Important figures in the evolution of psychotherapy

Five important figures in the evolution of psychotherapy

The contributions of these five pioneers shape our understanding of early development and human behaviour

Dr. Sigmund Freud

Freud: a pioneer in psychoanalysisPsychoanalysis was founded by Dr. Sigmund Freud (1856-1939) who revolutionised our thinking about the human mind. Dr. Freud’s psychoanalysis is both theory and therapy, and his psychoanalytic theory forms the basis for many current psychodynamic theories.

Freud was the first to discuss the unconscious mind and its role in human behaviour. His four key assumptions were:

  • The power of the unconscious. Much of what motivates us is stored in the unconscious mind and this influences our emotions, behaviour and judgments.
  • The human mind has three components: the id, ego and superego
  • Our behaviour and emotions in adulthood are rooted in our childhood experiences that shape our personalities and our behaviour.
  • All behaviour has a root cause that is usually unconscious.

Freud believed that there are three levels of consciousness:  the unconscious mind that exists outside of our awareness at all times, the preconscious mind that is information that we are not currently aware of but that can be recalled, and the conscious mind that is the current state of awareness.

Personality elements

According to his psychoanalytic theory, Freud also believed that there were three elements to the personality that work together to create complex human behaviours: the id, the ego and the superego. The personality is shaped by early childhood experiences.  This was a radical assumption at the time as it was thought that childhood experiences were not at all significant.

The id is present from birth and the first to develop. It operates in our conscious mind according to the pleasure principle and is driven by immediate gratifications of all desires, wants and needs.  If these needs are not satisfied immediately, the result is a state of tension or anxiety. This can be seen when a baby cries if it is tired, uncomfortable or doesn’t receive a feed.

The ego is the second to develop and is present in the preconscious and conscious mind. It is part of the personality that is realistic and makes decisions.

The superego is the last to develop and exists in all levels of consciousness. It is concerned with the conscience of what is right and wrong as well as having control over impulses and desires.

Defence mechanisms

Freud also introduced the idea of defence mechanisms which act like an immune system for the mind to keep threatening ideas, motives and thoughts out of consciousness. One defence mechanism is repression that keeps mainly sexual and aggressive impulses, ideas and thoughts out of consciousness by repressing them.

Another defence mechanism he identified was reaction formation. This is when we turn an unacceptable thought or action into a reaction or behaviour that is the exact opposite. Examples are a parent who holds hostility towards a child turning this into over-affectionate and smothering behaviours. Or a person who doesn’t feel friendly towards someone behaves in an excessively overfriendly and welcoming manner.  Freud called the excessive behaviour `overboarding’ as the person is trying to over-compensate for and distract from their true, hidden feelings and thoughts.

Dr. Freud’s contribution to psychotherapy

Freud first introduced the idea that our behaviours are driven by past events and experiences and are not conscious to us in the present. His theory changed the course of history because it changed the way we understand how our `self’ and personality develop. Although our past experiences, events and insights may be forgotten, they continue to inform the development of our self and how we respond to the world around us. Therefore how we feel and express ourselves in adulthood is strongly linked to early life experiences.

Freud taught us that any of the experiences that affect us today occurred before we were able to form lasting conscious memories.  He identified that these life experiences, not all of which can be evident in conscious, present memories, often left a lasting impact on how we behave and the emotions we feel.  Unconscious experiences derived from early life events influence and shape our habits, choices and behaviours throughout life. Freud observed that challenges and traumas experienced in life can continue to grow within oneself, emerging as certain feelings and behaviours in later life.

Melanie Klein

Melanie Klein is a pioneer in child psychology.Melanie Klein (1882-1960)pioneered the psychoanalysis of children, focusing on early childhood. She was one of the first to use psychoanalysis on children and implemented new tools and techniques, regularly using play and toys to help children discuss psychological issues.  Her approach to psychoanalysis conflicted with Dr. Freud’s work as he drew his ideas on child development from adult clients and their recollections. She also disagreed with Freud arguing that the superego is present when a child is born.

