What is the difference between psychotherapy, psychology, and psychiatry? Most people find them hard to distinguish, which isn’t surprising. The terms seem to be used interchangeably about the same activities, and some people describe themselves as practising more than one. Many psychologists and psychiatrists are also psychotherapists, and there are even the odd individuals who are all three. There are already Very Short Introductions (VSIs) on psychology and psychiatry, so we should start by distinguishing these subjects and explaining what this VSI to psychotherapy will add.
Psychology is the science of mental processes and behaviour. It uses all the standard scientific methods of observation, experimentation, and theory development. It isn’t even restricted to humans—many psychologists study animal behaviour, both for its own sake and also to model human thinking. Psychologists examine emotions, perceptions, thoughts, etc., and increasingly use very high-tech equipment such as computers and brain scanners. Some ‘clinical’ psychologists work in health services and apply what they learn from their science to help people with problems.
Psychiatry is a medical discipline. Psychiatrists first train as doctors with the full range of exposure—general practice, surgery, obstetrics, etc. When qualified they then specialize in psychiatry, which is defined as the diagnosis and treatment of mental illness. While modern medicine is very ‘scientific’, it is not first and foremost a science. It uses several sciences such as physiology, genetics, and biochemistry to advance its knowledge and practice, but its fundamental approach is observational, not theory driven. Psychiatrists do not start from experiments or theories but from the problems people bring to them, which they then attempt to categorize and find treatments for. Psychiatry is firmly wedded to the ideas of diagnosis and treatment, although mental illness, and in particular the boundary between health and illness, are often very controversial.
Psychotherapy is a form of treatment for emotional and psychological problems that is based on talking and understanding. It relies on two (sometimes more) individuals exploring the problems the patient or client brings. The aim is to gain greater understanding of the problems and better ways of dealing with them. Many psychotherapists use psychiatric diagnoses and the term ‘patient’, but they think more in terms of personal problems and identity. They do not prescribe medication. Like medicine, psychotherapy is not primarily a science, but more a skills-based profession, which uses various theoretical concepts to understand human experience and development. Like medicine, it also consists of many different approaches and techniques, and this book will describe and discuss those that are most significant.
Roy Porter, a historian of medicine, called the 20th century ‘the century of psychiatry’. He could just as well have called it ‘the century of psychotherapy’. In the period of these hundred years both have transformed from obscure, minor activities to topics of enormous public interest and investment. Psychiatry now accounts for about one-fifth of all medical costs throughout the world. Psychotherapy before World War I was an exotic practice restricted to rich intellectuals and their psychoanalysts. The war changed all that. Psychological treatments for emotional disorders altered psychiatric practice fundamentally and began to change society’s thinking. By the mid-20th century, psychotherapy had become a constant feature in artistic and cultural debate, but more importantly it had become recognized as an effective treatment for a wide range of emotional and interpersonal problems.
Psychotherapy is now widely available—not just within psychiatry and not just for mental illness. Psychotherapists are to be found in hospitals, schools, universities, prisons, and increasingly in some enlightened workplaces. People seek their help for longstanding problems, but also for crises and relationship difficulties.
Psychotherapy has never stood still. It has not only expanded its range and extent, but there have been exciting and lasting changes in its practice. The traditional psychoanalytic psychotherapy described at length in dominated the earlier years, but various styles and adaptations evolved up until World War II. The Nazis’ persecution of the Jews (almost all the early psychoanalysts were German-speaking Jews such as Sigmund Freud) drove psychotherapists abroad to the US, South America, and the UK. The result was a variation in practice in different societies and the beginning of radically different ways of thinking (see ). Since the war we have witnessed the establishment of time-limited therapies (), the exponential growth of counselling, psychotherapy’s less formal relative (), and more recently the rapid development of a strikingly different approach called cognitive behaviour therapy (CBT, ). As psychotherapeutic thinking became bolder it began to escape its traditional one-to-one format and experimented with group and interactive therapies ().
Just how different are these therapies from each other, and how much are they variations on the same theme? Is counselling just another form of psychotherapy, or is it something quite new and different? In writing a book like this we have described the differences, so that you can get a sense of the range. Many practitioners insist that they are radically different from each other, but we are not convinced. Our view is that they have more factors in common than separate them. All have the same starting point in their commitment to help fellow human beings who are struggling with distressing problems. All assume that things can get better, and that an honest, reliable, and tolerant relationship can provide a setting for change. Lastly, all are based on some form of belief that what matters in our lives is not simply what happens to us, but crucially what we make of it and how we deal with it, often based on mental processes we may only be dimly aware of. Psychotherapy aims to bring these processes into clear consciousness—to help us make sense of them and take more control of our lives.
It struck us in writing this book just how skewed the sexual representation was. More women seek psychotherapy than do men, and many more psychotherapists are women than are men. Yet when we were writing about who developed this or that psychotherapy, or who wrote what, it has tended to be dominated by men. We believe this is a historical legacy of the discrimination that characterized professional and educational opportunities in previous generations. We predict that any book covering the same ground in fifty years time will be peppered with creative women writers and scientists.
Gender stereotypes have played a significant (and not especially honourable) role in psychiatry’s history, so this is not unimportant. In the text we wanted to avoid the clumsy his/her but were not happy with just using ‘he, him, his’ throughout. Redressing the balance by always using ‘she, her, hers’ seemed equally artificial. We have opted to simply vary the gender in a random way. There is no hidden pattern in it, so don’t try and work it out!
Psychotherapy is an intellectually vibrant activity. It never stands still and is full of debate and disagreement. Psychotherapists are committed people who have undertaken long and demanding trainings, and who almost invariably are very passionate about their work. Any book that sails a middle course in describing them risks offending everyone. We have ensured that each of these chapters has been read by at least a couple of real experts in their areas. Invariably they have thought that we did not accord their therapy type quite enough space or importance. That is the nature of the beast. We both have our own specific therapy trainings (Eva in cognitive analytic therapy, and Tom in group analysis), so we know how they felt. However, our job has been to try and give you a balanced overview and we hope that we have. We have chosen to describe some therapies in more detail where we feel they illustrate underlying principles particularly well, not necessarily because they are the most important approaches.
A final word of warning. This is not a self-help book. There are plenty of those around and many are excellent. This VSI may help you decide which of the various types of psychotherapy appeals to you if you are thinking of seeking help. But that is all it can do. Psychotherapy, and particularly counselling, is now much more accessible and the old stigma that used to be attached to seeking such help is, mercifully, shrinking fast. So if you are thinking of talking things over there is absolutely nothing to be lost by making the move, and it could make all the difference. A good place to start is usually to discuss matters with your family doctor, or to access the websites of reputable psychotherapy organizations. Currently, psychotherapy registration is not statutory in most parts of the world, but responsible therapists would welcome you enquiring into their level of training or accreditation. We would recommend meeting with two or three therapists for assessment sessions before making a final decision on whom to see. Psychotherapy is a very personal business, and the ‘fit’ between you and your therapist will play a crucial role both for the experience and for the outcome of the process.