Introduction

Psychotherapy
!  Primarily, the therapeutic interaction between a client

Psychotherapy as social “suffering” of something and a therapist working with him/her

in order to promote his/her well-being (but also the social,
construction .
institutional and cultural context surrounding it)
!  Communicative and interpersonal context between a client
Reconciling differences with similarities (i.e., person suffering from „something“ [mental disorders,
in treatments, therapists and clients problems, or complaint]) and a therapist (i.e., person
supposed to help).
!  client-therapist communication is realized mainly through the
Dr. Omar Gelo verbal but also nonverbal (e.g., body, music) channel
!  Aims at resolving the client’s state of mental suffering
stimulating the change in his/her feelings, thoughts,
behaviors, relational patterns, etc.

Introduction
Issue at stake: Similarities and Diversities
!  Several psychotherapy families:
!  Although this definition which addresses some basic
similarities, what we call psychotherapy is characterized by
an extreme diversity.
!  This diversity may be observed both:
o  Diachronically (at a specific time point): There are different
psychotherapies today [current situation]
Introduction
1)  Traditional Psychoanalysis (TP)
2)  Relational- and Interpersonal Psychoanalysis (RIP)
3)  Behaviour therapy (BT)
4)  Cognitive-behavioural therapy (CBT)
5)  Humanistic- and Experiential therapy (HET)
6)  Systemic(-Family) therapy (SFT)
7)  Eclectic and Integrative therapy (EIT)
8)  etc.
 Familiy
Traditional Psychoanalysis (TP)
Relational and Interpersonal
Psychoanalysis (RIP)
Behavior therapies (BT)
Cognitive-Behavioral therapies
(CBT)
Humanist ic and Experential
therapies (HET)
Systemic(-Family) therapies
(SFT)
Eclectic and Integrative
therapies (EIT)
BEFORE:
TODAY:
Modern psychotherapy
Psychotherapeutic model
Pychoanalysis
Ego psychology
Object-relation psychoanalysis
Self-psychology
Interpersonal psychoanalysis
Behavior modification
Psychological skill training
Stress inoculation training
Cognitive therapy
Rational-emotive therapy
client-centered therapy
Gestalt therapy
Existential therapy
Structural family therapy
Strategic family therapy
Individual family therapy
Eclectic approach
Integrative approaches
Common factor approach
? Issue at stake: Similarities and Diversities
Authors
Freud, Jung
Hartmann, A. Freud
Introduction
Issue at stake: Similarities and Diversities
Klein, Winnicot, Bowlby
Kohut, Sternbegr, Stern, Mitchell !  Although this definition which addresses some basic
similarities, what we call psychotherapy is characterized by
Skinner, Wolpe
Goldstein an extreme diversity.
Meichenbaum
!  This diversity may be observed both:
Beck
o  Diachronically (at a specific time point): There are different
Ellis
psychotherapies today [current situation]
Rogers
o  Synchronically (over time): There have been different
Perls
psychotherapies over time [historical evolution]
Binswanger
Bateson, Minuchin, Satir,
Haley, Palazzoli,
Boscolo, Ugazio
Lazarus, Beutler
Wachtel, Mahoney, Guidano,
Beitman, Prochaska-DIClemente
Introduction
!  Although this definition which addresses some basic
similarities, what we call psychotherapy is characterized by
an extreme diversity.
!  This diversity may be observed both:
o  Diachronically (at a specific time point): There are different
psychotherapies today [current situation]
o  Synchronically (over time): There have been different
psychotherapies over time [historical evolution]
!  Relevant questions:
o  What is “really” psychotherapy?
o  Where does this diversity come from? How can we explain it?
o  Which are the implications of such explanation?
 Introduction What humans always do:
My answer
!  Psychotherapy is the result of the way human beings have
conceptualized/conceptualize it in specific times and places
!  These conceptualizations do not reflect a combination of attributes
mirroring some “objective” aspects of what psychotherapy is, but
are rather the results of a process of social construction and
negotiation between parties who have deep beliefs and interests to
protect and serve, and resulting in a “consensual” view of what
psychotherapy is.
!  This consensual view is strictly tied to the world-views (i.e.,
grounding implicit values and beliefs on human beings and life) of
a specific socio-cultural group at a specific historical time ! their
consideration may explain similarities and differences concerning
what psychotherapy is Engage with the
Face a problem Solve the problem
problem
!  Social constructionism (Gergen, 1985) is the perspective from
which I will consider psychotherapy in order to better understand it

What humans always do: Social constructionism

Human knowledge:
!  Not a re-presentation (objective reality ! its depiction in human mind
[Realism])

Increase of Knowledge (Order)