Melanie Klein extended and developed Freud’s understanding of the unconscious mind through the analysis of children’s play. She expanded the knowledge of children’s deepest fears and defence mechanisms against them to develop theories such as the ‘Paranoid-Schizoid Position’ and the `Depressive Position’.

Paranoid-Schizoid Position

The Paranoid-Schizoid Position occurs in the first few months when an infant is in a state of anxiety. In order to cope, the infant uses phantasies of splitting and projecting onto others. As the baby’s ego is not yet developed, its relationships are maintained with objects which are split between good objects and bad objects. The term `objects’ in this context refers to a mother, father or primary caregiver rather than an inanimate item. Because of its limited cognitive development and ability, the infant creates individual images of the mother that are unrelated to each other. The baby therefore splits the mother into parts and into good breast and bad breast objects. The good breast provides the baby with food and the bad breast is when food is removed thus depriving the baby.

The child will project outwards and have a desire to destroy the bad mother object whilst loving the good mother object that fulfils its needs. However in wanting to destroy the bad mother, this causes paranoia in the infant that the bad object may seek revenge, and in order to deal with this paranoia, the infant internalises some of the negative feelings.

The Depressive Position

The Depressive Position occurs after 6 months of this projection and internalisation cycle when the infant starts to understand that the good and bad mother are one entity, and the bad mother that he wants to destroy is also the good mother that satisfies him and he loves.  In the Depressive Position, the child feels that he has attacked and destroyed the good mother that he needs which causes him pain, and a need to restore and protect these loving objects develops. This will manifest in the infant as a capacity for concern and a wish to repair the damage that has been done, and is crucial for the development of healthy relationships in adulthood.

Object Relations Theory

Melanie Klein is regarded as one of the founders of Objects Relations Theory which was developed from Freud’s psychodynamic theory. It placed significance on the mother and child relationships and the wider family unit.

She introduced the theory that infant phantasies are destructive and guilt-inducing. Because these phantasies are so intolerable to infants, they were projected outwards onto mothers and caregivers. She also identified that projective identification is motivated by the self’s need to eliminate unwanted or dangerous aspects of the self meaning that when we have something we don’t like or want about ourself, it is projected outward and onto others.

Melanie Klein’s contribution to psychotherapy

Klein was a pioneer in the treatment of children, creating and developing original techniques that were specialised for children and different to adult psychotherapy. She worked directly with children using important, new tools and techniques such as play and toys in order to allow children to express themselves, giving her a unique insight into children and their development.  Her techniques form the much of the basis of child psychotherapy training today.

Donald Winnicott

Winnicott taught a generation how to parent.Donald Winnicott (1896–1971) was a paediatrician and psychoanalyst.  He played a vital role in public education on child rearing to help parents with their children. He suggested that ‘Good enough’ parents are able to take in their stride the quickly changing states of the infant, providing consistency and security to the child.  He is also known for his ideas on the true self and false self and the transitional object.

Winnicott’s approach was that happiness in humans depended upon the way parents brought up their children. He studied under Melanie Klein however later put forward his own theories on child development, principally suggesting that the external environment, including parental figures, had to be considered for the development of the child.

Winnicott thought the key aspect of healthy child development was rooted in the relationship with the mother, father and the key people who surrounded the parents.  He connected the mothering and nurturing process to the child’s cognitive development and concept of external reality. Initially the baby experiences the mother as part of himself, particularly through feeding and in the attentive holding and nurturing environment that the mother gives to the baby.  Gradually, the child becomes separated briefly from the mother so that the baby becomes an individual entity to the mother. This separating from the mother and returning to the mother initiates the start of the baby’s mental activity and a sense of their own presence in an external world and reality that is separate from the mother and itself.

