The best way to review this chapter is to think about the principles underlying each approach to treatment, about the potential problems of each approach, and about the evidence concerning its effectiveness. As a start in that review, the following ideas may be useful.
1. Self-knowledge and self-acceptance as goals of psychodynamic and humanistic therapies The psychodynamic and humanistic approaches to treatment focus less on the person’s specific symptoms or problems, and more on the person as a whole, than do the other approaches. A psychoanalyst or other psychodynamic therapist who is asked to describe the purpose of therapy might well respond with the Socratic dictum: Know thyself. A goal of such therapies is to enable clients to learn about aspects of themselves that were previously unconscious so that they can think and behave in more rational and integrated ways.
Most humanistic therapists would agree with the Socratic dictum, but they would add, and place greater emphasis on, a second dictum: Accept thyself. Humanistic therapists argue that people often learn to dislike or deny important aspects of themselves because of real or imagined criticism from other people. A major task for the humanistic therapist is to help clients regain their self-esteem so that they can regain control of their lives.
2. Biological, behavioral, and cognitive therapies as derivatives of basic approaches to psychological research Biological, behavioral, and cognitive therapies each focus on important features of psychological functioning generated from research in their parent discipline, for example (a) physiological mechanisms, including neurotransmitters, (b) the role of environmental stimuli and learned habits, and (c) the role of cognitive mediators of behavior. Although biological, behavioral, and cognitive therapies focus on different levels of causation of behavior, they have something in common with one another that differentiates them from psychodynamic and humanistic therapies: They each focus more closely on clients’ specific symptoms than do psychodynamic and humanistic therapies.
Biological treatments are founded on the knowledge that everything psychological is a product of the nervous system. Drugs, electroconvulsive therapy, psychosurgery, transcranial magnetic stimulation, and deep brain stimulation all involve attempts to help a person overcome psychological problems or disorders by altering the nervous system in some direct way.
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Behavioral treatments are founded on the knowledge that people acquire, through conditioning, automatic and sometimes maladaptive ways of responding to stimuli in the world around them. The goal of behavior therapy is to eliminate the maladaptive responses and replace them with useful responses. Cognitive treatments are founded on the knowledge that people interpret and think about stimuli in their environments and that those interpretations and thoughts affect the way they feel and behave. The goal of cognitive therapy is to replace maladaptive ways of thinking with useful ways of thinking.
3. Psychotherapy and science Two questions can be asked about the relationship between psychotherapy and science: (a) Is psychotherapy a science? (b) Has science shown that psychotherapy works?
The first question concerns the degree to which the techniques used in psychotherapy are based on scientific principles and can be described objectively. Most psychotherapists would respond that their practice is a blend of science and art—that it is based on theories that stem from scientific research but that it also involves a great deal of intuition, not unlike the sort of intuition that is critical to any prolonged interaction between two human beings. Each client is a distinct individual with distinct problems and needs who does not necessarily fit with the statistically derived principles that have emerged from scientific research. One can compare the various psychotherapy approaches in terms of the degree to which they are derived from empirical, usually laboratory-based research, versus empathy and an intuitive understanding of the patient. Rogers’s humanistic therapy lies at one end of this spectrum, and behavior therapy lies at the other.
The second question concerns the use of scientific methods to evaluate psychotherapy. Carefully controlled therapy-outcome experiments suggest that all the well-established psychotherapies work about equally well, on a statistical basis, though some may be more effective than others in treating certain kinds of problems. Such findings have led to increased recognition of the nonspecific therapeutic factors shared by the various approaches and have also inspired a movement toward eclecticism, in which therapists draw from each tradition those methods that seem most appropriate to the client’s specific needs.