Understanding Mental Health and Counselling. Группа авторов
in psychology in the 1960s, when information processing metaphors, driven by early computer technology, were used to challenge the previously dominant behaviourist approach to the mind (Baars, 1986). That said, neither Beck nor Ellis were actively reading developments in non-clinical academic psychology at the time, and it cannot be claimed that cognitive therapy was a direct application of cognitive science. It is perhaps no accident, though, that the image of the brain as an information processing machine came to be a prevalent concept in cultural discourse at the same time that cognitive therapy emerged.
Unlike psychoanalysis, it has only been in very recent years that CBT has begun to be historicised. Historian Rachael Rosner, through carefully researching Beck’s archival papers and extensive oral history interviews, has challenged the orthodox narrative that paints cognitive therapy as a rejection of psychoanalysis. As psychoanalysis – deemed outdated and inefficient – was phased out by the psychology department at the University of Pennsylvania where Beck worked, he had to generate new, scientifically valid approaches that would satisfy his superiors. His formulation of cognitive therapy allowed this, but while Beck agrees that he became disillusioned by the limitations of psychoanalysis during this time, he himself still saw cognitive therapy as essentially neo-Freudian. This may be disturbing to the identity of many CBT practitioners who see their approach as fundamentally different from, and superior to, psychoanalysis (Rosner, 2014).
Rosner has also written about Beck’s approach to ‘manualising’ therapy by delivering it in a way that was amenable to randomised control trials and evidence-based medicine. It became increasingly important to show that a particular psychotherapeutic approach could be evaluated to the same gold standard as other types of medicine. This developed as the Food and Drug Administration became a more powerful regulatory body, following the public outcry over the thalidomide crisis in the 1960s. It was in parallel with this that Beck designed methods to prove CBT’s efficacy (Rosner, 2018). In England and Wales, where the government-funded NHS already favoured randomised control trial data, CBT would become the gold standard.
The National Institute for Health and Care Excellence (NICE), after it was established in the UK in 1999, set out national guidelines for the treatment of particular conditions based on cost–benefit analysis and evidence of efficacy. Consequently, clinical psychologists set about providing evidence to ensure that CBT was included in the guidelines for the treatment of depression, alongside pharmacological interventions (NICE, 2004; Marks, 2015). But it took another few years before substantial government investment was made into the expansion of CBT, predominantly as a result of the initiative of the ‘happiness’ economist and Labour peer Richard Layard, who was concerned at the population-level effect of long-term anxiety and depression on national unemployment (Marks, 2015; Layard, 2011; Pickersgill, 2019). The invention and rise of cognitive behavioural therapies have been inextricably bound up with the increasing importance of evidence and economic efficiency in healthcare and, although the UK and the US have different systems for funding access to psychotherapy, their focus on randomised control trials goes some way to account for why they readily foster these approaches.
The success of cognitive and behavioural therapies has seen a number of other approaches – from mindfulness meditation to eye-movement desensitisation and reprocessing therapy – take shelter under the umbrella of ‘third-wave’ CBT. This suggests that the repertoire of psychotherapy is now much broader than merely a talking cure, with a wide range of approaches making use of the label.
3 Person-centred and humanistic approaches
The person-centred tradition, sometimes also referred to as the ‘humanistic’ tradition as it drew from humanistic psychology, emerged predominantly in the 1940s and became one of the most popular alternatives to psychoanalytic and psychodynamic psychotherapies in the twentieth century. It was built on the philosophical principles of optimism about human nature and potential; non-directive and non-authoritarian approaches to the therapeutic encounter; and hope that emotional insight would reduce conflict at both an interpersonal and international level (relevant in the wake of the Second World War and to the anxieties of the cold war). Like most traditions in psychotherapy, the person-centred approach is strongly associated with a founding father – Carl Rogers is at the centre of most of the historical literature, which is still predominantly written by practitioners from within the field (such as Kirschenbaum, 1979; Kirschenbaum and Henderson, 1989; Rogers, 1967).
Humanistic psychology An approach to psychology and psychotherapy that focuses on individual uniqueness, human agency, and personal growth and fulfilment. It challenges the deterministic aspects of behaviourism and psychoanalysis.
Rogers drew from an eclectic range of influences. Historian Christopher Harding has pointed out that he spent time training for Christian ministry (Harding, 2018). Immediately after his BA in History from the University of Wisconsin in 1924, Rogers began at the Union Theological Seminary in New York, and spent time as a visiting pastor in Vermont in 1925. He quickly became disillusioned with the seminary’s teaching and this crisis of faith led to his conversion to clinical psychology, which he formally began to study at Columbia University in the same year (Jones-Smith, 2016). Nevertheless, Rogers maintained an interest in Christian thought and, in 1965, he put himself in public dialogue with the theologian Paul Tillich. To Rogers, the most important emotional resources available to a person came from the human rather than the divine. Nevertheless, such dialogues showed a willingness to engage with spiritual ideas, as well as the resonances and parallels that person-centred counselling had with Christian thought and pastoral practice (Harding, 2018).
Clinical psychology A professional specialism in psychology. It is an ‘applied’ branch of psychology in that clinical psychologists work directly with clients, offering therapy but also performing many other roles in mental health services.
Rogers’ own person-centred philosophy later in life had secular origins, drawing heavily from thought in biology and the sciences. The son of a farmer, Rogers had spent his childhood poring over agricultural science books, learning about control trials for crops and the underlying biological principles of plant and livestock management. By his own reckoning, this early self-schooling was highly influential on his later career (Rogers, 1967). The curative power of psychotherapy, for Rogers, lay in its capacity to help an individual gain insight into their authentic self, and to remove obstacles to achieving their potential through self-actualisation. This type of language was especially resonant in the mid-twentieth century owing to the popularity of existentialist thinkers. However, Rogers appears to have encountered ideas about personal growth and potential through reflection on biological thought, including the work of the Nobel Prize-winning Hungarian biochemist Albert Szent-Györgyi, who argued that the universe, and all organic life, had a tendency towards increased order, growth and development (Szent-Györgyi, 1957). For Rogers, this creative drive forward was a fundamental part of human nature, and it was this force that needed to be facilitated in the therapeutic encounter (Raskin, 1996).
Self-actualisation A concept associated with humanistic psychology by which an individual is enabled to fulfil their potential and meaning in life, and to realise their personal talents.
Activity 3.1: Psychotherapeutic approaches and historical context
Allow about 15 minutes
Do psychoanalysis, cognitive behavioural therapies and person-centred approaches have fundamentally different ideas about how the human mind works? Do these reflect the historical period and culture from which they emerged?
Discussion
Modern psychotherapists sometimes draw on an eclectic range of models and techniques, adapting their approaches to the needs of the client. It is worth reflecting on the different ideas that these traditions developed about the mind’s structure and function. Psychoanalytic and psychodynamic approaches placed great emphasis on unconscious drivers and transference, whereas CBT and person-centred approaches emerged in contrast to these ideas, focusing more on conscious thoughts, feelings and behaviours. What might unite all of these different approaches? They all value the process of talking through the client’s experiences with