How we change what others think, feel, believe and do
A Brief History of Counseling and Therapy
Counseling has not had a long history in its current form, yet it has happened for centuries and longer.
There has been a long need for counseling in helping individuals with transitions and other difficulties in their lives. The long tradition of counseling is first of family members helping with advice. Parents counsel their children. Grandparents and other family elders offer the wisdom of the years.
In a close community, there may also be tribal elders or others with a concern for mental well-being. This role for many years was (and still is) taken on by the priest or religious person. For the individual, the priest offers confidentiality that enables discussion of family matters or things that are secret from the family. The priest meanwhile gets to steadily inculcate religious values, making it a valued relationship on both sides. The church tended to view mental illness as some form of possession and treatment, including exorcism, was of the soul rather than the body.
Those with more incurable issues were generally tolerated. The village idiot was found a place in the fields and others were cared for or handled within the community.
With the age of the enlightenment and the rise of the industrial revolution through the eighteenth and nineteenth centuries, populations became mobile as they sought employment in towns and cities that were often far from their original homes. This separated them from their natural counselors, although the religious support was still available. Yet with the rise of science, the power of the church declined and it was not always able to give the help that was needed.
Capitalism and science also had subtle effects on beliefs, values and general cognition. Everything had to be explained. The work ethic was dominant and hedonism was an option for only a few.
Along with the concentration of towns and cities came the need to protect its citizens and civic organizations such as police forces were developed. In small communities the power of shame and the threat of banishment is enough to sustain social control. In town, anonymity is an option which brings its own problems. Particularly in America, social mobility was very much a norm.
As much to protect the populace as the individual concerned, somewhere between the workhouse, hospital and prison sat the lunatic asylum. Here, the insane (as well as a few unhappy individuals who had embarrassed their families) were incarcerated with little treatment.
Science scoffed at the notion of possession by demons but had little idea what to do beyond basic approaches such as drugging and leeching. In the cruel days of misfit sideshows, the asylum was just another place to go and laugh at those less fortunate.
Hypnotism had been known about for some time (Mesmer lived around the turn of the eighteenth century), and was popular through the ninteenth century and was used as an informal therapeutic method. Nevertheless it perplexed scientists who were suspicious of its shamanistic roots.
With the continued development and dominance of scientific medicine, establishment attention was eventually turned to matters of the mind (something that empiricists had largely ignored as impenetrable). Medical science took over as the caretakers of the mentally disturbed and a new age of and discipline of psychiatry arose towards the end of the nineteenth century.
Sigmund Freud was perhaps the most significant pioneer in seeking to understand and treat mental problems, at least in those who lived in normal society but who suffered from emotional and behavioral difficulties. Rather than try to treat mental problems as a physical issue, he chose to listen to them and try to work out what was happening from what they said, and then apply treatment in the opposite direction, again through words.
Despite massive leaps, Freud was still trapped by notions of his day, such as the assumption that mental problems had an emotional basis and the derivation of ideas such as libido came from nineteenth century biological theories.
Psychoanalysis thus developed and was evolved by people such as Jaques Lacan and Melanie Klein into the approaches still used today. This was not without some internal division of opinion and Klein famously split with Sigmund Freud's daughter, the more traditionalist Anna.
In the way that a thing creates its opposite, the assumptions of psychoanalysis were challenged in the scientific search for hard evidence, and behaviorism and conditioning became popular for the focus on the external, measurable behavior.
In the opposite direction, and particularly in the more liberal America, a different view arose amongst people such as Carl Rogers, Albert Ellis, Eric Berne and Abraham Maslow. These put the person and their experience at the middle of attention, as opposed to the more therapist and method focus of psychoanalysis. This may seem unfair but the humanist approach is just that - human. It sees the client as a collaborative partner, not as a patient to be treated by an expert. Humanism, even more than Behaviorism and quite unlike Psychoanalysis, has a focus on the present rather than the past.
Humanism was largely a practitioner philosophy and was largely ignored by academe for a long time. Nevertheless its warm message resonated with both therapists and clients and it was widely used. Despite secular leanings, this approach was influenced by Protestant values such as free choice by the individual and the personal journey.
With the decline of the church as a social institution that exists at the heart of the community and the lives of its people, there arose a vacuum of meaning and care. Without the comfort of promised salvation, many lost their sense of purpose in the meaningless daily drudge. And without the sage and certain advice of the priest, the neuroses of industrial living worsened.
Cities can be lonely places. With family far away and fickle friends who enjoy the fun but step back when emotional support is needed, a person can be out and dancing yet feel terribly alone.
In such an environment there is a vacuum, a pent-up need for help towards the making of meaning for individual lives. It was this need, this pull, that created the new disciplines of therapy and counseling. It was the loss created by sundered societies that drove some to despair and other to consider what succor and treatment could be provided to create a more harmonious. Those who wanted just to do good and those who saw the social imperative worked to develop ways and means of putting people back together and back into society. In pursuit of happiness and the American Dream, self-development was a common focus. Even in the first world war, the US army employed psychologists and psychological testing was widespread.
Psychotherapy first caught on in a significant way in the USA, helped by a receptive culture and by European analysts who moved there away from fascist oppression. These ideas were then adopted into the American culture. Humanism in particular, as described above, was a particularly American approach. There is a notion of the 'empty self' and an American theme has been the search for meaning and the focus on the individual's story (the empty self is also a possible cause in the rise of consumerism and advertising).
In the latter half of the twentieth century, counseling developed significantly as a distinct profession, differing from therapy at least in the contexts of use and often in the types of issues faced. Counseling happens in the social community, in schools and colleges as well as homes. Counseling is often paid for by the community or is voluntarily offered (such as the Samaritans). Therapy is more likely to be a private practice. Therapy is largely found in the therapist's work room. Counseling addresses issues from small to large. Therapy tends to deal in the bigger issues. Counseling may be limited. Therapy can continue as long as the client is able to pay.
As with other new domains, there has been division of viewpoint and evolution of schools of thought. There have been views of counseling and therapy as a means to social change. The counselor-client relationship has been questioned. Even the dynamics resulting from the structure of expert-patient has been questioned.
Throughout the development of counseling and therapy, there has been an evolution of though about the way people are perceived and hence treated. In the days of the lunatic asylum, people were locked up and treated like animals. Freud viewed the person as conflicted and hidden. Behaviorists saw people as predictable machines. Humanists had a more botanical image, with ideas of feeding and growth. The perception of the client can significantly affect the counselor's view and hence how they interact with them.