A Brief History Of Psychotherapy

Medically reviewed by Laura Angers Maddox, NCC, LPC
Updated April 29, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention trauma-related topics that could be triggering to the reader. Please see our Get Help Now page for more immediate resources.

In 2021, over 41.7 million Americans saw a therapist, showcasing the popularity of counseling as an industry in the 21st century. However, therapy began centuries ago, and people have been helping each other with mental health issues for thousands of years. The first therapy happened over 3,500 years ago when healing “magic” and stories were a way for humans to come together and connect.

Today, therapy is a tool that has an expansive reach. There are over 400 types of therapy and hundreds of thousands of therapists who specialize in various areas of mental health and healthcare. Understanding the history of psychotherapy and how it has affected society today can help individuals make informed decisions on their current mental health treatment goals.

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The beginning of psychotherapy as a practice

There may not be an exact set date for the beginning of therapy as a practice, as it has likely taken place throughout much of history. Humans have been helping each other for centuries through talk, wellness practices, and meditation. Many agree that therapeutic-seeming practices have been documented since ancient Greece. However, “psychotherapy,” the official term for mental health therapy, officially became a term in the early 1800s (the 19th century).

Before psychotherapy became popular, mental health conditions were often treated as curses, possessions, or hysteria. Many women were still treated for “female hysteria” until the 1980s. Before the 1800s, individuals who experienced mental health symptoms or deviated from the norm in any way were commonly considered “witches.” Although there are still mental health stigmas today, many of these ideas are now considered outdated in modern psychotherapy.

It wasn’t until Sigmund Freud entered the clinical psychology field that talk therapy became mainstream. Freud created “psychoanalysis,” which involved a therapist speaking to a patient one-on-one and analyzing their thought patterns, actions, and emotions. A Freudian slip refers to an unintentional error in speech or action that reveals a hidden thought or desire. This concept is just one example of how therapy has permeated our everyday language and understanding of human behavior. Freud’s approach laid the foundation for understanding psychological disorders and providing psychological treatments. Although psychotherapy has come a long way since Freud, he’s generally one of the most notable players in psychology in the 20th century.

Freud’s work led to the development of psychodynamic therapy. Psychodynamic therapy delves into the unconscious and conscious aspects of the human mind. This approach opened up new possibilities for treating mental distress and mental illness. Although there were differing opinions during this time on what caused subconscious and conscious thoughts, Freud’s work has led to a growing industry of mental health services, unlike the traditional talking therapies of his day.

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The first mental health institutions

The first mental health hospital in the US opened in 1752, and practices that would be seen as inhumane today were commonplace therapeutic procedures. These practices included purging, bloodletting, and isolation. At the time, patients were often considered “insane” or unable to integrate into society. People from towns near these hospitals may have watched the patients for entertainment. In the 21st century, these terms and practices can be considered offensive and obsolete, indicating growth in the mental health field and ways of treating mental health disorders.

When psychotherapy was invented in the 1800s, mental health institutions in many cities adopted the practice. In 1896, Lightner Witmer opened the first psychological clinic. Professionals began diagnosing mental health conditions instead of “supernatural” causes. Although therapy may not have been as compassionate as it can be in modern times, humane practices for treating mental disorders became more commonplace. 

In the beginning of the history of psychotherapy, psychotherapy was often religious, often of the Christian faith. In addition, psychotherapy was most heavily available to wealthy white men and their families. Women, LGBTQIA+ individuals, and BIPOC were not factored into research and may have faced maltreatment or unprofessional care if they did receive care. 

Therapy's past forms

When psychotherapy became a practice in the early 1800s, the most common types of therapy were psychoanalysis and Jungian analysis therapy. Other types of therapy included:

  • Mesmerism: Using magnets to relieve distress (a practice still used today)

  • Phrenology: The study of the shape of the skull

Later on, as Freud and Jung’s differing opinions started to take hold in the world of psychology and psychiatry, more therapy methods were invented. 

In the early 1900s, behaviorism started to take hold as a popular form of therapy. Behavioral therapists started to practice talk therapy, which developed into what we now know as cognitive-behavioral therapy.

Other branches of therapy were also invented, including body psychotherapy, humanistic therapy, cognitive therapy, and somatic therapy. Modern therapists practice new offset branches like rapid eye movement and desensitization therapy (EMDR) and exposure-response therapy (ERP). 

Significant events in the therapeutic timeline

Below are several of the most significant events known about the development of psychotherapy in the early ages: 

  1. In the early 19th century, Sigmund Freud started his version of “talk therapy” by working with children with learning disabilities.

  2. The first Diagnostic and Statistical Manual of Mental Disorders (DSM) was published in 1952 as a way for psychologists to diagnose clients for clinical purposes. 

  3. In 1886, the first doctorate in psychology was given to Joseph Jastrow at John Hopkins University.

  4. In 1892, the APA (American Psychological Association) was founded.

  5. Margaret Washburn was the first woman to ever earn a Ph.D. in psychology in 1894. 

  6. In 1900, Sigmund Freud’s first book, An Interpretation of Dreams, was published, allowing his knowledge of psychotherapy to hit mainstream society.