The child will thus experience autonomy without feeling a void and this sense of self builds the capacity for the child to be alone and the ability to have an inner dialogue. It also builds creativity and allows the development of a free flow of thoughts and feelings, and rather than the child feeling cut off, it will have an organic flow of connection with its mother and others. 

Good enough parenting

Winnicott’s approach to being good enough parents is that the good enough mother would start by caring for her child, adapting herself to the changing needs of the baby and caring naturally for her baby.  The mother is devoted to the baby and ensures that the baby is looked after which will include sacrificing sleep, feeding the baby regularly and attending to the baby when it cries or is uncomfortable. The baby couldn’t exist without the mother.

Gradually the mother will allow the infant to express small amounts of anger and frustration. Although empathetic to her child, she will not immediately rush to the baby when it cries, allowing it to cry and feel slight frustration. Winnicott suggested that it was productive to let a child be angry and frustrated.

A child will experience hate and violence in infancy, projecting outwards with rage when its needs are not being met, and is it beneficial for the parent to let the anger and rage be expressed without feeling threatened by or judgemental of the bad behaviour.  Remaining calm reinforces to the child that what the child perceives to be true isn’t necessarily real and thus helps the child get over the rage. Aggression in the child is seen as a natural part of development and tests the limits of the personality. Individuals who do not express aggression in childhood may have repressed emotions as adults.

He also suggested that a child is very vulnerable and fragile psychologically, not understanding himself, not knowing where he is and struggling to survive, unable to communicate with himself and others.  It is the responsibility of those caring for the child to adapt and interpret the child’s needs rather than imposing demands for which the child is not ready.

True and false self

Winnicott also suggested that a child shouldn’t be too compliant. Parents prefer when an infant follows their rules and judge them to be `good’ when doing so. According to Winnicott’s belief, stricter parents who do not tolerate non-compliant behaviour would impose discipline and rules at an early age. This parenting style would lead to a suppression of a `true self’ in the child that would lead to the development of a `false self’ persona later in life which might appear outwardly mannerly and compliant in order to fit into society. The true self, however, could be brought out by creativity and play in order to develop an authentic, emotional self.

A further belief of Winnicott was to let children be, with parents suppressing their own needs rather than imposing their own circumstances, reactions, feelings and issues onto the child – intentionally or not. Parents should also respect and acknowledge their child and put aside their own ego, needs and assumptions.

Winnicott thought that parents should realise the seriousness of their parental role. Being a parent is hard work and he encouraged and applauded the importance and significance parents have in the development of their children.

Donald Winnicott’s  contribution to psychotherapy

Donald Winnicott’s ideas and approach were simple, proposing that the happiness and fulfilment of individuals and humanity as a whole depended upon the way parents brought up their children.  Issues and problems that individuals experienced were the consequences of poor parenting and bad, unhappy childhoods.  He believed that improved parenting led to a better society and happier individuals.  He played a large and important part in educating the British public about child-rearing and parenting through his numerous books and publications and over 50 BBC radio broadcasts between 1943 and 1962.

Winnicott developed several theories and concepts that influenced psychoanalysis practice today. His term “holding environment” for mother with her baby forms the basis of a supportive environment that a therapist creates for a client, similar to the caring behaviour of a mother with her child in creating an environment of safety and trust.

Through his conception of the true and false self, Winnicott believed the therapist could help a client reveal the uninhibited child within and rediscover a true sense of being and self.

John Bowlby

John Bowlby is the founder of attachment theory.John Bowlby (1907-1990) was a psychologist, psychiatrist, and psychoanalyst who developed attachment theory. The theory suggests there is an innate need in very young children to develop a close emotional and nurturing bond with a mother or its caregiver.

Bowlby’s theory suggested that the earliest bonds formed by children with their caregivers have a great impact that continues throughout life.

He researched the psychological consequences of both strong and weak emotional bonds between mothers and their young children and the effect it had later on in adulthood.

