Who was Sigmund Freud?

Introduction

Sigmund Freud (born Sigismund Schlomo Freud; 06 May 1856 to 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for treating psychopathology through dialogue between a patient and a psychoanalyst.

Freud was born to Galician Jewish parents in the Moravian town of Freiberg, in the Austrian Empire. He qualified as a doctor of medicine in 1881 at the University of Vienna. Upon completing his habilitation in 1885, he was appointed a docent in neuropathology and became an affiliated professor in 1902. Freud lived and worked in Vienna, having set up his clinical practice there in 1886. In 1938, Freud left Austria to escape Nazi persecution. He died in exile in the United Kingdom in 1939.

In founding psychoanalysis, Freud developed therapeutic techniques such as the use of free association and discovered transference, establishing its central role in the analytic process. Freud’s redefinition of sexuality to include its infantile forms led him to formulate the Oedipus complex as the central tenet of psychoanalytical theory. His analysis of dreams as wish-fulfilments provided him with models for the clinical analysis of symptom formation and the underlying mechanisms of repression. On this basis, Freud elaborated his theory of the unconscious and went on to develop a model of psychic structure comprising id, ego and super-ego. Freud postulated the existence of libido, sexualised energy with which mental processes and structures are invested and which generates erotic attachments, and a death drive, the source of compulsive repetition, hate, aggression, and neurotic guilt. In his later works, Freud developed a wide-ranging interpretation and critique of religion and culture.

Though in overall decline as a diagnostic and clinical practice, psychoanalysis remains influential within psychology, psychiatry, and psychotherapy, and across the humanities. It thus continues to generate extensive and highly contested debate concerning its therapeutic efficacy, its scientific status, and whether it advances or hinders the feminist cause. Nonetheless, Freud’s work has suffused contemporary Western thought and popular culture. W.H. Auden’s 1940 poetic tribute to Freud describes him as having created “a whole climate of opinion / under whom we conduct our different lives”.

Biography

Early Life and Education

Freud was born to Jewish parents in the Moravian town of Freiberg, in the Austrian Empire (now Příbor, Czech Republic), the first of eight children. Both of his parents were from Galicia, a historic province straddling modern-day West Ukraine and southeast Poland. His father, Jakob Freud (1815-1896), a wool merchant, had two sons, Emanuel (1833-1914) and Philipp (1836-1911), by his first marriage. Jakob’s family were Hasidic Jews and, although Jakob himself had moved away from the tradition, he came to be known for his Torah study. He and Freud’s mother, Amalia Nathansohn, who was 20 years younger and his third wife, were married by Rabbi Isaac Noah Mannheimer on 29 July 1855. They were struggling financially and living in a rented room, in a locksmith’s house at Schlossergasse 117 when their son Sigmund was born. He was born with a caul, which his mother saw as a positive omen for the boy’s future.

In 1859, the Freud family left Freiberg. Freud’s half-brothers immigrated to Manchester, England, parting him from the “inseparable” playmate of his early childhood, Emanuel’s son, John. Jakob Freud took his wife and two children (Freud’s sister, Anna, was born in 1858; a brother, Julius born in 1857, had died in infancy) firstly to Leipzig and then in 1860 to Vienna where four sisters and a brother were born: Rosa (b. 1860), Marie (b. 1861), Adolfine (b. 1862), Paula (b. 1864), Alexander (b. 1866). In 1865, the nine-year-old Freud entered the Leopoldstädter Kommunal-Realgymnasium, a prominent high school. He proved to be an outstanding pupil and graduated from the Matura in 1873 with honours. He loved literature and was proficient in German, French, Italian, Spanish, English, Hebrew, Latin and Greek.

Freud entered the University of Vienna at age 17. He had planned to study law, but joined the medical faculty at the university, where his studies included philosophy under Franz Brentano, physiology under Ernst Brücke, and zoology under Darwinist professor Carl Claus. In 1876, Freud spent four weeks at Claus’s zoological research station in Trieste, dissecting hundreds of eels in an inconclusive search for their male reproductive organs. In 1877 Freud moved to Ernst Brücke’s physiology laboratory where he spent six years comparing the brains of humans and other vertebrates with those of frogs and invertebrates such as crayfish and lampreys. His research work on the biology of nervous tissue proved seminal for the subsequent discovery of the neuron in the 1890s. Freud’s research work was interrupted in 1879 by the obligation to undertake a year’s compulsory military service. The lengthy downtimes enabled him to complete a commission to translate four essays from John Stuart Mill’s collected works. He graduated with an MD in March 1881.

Early Career and Marriage

In 1882, Freud began his medical career at the Vienna General Hospital. His research work in cerebral anatomy led to the publication of an influential paper on the palliative effects of cocaine in 1884 and his work on aphasia would form the basis of his first book On Aphasia: A Critical Study, published in 1891. Over a three-year period, Freud worked in various departments of the hospital. His time spent in Theodor Meynert’s psychiatric clinic and as a locum in a local asylum led to an increased interest in clinical work. His substantial body of published research led to his appointment as a university lecturer or docent in neuropathology in 1885, a non-salaried post but one which entitled him to give lectures at the University of Vienna.

