Date Posted: Thursday, 21 April 2011
I wrote this introductory article about psychotherapy in 1996. It was written for residential child care workers and youth care outreach workers who were students on the Caldecott College/Exeter University post-graduate diploma course on Child Development and the Care of Children and Young people. The course was principally underpinned by the dissemination of psychodynamic theory as a basis for the therapeutic care of children and young people. I think it may still be of interest – as a basic introduction – to those setting out to explore psychotherapy for the first time.
Psychotherapy is a form of treatment for psychological disorders. In psychotherapy a patient or client talks with a therapist to obtain help in changing emotions, thinking, or behaviour patterns that are distressing. Many types of human problems are treated by psychotherapy: disorders such as a phobia, generalised anxiety, obsessions, compulsions, depression and psychosomatic and psychosexual disorders. Psychotherapy may also help clients and their families cope with severe disorders such as schizophrenia.
Psychotherapy also addresses interpersonal difficulties, such as unassertiveness, lack of interpersonal skills, and marital and family difficulties, as well as habit problems, such as drug abuse, excessive alcohol consumption, tobacco smoking and eating disorders. Psychotherapy may be used as an alternative to or in conjunction with medications and other somatic (physical) treatments.
Psychotherapy has traditionally been offered by psychiatrists, clinical psychologists, and psychiatric social workers. Psychiatric social workers are trained in treatment methods and often work as part of a treatment team in a hospital or clinic. In current times psychotherapy is being increasingly practised by paraprofessionals, who, though they may have less training than a qualified psychotherapist, are supervised by a fully trained psychotherapist or by someone who may be trained to work with specific problems using specific methods. More and more residential child care workers fall into this category. Such training may focus on one to one therapy as well as group therapy. In the United Kingdom this is evidenced by the development of milieu therapy in the therapeutic communities for children and young people and in Europe by the development of social pedagogy.
One form of therapy is the self-help group in which the therapists share the characteristics of their patients. People who may have overcome serious drug abuse problems, for example, serve as therapists for those who are struggling with drug abuse issues.
How therapy is provided
The provision of psychotherapy is made in a number of ways. Individual therapy refers to a therapist’s work with one person on his or her own unique problem. In individual therapy, the relationship between the client and the therapist is very often important in producing change. In group therapy, therapists meet with a group of clients, and the interaction of the members of the group becomes an important part of the therapeutic process. Relationship therapy focuses on the relationship between partners in a full relationship, for instance, a husband and wife. Frequently both a male and female therapist are involved in order to provide both male and female perspectives. Family therapy brings all the members of one family into a therapy group, on the assumption that families operate as an interacting system and that one member’s problems are only symptomatic of problems in the system. Residential child care workers in carrying out their individual and group work with children and young people in children’s homes may draw – in varying degrees elements – from all these approaches to providing therapy.
Schools of psychotherapy
There are many different schools or theories of psychotherapy. In order to make sense of this variety, it may be useful to divide the thoeiries into fall into four general though not exclusive categories:
Psychodynamic therapy makes the fundamental assumption that emotional disorders are symptoms of internal, unobservable, and unconscious conflicts between the components which make up the personality. These conflicts are the consequences of unresolved family conflicts, experienced in the early stages of childhood, that become reactivated in problem situations in adulthood. The aim of psychodynamic therapies is to revive the early conflict and to transfer it to the relationship with the therapist. The symptoms are removed when the therapist helps the patient to resolve the conflict in the transference relationship. The therapist interprets the transference for the patient and helps him or her overcome resistances to accepting the interpretation. Additional methods, such as dream interpretation or word association techniques, are used to aid the uncovering of unconscious material. Sigmund Freud’s psychoanalysis is the primary example of a psychodynamic therapy. British based psychoanalysts who have been influential in the field of psychodynamic theory in relation to children include Melanie Klein, Anna Freud and D.W. Winnicott. Other theoretical variations which represent a development from Freudian theory or represent a break away from it include analytic psychology founded in the work of Carl Jung; will therapy espoused by Otto Rank; holistic therapy based on the writings and practice of Karen Horney; individual psychology developed by Alfred Adler); Harry Stack Sullivan’s concepts of interpersonal psychiatry and transactional analysis which in large part grew from the work of Eric Berne. Group psychodynamic therapy has been influenced by the theories of Wilfred Bion and S.H. Foulkes though the group care of children based on psychodynamic theory has been influenced the Fritz Redl’s concept of the Life Space Interview which uses informal day to day situations as the space for therapeutic engagement. Similarly group work with children has also been influenced Bruno Bettelheim’s ideas about the therapeutic potential of the milieu.