 Realism

Realism
Social constructionism
Human knowledge:
!  Not a re-presentation (objective reality ! its depiction in human mind
[Realism]) but rather a construction (multiple reality "! construction
which refer to it [Constructivism]) Constructivism
 Social constructionism
Human knowledge:
!  Not a re-presentation (objective reality ! its depiction in human mind
[Realism]) but rather a construction (multiple reality "! construction
which refer to it [Constructivism])
o  This construction allows to make sense (not to find it) out of the reality

o  To “make sense of something” (construction of knowledge) = to “create” order

out of disorder (principle of “order out of noise”: noise!order)
o  If knowledge is not a representation but a construction, humans are then not
passive receptors but rather active creators of it

Example 2
 Realism
Social constructionism
Human knowledge:
!  Not a re-presentation (objective reality ! its depiction in human mind
[Realism]) but rather a construction (multiple reality "! construction
which refer to it [Constructivism]) Constructivism
o  This construction allows to make sense (not to find it) out of the reality

o  To “make sense of something” (construction of knowledge) = to “create” order

out of disorder (principle of “order out of noise”: noise!order)
o  If knowledge is not a representation but a construction, humans are then not
passive receptors but rather active creators of it
!  This construction takes place within social networks, and is therefore Social constructionism
culturally and historically embedded and situated [Social
Constructionism]
 Social constructionism Psychotherapy as social construction
!  Human beings have always suffered and found ways to heal this
Human being as social inquirer: suffering
!  Human beings, in order to survive, need to constantly and inevitably “look !  Psychotherapy (from the Greek psycho = “soul” and therapeuein =
for” for meaning/sense within a social network/interpersonal context “nourish”) is not objectively given (i.e., an immutable and universal
!  Fundamental criteria to produce knowledge: category), but rather a social construction (i.e., a culturally negotiated
product based on a consensus among the members of a specific
1)  Internal coherence
group of people at a specific time and place)
2)  Intersubjective sheareability

3)  Openess to revision

Psychosis:
!  extreme and desperate attempt to construct a meaningful reality (which is
intersubjectively not shareable and not open to revision)

(I) Psychotherapy (I) Psychotherapy

(II) Cultural values and

(II) Cultural values and
beliefs
beliefs
 Psychotherapy as social construction The historical roots of psychotherapy
!  Human beings have always suffered and found ways to heal this
suffering !  Modern psychotherapies are rooted in three historical tradition of
healing (Frank & Frank, 1991):
!  Psychotherapy (from the Greek psycho = “soul” and therapeuein =
“nourish”) is not objectively given (i.e., an immutable and universal 1)  Religiomagical
category), but rather a social construction (i.e., a culturally negotiated 2)  Rhetorical
product based on a consensus among the members of a specific 3)  Empirical/Naturalistic
group of people at a specific time and place)
!  Psychotherapy = set of institutionally and socially legitimated beliefs
and practices that characterize what psychotherapy is in a specific
time and geographical location
!  In order to emphasize the social construction of psychotherapy, an
historical examination is necessary. This latter will allow us to:
o  show how different cultures in different places and times have produced
different conceptions of what psychotherapy (with reference to “what is
illness” and “what is cure”)
o  Identify some invariants across these different conceptions

(1) Religiomagical healing

(1) Religiomagical (2) Rhetorical (3) Empirical/Naturalistic
!  Originated in prehistory ! through ancient Greek (until 450 BC) !
and Gassner (1775) ! to nowadays in nonindustrialized and
industrialized societies (e.g.: Lourdes, Scientology)
!  Theory of illness (supernatural)
a)  Soul loss
b)  Possession by evil spirit
c)  Magical insertion of a harmful body by a sourcerer
d)  Machination of offended or malicious ancestral ghosts
!  Consider that: Not a sharp distinction between mental vs. bodily
and natural vs. supernatural as we know these today