Attachment Theory

Bowlby defined attachment as a “lasting psychological connectedness between human beings.” His theory of attachment suggests that infants have an innate need to form an attachment bond with a caregiver and that early experiences in childhood have an important influence on development and behaviour in adulthood. The theory examines a child’s bonds with parents or caregivers and enables us to understand how this relationship affects the child. An attachment also provides a template for future emotional relationships.

Early attachment styles – or thought patterns – are established in childhood through the infant and caregiver relationship. Bowlby believed that attachment had a basis in evolution and was built into humans, writing that “The propensity to make strong emotional bonds to particular individuals is a basic component of human nature.”

This evolved response increases a child’s chances of survival. Babies are born with behaviours such as crying and cooing and caregivers are biologically programmed to respond to these signals and attend to the child’s needs.

While mothers are often associated with this role as primary caregivers and attachment figures, Bowlby believed that infants could form similar bonds with others.  When attachment figures are available and reliable, the child develops a sense of trust and can rely on the caregiver to be a secure base from which to explore the world.

Attachment can be broken down into four main aspects:

Proximity Maintenance is the child’s desire to be around and near to the people they are attached to. This need is heightened in young children.

Safe Haven is the safe house of the child’s attachment. When confronted with or experiencing danger or threat, the child’s desire is to return to the caregiver for safety and comfort.

Secure Base allows the child to explore the world around it. A secure base attachment allows the child to have a safe, familiar base to return to and receive reassurance. A child needs to believe that their secure base will not abandon them and will always be there to keep them safe and away from danger.

Separation Distress is when a child experiences anxiety from being away from their caregiver. For instance when a parent leaves their child at a nursery or a child gets lost in a store or park.

Different attachment styles

The level of care, attention and type of relationship a child has with their caregiver can have a huge effect on their personality and on personal relationships throughout the life cycle.

Secure attachment is the result of a caregiver having a good relationship with the child who is confident that their needs will be met. The child is confident when separating from the caregiver to leave and explore and is secure in the fact that the caregiver is a reliable and safe base and haven. As adults they are often able to have long and trusting relationships and have good self esteem, self image and a calm disposition.

Ambivalent attachment leads to emotional and psychological insecurities and needy behaviour. This is a result of a caregiver who is inconsistent with the level of care and response towards a child. The caregiver may be attentive to the child’s needs at times but also ignores them at other times. The child craves the highest level of care when it is being neglected and ignored. It causes the child to constantly seek reassurance and attention, however they will steer away from attachment because they fear what they perceive to be the upcoming neglect based on their experiences. Due to the lack of a reliable safe haven, they become easily distressed and it will be difficult to calm them down.  In adulthood, they may struggle to form long lasting relationships as they will worry that the partner does not love them or the partner cannot be trusted.

Avoidant attachment is the result of a caregiver who is insensitive to and rejects the needs of a child. The care giver will show no emotional or physical signs of connecting with the child and be dismissive at times of distress. This form of attachment leads to insecurities. The caregiver neglects the child who learns to not seek their attention as there will be no response. The child may be mature and independent, because they will not seek assurance from others and will be comfortable playing on their own. Because they do not have a safe base, they will not seek comfort and may avoid those who try to comfort them. As adults, they will struggle with intimacy and may actively avoid it, finding it hard to accept praise and be uncomfortable with sharing their thoughts and feelings.

Disorganised attachment is when a child experiences frightening or threatening situations or behaviour including role confusion (for example, a child taking on the role of the caregiver) neglect and abuse. The child will show signs of both ambivalent and avoidant attachments which leads to inner confusion, frustration and anger.  This can lead to rage and violence to themselves and those around them. As they do not believe that they have a safe base or safe haven, they will show no sense of loyalty and may lose empathy for other people. They will struggle to feel remorse for their actions and may feel separated, alone and misunderstood.

John Bowlby’s contribution to psychotherapy

John Bowlby’s research on attachment theory and child development left a lasting impression on psychology, education, childcare, and parenting. Researchers extended his research to develop clinical treatment techniques and prevention strategies. His work has influenced other important psychologists.

