Understanding Mental Health and Counselling. Группа авторов

      ‘Silence is enough’ by Lu Szweda

      Few today would challenge the argument that therapy should be made available to people experiencing mental health difficulties. Since the mid-twentieth century, therapeutic concepts and practices have become a common motif in everyday culture, from newspaper advice columns to prime-time television. But the idea that mental distress can be ameliorated through talking with a trained professional is a remarkably modern one. As a term, ‘psychotherapy’ has existed since the 1870s, but its original usage had a wider range of meanings than it does today, including an understanding that both mental and physical ailments could be cured by hypnosis and the suggestive power of an authoritative therapist figure (Carroy, 2000; Chaney, 2017; Shamdasani, 2005; Shamdasani, 2017).

      As Chapter 1 explained, the suggestion that the mind could be cured without physical treatment (or religious intervention) only emerged in earnest towards the end of the eighteenth century, with the birth of moral treatment. Freud’s invention of psychoanalysis further shifted the meaning of psychotherapy, through its unique focus on interpreting the patient’s free associations, dream content and reminiscences of childhood, as well as how the patient behaved and felt towards the analyst. In contrast with histories of psychiatry, the volume of publications specifically on the history of psychotherapy is generally smaller and has tended to focus on the development of psychoanalysis at the expense of other approaches. This chapter will examine the impact of psychoanalysis on the development of psychotherapy, but it will also look more broadly at competing ideas which emerged later in the twentieth century, and which remain influential today.

      Specifically, this chapter will map the development of three of the dominant approaches to psychotherapy:

      The chapter will argue that historical research suggests we need to understand how such practices emerge within, and are shaped by, particular social and political contexts, and how psychotherapeutic knowledge has, in turn, impacted on the modern world, changing the way we understand ourselves in relation to each other.

      This chapter aims to:

      1 Psychoanalysis and the birth of the psychodynamic traditions

      Various forms of psychotherapy predated psychoanalysis, but Sigmund Freud’s work offered a new form of therapeutic ‘talking cure’, which arguably shaped all subsequent forms of psychotherapy. Freud was a medically trained Viennese doctor who self-described as a neurologist. Freud encountered the idea of unconscious suggestion and psychotherapy through the work of his contemporary, Hyppolyte Bernheim, a French neurologist with an interest in the power of hypnotism. His curiosity for the subject was augmented by a study trip to the Parisian Salpêtrière hospital in 1895, under the mentorship of the celebrated neurologist Jean-Marie Charcot. Charcot was conducting research into a nervous illness associated with convulsions, emotional outbursts and odd or dramatic physical gestures, classed at the time as hysteria. He conducted experiments with hypnosis on hysteria patients, and claimed that the ability to be hypnotised was itself a symptom of hysteria. He believed there was a hereditary disposition towards susceptibility to hysteria, but challenged other doctors who saw it as a disease of the female reproductive system, arguing that it could also affect male patients who had undergone some form of trauma (Goldstein, 1987; Libbrecht and Quackelbeen, 1995). These cases enthralled the young Freud who, on this return to Vienna, began to elaborate on Charcot’s ideas. Inspired by the case of his friend Josef Breuer’s patient, Freud contended that hysteria was caused by underlying mental conflicts related to sexual trauma.

      Psychoanalysis A form of long-term, one-to-one talking therapy developed by Sigmund Freud and his followers since the 1890s. It focuses on examining unconscious feelings, thoughts and desires, particularly through analysing transference.

      Psychotherapy The use of a wide range of techniques, usually involving regular interpersonal meetings with a therapist, to work through emotional or behavioural difficulties in order to improve mental health or well-being.

      In 1880 Breuer began treating Anna O (a pseudonym for Bertha Pappenheim), shown in Figure 3.1. Anna suffered from symptoms including paralysis, aphasia (loss of speech), amnesia and visual disturbances, and was eventually diagnosed with hysteria. During her consultations with Breuer, Anna O became preoccupied by reminiscences: discussing memories of significant relationships from her past, particularly her childhood, appeared to have a cathartic effect, and therefore a therapeutic benefit.