Modern psychotherapy
 (1) Religiomagical healing
!  Theory of cure (ritual/ceremony)
o  Healer:
-  Shaman, priest
-  Special faculties/powers (inherited, training, personal experience)
which are socially acknowledged in charge of diagnosis and cure
o  Series of actions involving objects and eventually drugs (ritual,
ceremony):
-  Gathering together (usually with family and/or tribe and/or with
other sufferers) in a temple or around fire, music, clothes, animals,
masks and baton, drugs
-  In ancient Greek (temples of Aesculapius): the sufferer(s) entered a
dream-like state of induced sleep (“enkoimesis”) in the sacred
temples and had dreams which were considered revelations of
Gods for recovery ! the priest interpreted their contents (see
Rhetoric healing later)
(2) Rhetorical healing
!  Theory of cure
o  Healer:
-  Rhetorician: possesses rhetorical abilities gained through training
combined with moral values
o  Therapeutic (rhetoric) discourse:
-  To “implant” virtue by means of talking to the audience by
strengthening will, reorganizing beliefs, or by eliciting new beliefs
and persuasions more “noble” than the old
-  Plato calls this reorganizing and enlightening process Khatarsis
(“emotional cleansing”)
-  Aristotle says that we have to resort to Ethos (the character and
credibility of the speaker which makes him credible), Pathos (use
of emotional appeal in order to evoke strong emotions in the
audience) and Logos (the use of reasoning to construct an
argument)
(2) Rhetorical healing
!  Formally originated in ancient Greek with the Sophists (Protagoras:
450 BC), Plato (400 BC), Aristotle (360 BC) ! has been then
ignored until the recent Linguisic turn (‘50s) and Narrative Turn
(‘80s)
o  Rhetoric is the art of discourse in order to inform, persuade or motivate
a specific public audience in a specific situation
o  Originally born for civic education (“civic art”), was also used with
healing purposes (“therapeutic rhetoric”)
o  The idea is that to have control of language is to have control of oneself
and others (virtue)
!  Theory of illness
-  Lack of virtue (i.e., moral excellence)
-  Virtue is described by Plato as sophrosyne: “a beautiful, harmonious
and rightful ordering of all ingredients of the psychic life: beliefs,
feelings, impulses, knowledge, thoughts and valued judgments.”
(3) Empirical-Naturalistic healing
!  From prehistory ! and Hippocrates (480 BC) ! to the birth of first
dynamic psychiatry (19th Century)
!  Theory of illness (1): Humoral/Fluidic
-  Hippocrates (480 BC): excess, deficit or unbalance between four
bodily fluids (humours: “blood” [air, spring], “yellow” bile [fire, summer],
“black bile” [earth, autumn] and “phlegm” [water, winter]) ! produces
crisis
“Illness does not regard the divine nor the sacred than other disease, but has a
natural cause. Men regard its nature and cause as divine from ignorance and
wonder…” [On the Sacred Disease]
-  Mesmer (1775: Animal magnetism): blockage of a vital fluid (universal
principle of fluid matter which cannot measured nor touched). It is
consider to produce a “magnetic force” responsible for the reciprocal
influence/attraction between the healer and the sufferer [first attempt of
scientifically describe and explains these phenomena, differently from
Gassner (Religiomagical tradition)]
-  In both cases, crises are produced as well in the genesis as in the cure
of the illness
(3) Empirical-Naturalistic healing
!  Theory of illness (2): Ideodynamism
-  “The tendency of an idea to materialize into an act” (Bernheim, 1880)
-  “An idea (or group of associated ideas) settles in the mind in the
fashion of parasites, remaining isolated from the rest of the mind and
expressing themselves outwardly through corresponding otor
phenomena. … The group of suggested (or spontaneously settled)
ideas find themselves isolated and cut off from the control of that large
collection of personal ideas accumulated and organized from a long
time, which constitutes the consciousness proper, that is the
Ego” (Charcot, 1885)
-  This may happen by suggestion in everyday life (Braid, Puységur,
Bernheim) or spontaneously (Charcot; “autosuggestion” of hysteric
clients)
Important
The invention of a word: “Psychotherapy”
!  Duke (1872): “Psycho-Therapeutics: Practical applications of the
influence of the mind on the body to medical practice”
!  Bernheim (1880): equates Hypnosis = Psychotherapy
!  Van Eeden (1889):
o  Psychotherapy: “all therapies which cure by the intermediary of the
psychic functions of the client, mainly by means of suggestions”
!  Freud (1895): defines the cathartic method as “the psychotherapy of
hysteria” (his use of the word “psychoanalysis” comes later)
!  1901: the London Psycho-therapeutic society and the Psycho-therapeutic
Journal are established
o  The editorial stated that the society was “the result of a few interested
persons to promote the study and consideration of psychic and
mental therapeutics in an enlightened scientific spirit”
(3) Empirical-Naturalistic healing
!  Theory of cure (1: physical and somatic)
-  Hippocrates (480 BC): rest and immobilization, medication and good
nutrition
!  Theory of cure (2: suggestive/suggestion)
Catharsis (from the Greek: “to purify”, “to purge”) through suggestion
mediated by a personal “rapport” (Mesmer) in different forms:
-  Mesmer: through his Animal Magnetism (removed the blockages of the
vital fluid by touching the clients in different parts of the body ! falling into
what we would today call “trance” and talked to them telling them that the
pain was gone)
-  Braid: through Hypnosis (eye-fixation + manual stimulation of body part !
nervous sleep (trance) [physical relaxation which produces a state of
mental concentration on a single idea or trains of thought] see also
Puységur: Artificial Somnambulism)
-  Bernheim: always Hypnosis, which is now considered a mainly psychical
phenomenon (and note derived from a bodiy state) ! Charcot ! Breuer &
Freud
Important
The invention of a word: “Psychotherapy” (cont.)
!  Cabot (1906):
o  Psychotherapy: scientific mind-cure, i.e., “the attempt to help the sick through
mental, moral and spiritual methods. It is a most terrifying word, but we are
forced to use it because there is no other term which serves to distinguish us
from Christian Scientists, the New Thought people, the Faith Healers, and the
thousand and one other schools and all of the accumulative knowledge of the
past”
!  Psychotherapy so as defined here in the empirical/naturalistic tradition
emancipates itself from the religiomagical tradition
!  Result of a complex process begun with Enlightenment (17th century:
Locke [Empiricism] and Descartes [Rationalism]), and consolidated itself
with positivism (19th Century: Comte and Mill):
o  Faith ! sensory experience and reason
o  God(s) ! Humans (Renaissance and Humanism)
o  Collectivism (belonging to a group) ! Individualism (subjectivity vs. objectivity)
 Years, Models, Authors
1900
Modern psychotherapy Psychoanalysis
(Freud, Jung, A. Freud, Klein)