Phenomenological therapeutic approaches view people as naturally evolving in the direction of psychological growth and maturity. Society may hinder this process by imposing false values and causing the individual to distort his or her awareness of experience. Emotional disorder results from this distortion. The goal of therapy is to restore the patient’s natural self-direction by helping him or her to become aware of distorted or denied feelings and emotions. The therapist attempts, as far as possible, to understand the subjective experience of the client and to communicate back – and thus clarify – this experience. The therapist is an active, empathic listener who provides an accepting atmosphere and helps the client to regain awareness and therefore control of his or her emotions and behaviour. Emphasis is on present experience as opposed to recollections of early development. In some forms of phenomenological therapy the therapist may use various exercises to elicit emotional responses within the therapy session. The client-centred therapy of Carl Rogers is a well developed example of this type of approach. Fritz Perl’s gestalt therapy is a related technique that uses therapy exercises. The existential approaches of Maslow and Rollo May can also be placed in this group.
Cognitive approaches to therapy assume that emotional disorders are the result of irrational beliefs or perceptions. Cognition is assumed to precede and determine emotion and behaviour. Each person develops a complex set of categories (variously referred to as constructs , schemas or plans)which is used to construe or understand events. The way in which an event is construed makes it frightening or calming, happy or sad. The emotionally disordered person distorts categorisation (for instance, he or she decides, “If I am not loved by everybody, I am worthless”. Cognitive psychotherapies attempt to make the client aware of the occurrence and irrationality of these distortions and to substitute more rational and realistic evaluation. The therapist’s role is to educate and to persuade logically. Examples of cognitive psychotherapies are personal construct theory developed by George Kelly; rational-emotive therapy expounsed Albert Ellis and cognitive therapy which arose out of the observations of Aaron T. Beck. With its emphasis on social modelling there are also cognitive elements in social learning theory which grew from the studies of Albert Bandura. In more recent times “self-improvement”approaches such as “life coaching” have largely developed out of cognitive therapy.
Behavioural approaches assume that all behaviour is learned. Emotional disorders are considered to be conditioned responses or habits that can be modified by the same principles of learning that govern all behaviour. From this perspective psychotherapy means providing corrective learning or conditioning experiences. Different therapy techniques are employed for remedying specific disordered behaviours. Phobias , for instance, are treated by desensitisation, in which the client is taught to relax while approaching the feared object in a gradual progression. In social skill training, clients practice handling different difficult inter-personal situations via role playing. Joseph Wolpe is an originator and populariser of behavioural therapy. Behaviourist techniques using external rewards as a method of reinforcing desired changes in behaviour have been used formally and informally in residential child care.
Reading this, residential child care workers may become aware not only that they have used one or more of these approaches informally if not formally but that they have used one or more simultaneously. The four categories laid out are not distinctly separate and do overlap. In practice each of these approaches may be helpful depending on the different needs of individual children. The most conclusive research studies into the various psychotherapies all conclude that no matter which of the theories are followed, the therapy’s effectiveness depends on the quality of the relationship between the client and the therapist. This may be a useful message to bear in mind !
Charles Sharpe, February, 1996
Minor modifications April, 2011.
© 2011 goodenoughcaring.com and Charles Sharpe
Links to other related articles
Children who need a therapeutic residential experience by Cynthia Cross at http://www.goodenoughcaring.com/Journal/Article142.htm
Good Enough Caring : using a psychodynamic approach to the care of children and young people in the care system by Charles Sharpe, Evelyn Daniel & Siobain Degregorio athttp://www.goodenoughcaring.com/Journal/Article18.htm
Care is therapy by John Burton at http://www.goodenoughcaring.com/Journal/Article76.htm
In Care in Therapy ? A consideration of the usefulness of psychoanalytic theory for the care of young people living in children’s homes by Charles Sharpe athttp://www.goodenoughcaring.com/Writings/Writing31.htm
We can all be therapeutic if we care to be : being therapeutic in the group living setting of a children’s home by Charles Sharpe at http://www.goodenoughcaring.com/Writings/Writing89.htm
Humanist Therapeutic Theory and Its Influence on Life Space Work by Charles Sharpe at
Aspects of Social Learning Theory which Can Inform the Care of Children and Young People by Charles Sharpe at http://www.goodenoughcaring.com/Writings/Writing72.htm
Theoretical approaches in residential child care : the milieu as therapy by Charles Sharpe at http://www.goodenoughcaring.com/Writings/Writing68.htm
Therapeutic child care : psychodynamic aspects of residential child care by Charles Sharpe at http://www.goodenoughcaring.com/Writings/Writing11.htm
The concept of the therapeutic holding environment and how it has been implemented in the residential home for young people in which I work by Ariola Vishnja Zjarri athttp://www.goodenoughcaring.com/Journal/Article13.htm
Fritz Redl and the Life Space Interview by Charles Sharpe in CYC-Online Issue 129, November 2009 at