Psychotherapy, like other healthcare fields, is a constantly evolving endeavor. Over the years, research and practice have expanded our understanding and refined the techniques used to treat psychological disorders.
47 years of practicing psychotherapy helps me appreciate how things have changed. Here are some observations. Counseling: An Update. | Pastoral Counseling Syracuse NY
Psychotherapy: From the Beginning
Many people are unaware that the counseling profession is relatively young. Of course, clergy and teachers have helped folks over the centuries, but the start of a medical profession dates back to the late 19th century and Sigmund Freud.
Freud discovered that mental problems could, in addition to medical causes, be the result of psychological trauma. His approach in sessions was to listen while the patient “free associated”, i.e., to say whatever came into their minds.
Freud believed that given time, a person would uncover emotional conflicts created by childhood trauma and that the therapist’s job was to interpret the meaning of what the patient said. In other words, therapy “connected the dots”, and revealed how the past interferes with the person’s present experience.
This increased awareness freed a person from the control of unconscious trauma. In addition to feeling better, greater self-knowledge helped the person to change and eliminate unwanted behaviors.
Behaviorism
In the early 20th century, behavioral therapies, inspired by Pavlov and Watson, arose as an alternative to analytic approaches. Unlike analysis, behavioral therapies placed an emphasis on redirecting conditioned responses rather than increasing awareness.
They believed that understanding is unnecessary to treat psychological problems. Essentially, creating new behavior patterns changes behavior, which changes how you feel,
Some Other Changes
Somewhere in the 1950’s two other developments took place which complicated the treatment of mental disorders. The field of psychopharmacology introduces medication for depression, anxiety, and schizophrenia.
Likewise, psychologists, social workers, and other types of mental health practitioners who were not medical doctors began counseling. These new professions spawned a variety of therapies Different approaches to psychotherapy
As a result, since these new practitioners were not medical doctors, a new attitude toward the people served emerged. Individuals, couples and families were regarded as clients and not as patients.
In addition to these changes, here are 6 major advances in psychotherapy which define the state of the art today:
SIGNIFICANT ADVANCES
1) Mindfulness
Sigmund Freud’s notion of the unconscious expressed the fact that the brain knew more than a person was conscious of. Today, the concept of mindfulness expands not only what the brain knows but also how it can be brought to consciousness.
Specifically, mindfulness has come to mean, in addition to memories of past trauma, the ongoing self-monitoring of one’s thoughts, feelings, and body sensations that arise in the wake of stress. Mindfulness in Counseling: 8 Best Techniques & Interventions
Understanding and becoming aware of how past events, especially trauma, distort current perceptions and experiences. Greater mindfulness allows one to be aware of and to correct irrational perceptions and emotional/behavioral reactions.
2) The Role of Trauma
Freud’s concern for trauma was restricted primarily to sexual conflicts, which did not necessarily involve actual abuse or threats. He recognized that early life conflict created what he called neuroses, which we refer to as psychological disorders.
Today, our understanding of trauma has expanded. Rather than simply events involving violence or the threat of death, trauma is any event that occurred in the past that continues to influence or interfere with reasonable feelings and reactions in the present. The Ever-Expanding Definition of Trauma
Freud referred to irrational reactions to past trauma as transference; today, we call it being triggered. Whatever you call it, past trauma is responsible for much of the irrational thoughts, feelings and behavior that compose emotional disorders.
In other words, the task of psychotherapy is simple. It seeks to undo the emotional and cognitive damage caused by prior trauma and restore a person’s rational faculties.
3) Neurobiology Advances.
Increased understanding of neurobiology explains how trauma causes a person to lose a rational outlook and reasonable control of his/her behavior. Specifically, a greater understanding of the polyvagal nervous system and the limbic disruption of normal neural pathways, slow and even, prevents access to the medial pre-frontal cortex (mPFC).
In other words, a threat perceived by the animal part of our animal brain sets off an alarm, which blocks immediate access to the human part of our brain, which rationally assesses the level of danger and makes decisions on how to respond. Thus, when a person is “triggered”, they experience a mini-panic and lose the immediate capacity to think or respond rationally. Limbic System Dysfunction – Symptoms and Therapy
4) Getting Beyond Understanding
Another significant advance in modern psychotherapy deals with the limits of understanding. Experience has shown that, sometimes, understanding alone is not enough to heal emotional wounds. Put another way, understanding alone can’t always make us feel better or allow us to change.
In addition to understanding the connection between past trauma and present reactive distortion, it is often necessary to be aware of and calm the physical distress (panic) in our bodies caused by the trauma. The Ever-Expanding Definition of Trauma
Modern treatment realizes that before emotional healing can occur, the panic experience must be calmed. Advances in somatic therapy demonstrate the importance of calming the panic experience before understanding or change is possible.
Somatic therapies raise clients’ awareness and calm the intensity of the physical aspects associated with prior trauma. These approaches contribute to better and longer-lasting outcomes.
Important breathing and “dive” techniques (TIPP) have proved effective in calming trigger reactions. Research shows that changing breathing patterns to reduce oxygen intake and quickly lowering body temperature shuts off the release of stress hormones.
Likewise, Eye Movement Desensitization and Reprocessing (EMDR) treatments are proving very efficient and effective in reducing incapacitating emotional symptoms.
5) Self-Care and Preventing Dysregulation
Finally, advances in neuroscience revealed how to heal stress-broken neuropathways in the brain. In addition to sleep, conscious rest, i.e., non-demand neural activity like meditation, listening to music or enjoying nature during a walk, repairs broken communication links in the brain. During these activities, there are no worries about the past, dread of the future or problems to solve. The brain can rest while the person can simply enjoy being in the present moment. The Importance of Self-care in Therapy and Counseling – MindSol Wellness Center – Sarasota
Understanding the importance of leisure, adequate self-care, and self-monitoring to prevent stress overload are common aspects included in most counseling experiences.
So, in taking stock, it’s obvious psychotherapy has moved beyond just dealing with unresolved Oedipal conflicts. Nonetheless, there is still much to learn. Just know that if you struggle with emotional difficulties, there are many therapeutic resources available to help you out.
6) Loss of Stigma
Perhaps one of the most important changes has taken place within public opinion. Studies show that psychotherapy is no longer seen as shameful or embarrassing. No matter how effective treatments are, they’re of no use if people don’t use them. Trends in Public Stigma of Mental Illness in the US, 1996-2018 | Public Health | JAMA Network Open | JAMA Network
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Currently, new treatments involving Ketamine and Transcranial Magnetic Stimulation (TMS) offer promise and alternatives to talk therapy. On the Horizon, PTSD specific medication as well as the use of hallucinogens show great promise.
All in all, as the effectiveness of psychotherapy rises, the stigma declines. Indeed, more and more people accept psychotherapy and turn to it for help.
Rev. Michael Heath, LMHC, Fellow AAPC 8 3 2025
