Psychotherapy now and in the future

The following in an extract from Psychotherapy: A Very Short Introduction, by Tom Burns and Eva Burns-Lundgren, in which they discuss the future of psychotherapy.

The 20th century has been called ‘the century of psychiatry’, and in many ways one could read that as ‘the century of psychotherapy’. A hundred years ago, at the onset of World War I, psychotherapy had touched the lives of only a tiny number of people, and most of the population had simply never heard of it. Since then it has reached into almost every aspect of our lives—how we treat the mentally ill, how we understand our relationships, our appreciation of art and artists, and even how we manage our schools, prisons, and workplaces. Our culture has become one quite obsessed with understanding how people feel and our daily language is peppered with psychotherapy language.

What does the future hold? Have we witnessed the flowering of a cultural movement that is tied to just one unique time and place, or is it a fundamental step forward in human thinking and relationships? In our increasingly global world will it spread ever more widely or perhaps fade away altogether? Have the various changes in its practice made it more relevant to modern man or less so? Will the enormous advances in medicine, neuroscience, and psychology, and our move into the digital age of social media, render it obsolete?

How we judge psychotherapy’s future will probably reflect what we think of it now: as a profound breakthrough in understanding ourselves and a step forward in social evolution, or as simply one among many technical procedures to reduce distress and improve human well-being. Reducing distress is certainly not a trivial achievement, but it does not satisfy psychotherapy’s strongest advocates—they believe it has irrevocably changed the way we see the world and how we behave. From a different perspective, psychotherapy has been criticized right from the beginning for having ‘cult-like’ and religious overtones.

We have roughly divided psychotherapy’s century into two halves. Up to the 1960s it was either psychoanalysis or one of its modifications. Therapies were verbal, protracted, and intensive, drawing on a detailed theory of unconscious forces. Understanding was the key to recovery. Later therapies have been much more experiential. Understanding remains important, but the process of psychotherapy and the therapeutic relationship have come to the fore.

Some people are struck by the similarities between these psychotherapies and some by their differences. Are they adaptations of the same basic model or new and original approaches? It is a bit like deciding whether a glass is half full or half empty. Therapists usually stress the differences and the unique therapeutic mechanisms in their approach. Psychoanalysts and CBT therapists have traditionally had very little positive to say about each other’s practice.

You may have found yourself drawn to one or other specific therapy. Alternatively you may come to the conclusion that they have more elements in common than divide them. The latter perspective is probably how we view things. Yes, CBT is undoubtedly radically different in tone, duration, and immediate focus from psychoanalysis. But both work by helping troubled individuals understand better the mental mechanisms that have caused and sustain their problems.

One thing the psychotherapies share is that they have all expanded their reach. The threshold for seeking psychotherapy or counselling has steadily lowered over the decades, and our demand for it seems inexhaustible. Their goals have also expanded—from just the reduction or removal of symptoms, towards self-fulfilment and well-being.

We can be certain that psychotherapy will undergo changes in both theory and practice. What is impossible to foresee is precisely where these changes will occur. The trend towards shorter, more structured and democratic therapies seems inexorable, but radical changes may come out of the blue. Will they come from developments such as computer science, or perhaps from other cultures than the Judeo-Christian origins of most current therapies? Prediction is a risky business.