1950
Behaviour therapy
(Skinner, Wolpe)

1960
Humanist therapy
Interpersonal therapy
Systemic therapy
(Rogers, Sullivan, Bateson)

1970
Cognitive-behaviour therapy
(Beck, Ellis, Meichenbaum)
1980
Eclectic psychotherapy
Constructivist therapies
Narrative therapies
(Beutler, Wachtel, Mahoney,
Beitman, Goncalves)

Are there similaritities? Are there similaritities?

1)  A sufferer
2)  A Healer
3)  A Healing setting
(1) Religiomagical (2) Rhetorical
4)  A Healer relationship
5)  A Rational (Myth)
6)  A Ritual/Procedure
(3) Empirical/Naturalistic
 Are there similaritities? Are there similaritities?
1)  A sufferer who seeks relief from a healer. Suffering = Demoralization 4)  A healing relationship, i.e., an emotionally charged, confiding relationship
(demoralize: “to deprive a person of spirit, courage, to dishearten, with the healer (often with the participation of a group) [see therapeutic
bewilder, to throw a person into disorder and confusion) alliance].

2)  A healer, possessing a socially sanctioned method believed to be -  clients are willing to depend (see Bowlby: attachment system) on a therapist for

effective by the sufferer and by at least some members of his/her social help because they believe he/she is competent, genuinely cares about their
well-being, and accepts the sufferer if not for what he/she is, at least for what he/
group
she can become.
3)  A healing setting (where the treatment is supposed to take place):
-  This dependence is reinforced/mediated by the congruence between the
a)  Heightens the healer’s prestige and strengthens the sufferer’s expectation of healer’s approach with the sufferer’s expectations (see rationale/myth), the
help by symbolizing the healer’s role as such (masks and fire, prestigious healer’s socially sanctioned role as such, and the sufferer’s knowledge that the
oratory or clinic, private practice with impressive desk, certificates etc.) healer is an expert in a particular method (see rituale)
b)  Provides safety (sufferers know they are free to express/manifest their
suffering, that they will not be hurt, etc.)

Are there similaritities? Why does this work?

5)  A rationale, conceptual scheme, myth: Theories which provides a   Combating the sufferer’s sense of alienation and
plausible explanation for the sufferer’s symptoms (theory of ill) and prescribes strengthening of the therapeutic relationship (see shared
a procedure/ritual for resolving them (theory of cure).
belief system to create a powerful bound).
-  “Myth”: because these theories (i) contain imagination-catching formulations of
recurrent and important human experiences and because (ii) they reflect (and   Inspiring and maintaining the sufferer’s expectation of
acuire relevance and plausibility only with regard of specific) world-views, which help.
cannot be tested empirically (see Lakatos, Laudan)
  Providing new learning experience.
6)  A ritual or procedure that requires the active participation of the healer and
sufferer and that is believed by both to be the means of restoring the   Arousing emotions (see positive and negative emotions).
sufferer’s health and well-being.
  Enhancing the sufferer’s sense of mastery and self-
a)  Vehicle for establishing/maintaining the therapeutic alliance and trasmitting the
efficacy
healer’s influence (Important: techniques at the service of relationship and not
vice-versa)   Providing opportunities for practice
b)  Enhances the healer’s self-confidence and allegiance by demonstrating
mastery of a special set of skills.
 Conclusion The power of psychotherapy
!  Human beings have always suffered and found ways to heal this
suffering
!  Several conceptualizations across times and places can be found
in the way humans have found to conceptualize (mental) illness
and cure.
!  The way I conceive cure depends on the way I conceive illness and
health. In turn, these all are always strictly bound to specific socio-
cultural values and beliefs (worldviews).
!  This shows how psychotherapy can be conceived as a set of
institutionally and socially legitimated beliefs and practices that
characterize what psychotherapy is in a specific time and
geographical location (based on socio-cultural consensus):
a)  Differences: socio-cultural dependent variability

b)  Similarities: universal core elements