Before the advent of psychotherapeutic drugs in the late 1950s and early 1960s, people with serious mental illnesses – in particular schizophrenia and severe depression – spent much of their adult lives in large state hospitals. While doctors and researchers still do not have true cures for such disorders, advances in treatment and deinstitutionalization have dramatically changed the way patients are now cared for.
Today, patients are generally hospitalized only during psychotic flare-ups and periods of suicidal depression, and then released to outpatient care within a matter of weeks or months after their symptoms are brought under control with medication. The hospital offers intense treatment and the highly structured setting that patients need during the serious phases of their illnesses when they are out of touch with reality, out of control and possibly dangerous to themselves and to others.
After World War II, attempts were made by psychiatrists in many countries to apply Freudian psychoanalysis to the treatment of virtually everything from neurosis to psychosis and schizophrenia. Freudian psychology, named after Sigmund Freud who developed the technique, is an open-ended verbal probe into the unconscious over a long period of treatment. The results were disappointing for the more serious disorders, but the ideas and principles behind "talk therapy" took root and flourished, with the development of dozens of different methods of psychotherapy. Few people now have traditional psychoanalysis. Briefer, more directive psychological interventions, which are sometimes combined with drug treatments, are now the norm.
So what’s the difference between psychoanalysis and psychotherapy?
Freudian psychoanalysis is based on the belief that various types of behavior in the early years may be suppressed or altered, then emerge later on to cause problems in terms of self-esteem, personality deviations, and relationships with others. Treatment, which may involve visiting an analyst four to five times a week, is designed to show how "unconscious" factors have evolved over the years and may be affecting adult behavior. Free association, dream interpretation, and analysis of the patient’s relationship with the therapist are used to get at unconscious conflicts.
The various kinds of psychotherapy are founded on Freudian psychoanalytic theory, but differ in certain ways. Patients are usually seen one to three times a week. The goals of psychotherapy are more specific and less ambitious than those of psychoanalysis. Thus psychotherapy may last one to four years, psychoanalysis four to seven years.
In one kind of psychotherapy, known as group therapy, a number of individuals meet regularly and work to resolve problems by discussing them with each other under the guidance of a therapist. During discussions, group members may offer new perspectives and also learn how others have solved particular problems. Groups usually consist of six to eight people who meet for an hour or more. Group therapy has been effective in helping people to resolve problems such as drug or alcohol abuse, eating disorders, and to cope with crises such as divorce or bereavement.
Family therapy recognizes that every member of the family has an effect on others. So one member’s mental problems may affect the entire family. Conversely, one family member’s illness may suggest that other members also may develop emotional problems because of inadequate emotional support. Family therapy is also useful when the level of turmoil among family members is adversely affecting them.