Psychotherapy

PSYCHOTHERAPY. - P. 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 agents or in any case exert a preponderant influence in their genesis.

P. has its roots in the earliest beginnings of the development of humanity. In antiquity, in fact, illnesses were often treated by contact with sorcerers, magicians, etc., who also performed the function of physician. They made use of exorcisms, rites, magical maneuvers, in order to drive out the "evil spirits" responsible for the ailment. It was, at bottom, a matter of powerful suggestive means that easily took hold on the psyche of primitive peoples. It was perhaps the magical and mysterious character with which those "healers" surrounded themselves that caused p. to be regarded as something not serious and not worthy of consideration on the part of physicians. Another factor that opposed p., especially in recent centuries, was the wave of empiricism and mechanistic materialism that pervaded science. The concept of Morgagni and Virchow, which saw in the disturbances of the organism the expression of the alteration of specific organs, indeed of specific cell groups (alteration in the sense of organic lesion), spread also into psychiatry, so that in disturbances of the psyche one always wanted to see a lesion of specific cerebral areas. The anatomo-histological and biological findings, almost always negative in the vast majority of mental morbid manifestations, were of no avail. The concept of the hypothetical "lesion" of cerebral matter certainly hindered the therapy of these affections by psychological means; only at the end of the 19th century and the beginning of the 20th, under the impetus of Charcot, Bernheim, Freud, Janet, Jung, etc., did p., stripped of its mysterious and miracle-working aspects, return in its true light to medicine. Naturally a field such as this gave easy access to certain fraudulent charlatans who served to cast a veil of discredit upon anyone who sought to resolve the disturbances of the psyche by psychological means.

There exist various forms of psychological treatment. Given the enormous development that psychoanalysis has had in this field, it will be useful to describe: 1) p. with a psychoanalytic orientation, 2) p. with a non-psychoanalytic orientation.

1. P. with a psychoanalytic orientation

Psychoanalysis is a means of psychological investigation that accepts as a central fact the action of the so-called "unconscious" in the genesis of the neuroses and of certain psychoses and recognizes the enormous therapeutic importance of "transference." Our psychic life unfolds also at levels lower than those with which we think, will, criticize, etc. These psychic levels constitute the unconscious, whose contents are made up of memories and fantasies that with time have fallen into oblivion and that we can recall thanks to memory whenever we wish. But there also exist reminiscences that we cannot bring back to consciousness, because they have faded with time or because we perceived them subliminally. There also exist psychological contents endowed with a strong affective charge that we cannot always accept into consciousness because they are incompatible with its demands, which are of a moral, cultural, etc., character.

Such rejected psycho-affective contents come to be dissociated from the personality and lead an autonomous life in an unconscious state (complexes), often interfering, hindering, parasitic with regard to consciousness, which, believing 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, having again become conscious, have been reintegrated into the unitary complex of the personality. The paths of access to these complexes are free associations, subjective and objective contexts, and the interpretation, according to determinate rules, of dreams. But, in order to arrive at this, it is necessary that the patient recognize how to overcome the "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 realize, even though these are interpersonal relations often in contrast with present reality (the external world which in the therapeutic situation is represented by the analyst). By recognizing and overcoming the interfering play of such past situations upon present reality, the patient develops new attitudes more consonant with the current objective situation, that is to say, more mature and less neurotic. The immature infantile attitudes were motivated by the complexes which, one may say, obtained through this path 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 down on a couch in such a way as not to see the analyst, and this for the purpose of remaining 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 afterward, with the interpretive help of the analyst, he may better understand his own unconscious world, and this in order to realize the new data acquired. Dreams have an analogous value, into which, given the synthetic character of the present work, we cannot delve (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 the analyst in the classical technique has a rather passive attitude. The long duration of such a treatment has induced many psychoanalysts, especially American ones, to seek to modify it in order to make it more malleable and briefer (v. bibl.). There is a tendency to reduce the number of sessions from daily 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 on their own in the course of free associations; one may say that the aim is more than anything else to apply directly the discoveries that psychoanalysis reached with its classical technique. If the patient does not arrive at those profound changes of personality, it is nonetheless true that the therapeutic results are fairly satisfactory, which is a great deal, considering the shorter duration of the treatment (psychotherapy-analytically oriented). These psychoanalytic principles are brilliantly applied in treatments that are also collective (group psychotherapy), which represents a notable advantage when one has to deal with a considerable number of patients and there is not a sufficient number of physicians, for example, in psychiatric hospitals (for the moral evaluation, v. PSICANALISI).

2. Non-psychoanalytic p

There exist various other forms of p. not on a psychoanalytic basis. They generally date from very old epochs and are still applied today in certain psychiatric centers. They are based on suggestion (Charcot), on persuasion (Dubois), on the clarification of the structure of the personality (Kretschmer), on the liberation of psychic energy through the movement of dramatic action (Moreno's psychodrama), or else through a state of hypnosis (dianetics). These last two therapies, although new, draw their inspiration from old psychiatric hypotheses.

Gianfranco Tedeschi