In 1886, Freud resigned his hospital post and entered private practice specializing in “nervous disorders”. The same year he married Martha Bernays, the granddaughter of Isaac Bernays, a chief rabbi in Hamburg. They had six children: Mathilde (b. 1887), Jean-Martin (b. 1889), Oliver (b. 1891), Ernst (b. 1892), Sophie (b. 1893), and Anna (b. 1895). From 1891 until they left Vienna in 1938, Freud and his family lived in an apartment at Berggasse 19, near Innere Stadt, a historical district of Vienna.

In 1896, Minna Bernays, Martha Freud’s sister, became a permanent member of the Freud household after the death of her fiancé. The close relationship she formed with Freud led to rumours, started by Carl Jung, of an affair. The discovery of a Swiss hotel guest-book entry for 13 August 1898, signed by Freud whilst travelling with his sister-in-law, has been presented as evidence of the affair.

Freud began smoking tobacco at age 24; initially a cigarette smoker, he became a cigar smoker. He believed smoking enhanced his capacity to work and that he could exercise self-control in moderating it. Despite health warnings from colleague Wilhelm Fliess, he remained a smoker, eventually suffering a buccal cancer.[29] Freud suggested to Fliess in 1897 that addictions, including that to tobacco, were substitutes for masturbation, “the one great habit.”

Freud had greatly admired his philosophy tutor, Brentano, who was known for his theories of perception and introspection. Brentano discussed the possible existence of the unconscious mind in his Psychology from an Empirical Standpoint (1874). Although Brentano denied its existence, his discussion of the unconscious probably helped introduce Freud to the concept. Freud owned and made use of Charles Darwin’s major evolutionary writings, and was also influenced by Eduard von Hartmann’s The Philosophy of the Unconscious (1869). Other texts of importance to Freud were by Fechner and Herbart, with the latter’s Psychology as Science arguably considered to be of underrated significance in this respect. Freud also drew on the work of Theodor Lipps, who was one of the main contemporary theorists of the concepts of the unconscious and empathy.

Though Freud was reluctant to associate his psychoanalytic insights with prior philosophical theories, attention has been drawn to analogies between his work and that of both Schopenhauer and Nietzsche. In 1908 Freud said that he occasionally read Nietzsche, and had a strong fascination for his writings, but did not study him, because he found Nietzsche’s “intuitive insights” resembled too much his own work at the time, and also because he was overwhelmed by the “wealth of ideas” he encountered when he read Nietzsche. Freud sometimes would deny the influence of Nietzsche’s ideas. One historian quotes Peter L. Rudnytsky, who says that based on Freud’s correspondence with his adolescent friend Eduard Silberstein, Freud read Nietzsche’s The Birth of Tragedy and probably the first two of the Untimely Meditations when he was seventeen. In 1900, the year of Nietzsche’s death, Freud bought his collected works; he told his friend, Fliess, that he hoped to find in Nietzsche’s works “the words for much that remains mute in me.” Later, he said he had not yet opened them. Freud came to treat Nietzsche’s writings “as texts to be resisted far more than to be studied.” His interest in philosophy declined after he had decided on a career in neurology.

Freud read William Shakespeare in English throughout his life, and it has been suggested that his understanding of human psychology may have been partially derived from Shakespeare’s plays.

Freud’s Jewish origins and his allegiance to his secular Jewish identity were of significant influence in the formation of his intellectual and moral outlook, especially concerning his intellectual non-conformism, as he was the first to point out in his Autobiographical Study. They would also have a substantial effect on the content of psychoanalytic ideas, particularly in respect of their common concerns with depth interpretation and “the bounding of desire by law”.

Development of Psychoanalysis

In October 1885, Freud went to Paris on a three-month fellowship to study with Jean-Martin Charcot, a renowned neurologist who was conducting scientific research into hypnosis. He was later to recall the experience of this stay as catalytic in turning him toward the practice of medical psychopathology and away from a less financially promising career in neurology research. Charcot specialised in the study of hysteria and susceptibility to hypnosis, which he frequently demonstrated with patients on stage in front of an audience.

Once he had set up in private practice back in Vienna in 1886, Freud began using hypnosis in his clinical work. He adopted the approach of his friend and collaborator, Josef Breuer, in a type of hypnosis that was different from the French methods he had studied, in that it did not use suggestion. The treatment of one particular patient of Breuer’s proved to be transformative for Freud’s clinical practice. Described as Anna O., she was invited to talk about her symptoms while under hypnosis (she would coin the phrase “talking cure” for her treatment). In the course of talking in this way, her symptoms became reduced in severity as she retrieved memories of traumatic incidents associated with their onset.

The inconsistent results of Freud’s early clinical work eventually led him to abandon hypnosis, having concluded that more consistent and effective symptom relief could be achieved by encouraging patients to talk freely, without censorship or inhibition, about whatever ideas or memories occurred to them. In conjunction with this procedure, which he called “free association”, Freud found that patients’ dreams could be fruitfully analysed to reveal the complex structuring of unconscious material and to demonstrate the psychic action of repression which, he had concluded, underlay symptom formation. By 1896 he was using the term “psychoanalysis” to refer to his new clinical method and the theories on which it was base

Freud’s development of these new theories took place during a period in which he experienced heart irregularities, disturbing dreams and periods of depression, a “neurasthenia” which he linked to the death of his father in 1896 and which prompted a “self-analysis” of his own dreams and memories of childhood. His explorations of his feelings of hostility to his father and rivalrous jealousy over his mother’s affections led him to fundamentally revise his theory of the origin of the neuroses.

