History of Psychotherapy

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The history of psychotherapy describes the development of “modern” psychotherapeutic approaches from the end of the 19th century, as well as their cultural history.

Cultural history

In many cultures , the idea of mental disorder was and is not present or incorporated into religious contexts. Some mental disorders were understood as a result of (demonic) possessions or curses . Accordingly, the “psychotherapies” were often carried out by priests , shamans or philosophers . Some of the criteria mentioned apply to the "treatments" of the time, such as: B. that disorders / illnesses should be treated, that corresponding (explicit or implicit) agreements were in place and that the treatment methods were based on culturally valid theories.

The “ medical treatments ” could not always be clearly differentiated . From the hunters and gatherers up to the present day, shamanic medicine, which was deeply anchored in religion and mysticism, became "modern medicine" and, as a goal, evidence-based medicine . For many millennia, the medical treatment of mental disorders comprised the execution of certain rituals or behaviors, as well as the administration of active substances (drugs) from plants ( phytopharmaceuticals ), animals or minerals. The first accounts of mental disorders were written around 400 BC. The Greek physician Hippocrates . His work contains descriptions of depression and delusions , but also of drunkenness and delirium . As for all other diseases, he explained that the cause of all these disorders was an imbalance between the body fluids.

In the Middle Ages , knowledge of the existence of mental illnesses was not completely lost; the four-juice theory of body fluids was recognized and applied , for example, by Hildegard von Bingen for mood disorders. But sick people with psychoses, hysteria, epilepsy and some organic brain changes with hearing voices and delusional ideas were considered possessed by Satan and evil spirits and were not only tortured and locked away with pointless exorcisms , but often also by cruel methods. On the other hand, there have been monastery hospitals since the seventh century which cared for epileptics according to the rules of charity. This must be distinguished from the multitude of psychosomatic disorders and accompanying symptoms with fear and pain, protracted bleeding, sleep disorders , dysmenorrhoea, as well as help with childbirth and surgical interventions and much more. The medieval therapy methods of that time, initially practiced mainly by monk doctors, consisted of a kind of conversation therapy with evocations of demons of illness, with blessing texts and healing prayers, which were based on imaginations, narrations, perturbing incongruent rhetoric, metaphorical constructions, chants via "labeling emotions", to regulate emotions and provided encouragement. In terms of content, they corresponded to the structure of Christocentric society and functionally to a trance or hypnoid-forming imagination method in today's sense. Their organic brain effect profiles can be traced. Until the early modern times are z. B. eye blessings, blood blessings, fever blessings, conjurations of gout and bumps, herbal blessings in the codices of the monasteries and the standard works of doctors inscribed directly next to the practical measures, which proves a simultaneous use in the sense of a tendency towards holistic medicine.

It was not until the late 18th century that the French doctor Philippe Pinel revived the medical treatment of “mental” disorders (schizophrenic psychoses) with new methods. From this new beginning the tradition of modern psychiatry developed , which today clearly overlaps with the later psychotherapy. → History of psychiatry

