The Early Beginnings of Talk Therapy

Talk therapy, otherwise known as psychotherapy, has evolved through the centuries into a more viable treatment option for mental illness. However, mental illness was not always considered a medical condition.

In the Middle Ages, following the fall of the Roman Empire, mental illness was regarded as a supernatural problem; “to be touched by witchcraft” was how some described the condition. And people who exhibited symptoms were tortured and forced to confess. However, the Ancient Greeks recognized mental illness as a medical problem. They developed condition specific methods for treating mental disorders such as bathing for depression and blood-letting for psychosis.

Paracelsus, a Swiss physician who lived during the Renaissance, found the idea of demonic possession - the explanation for mental illness in the Middle Ages - absurd. A dissonance- a lack of psychological harmony- between man and the society he lives in was a better explanation. Most importantly, Paracelsus believed in the ideas that would influence psychotherapy tenets: prescription instructions, persuasion, and exhortation.

“Psycho-therapeia’ was introduced by Walter Cooper Dendy, a London surgeon, in his 1853 treatise, Psyche: A discourse on the birth and pilgrimage of thought. Two decades later, Daniel Tuke adopted the term “psycho-therapeutics” to describe the healing power of the imagination over the body, giving rise to the construction of mental institutions across the United States and Europe in the 19th century. Despite many of the methods employed by these institutions, including conversations between patients and staff in sober, structured environments, detached from the chaos of the cities, discharge rates were low while the number of intakes spiked.

The inability to rehabilitate patients in these asylums drove further explorations of new forms of therapy. German physician Franz Mesmer was convinced that within the mind existed hidden forces. A professor of medicine, Hippolyte Bernheim, described his use of hypnosis to treat his patients as psychotherapy. Paul Dubois rejected this view of psychotherapy, adopting the term to describe his method of treatment, dubbed “rational therapy.”

Elsewhere in Europe, the collaborative efforts of Sigmund Freud, an Austrian neurologist, and Josef Breuer, an Austrian physician and physiologist, laid the foundation for modern-day psychotherapy. The duo co-authored a book entitled “Studies on Hysteria” in 1895 and are credited with officially establishing psychoanalysis.

Keeping memories or thoughts in the subconscious, Freud believed, was what caused mental illness. He also believed that listening to the patient while interpreting their words, bringing memories to the fore, improved the treatment’s success and reduced the symptoms.

In their book, Studies on Hysteria, they described the Cathartic Method, which they had applied to a patient called Ana O (whose real name was Bertha Pappenheim). Subsequently, together they developed free association, the archetypical picture of psychotherapy where a patient is lying on a couch, discussing with a therapist.

America’s psychotherapy scene became redefined by a wave of psychoanalysts who flooded the New World after the Nazi’s conquest of Germany in 1933. The trained emigres, including Heinz Hartmann and Erik Erikson, would modify many of Freud’s concepts.

Columbia graduate Carl Rogers wrote the first of many books in 1939 which explored his approach to psychotherapy. Instead of a strict technique, he encouraged a free-form process. He preferred the term “client” to “patient” and created client-centered therapy. This form of therapy became first-choice among American psychologists and social workers after the war.