Based on his early clinical work, Freud had postulated that unconscious memories of sexual molestation in early childhood were a necessary precondition for the psychoneuroses (hysteria and obsessional neurosis), a formulation now known as Freud’s seduction theory. In the light of his self-analysis, Freud abandoned the theory that every neurosis can be traced back to the effects of infantile sexual abuse, now arguing that infantile sexual scenarios still had a causative function, but it did not matter whether they were real or imagined and that in either case, they became pathogenic only when acting as repressed memories.

This transition from the theory of infantile sexual trauma as a general explanation of how all neuroses originate to one that presupposes autonomous infantile sexuality provided the basis for Freud’s subsequent formulation of the theory of the Oedipus complex.

Freud described the evolution of his clinical method and set out his theory of the psychogenetic origins of hysteria, demonstrated in several case histories, in Studies on Hysteria published in 1895 (co-authored with Josef Breuer). In 1899 he published The Interpretation of Dreams in which, following a critical review of existing theory, Freud gives detailed interpretations of his own and his patients’ dreams in terms of wish-fulfilments made subject to the repression and censorship of the “dream-work”. He then sets out the theoretical model of mental structure (the unconscious, pre-conscious and conscious) on which this account is based. An abridged version, On Dreams, was published in 1901. In works that would win him a more general readership, Freud applied his theories outside the clinical setting in The Psychopathology of Everyday Life (1901) and Jokes and their Relation to the Unconscious (1905). In Three Essays on the Theory of Sexuality, published in 1905, Freud elaborates his theory of infantile sexuality, describing its “polymorphous perverse” forms and the functioning of the “drives”, to which it gives rise, in the formation of sexual identity. The same year he published Fragment of an Analysis of a Case of Hysteria, which became one of his more famous and controversial case studies.

Relationship with Fliess

During this formative period of his work, Freud valued and came to rely on the intellectual and emotional support of his friend Wilhelm Fliess, a Berlin-based ear, nose, and throat specialist whom he had first met in 1887. Both men saw themselves as isolated from the prevailing clinical and theoretical mainstream because of their ambitions to develop radical new theories of sexuality. Fliess developed highly eccentric theories of human biorhythms and a nasogenital connection which are today considered pseudoscientific. He shared Freud’s views on the importance of certain aspects of sexuality – masturbation, coitus interruptus, and the use of condoms – in the aetiology of what was then called the “actual neuroses,” primarily neurasthenia and certain physically manifested anxiety symptoms. They maintained an extensive correspondence from which Freud drew on Fliess’s speculations on infantile sexuality and bisexuality to elaborate and revise his own ideas. His first attempt at a systematic theory of the mind, his Project for a Scientific Psychology was developed as a metapsychology with Fliess as interlocutor. However, Freud’s efforts to build a bridge between neurology and psychology were eventually abandoned after they had reached an impasse, as his letters to Fliess reveal, though some ideas of the Project were to be taken up again in the concluding chapter of The Interpretation of Dreams.

Freud had Fliess repeatedly operate on his nose and sinuses to treat “nasal reflex neurosis”, and subsequently referred his patient Emma Eckstein to him. According to Freud, her history of symptoms included severe leg pains with consequent restricted mobility, as well as stomach and menstrual pains. These pains were, according to Fliess’s theories, caused by habitual masturbation which, as the tissue of the nose and genitalia were linked, was curable by removal of part of the middle turbinate. Fliess’s surgery proved disastrous, resulting in profuse, recurrent nasal bleeding; he had left a half-metre of gauze in Eckstein’s nasal cavity whose subsequent removal left her permanently disfigured. At first, though aware of Fliess’s culpability and regarding the remedial surgery in horror, Freud could bring himself only to intimate delicately in his correspondence with Fliess the nature of his disastrous role, and in subsequent letters maintained a tactful silence on the matter or else returned to the face-saving topic of Eckstein’s hysteria. Freud ultimately, in light of Eckstein’s history of adolescent self-cutting and irregular nasal (and menstrual) bleeding, concluded that Fliess was “completely without blame”, as Eckstein’s post-operative haemorrhages were hysterical “wish-bleedings” linked to “an old wish to be loved in her illness” and triggered as a means of “rearousing [Freud’s] affection”. Eckstein nonetheless continued her analysis with Freud. She was restored to full mobility and went on to practice psychoanalysis herself.

Freud, who had called Fliess “the Kepler of biology”, later concluded that a combination of a homoerotic attachment and the residue of his “specifically Jewish mysticism” lay behind his loyalty to his Jewish friend and his consequent over-estimation of both his theoretical and clinical work. Their friendship came to an acrimonious end with Fliess angry at Freud’s unwillingness to endorse his general theory of sexual periodicity and accusing him of collusion in the plagiarism of his work. After Fliess failed to respond to Freud’s offer of collaboration over the publication of his Three Essays on the Theory of Sexuality in 1906, their relationship came to an end.

Early followers

In 1902, Freud, at last, realised his long-standing ambition to be made a university professor. The title “professor extraordinarius” was important to Freud for the recognition and prestige it conferred, there being no salary or teaching duties attached to the post (he would be granted the enhanced status of “professor ordinarius” in 1920). Despite support from the university, his appointment had been blocked in successive years by the political authorities and it was secured only with the intervention of one of his more influential ex-patients, a Baroness Marie Ferstel, who (supposedly) had to bribe the minister of education with a valuable painting.