History of psychotherapy

History by directions

  • Psychoanalysis : From medicine and especially from psychiatry, psychotherapy developed around the same time as "modern (empirical) psychology ", the beginning of which is seen in Wilhelm Wundt's psychophysical experiments from around 1860 onwards. The first genuinely psychotherapeutic methods are attributed to Sigmund Freud , although he built on the work of Franz Anton Mesmer , Jean-Martin Charcot and Pierre Janet (see the article “ The discovery of the unconscious ” ). Freud began to study mental disorders at the end of the 19th century and developed psychoanalysis from his research. He taught his methodology and in the course of time trained many psychoanalysts who further developed or partly changed psychoanalysis (including Alfred Adler , Wilhelm Reich [see also under “ Body Psychotherapy ”] and CG Jung ).
  • Behavioral therapy : Also at the end of the 19th century, especially at American universities, so-called behaviorism developed from a radically positivist point of view , which uses speculative constructs such as B. categorically rejected “psychic structure” and “psychic dynamics”. The "behaviorists" (including Edward Lee Thorndike , John B. Watson and later Burrhus Frederic Skinner ) developed the first forerunners of behavior therapy based on experimentally developed learning theories (see conditioning ). In the 1980s, the so-called "cognitive turn" took place in the behavioral therapy institutes , in which introspection , thoughts and emotions were included more in therapy for the first time in behavioral therapy. In addition to specific directions in behavioral therapy ( Rational Emotive Therapy according to Ellis , Cognitive Therapy according to Beck ), an overall expanded behavioral therapy developed from this.
  • Conversational psychotherapy : In 1938 the American psychologist Carl Rogers began to practice so-called client-centered psychotherapy in his psychotherapies (which is often counted among the humanistic psychotherapy procedures). In German-speaking countries, conversation psychotherapy, as it was also known, became known primarily through the couple Reinhard and Annemarie Tausch .
  • Humanistic psychotherapy , Gestalt therapy and body psychotherapy : In 1951 Fritz and Laura Perls and Paul Goodman founded Gestalt therapy, which was more hermeneutic - phenomenologically oriented and aimed at promoting the patient's self-perception and attention to himself (in English: "awareness"). Common to this and subsequently developed therapy method is an image of man that also includes the assumption of “inner-psychological” or unconscious processes. They are based on the so-called " humanistic psychology ". This tries to include the human being as a whole in its theories, sees him as a relational being and as a responsible and decisive individual for himself. For this reason, the aim of all humanistic psychotherapies is to promote the "good nature" of the person. A further development of this approach consists in the inclusion of the body in the diagnosis and the psychotherapeutic process, as already practiced by the psychoanalyst Wilhelm Reich . The most modern neurological research ( mirror neurons , Damasio) corroborates this approach of body psychotherapy. Since 1980, develops and teaches Hans-Werner Gessmann the Humanistic Psychodrama .
  • Systemic therapy : Parallel to the development of behaviorism, psychotherapists and social pedagogues researched the connections between mental disorders and family conditions worldwide . Particularly in the treatment of schizophrenia , various institutes worked on family therapy or “systemic” concepts in the 1960s. From this, systemic therapy and family therapy developed , with their different forms (structural or strategic family therapy, multi-generation family therapy, solution-oriented therapy). The common denominator of systemic therapies is the assumption that psychological problems arise as symptoms in larger human systems (e.g. families) and are easiest to understand and change in this context, even if individuals ( index patients ) are the "symptom carriers" occur. In the meantime, systemic therapies are taught both as an independent treatment method and integrated into other forms of therapy. There are depth psychological, humanistic as well as behavioral and integrated forms of family therapy.
  • Recent developments: In the 1980s, several new therapy methods emerged, especially for the treatment of fears and traumatic memories (e.g. EMDR according to Shapiro and Somatic Experiencing according to Levine ). In part, these methods, which are usually assigned to body psychotherapy , are based on the effort to strengthen the client's "awareness" (in English: " Awareness ", see gestalt therapy ) to his emotional and physical reactions, in part - under influenced by Asian philosophies (Zen Buddhism, traditional Chinese medicine [= "TCM"]) - they work with the assumption of an "energy system" in the human body (the so-called " energetic psychology "), and on the other hand they use newer knowledge of the Imaging neurophysiology to facilitate psychotherapeutic changes. Some of these new therapy methods are not yet scientifically proven and some are controversial.

History by country

Psychotherapy in the GDR

As in the FRG, the beginnings are characterized by the tradition of medical psychotherapy anchored in medicine. The new state-organized structures of the health and social services meant that psychotherapy was also provided under medical supervision by both doctors and psychologists and, like all medical services, was financed by compulsory social insurance and not limited for cost reasons.

