning as persons, together with (4) one or more individuals defined as able to render such help.” That is, psychotherapy (and the closely related activity of counseling) essentially consists of a socially constructed relationship in which one person (with the appropriate credentials and training) is seen as able to help others through the process of relating with that person or persons. The form and content of that relating can and does vary enormously.
GOALS OF PSYCHOTHERAPY
Psychotherapy and counseling are complex activities because both typically focus on the alleviation of symptoms and psychological disorders and on individual growth and goal attainment. Furthermore, psychotherapies and methods of counseling encompass working with a range of process goals (e.g., improving insight, cognitions, or the client’s behavioral repertoire) that are seen as crucial in achieving the ultimate goals of treatment. A consideration of the field is further complicated because different treatments aim toward these respective process and ultimate goals to different extents, although almost all treatments make some claim to help attain each set of ultimate goals.
In considering the variety of treatment models in books of this kind, we are left with many difficult and complicated questions, such as:
How do we compare treatments such as behavior therapies that almost entirely focus on change in behavior as both the process and ultimate goals of treatment with treatments (e.g., experiential psychotherapies) that primarily aim to deepen client experience?
How do we compare the outcomes sought in a psychoanalytic treatment that are focused on increasing individual understanding with those of mindfulness therapies that aim to increase the ability to defocus from problems?
How do we compare the outcomes of individually oriented treatments that focus exclusively on change in the individual with family treatments that prioritize family change?
These sorts of questions are widely debated by authors committed to diverse positions about what works best and about how psychotherapy/counseling can best benefit clients.
VIEWS OF HOW TO LIVE LIFE
Questions as to what constitutes the life best worth living have been discussed at least since the time of Aristotle and competing visions have evolved. Originally, these discussions were the province of philosophy and religion, but in the past century, such issues concerned with the best and most effective way to live have come to occupy a central place in psychotherapy and counseling. As Messer (Messer & Winokur, 1980, 1984, 1986) has highlighted, therapies differ considerably in their core view of human existence. Some psychotherapies feature a basically optimistic view of life. (Messer describes these in the tradition of literature as comedic.) Treatments such as cognitive-behavioral therapies and experiential therapies see hard work and personal improvements as leading to good outcomes if the client participates as prescribed. Other treatments have a more tragic focus. Freud (1966) viewed the result of psychoanalysis as coming to terms with the limitations imposed by the world and envisioned a world filled with trouble. Existential therapists and most psychoanalytic therapists have shared a similar vision.
CORE DETERMINANTS OF HUMAN EXPERIENCE
Beyond implying a world vision, there also are ideas at the core of most therapy approaches that specify which aspects of human experience are most important and crucial to address in treatment. The schools of psychotherapy summarized in the chapters in this book vary considerably in their core view of human personality and social psychology and in how to be most helpful. Is it best to be fully in touch with our emotions as experiential therapists suggest, or to maintain a stoic view of the world that highlights using the human cognitive capacity to keep emotion under control as in cognitive therapy? How important is it to gain insight versus achieve behavior change? Is it best for clients to see themselves as separate individuals or as connected to families and larger social systems? Where theories stand with regard to such questions to a great extent shapes the focus of intervention.
TREATMENT OF DISORDERS AND DIFFICULTIES
If one thread in psychotherapy is concerned with how to live, another is concerned with improving individual functioning so that problems in living are alleviated. In the past few decades, more and more specific therapies have been developed to reach the ultimate goal for treatment of reducing specific sets of dysfunctional behaviors and increasing functional ones.
There are actually two variants of such approaches:
The aim of this latter group of treatments, which incorporate the medical model of disorder at the foundation of DSM, to reduce or eliminate psychopathology. From the time of Freud, it has been clear that psychotherapy was one method for alleviating the sorts of disorders catalogued in the DSM (and for some time, the only available; in the past 50 years, medications have also been readily available). Recently, there have been numerous treatments developed with such a specific syndrome focus that have been empirically tested and demonstrated to be effective in treating the designated disorder and labeled as empirically supported treatments (ESTs). Although ESTs clearly work (they have been demonstrated to do so), they have been highly controversial in the field of psychotherapy. There is considerable debate about whether the movement to specific evidence based treatments for specific DSM disorders is a positive or negative change in the world of psychotherapy (see the discussion in Chapter 14 in this book for one side of this argument and Chapter 13 for the other).
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