With his prestige thus enhanced, Freud continued with the regular series of lectures on his work which, since the mid-1880s as a docent of Vienna University, he had been delivering to small audiences every Saturday evening at the lecture hall of the university’s psychiatric clinic.

From the autumn of 1902, a number of Viennese physicians who had expressed interest in Freud’s work were invited to meet at his apartment every Wednesday afternoon to discuss issues relating to psychology and neuropathology. This group was called the Wednesday Psychological Society (Psychologische Mittwochs-Gesellschaft) and it marked the beginnings of the worldwide psychoanalytic movement.

Freud founded this discussion group at the suggestion of the physician Wilhelm Stekel. Stekel had studied medicine at the University of Vienna under Richard von Krafft-Ebing. His conversion to psychoanalysis is variously attributed to his successful treatment by Freud for a sexual problem or as a result of his reading The Interpretation of Dreams, to which he subsequently gave a positive review in the Viennese daily newspaper Neues Wiener Tagblatt.

The other three original members whom Freud invited to attend, Alfred Adler, Max Kahane, and Rudolf Reitler, were also physicians and all five were Jewish by birth. Both Kahane and Reitler were childhood friends of Freud. Kahane had attended the same secondary school and both he and Reitler went to university with Freud. They had kept abreast of Freud’s developing ideas through their attendance at his Saturday evening lectures. In 1901, Kahane, who first introduced Stekel to Freud’s work, had opened an out-patient psychotherapy institute of which he was the director in Bauernmarkt, in Vienna. In the same year, his medical textbook, Outline of Internal Medicine for Students and Practicing Physicians, was published. In it, he provided an outline of Freud’s psychoanalytic method. Kahane broke with Freud and left the Wednesday Psychological Society in 1907 for unknown reasons and in 1923 committed suicide. Reitler was the director of an establishment providing thermal cures in Dorotheergasse which had been founded in 1901. He died prematurely in 1917. Adler, regarded as the most formidable intellect among the early Freud circle, was a socialist who in 1898 had written a health manual for the tailoring trade. He was particularly interested in the potential social impact of psychiatry.

Max Graf, a Viennese musicologist and father of “Little Hans”, who had first encountered Freud in 1900 and joined the Wednesday group soon after its initial inception, described the ritual and atmosphere of the early meetings of the society:

The gatherings followed a definite ritual. First one of the members would present a paper. Then, black coffee and cakes were served; cigars and cigarettes were on the table and were consumed in great quantities. After a social quarter of an hour, the discussion would begin. The last and decisive word was always spoken by Freud himself. There was the atmosphere of the foundation of a religion in that room. Freud himself was its new prophet who made the heretofore prevailing methods of psychological investigation appear superficial.

By 1906, the group had grown to sixteen members, including Otto Rank, who was employed as the group’s paid secretary. In the same year, Freud began a correspondence with Carl Gustav Jung who was by then already an academically acclaimed researcher into word-association and the Galvanic Skin Response, and a lecturer at Zurich University, although still only an assistant to Eugen Bleuler at the Burghölzli Mental Hospital in Zürich. In March 1907, Jung and Ludwig Binswanger, also a Swiss psychiatrist, travelled to Vienna to visit Freud and attend the discussion group. Thereafter, they established a small psychoanalytic group in Zürich. In 1908, reflecting its growing institutional status, the Wednesday group was reconstituted as the Vienna Psychoanalytic Society with Freud as president, a position he relinquished in 1910 in favour of Adler in the hope of neutralising his increasingly critical standpoint.

The first woman member, Margarete Hilferding, joined the Society in 1910 and the following year she was joined by Tatiana Rosenthal and Sabina Spielrein who were both Russian psychiatrists and graduates of the Zürich University medical school. Before the completion of her studies, Spielrein had been a patient of Jung at the Burghölzli and the clinical and personal details of their relationship became the subject of an extensive correspondence between Freud and Jung. Both women would go on to make important contributions to the work of the Russian Psychoanalytic Society founded in 1910.

Freud’s early followers met together formally for the first time at the Hotel Bristol, Salzburg on 27 April 1908. This meeting, which was retrospectively deemed to be the first International Psychoanalytic Congress, was convened at the suggestion of Ernest Jones, then a London-based neurologist who had discovered Freud’s writings and begun applying psychoanalytic methods in his clinical work. Jones had met Jung at a conference the previous year and they met up again in Zürich to organise the Congress. There were, as Jones records, “forty-two present, half of whom were or became practicing analysts.” In addition to Jones and the Viennese and Zürich contingents accompanying Freud and Jung, also present and notable for their subsequent importance in the psychoanalytic movement were Karl Abraham and Max Eitingon from Berlin, Sándor Ferenczi from Budapest and the New York-based Abraham Brill.