The centers had been Berlin since 1949 and 1957 ( Kurt Höck in the House of Health), since 1951 Jena ( Hellmuth Kleinsorge and Gerhard Klumbie's Department for Internal Psychotherapy), and since 1953 Leipzig ( Dietfried Müller-Hegemann Special Department for Psychotherapy at Karl Marx University Leipzig, initially as well as until 1962 in the Central Institute for Cardiovascular Regulation Research of the Academy of Sciences Berlin-Buch, mainly sleep therapy, autogenic training, hypnosis and milieu therapy as an alternative to western psychoanalytic conceptions with reference to Pavlov and his materialistic view of psychosomatic connections In 1962, Christa Kohler implemented a “communicative psychotherapy” there by applying socio-psychological and learning-theoretical knowledge), 1958 Berlin (individual therapy by Karl Leonhard , which is conceptually oriented towards behavioral therapy - continued from 1976 by Helmut Kulawik as psychodynamically oriented P sychotherapy) and from 1963 Uchtspringe ( Harro Wendt together with Irmfried Tögel with his "Dynamic Individual Therapy").

In 1963 the "Rodewian Theses" were adopted as the result of an international symposium, which reorganized the traditionally existing large psychiatric hospitals and the custodial principle of custody of the old psychiatry by opening up closed institutions, equating physically and mentally ill people and developing a network of complex treatment offers proclaimed. These concerns, accepted by the ministerial side as binding recommendations, were continued in the “Brandenburg Theses” of 1972 on “Problems of the Therapeutic Community”. Under the direction of Klaus Weise , a sectorization of psychiatric care facilities was implemented in Leipzig.

There were also corresponding developments in clinical psychology : 1969 Berlin ( Johannes Helm , Inge Frohburg and Jürgen Mehl training in conversation psychotherapy and behavioral therapy ) 1974 Leipzig (Manfred Vorwerg and Harry Schröder form of family therapy based on action theory, various training programs based on social psychology to increase social skills) .

The psychotherapists were organized in the Clinical Psychology Section of the Society for Psychology of the GDR as well as in the Society for Medical Psychotherapy (about half members are psychologists).

Thereafter, conversational therapies gained greater influence through university training. In 1978 it was possible for doctors to acquire a “second specialist” in the field of psychotherapy, for whom there was formalized further training from 1985. Psychotherapy became increasingly established and its further development was largely taken over by psychologists. Since 1980 they have been able to acquire the title of "specialist psychologist in medicine", which expresses their psychotherapeutic competence. A form of therapy developed outside the university was Intentional Dynamic Group Psychotherapy, which was developed by Kurt Höck at the House of Health in Berlin. The aim was to integrate psychoanalytic and group dynamic concepts and based on the psychoanalytic disease and personality model. Psychoanalytic techniques and at the same time the phenomena of group dynamics were used for the therapeutic process. More than 200 doctors and psychologists have been trained in it.

The attitudes of the psychotherapists working in the GDR to the politics of their state varied. Many described themselves as "critical" towards the GDR or asserted an "opposing attitude". However, the accessible Stasi files show that several leading psychotherapists were “surgically processed”, that is, they were observed and listened to. Some specialist representatives worked as unofficial employees for the Stasi and, disregarding their professional confidentiality, listened to their patients and colleagues in order to pass this information on to the state. So far the extent of the involvement of the psychotherapists of the GDR with the Stasi is unclear.

literature

Individual evidence

  1. ↑ Oskar Ebermann: Blood and wound blessings presented in their development. Berlin 1903 (= Palaestra. Volume 24).
  2. ↑ a b c Inge Frohburg: Forgotten data - On the development of psychotherapy in the GDR. Psychotherapists Journal 3/2004. P. 231 ff
  3. ^ Social psychiatry in the GDR: Norbert Jacherz: The unfinished reform Dtsch Arztebl 2013; 110 (38): A-1732 / B-1528 / C-1504
  4. ^ Marion Sonnenmoser: Psychotherapy in the GDR. Revolt as a cure . In: Deutsches Ärzteblatt . PP 8, 2009, p. 264 ( aerzteblatt.de [accessed on November 18, 2019]).
  5. ^ Marion Sonnenmoser: Psychotherapy in the GDR. Sunken world . In: Deutsches Ärzteblatt . PP 8, 2009, p. 115 ( aerzteblatt.de [accessed on November 18, 2019]).