Mental Health


Lesson 3

The roots of different schools and traditions of psychotherapy can be found in the early 1900s (Pilgrim, 1996). Sigmund Freud, who was working with neurological specialists in the late 19th century in Austria, is perhaps the best known of the early psychoanalysts.

Freud's ideas were shared and developed by a committed group of doctors and psychologists who aimed to develop the techniques of psychoanalysis to provide a therapeutic response to psychological and emotional problems. Over time, different schools of


psychotherapy was formed. This range of other psychotherapies, including humanistic, personal construct, psychodynamic and Gestalt, is illustrated in the Department of Health's (2001b) report on treatment choice.

In essence, a psychotherapeutic approach is a longer-term and more in-depth exploration of past and present feelings, actions and relationships. It is an approach (or a set of approaches) that explores conscious and less conscious feelings and emotions, tracing them to childhood events and experiences such as abuse, loss of parents, separation or break-up of the family.

It is thought that these experiences, and others in later life (such as prejudice, discrimination and segregation), can lead to poor self-esteem, an uncertain identity, a lack of close relationships and the possibility of associated mental distress.

Much psychotherapy is provided privately, and people may see a therapist regularly for several years. NHS provision is extremely variable: some areas have long waiting lists, while other areas develop specialised services for needs, such as therapeutic communities.

Up to now you have been considering the premise that counselling, CBT and forms of psychotherapy all have something to offer people experiencing mental distress.

However, although the role of the therapeutic relationship between service user/survivor and counsellor or therapist is frequently reported to be of great benefit, it is often the hardest area to measure. Gardiner describes the many therapeutic approaches she has received for her depression as trying to 'raise the Titanic'. 

One of the most important aspects in this enterprise is the development of a therapeutic relationship:

"The psychologist has offered me that most important of things when someone is so depressed - a truly safe relationship in which to learn how to hold my own hand and help myself".

(Gardiner, 1999, p. 21)


Department of Health (2001b) Treatment Choice in Psychological Therapies and Counselling: Evidence Based Clinical Practice Guidelines, London, DH.

Gardiner, L. (1999) 'Raise the Titanic', Openmind, Vol. 99, Sept/Oct, pp. 20-1.

Pilgrim, D. (1996) 'British psychotherapy in context' in Dryden, W. (ed.) Handbook of Individual Therapy, London, Sage.