Important decisions were taken at the Congress to advance the impact of Freud’s work. A journal, the Jahrbuch für psychoanalytische und psychopathologishe Forschungen, was launched in 1909 under the editorship of Jung. This was followed in 1910 by the monthly Zentralblatt für Psychoanalyse edited by Adler and Stekel, in 1911 by Imago, a journal devoted to the application of psychoanalysis to the field of cultural and literary studies edited by Rank and in 1913 by the Internationale Zeitschrift für Psychoanalyse, also edited by Rank. Plans for an international association of psychoanalysts were put in place and these were implemented at the Nuremberg Congress of 1910 where Jung was elected, with Freud’s support, as its first president.

Freud turned to Brill and Jones to further his ambition to spread the psychoanalytic cause in the English-speaking world. Both were invited to Vienna following the Salzburg Congress and a division of labour was agreed with Brill given the translation rights for Freud’s works, and Jones, who was to take up a post at the University of Toronto later in the year, tasked with establishing a platform for Freudian ideas in North American academic and medical life. Jones’s advocacy prepared the way for Freud’s visit to the United States, accompanied by Jung and Ferenczi, in September 1909 at the invitation of Stanley Hall, president of Clark University, Worcester, Massachusetts, where he gave five lectures on psychoanalysis.

The event, at which Freud was awarded an Honorary Doctorate, marked the first public recognition of Freud’s work and attracted widespread media interest. Freud’s audience included the distinguished neurologist and psychiatrist James Jackson Putnam, Professor of Diseases of the Nervous System at Harvard, who invited Freud to his country retreat where they held extensive discussions over a period of four days. Putnam’s subsequent public endorsement of Freud’s work represented a significant breakthrough for the psychoanalytic cause in the United States. When Putnam and Jones organised the founding of the American Psychoanalytic Association in May 1911 they were elected president and secretary respectively. Brill founded the New York Psychoanalytic Society the same year. His English translations of Freud’s work began to appear from 1909.

Resignations from the IPA

Some of Freud’s followers subsequently withdrew from the International Psychoanalytical Association (IPA) and founded their own schools.

From 1909, Adler’s views on topics such as neurosis began to differ markedly from those held by Freud. As Adler’s position appeared increasingly incompatible with Freudianism, a series of confrontations between their respective viewpoints took place at the meetings of the Viennese Psychoanalytic Society in January and February 1911. In February 1911, Adler, then the president of the society, resigned his position. At this time, Stekel also resigned from his position as vice president of the society. Adler finally left the Freudian group altogether in June 1911 to found his own organization with nine other members who had also resigned from the group. This new formation was initially called Society for Free Psychoanalysis but it was soon renamed the Society for Individual Psychology. In the period after World War I, Adler became increasingly associated with a psychological position he devised called individual psychology.

In 1912, Jung published Wandlungen und Symbole der Libido (published in English in 1916 as Psychology of the Unconscious) making it clear that his views were taking a direction quite different from those of Freud. To distinguish his system from psychoanalysis, Jung called it analytical psychology. Anticipating the final breakdown of the relationship between Freud and Jung, Ernest Jones initiated the formation of a Secret Committee of loyalists charged with safeguarding the theoretical coherence and institutional legacy of the psychoanalytic movement. Formed in the autumn of 1912, the Committee comprised Freud, Jones, Abraham, Ferenczi, Rank, and Hanns Sachs. Max Eitingon joined the committee in 1919. Each member pledged himself not to make any public departure from the fundamental tenets of psychoanalytic theory before he had discussed his views with the others. After this development, Jung recognised that his position was untenable and resigned as editor of the Jarhbuch and then as president of the IPA in April 1914. The Zürich Society withdrew from the IPA the following July.

Later the same year, Freud published a paper entitled “The History of the Psychoanalytic Movement”, the German original being first published in the Jahrbuch, giving his view on the birth and evolution of the psychoanalytic movement and the withdrawal of Adler and Jung from it.

The final defection from Freud’s inner circle occurred following the publication in 1924 of Rank’s The Trauma of Birth which other members of the committee read as, in effect, abandoning the Oedipus Complex as the central tenet of psychoanalytic theory. Abraham and Jones became increasingly forceful critics of Rank and though he and Freud were reluctant to end their close and long-standing relationship the break finally came in 1926 when Rank resigned from his official posts in the IPA and left Vienna for Paris. His place on the Committee was taken by Anna Freud. Rank eventually settled in the United States where his revisions of Freudian theory were to influence a new generation of therapists uncomfortable with the orthodoxies of the IPA.

Early Psychoanalytic Movement

After the founding of the IPA in 1910, an international network of psychoanalytical societies, training institutes, and clinics became well established and a regular schedule of biannual Congresses commenced after the end of World War I to coordinate their activities.

Abraham and Eitingon founded the Berlin Psychoanalytic Society in 1910 and then the Berlin Psychoanalytic Institute and the Poliklinik in 1920. The Poliklinik’s innovations of free treatment, and child analysis, and the Berlin Institute’s standardisation of psychoanalytic training had a major influence on the wider psychoanalytic movement. In 1927 Ernst Simmel founded the Schloss Tegel Sanatorium on the outskirts of Berlin, the first such establishment to provide psychoanalytic treatment in an institutional framework. Freud organised a fund to help finance its activities and his architect son, Ernst, was commissioned to refurbish the building. It was forced to close in 1931 for economic reasons.

