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 had gained entrance into the sufferer. Treatment was based on participation in suitable rites under the guidance of a priest-physician, medicine man, or shaman. By contrast, 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 non-hospitalized patients in the naturalistic tradition was not distinguishable from ordinary medical practice until the latter half of the 19th century. In the late 18th century, however, a dramatic demonstration by Austrian 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, a widely used psychotherapeutic method that arose from the research of Jean-Martin Charcot. Using hypnotism, 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 the first modern “talking cure,” psychoanalysis, which, with its many modifications, influenced the subsequent development of psychotherapy.

Modern psychotherapeutic methods for directly treating patients include emotional support, problem exploration, interpretation, feedback, and psychosocial-skills training. Behavior therapies are aimed at correcting specific pathological emotional states or behavior patterns through appropriate countermeasures. They are based largely on physiologist Ivan P. Pavlov's conditioned-reflex theory, psychologist B.F. Skinner's operant conditioning theory, and psychologist Albert Bandura's social learning theory.

Humanistic, psychoanalytic, cognitive, and interpersonal therapies contribute to general personality growth and problem-resolution skills by helping people gain insight into their feelings and behavior. To facilitate this development, psychotherapists try to create a therapeutic situation that will enable patients to express themselves with complete freedom while the therapist maintains a consistent, nonjudgmental interest. This approach is meant to help patients discover aspects of their personalities that have been pushed out of awareness. It also causes the individual to experiment with more adaptive ways of thinking and behaving.

Humanistic schools of psychotherapy hold that the empathy, warmth, and consistent “unconditional positive regard” of the therapist for the patient are sufficient to produce important changes. Therapies in the psychoanalytic tradition take a somewhat different approach: while placing similar emphasis on the importance of the therapeutic relationship, psychoanalytic therapies also focus on the analysis of feelings as a means of helping patients understand the emotions they experience.

Traditional psychoanalysis emphasizes the use of dreams as shortcuts to the patient's unconscious experience. This approach also puts great attention on helping the patient to rediscover, reexperience, and “work through” any traumatic emotional experiences of early life that are thought to contribute to difficulties in later years. Subsequent modifications of psychoanalysis put greater emphasis on analysis of the patient's current problems, while others emphasize helping the patient to gain a better philosophy of life. All schools agree that a prolonged relation with the therapist can cause the patient to experience feelings toward the therapist that resemble those which trouble the patient's relationships with other persons. Because both therapist and patient can observe these transference reactions, as Freud termed them, their exploration is deemed a powerful means of resolving them.

Cognitive therapies focus almost exclusively on maladaptive modes of thinking underlying the patient's symptomatology. A cognitive approach known as rational emotive behavior therapy, developed by American psychologist Albert Ellis, aims to help the patient overcome irrational beliefs and unrealistic expectations. In Ellis's cognitive approach, patients are taught to eliminate self-defeating thoughts while focusing on those that are beneficial and self-accepting.  Interpersonal therapies draw upon a broader context, in that they help patients view their symptoms in terms of their social and communicational implications. Successful interpersonal approaches are meant to replace symptomatic interpersonal styles with more adaptive ones.

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 share many similarities in their methods of conceptualizing problems and in the therapeutic factors they provide for the patient. For example, most schools emphasize the importance of the therapeutic relationship, an intensive analysis of problem situations, and beneficial alterations in the patient's thoughts and behavior.

Chances of successful treatment generally correspond to the degree of the patient's involvement in the treatment process. This is influenced not only by the intensity of a patient's distress but also by the level of confidence a patient has in the therapist and the treatment method. Expectations of help are enhanced by the therapist's ability to convey to patients that he or she understands them intimately and is dedicated to their welfare. Personal qualities of the therapist are considered important to the development of a successful therapeutic relationship.  To read more about psychotherapy, see our Links & Readings...