The Evolution of Therapy and Mental Health Care

Presented by BetterHelp.

Today, psychotherapy is commonplace, and the stigma surrounding mental health care continues to decrease. However, many people are still weary of visiting a mental health professional. Mental health care has had a tumultuous past, and many may be concerned by previous best practices or common misconceptions. This article will briefly examine the history of therapy and mental health care and why today’s techniques are considered safe, effective, and beneficial. 

The early days of therapy

Many people are surprised to discover that the origins of mental health care go back thousands of years. Ancient Greek philosophers were some of the first to identify mental disorders as medical conditions, as opposed to signs of supernatural intervention. However, their observations were broad, and it would be centuries before true scientific investigation began. 

The modern genesis of psychotherapy is thought to have occurred when Sigmund Freud and Josef Breuer published “Studies on Hysteria” in 1895. Freud and Breuer’s studies investigated how their newfound “talking cure” affected patients with nervous disorders. Freud expanded his investigations into a now mostly defunct branch of psychotherapy: psychoanalysis. Many modern techniques were initially built on Freud’s psychoanalytic techniques, although psychoanalysis is not considered as effective as other methods today. 

Shortly after the launch of psychoanalysis, physicians in the United States began to take a greater interest in mental well-being. 1908 marked the beginning of the “mental hygiene movement.” The term “mental hygiene” was commonly used to refer to mental health in the early-to-mid 20th century. By 1937, the United State’s National Committee for Mental Hygiene established five goals of the movement:

• Promote early diagnosis and treatment
• Develop adequate resources for hospitalization
• Stimulate research into mental well-being
• Secure public support and understanding of psychiatric disorders
• Providing instruction and guidance on mental hygiene principles

Therapy’s second wave

The early days of mental health care were primarily focused on a disease model. As the 20th century progressed, an increasing number of psychiatrists and psychologists began to recognize the importance of holistic approaches to mental health. Early therapists recognized that some concerns did not fit well within the disease model, and pioneers like Carl Rogers began to develop person-centered rather than symptom-centered approaches to therapy. While it would be years before psychology moved to a model that prioritizes growth and betterment rather than symptom reduction, the 1950s represented a significant shift toward modern therapy. 

By the 1960s, a wealth of empirically supported psychotherapies began to appear. Perhaps the most notable was cognitive behavioral therapy (CBT), developed by Aaron Beck. CBT is one of the most effective psychotherapies in use today and has been adapted to dozens of conditions and situations. By the 1970s, the work of researchers like Rogers and Beck had begun to transform mental health into something malleable and improvable, regardless of a relevant diagnosis. 

Modern approaches to therapy

Therapy is commonly considered to be in its “third wave” today. Modern research has built off the work of Freud, Rogers, Beck, and others to introduce concepts like mindfulness, acceptance, intentional positivity, and metacognition. CBT is also in its third wave and tends to focus on models of pathology, while other therapies tend to focus on improving mental well-being. 

Modern psychotherapy commonly works alongside modern psychiatry. In the past, the two fields often had parallel goals but radically different approaches to meet them. Psychiatry tends to utilize the medical model, conceptualizing mental disorders as disruptions in the brain that ultimately have a biological origin. Psychiatrists tend to use medication and other medical methods to treat mental health conditions. 

One well-known psychiatric treatment is electroconvulsive therapy (ECT). ECT uses electrical stimulation to disrupt electrical potentials within the brain. It is commonly seen as barbaric or inhumane, but modern ECT is considered safe and effective when used appropriately. The mental health resource BetterHelp has more information on how ECT is used to provide relief from mental health concerns. 

Some mental disorders, like schizophrenia or severe depression, respond well to medication or ECT. Other disorders, like anxiety, often require psychotherapy to treat directly. Because of this, modern therapists often work alongside psychiatrists to ensure the best possible outcome for their patients. The mental health care system isn’t perfect, and research continues, but the significant gains made since the early days of the mental hygiene movement are notable.