The 1910 Moscow Psychoanalytic Society became the Russian Psychoanalytic Society and Institute in 1922. Freud’s Russian followers were the first to benefit from translations of his work, the 1904 Russian translation of The Interpretation of Dreams appearing nine years before Brill’s English edition. The Russian Institute was unique in receiving state support for its activities, including publication of translations of Freud’s works. Support was abruptly annulled in 1924, when Joseph Stalin came to power, after which psychoanalysis was denounced on ideological grounds.

After helping found the American Psychoanalytic Association in 1911, Ernest Jones returned to Britain from Canada in 1913 and founded the London Psychoanalytic Society the same year. In 1919, he dissolved this organisation and, with its core membership purged of Jungian adherents, founded the British Psychoanalytical Society, serving as its president until 1944. The Institute of Psychoanalysis was established in 1924 and the London Clinic of Psychoanalysis was established in 1926, both under Jones’s directorship.

The Vienna Ambulatorium (Clinic) was established in 1922 and the Vienna Psychoanalytic Institute was founded in 1924 under the directorship of Helene Deutsch. Ferenczi founded the Budapest Psychoanalytic Institute in 1913 and a clinic in 1929.

Psychoanalytic societies and institutes were established in Switzerland (1919), France (1926), Italy (1932), the Netherlands (1933), Norway (1933), and in Palestine (Jerusalem, 1933) by Eitingon, who had fled Berlin after Adolf Hitler came to power. The New York Psychoanalytic Institute was founded in 1931.

The 1922 Berlin Congress was the last Freud attended. By this time his speech had become seriously impaired by the prosthetic device he needed as a result of a series of operations on his cancerous jaw. He kept abreast of developments through regular correspondence with his principal followers and via the circular letters and meetings of the Secret Committee which he continued to attend.

The Committee continued to function until 1927 by which time institutional developments within the IPA, such as the establishment of the International Training Commission, had addressed concerns about the transmission of psychoanalytic theory and practice. There remained, however, significant differences over the issue of lay analysis, i.e. the acceptance of non-medically qualified candidates for psychoanalytic training. Freud set out his case in favour in 1926 in his The Question of Lay Analysis. He was resolutely opposed by the American societies who expressed concerns over professional standards and the risk of litigation (though child analysts were made exempt). These concerns were also shared by some of his European colleagues. Eventually, an agreement was reached allowing societies autonomy in setting criteria for candidature.

In 1930 Freud received the Goethe Prize in recognition of his contributions to psychology and German literary culture.

Patients

Freud used pseudonyms in his case histories. Some patients known by pseudonyms were:

  • Cäcilie M. (Anna von Lieben);
  • Dora (Ida Bauer, 1882–1945);
  • Frau Emmy von N. (Fanny Moser);
  • Fräulein Elisabeth von R. (Ilona Weiss);
  • Fräulein Katharina (Aurelia Kronich);
  • Fräulein Lucy R.;
  • Little Hans (Herbert Graf, 1903-1973);
  • Rat Man (Ernst Lanzer, 1878-1914);
  • Enos Fingy (Joshua Wild, 1878-1920); and
  • Wolf Man (Sergei Pankejeff, 1887-1979).

Other famous patients included:

  • Prince Pedro Augusto of Brazil (1866-1934);
  • H.D. (1886-1961);
  • Emma Eckstein (1865-1924);
  • Gustav Mahler (1860-1911), with whom Freud had only a single, extended consultation;
  • Princess Marie Bonaparte;
  • Edith Banfield Jackson (1895-1977); and
  • Albert Hirst (1887-1974).

Cancer

In February 1923, Freud detected a leucoplakia, a benign growth associated with heavy smoking, on his mouth. He initially kept this secret, but in April 1923 he informed Ernest Jones, telling him that the growth had been removed. Freud consulted the dermatologist Maximilian Steiner, who advised him to quit smoking but lied about the growth’s seriousness, minimising its importance. Freud later saw Felix Deutsch, who saw that the growth was cancerous; he identified it to Freud using the euphemism “a bad leukoplakia” instead of the technical diagnosis epithelioma. Deutsch advised Freud to stop smoking and have the growth excised. Freud was treated by Marcus Hajek, a rhinologist whose competence he had previously questioned. Hajek performed an unnecessary cosmetic surgery in his clinic’s outpatient department. Freud bled during and after the operation, and may narrowly have escaped death. Freud subsequently saw Deutsch again. Deutsch saw that further surgery would be required, but did not tell Freud he had cancer because he was worried that Freud might wish to commit suicide.

Escape from Nazism

In January 1933, the Nazi Party took control of Germany, and Freud’s books were prominent among those they burned and destroyed. Freud remarked to Ernest Jones: “What progress we are making. In the Middle Ages they would have burned me. Now, they are content with burning my books.” Freud continued to underestimate the growing Nazi threat and remained determined to stay in Vienna, even following the Anschluss of 13 March 1938, in which Nazi Germany annexed Austria, and the outbreaks of violent antisemitism that ensued. Jones, the then president of the International Psychoanalytical Association (IPA), flew into Vienna from London via Prague on 15 March determined to get Freud to change his mind and seek exile in Britain. This prospect and the shock of the arrest and interrogation of Anna Freud by the Gestapo finally convinced Freud it was time to leave Austria. Jones left for London the following week with a list provided by Freud of the party of émigrés for whom immigration permits would be required. Back in London, Jones used his personal acquaintance with the Home Secretary, Sir Samuel Hoare, to expedite the granting of permits. There were seventeen in all and work permits were provided where relevant. Jones also used his influence in scientific circles, persuading the president of the Royal Society, Sir William Bragg, to write to the Foreign Secretary Lord Halifax, requesting to good effect that diplomatic pressure be applied in Berlin and Vienna on Freud’s behalf. Freud also had support from American diplomats, notably his ex-patient and American ambassador to France, William Bullitt. Bullitt alerted US President Roosevelt to the increased dangers facing the Freuds, resulting in the American consul-general in Vienna, John Cooper Wiley, arranging regular monitoring of Berggasse 19. He also intervened by phone call during the Gestapo interrogation of Anna Freud.

