Psychology has been described as a ‘hub science’ with psychological findings linked to research and perspectives from the social sciences, natural sciences, medicine, and the humanities, such as philosophy. Over the past few centuries, the field of psychology has undergone several theoretical paradigm shifts (i.e. structuralism, functionalism, psychoanalysis, behaviorism, cognitivism) and is currently typically structured in subfields of which biological, experimental, developmental and clinical psychology have become closer to the biomedical field. Based on such principles, constructs and methods, the science of psychology has also provided a set of unique methods and techniques for psychological interventions (i.e. psychotherapy) with the goal of preventing, treating and rehabilitating dysfunctional behavior and mental disorders. Within this context of psychology, psychotherapy is defined as an applied clinical psychological domain discipline, dealing, generally spoken, with psychological treatments and interventions. More precisely psychotherapy has been defined as ‘clinically relevant, empirically supported interventions of any type that are based on knowledge and expertise in the psychological sciences using psychological methods and means (as opposed to drugs as in psychiatry), typically by communication and/or behavioral exercises’.
Cognitive Behavior Therapy (CBT) has recently emerged as a dominant paradigm in psychotherapy, and is influencing training and professionalism. It is not entirely happy marriage in the 1970s of Cognitive Therapy (CT) and Behavior Therapy (BT). Whilst BT was derived from the physiological studies of learning going back to Pavlov 120 years ago, and the later operant work of Thorndike and others, CT was never based on a sophisticated theory of mind but on a set of useful heuristics, such as automatic thoughts, core beliefs and schemas. Cognitive Therapy developed from the ego-analytic traditions of the 1940s and 1950s along with the emergent interest in how humans ‘construct’ reality. Today CBT uses Socratic dialogues, guided discovery, behavioral experiments, exposures to the feared and avoided, psycho-education, mindfulness, and teaching the skills of self-monitoring, self-reflection and self-change. CBT is not about correcting faulty thinking as is often simplistically suggested; rather it is about helping people understand how they have become trapped by their attention, reasoning and safety-seeking strategies and how to find ways to develop out of those traps. The focus is on helping people find and distinguish helpful ways of thinking and behaving – not just accuracy.
However, psychological interventions in the future are going to be much more sensitive to individual variation in physiology and genes, much more orientated to tailoring specific inputs, and brain-training exercises for particular people, and much more socially contextualized. Given that poor mental health is linked to poverty poor community integrations, and the competitiveness of groups, key questions arise as to whether we should be working with individuals at all or with communities – addressing their basic social needs and developing mutual social support systems. Moreover, in the 21st century, the increasing pace of technological change may also create new sets of problems, which current therapeutic approaches may be insufficiently equipped to address, stemming from changes in how people work and communicate. In addition the materialism rampant consumerism may be exacerbating people’s tendencies to greed and consequent feelings of depression and alienation when their attempts to buy happiness fail. But at the same time one should appreciate human’s huge potential to think, feel, act and communicate constructively. Thus, therapy can become a matter of releasing and cultivating higher human potentials as well as of containing and overcoming destructive tendencies.
We must do a much better job in working with communities and the voluntary sector in setting up long-term supportive systems for people that will also offer life-skills learning and help. Clinical psychologists must also push forward on preventative agendas, because our science has shown so clearly that the early years matter enormously to how our brains mature and that poverty disadvantage, neglect and abuse are breeding grounds for mental distress. CBT is good at what it attempts to do, but (clinical) psychology as a science and service model goes way beyond it.
Psychotherapy research needs to broaden in terms of adoption of large-scale public health strategies and treatments that can be applied to more people in a simpler and cost-effective way. Given the established efficacy and benefits of psychotherapy and CBTs in particular, time has now come to adopt a developmental framework covering all ages, instead of a smaller-scale, narrow research agenda. Clear conceptual frameworks that bring together the wide variety of findings, models and perspectives and essential linkages to basic psychological and neurobiological research evidence are lacking. Further, attempts to develop common overarching integrative frameworks, such as proposals for empirically based ‘psychological therapies’ or a ‘unified treatment’ have not been successful so far. Thus, it is not surprising that there is a tremendous gap between psychotherapy methods as applied in well-controlled clinical trials and psychotherapy in routine care. More stringent delineation of targeted preventive and therapeutic psychological interventions and an optimization and better understanding of cognitive-behavioral therapies and other psychological interventions is needed within the next few decades.