  7. In 1936, a lobotomy was performed for the first time for mental health reasons.

  8. In 1953, the APA published a book of ethical standards for practicing psychotherapists and psychiatrists.

  9. In 1961, Carl Rogers published ‘On Becoming a Person: A Therapist’s View of Psychotherapy’. Carl Rogers is generally seen as one of the founders of humanistic psychology, which features a client-centered approach and emphasizes the importance of the therapeutic relationship in clinical psychology.

  10. In 1973, homosexuality was removed from the DSM as a mental health condition.

Therapy and society’s understanding of mental health have made strides throughout the years, and medical professionals have learned from the errors and triumphs of past psychologists. 

How has the past affected the present?

The modern soul is often plagued by a myriad of mental health issues, and therapists are now equipped to address various disorders. Although current therapy practices were inspired by the psychoanalytic therapy of Freud’s era, many famous psychologists have paved the way since. 

Carl Rogers, a prominent figure in humanistic therapy, emphasized the importance of the therapeutic relationship between the therapist and the client. His approach, along with the work of early psychologists like Aaron Beck and Albert Ellis, contributed to the development of evidence-based practices in psychotherapy today.

Competing claims in the field of psychology have led to the development of diverse therapeutic approaches, such as cognitive-behavioral therapy, pioneered by Beck and Ellis. Cognitive-behavioral therapy has gained the most traction since its evolution in the 1900s. It is the most similar type of therapy to what historic behaviorists may have practiced.

In the 21st century, therapists often talk to clients about more than subconscious thoughts, dreams, and speculation. Therapy is often client-led and may be focused on several factors, including:

  • Family mental health history

  • Trauma

  • Past experiences

  • Interpersonal relationships

  • Habits, compulsions, and dependency 

  • Behaviors

  • Feelings

  • Responses to imagery or stimuli

  • Sensory needs 

Modern psychologists have taken the aspects of past therapy modalities that work and applied them to modern science. In the 21st century, psychology has been more connected to neuroscience and psychiatry, which study the medical and physical aspects of the mind.

For example, scientists now know that certain mental health disorders can appear in the brain on an MRI scan. They also know that the brain can light up and react differently to stimuli depending on past experiences. These medical studies indicate that the existence of mental health conditions is more than a possession or spiritual experience, as believed centuries ago. 

Scientists have also studied the chemical compounds in the brain and how they impact mental health. For example, depression is often caused by a lack of serotonin, dopamine, or other neurotransmitters in the body. We can also see the effect of trauma on the physical size of the brain’s emotional processing center, the hippocampus. These chemical and physical findings have since led to the development of medicine to treat mental health conditions.

The state of therapy today

Academic psychologists have made significant strides in understanding the complexities of the human experience. Influential works, like those published by Oxford University Press, have expanded our knowledge of the mind and mental health. Self-help books and resources have also become increasingly popular, providing individuals with tools to better understand themselves and cope with challenges.

In 2021, 84% of therapists saw increased demand for therapy services. More people than ever before in history are using therapy as the world population increases and mental health stigmas decrease. Understanding the past can help individuals understand how the future might look. 

How effective is talk therapy?

There are a lot of forms of therapy out there such as talk therapy, family therapy, solution-focused brief therapy, and more, but the question is does psychotherapy work? Is all of this history for nothing?

The answer is yes; therapy does work! Science even backs this up. We can see from studies that 75% of people who enter into treatment benefit from it. In fact, these studies show that therapy can even be more effective than medication or medical intervention for mental health conditions. While some psychologists believe in biological factors that go into mental health, many studies show that symptoms of most mental health conditions can be lessened or treated through talk therapy.

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Want to take advantage of therapy’s benefits for yourself?

Today, online therapy is more popular than ever before. With online therapy, you can choose from an extensive database of therapists who specialize in many different areas and meet with your provider from the comfort of your homes. For those who can’t get to therapy in person, or those looking for a cost-effective alternative, online therapy can be a fantastic way to get help.

Research supports the effectiveness of online therapy for treating various mental health disorders. In fact, one review of studies regarding online cognitive behavioral therapy found that online treatment could significantly reduce symptoms of mental illnesses like anxiety, depression, PTSD, and other disorders. Online therapy and similar treatment options may be the future of mental healthcare, especially as more and more people worldwide seek out resources for themselves and others. If you want to learn more, take the next step with BetterHelp.

Takeaway

The history of psychotherapy and other forms of mental healthcare is nuanced and sometimes clouded by prejudiced and harmful beliefs. Fortunately, progress over the past two centuries has transformed mental healthcare into a legitimate and beneficial field. Thanks to the work of many professionals over time, we now have a much better understanding of mental health disorders and how to treat them, whether it be in-person or the comfort of your own home.

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