The departure from Vienna began in stages throughout April and May 1938. Freud’s grandson, Ernst Halberstadt, and Freud’s son Martin’s wife and children left for Paris in April. Freud’s sister-in-law, Minna Bernays, left for London on 05 May, Martin Freud the following week and Freud’s daughter Mathilde and her husband, Robert Hollitscher, on 24 May.

By the end of the month, arrangements for Freud’s own departure for London had become stalled, mired in a legally tortuous and financially extortionate process of negotiation with the Nazi authorities. Under regulations imposed on its Jewish population by the new Nazi regime, a Kommissar was appointed to manage Freud’s assets and those of the IPA whose headquarters were near Freud’s home. Freud was allocated to Dr. Anton Sauerwald, who had studied chemistry at Vienna University under Professor Josef Herzig, an old friend of Freud’s. Sauerwald read Freud’s books to further learn about him and became sympathetic towards his situation. Though required to disclose details of all Freud’s bank accounts to his superiors and to arrange the destruction of the historic library of books housed in the offices of the IPA, Sauerwald did neither. Instead, he removed evidence of Freud’s foreign bank accounts to his own safe-keeping and arranged the storage of the IPA library in the Austrian National Library, where it remained until the end of the war.

Though Sauerwald’s intervention lessened the financial burden of the “flight” tax on Freud’s declared assets, other substantial charges were levied concerning the debts of the IPA and the valuable collection of antiquities Freud possessed. Unable to access his own accounts, Freud turned to Princess Marie Bonaparte, the most eminent and wealthy of his French followers, who had travelled to Vienna to offer her support, and it was she who made the necessary funds available. This allowed Sauerwald to sign the necessary exit visas for Freud, his wife Martha, and daughter Anna. They left Vienna on the Orient Express on 04 June, accompanied by their housekeeper and a doctor, arriving in Paris the following day, where they stayed as guests of Marie Bonaparte, before travelling overnight to London, arriving at London Victoria station on 06 June.

Among those soon to call on Freud to pay their respects were Salvador Dalí, Stefan Zweig, Leonard Woolf, Virginia Woolf, and H.G. Wells. Representatives of the Royal Society called with the Society’s Charter for Freud, who had been elected a Foreign Member in 1936, to sign himself into membership. Marie Bonaparte arrived near the end of June to discuss the fate of Freud’s four elderly sisters left behind in Vienna. Her subsequent attempts to get them exit visas failed, and they would all die in Nazi concentration camps.

In early 1939, Sauerwald arrived in London in mysterious circumstances, where he met Freud’s brother Alexander. He was tried and imprisoned in 1945 by an Austrian court for his activities as a Nazi Party official. Responding to a plea from his wife, Anna Freud wrote to confirm that Sauerwald “used his office as our appointed commissar in such a manner as to protect my father”. Her intervention helped secure his release from jail in 1947.

In the Freuds’ new home, 20 Maresfield Gardens, Hampstead, North London, Freud’s Vienna consulting room was recreated in faithful detail. He continued to see patients there until the terminal stages of his illness. He also worked on his last books, Moses and Monotheism, published in German in 1938 and in English the following year and the uncompleted An Outline of Psychoanalysis, which was published posthumously.

Death

By mid-September 1939, Freud’s cancer of the jaw was causing him increasingly severe pain and had been declared inoperable. The last book he read, Balzac’s La Peau de chagrin, prompted reflections on his own increasing frailty, and a few days later he turned to his doctor, friend, and fellow refugee, Max Schur, reminding him that they had previously discussed the terminal stages of his illness: “Schur, you remember our ‘contract’ not to leave me in the lurch when the time had come. Now it is nothing but torture and makes no sense.” When Schur replied that he had not forgotten, Freud said, “I thank you,” and then “Talk it over with Anna, and if she thinks it’s right, then make an end of it.” Anna Freud wanted to postpone her father’s death, but Schur convinced her it was pointless to keep him alive; on 21 and 22 September, he administered doses of morphine that resulted in Freud’s death at around 3 am on 23 September 1939. However, discrepancies in the various accounts Schur gave of his role in Freud’s final hours, which have in turn led to inconsistencies between Freud’s main biographers, has led to further research and a revised account. This proposes that Schur was absent from Freud’s deathbed when a third and final dose of morphine was administered by Dr. Josephine Stross, a colleague of Anna Freud, leading to Freud’s death at around midnight on 23 September 1939.

