PSYCHOTHERAPY. — Psychotherapy is therapy by psychological means. Its field of action is essentially represented by those psychic and somatic disorders in which emotional psychological factors are the causal motives or in any case exert a predominant influence in their genesis.
Psychotherapy has its roots in the earliest beginnings of the development of humanity. In antiquity, illnesses were in fact often treated through contact with sorcerers, magicians, etc., who also performed the function of physicians. They employed exorcisms, rites, and magical procedures in order to drive out the “evil spirits” held responsible for the illness. These were ultimately powerful suggestive means that easily took hold of the primitive psyche. It was perhaps the magical and mysterious character with which those “healers” surrounded themselves that led psychotherapy to be regarded as something unserious and unworthy of consideration by physicians. Another factor that opposed psychotherapy, especially during the last few centuries, was the wave of empiricism and mechanistic materialism that swept through science. The concept of Morgagni and Virchow, which saw in disorders of the organism the expression of an alteration of particular organs, indeed of particular cellular groups (alteration in the sense of organic lesion), also spread into psychiatry, so that in disorders of the psyche people always wished to see a lesion of particular cerebral areas. The almost invariably negative anatomo-histological and biological findings in the overwhelming majority of morbid mental manifestations were of no avail. The concept of the hypothetical “lesion” of cerebral matter certainly obstructed the treatment of these disorders by psychological means; only at the end of the nineteenth century and the beginning of the twentieth, under the impetus of Charcot, Barnheim, Freud, Janet, Jung, etc., did psychotherapy, stripped of its mysterious and miraculous aspects, return to its proper place in medicine. Naturally, a field such as this offered easy access to certain abusive charlatans, who succeeded in casting a veil of discredit over anyone who sought to resolve disorders of the psyche by psychological means.
There are various forms of psychological treatment. In view of the enormous development that psychoanalysis has undergone in this field, it will be useful to describe: 1) psychoanalytic-oriented psychotherapy, 2) non-psychoanalytic-oriented psychotherapies.
1. Psychoanalytic-oriented psychotherapy
Psychoanalysis is a means of psychological investigation that accepts the action of the so-called “unconscious” in the genesis of neuroses and some psychoses as a central fact and recognizes the enormous therapeutic importance of the “transference.” Our psychic life also unfolds at levels lower than those at which we think, will, criticize, etc. These psychic levels constitute the unconscious, whose contents consist of memories and fantasies that have fallen into oblivion over time and which we can recall through memory whenever we wish. But there are also reminiscences that we cannot summon to consciousness, either because they have been faded by time or because we perceived them subliminally. There are also psychological contents endowed with a strong affective charge that we cannot always accept into consciousness because they are incompatible with its demands, which are moral, cultural, etc., in character.These rejected psycho-affective contents become dissociated from the personality and, in an unconscious state, lead an autonomous life (complexes), often interfering with, obstructing, and parasitically burdening consciousness, which, believing that it has definitively repressed them (repression), is often subjugated by them. Many morbid manifestations are precisely the expression of the dynamism of these unconscious experiences. The symptoms will disappear when these experiences, having once again become conscious, have been reintegrated into the unitary whole of the personality. The avenues of access to these complexes are free associations, subjective and objective contexts, and the interpretation, according to definite rules, of dreams. But in order to arrive at this, it is necessary for the patient to recognize how to overcome the “transference” with the therapist. What is the “transference”? It is the unconscious projection onto the external world of past, often infantile and unresolved interpersonal relationships, which the individual, without realizing it, seeks to bring about, even though these interpersonal relationships are often in conflict with present reality (the external world, which in the therapeutic situation is represented by the analyst). By recognizing and overcoming the interfering effect of such past situations upon present reality, the patient develops new attitudes more consonant with the current objective situation, that is, more mature and less neurotic. The immature infantile attitudes were motivated by the complexes, which may be said, through this means, to obtain an energetic discharge and 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 down on a couch in such a way as not to see the analyst, so that he may remain undisturbed face to face with his own neurosis, without being influenced by the person of the physician. The patient is invited to say everything that comes into his consciousness, so that, with the interpretive help of the analyst, he may then better understand his own unconscious world, with the aim of realizing the new data acquired. Dreams have an analogous value; given the synthetic character of the present work, it is not possible to go into them in detail (cf. G. Tedeschi, Casualità e finalismo nello studio dei sogni e riflessi in psichiatria, in Lavoro neuropsichiatrico, II, Rome 1925). It should be remembered that, in classical technique, the analyst adopts a rather passive attitude. The long duration of such treatment has led many psychoanalysts, especially American ones, to seek to modify it in order to make it more malleable and shorter (v. BIBLICA). There is a tendency to reduce the number of sessions from daily sessions to three per week. The analyst assumes a more active attitude and brings the patient directly into confrontation with the motives of his neurosis, without waiting for these to emerge by themselves in the course of free associations; one may say that the aim is above all to apply directly the discoveries reached by psychoanalysis through its classical technique. If the patient does not arrive at those profound changes in personality, it is nevertheless true that the therapeutic results are fairly satisfactory, which is considerable given the shorter duration of the treatment (psychotherapy-analitically oriented). These psychoanalytic principles are applied brilliantly in treatments that are also collective (group psychotherapy), which represents a considerable advantage when dealing with a large number of patients and when there are not enough physicians, for example, in psychiatric hospitals (for the moral evaluation, V. PSICANALISI).