PSYCHOTHERAPY. – Psychotherapy is therapy by psychological means. Its essential field of action is represented by those psychic and somatic disorders in which emotional psychological factors are the causal motivating forces or at least exert a preponderant influence in their genesis.
Psychotherapy has its roots in the earliest stages of human development. In antiquity, in fact, diseases were often treated through contacts with sorcerers, magicians, etc., who also performed the function of physicians. They employed exorcisms, rituals, magical maneuvers to drive out evil spirits, which were held responsible for the illness. These were, in essence, powerful suggestive means that easily took hold of the primitive psyche. It was perhaps the magical and mysterious character with which these healers surrounded themselves that led to psychotherapy being considered an unserious and unworthy pursuit by physicians. Another factor that especially opposed psychotherapy in recent centuries was the wave of empiricism and mechanistic materialism that pervaded science. The concept of Morgagni and Virchow, which saw in organic disorders the expression of the alteration of specific organs, indeed of specific groups of cells (alteration in the sense of organic lesion), spread even into psychiatry, so that in mental disorders one sought always to see a lesion of specific areas of the brain. The almost always negative anatomo-pathological and biological findings in the vast majority of mental morbid manifestations were of no avail. The concept of the hypothetical “lesion” of cerebral matter certainly hindered the treatment of these affections by psychological means; only toward the end of the 19th and the beginning of the 20th century, under the impetus of Charcot, Bernheim, Freud, Janet, Jung, etc., did psychotherapy, stripped of its mysterious and miraculous aspects, regain its proper place in medicine. Naturally, a field such as this provided easy access to certain quacks, who helped cast a veil of discredit over anyone attempting to resolve psychic disorders by psychological means.
There are various forms of psychological treatment. Given the enormous development that psychoanalysis has undergone in this field, it will be useful to describe: 1) psychotherapy with a psychoanalytic orientation, 2) psychotherapy with a non-psychoanalytic orientation.
1. Psychotherapy with a psychoanalytic orientation
Psychoanalysis is a means of psychological investigation that admits as a central fact the role of the so-called “unconscious” in the genesis of neuroses and some psychoses and recognizes the enormous therapeutic importance of “transference.” Our psychic life unfolds also at levels below those at which we think, will, and criticize, etc. These psychic levels constitute the unconscious, whose contents consist of memories and fantasies that, with the passage of time, have fallen into oblivion and that we can recall to memory whenever we wish. But there also exist recollections that we cannot bring to consciousness because they have faded with time or because the perceptions were subliminal. There also exist psychological contents endowed with a strong affective charge that we cannot always accept into consciousness because they are incompatible with its moral, cultural, etc., exigencies.These repressed psychic contents come to be dissociated from the personality and lead an autonomous existence in the unconscious (complexes), often interfering with, hindering, and parasitizing consciousness, which, believing them to have been definitively repressed (repression), is often enslaved by them. Many morbid manifestations are precisely the expression of the dynamism of these unconscious experiences. The symptoms will disappear when these experiences, having become conscious once more, are reintegrated into the unitary complex of the personality. The pathways to these complexes are free association, subjective and objective contexts, and the interpretation, according to determinate rules, of dreams. But to arrive at this, it is necessary for the patient to recognize how to overcome “transference” with the therapist. What is “transference”? It is the unconscious projection onto the external world of past interpersonal relations, often infantile and unresolved, which the individual, without realizing it, seeks to actualize, even though these interpersonal relations are often in contrast with present reality (the external world in the therapeutic situation being represented by the analyst). By recognizing and overcoming the interfering play of such past situations on present reality, the patient develops new attitudes more suited to the current objective situation, that is, more mature and less neurotic. The infantile attitudes that have matured were motivated by the complexes, which can be said to obtain, through this process, an energetic discharge, a conscious realization. By controlling the former and realizing the latter, the patient overcomes his neurosis.
The psychotherapeutic technique consists in having the patient lie on a couch in such a way as not to see the analyst, this in order to remain undisturbed face to face with his own neurosis, without being interfered with by the person of the physician. The patient is invited to say everything that comes to his consciousness so that, with the analyst’s interpretive help, he may better understand his own unconscious world and, in so doing, realize the new data acquired. Dreams have an analogous value, but, given the synthetic character of the present work, we cannot delve into them (cf. G. Tedeschi, Causalità e finalismo nello studio dei sogni e riflessi in psichiatria, in Lavoro neuropsichiatrico, II, Rome 1925). It should be noted that in classical technique the analyst adopts a rather passive attitude. The long duration of such treatment has led many psychoanalysts, especially in America, to seek to modify it in order to make it more flexible and shorter (v. BIBLICA). The tendency is to reduce the number of sessions from daily to three per week. The analyst adopts a more active attitude and brings the patient directly face to face with the motives of his neurosis without waiting for these to emerge spontaneously in the course of free association; one might say that the discoveries of classical psychoanalytic technique are being applied more directly. Even if the patient does not achieve those profound personality changes, it is true that the therapeutic results are quite satisfactory, which is much, given the shorter duration of the treatment (analytically oriented psychotherapy). These psychoanalytic principles are brilliantly applied also in collective treatments (group psychotherapy), which represents a notable advantage when dealing with a large number of patients and there is an insufficient number of physicians, e.g., in psychiatric hospitals (for moral evaluation, V. psychoanalysis).