PSYCHOTHERAPY

any form of treatment for psychological or emotional disorders in which a trained person establishes a relationship with one or several patients for the purpose of modifying or removing existing symptoms and promoting personality growth. Drugs may be used as adjuncts, but the healing influence is exerted primarily by words and actions that are believed by sufferer, therapist, and the group to which they both belong to have healing powers and that create an emotionally charged relationship between or among them. Modern individual and group psychotherapeutic methods are used to treat all forms of suffering in which emotional factors play a part. These include behaviour disorders of children and adults; emotional reactions to the ordinary hardships or crises of life; psychoses, characterized by derangements of thinking and behaviour usually so severe as to require hospitalization; psychoneuroses, which are chronic disorders of personal functioning often accompanied by bodily symptoms of emotional strain; addictions; psychosomatic disorders, in which tissue damage is caused or aggravated by emotional components; and stress. Psychotherapeutic principles are also emphasized in rehabilitation programs for the disabled and chronically ill. Early treatment of mental illness was based on either a religio-magical or a naturalistic view of disease. The former, originating before recorded history, saw certain forms of personal suffering or of alienation from one's fellows as caused by an evil spirit that gained entrance into the sufferer. Treatment was based on participation in suitable rites under the guidance of a priest-physician, medicine man, or shaman. The naturalistic tradition viewed mental illness as a phenomenon that could be scientifically studied and treated. Treatment consisted of measures to promote bodily well-being and mental tranquillity. Psychotherapy of nonhospitalized patients in the naturalistic tradition was not distinguishable from ordinary medical practice until the latter half of the 19th century. The emergence of psychotherapy as a specialized treatment probably is traceable to the late 18th century. A dramatic demonstration by an Austrian mystic and physician, Franz Anton Mesmer, showed that many symptoms could be made to disappear by putting a patient into a trance. Mesmerism was the precursor of hypnotism, which became a widely used psychotherapeutic method. Through it, Josef Breuer and Sigmund Freud together made the epochal observations on the relationship to later mental illness of emotionally charged, damaging experiences in childhood. From these discoveries grew the theory and practice of psychoanalysis, which, with its many modifications, immensely influenced the subsequent development of psychotherapy. Modern psychotherapeutic methods for influencing patients directly include giving advice, persuasion, suggestion, and training in specific curative activities. Behaviour therapies are aimed at correcting specific pathological emotional states or behaviour patterns by appropriate countermeasures. They are based largely on the conditioned-reflex theory of I.P. Pavlov and on other theories of learning. Individual therapies that aim to foster a patient's general personality growth emphasize helping him to gain insight into his feelings and behaviour. To facilitate this they try to create a therapeutic situation that will enable the patient to express himself with complete freedom, while the therapist maintains a consistent, warm, nonjudgmental interest. Feeling himself understood and accepted by someone whom he admires and to whom he feels close, the patient will progressively dare to reveal those shameful or frightening aspects of himself that he has pushed out of awareness. Some schools of psychotherapy hold that the consistent, warm unconditional positive regard of the therapist for the patient is sufficient to produce important changes. Therapies in the psychoanalytic tradition, while also emphasizing the importance of the therapeutic relationship, try to help the patient understand and master his feelings by analyzing them. They differ in their concepts and in the relative emphasis placed on different types of material produced by the patient. Traditional psychoanalysis emphasizes the use of dreams as short cuts to the patient's deeper feelings. It also puts great stress on helping the patient to rediscover, reexperience, and work through the traumatic emotional experiences of early life in which his current difficulties are believed to originate. Later modifications of psychoanalysis put more emphasis on analysis of the patient's current problems, and some emphasize helping the patient to gain a better philosophy of life. All agree that in an intimate, prolonged relation with the therapist, the patient will eventually experience toward him the feelings that trouble his relationships with persons emotionally close to him in his past and present life. Since both therapist and patient can observe these transference reactions, as Freud termed them, exploring their inappropriateness is deemed a powerful means of resolving them. There is no convincing evidence that the results of one form of treatment are better than any other. Despite differences in emphasis, most schools of psychotherapy agree that mental illnesses are, at least in part, expressions of chronic states of anxiety and frustration related to unresolved inner conflicts or unsuccessful ways of dealing with other persons. Though genetically or physiologically caused vulnerabilities might contribute to the difficulties of these patients, unfortunate early experiences with family members and other emotionally significant persons are believed to play a major role. Chances of successful treatment are generally held to be related to the degree of the patient's emotional involvement in the treatment process. This is influenced by the intensity of his suffering and by his faith in the therapist and the treatment method. The patient's expectation of help is enhanced by the therapist's ability to convince the patient that he understands him intimately and is dedicated to his welfare. Personal qualities of the therapist seem important in the development of a successful therapeutic relationship. See also behaviour therapy; nondirective psychotherapy; group therapy.