Irvin D. Yalom

Irving Yalom and the value of existential psychotherapy.Irvin D. Yalom  (born 1931) is an existential psychiatrist. In 1980 he published the booked “Existential Psychotherapy”. Yalom’s writing on existential psychology focuses on what he refers to as the four “givens” of the human condition: isolation, meaninglessness, mortality and freedom. He discusses ways in which the individual can respond to these concerns either in a functional or dysfunctional manner.

Four ultimate concerns

Irvin’s existential psychotherapy as a dynamic approach to therapy recognises four basic human issues that all people struggle with in life. These four `ultimate concerns’ are death, freedom, isolation and meaninglessness.  He believes that these givens of our existence are in the subconscious of every human being and may surface during our lives and be triggered at some point by an event or situation.

Death. We respond to death with mortal terror, fearing our inability to control it. However, death is also the means in which we can live our lives to the fullest in an authentic way. Death itself is not the issue as it can enhance our sense of living in the present moment, and increase our mindfulness of being in the moment. It can also highlight that trivial things are not to worry about and help us to live more fulfilling lives.

Yalom states that although death eliminates life as well as fills us with terror, the event of death can act as a catalyst to reassess our life perspective, open our mind and make improvements.

Freedom. Man has the freedom to create his own life and reality. Freedom in the existential sense refers to the absence and lack of any external structure to life.  Freedom brings a great responsibility with it as the individual is entirely responsible for his or her own world including their life decisions, desires and actions.

Isolation. We enter this world alone, and we depart this world alone.  Only we can feel our emotions, have our dreams, make our decisions and die our death. We can react to existential isolation in three ways. We can choose to believe that we only exist to the extent of how others see us, we can be in a state of fusion where we think we are not alone and are part of others. Or we can be in a state of mindfulness and be in a constant awareness of being and live authentically.  In this mode, we embrace our possibilities and limitations.

Yalom suggests that another existential conflict is between our innate awareness of our absolute isolation and our desire for continued contact with others and our need to be part of a larger whole.

Meaningless. Man is naturally seeking the meaning of life and existence, however we live in a universe that has no coherent meaning.  Man can experience dissatisfaction or helplessness with no sense of meaning, whether in oneself or in the world. Meaning can bring a sense of mastery and control to one’s life.

Life meanings

So therefore if there is no predefined template of meaning, we must construct our own meanings that are robust enough to support and motivate us in our own life. There are two types of meanings; cosmic and secular.

Yalom suggests that personal meaning in one’s life can be developed through a system that encompasses clear values and guidelines for conduct that are courage, prideful rebellion, fraternal solidarity, love and secular saintliness.

Group therapy

Yalom studied and practised group therapy, publishing a book. He identified eleven factors that lead to significant changes for group members participating in group therapy, with a therapist acting as a facilitator for the group.

His therapeutic factors for group therapy included a supportive environment in which to share experiences, help one another, give inspiration and encouragement, freely give information and gain self understanding. Other factors were the sense of belonging, validation and acceptance from a group therapy environment, the feelings of relief through uninhibited expression and improved interpersonal and social skills. Existential factors included that one will take responsibility for one’s life and accept the consequences of decisions made.

Irvin Yalom’s contribution to psychotherapy

Yalom is a thought leader and pioneer in the area of existential psychotherapy. Existential psychotherapy emphasises that mental health problems are frequently caused by struggles with existence and the fear of death, the need for freedom, and the avoidance of isolation.

Existential psychotherapy proposes the four basic human issues that individuals find challenging including isolation, meaninglessness, mortality and freedom. Yalom’s books help to  explain existentialism and demonstrate its importance in therapy.

Yalom is an advocate for group therapy, believing that group therapy increases and aids healing in a supportive and trusted environment. He believes that members of the group will drive change through interacting, sharing, giving and integrating with one another.