Three days after his death, Freud’s body was cremated at the Golders Green Crematorium in North London, with Harrods acting as funeral directors, on the instructions of his son, Ernst. Funeral orations were given by Ernest Jones and the Austrian author Stefan Zweig. Freud’s ashes were later placed in the crematorium’s Ernest George Columbarium (see “Freud Corner”). They rest on a plinth designed by his son, Ernst, in a sealed ancient Greek bell krater painted with Dionysian scenes that Freud had received as a gift from Marie Bonaparte, and which he had kept in his study in Vienna for many years. After his wife, Martha, died in 1951, her ashes were also placed in the urn.

What is a Therapeutic Relationship?

Introduction

The therapeutic relationship refers to the relationship between a healthcare professional and a client or patient. It is the means by which a therapist and a client hope to engage with each other and effect beneficial change in the client.

In psychoanalysis the therapeutic relationship has been theorised to consist of three parts: the working alliance, transference/countertransference, and the real relationship. Evidence on each component’s unique contribution to the outcome has been gathered, as well as evidence on the interaction between components. In contrast to a social relationship, the focus of the therapeutic relationship is on the client’s needs and goals.

Therapeutic/Working Alliance

The therapeutic alliance, or the working alliance may be defined as the joining of a client’s reasonable side with a therapist’s working or analysing side. Bordin (1979) conceptualised the working alliance as consisting of three parts: tasks, goals and bond. Tasks are what the therapist and client agree need to be done to reach the client’s goals. Goals are what the client hopes to gain from therapy, based on their presenting concerns. The bond forms from trust and confidence that the tasks will bring the client closer to their goals.

Research on the working alliance suggests that it is a strong predictor of psychotherapy or counselling client outcome. Also, the way in which the working alliance unfolds has been found to be related to client outcomes. Generally, an alliance that experiences a rupture that is repaired is related to better outcomes than an alliance with no ruptures, or an alliance with a rupture that is not repaired. Also, in successful cases of brief therapy, the working alliance has been found to follow a high-low-high pattern over the course of the therapy. Therapeutic alliance has been found to be effective in treating adolescents suffering from PTSD, with the strongest alliances were associated with the greatest improvement in PTSD symptoms. Regardless of other treatment procedures, studies have shown that the degree to which traumatised adolescents feel a connection with their therapist greatly affects how well they do during treatment.

Necessary and Sufficient Conditions

In the Humanistic approach, Carl Rogers identified a number of necessary and sufficient conditions that are required for therapeutic change to take place. These include the three core conditions: congruence, unconditional positive regard, and empathy. Rogers (1957; 1959) stated that there are six necessary and sufficient conditions required for therapeutic change:

  1. Therapist–client psychological contact: a relationship between client and therapist must exist, and it must be a relationship in which each person’s perception of the other is important.
  2. Client incongruence: that incongruence exists between the client’s experience and awareness.
  3. Therapist congruence, or genuineness: the therapist is congruent within the therapeutic relationship. The therapist is deeply involved, they are not ‘acting’ and they can draw on their own experiences (self-disclosure) to facilitate the relationship.
  4. Therapist unconditional positive regard: the therapist accepts the client unconditionally, without judgment, disapproval or approval. This facilitates increased self-regard in the client, as they can begin to become aware of experiences in which their view of self-worth was distorted or denied.
  5. Therapist empathic understanding: the therapist experiences an empathic understanding of the client’s internal frame of reference. Accurate empathy on the part of the therapist helps the client believe the therapist’s unconditional regard for them.
  6. Client perception: that the client perceives, to at least a minimal degree, the therapist’s unconditional positive regard and empathic understanding.

Transference and Counter-Transference

The concept of therapeutic relationship was described by Freud (1912) as “friendly affectionate feeling” in the form of a positive transference. However, transferences, or more correctly here, the therapist’s ‘counter-transferences’ can also be negative. Today transference (from the client) and counter-transference (from the therapist), is understood as subconsciously associating a person in the present, with a person from a past relationship. For example, you meet a new client who reminds you of a former lover. This would be a counter-transference, in that the therapist is responding to the client with thoughts and feelings attached to a person in a past relationship. Ideally, the therapeutic relationship will start with a positive transference for the therapy to have a good chance of effecting positive therapeutic change.

Operationalisation and Measurement

Several scales have been developed to assess the patient-professional relationship in therapy, including:

Reference

Bordin, E.S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice. 16(3), pp.252-260.

Book: Play in Child Development and Psychotherapy

Book Title:

Play in Child Development and Psychotherapy: Toward Empirically Supported Practice (Personality & Clinical Psychology).

Author(s): Sandra Walker Russ.

Year: 2003.

Edition: First (1st).

Publisher: Routledge.

Type(s): Hardcover, Paperback, and Kindle.

Synopsis:

Child psychotherapy is in a state of transition. On the one hand, pretend play is a major tool of therapists who work with children. On the other, a mounting chorus of critics claims that play therapy lacks demonstrated treatment efficacy. These complaints are not invalid. Clinical research has only begun.

Extensive studies by developmental researchers have, however, strongly supported the importance of play for children. Much knowledge is being accumulated about the ways in which play is involved in the development of cognitive, affective, and personality processes that are crucial for adaptive functioning. However, there has been a yawning gap between research findings and useful suggestions for practitioners.

Play in Child Development and Psychotherapy represents the first effort to bridge the gap and place play therapy on a firmer empirical foundation. Sandra Russ applies sophisticated contemporary understanding of the role of play in child development to the work of mental health professionals who are trying to design intervention and prevention programs that can be empirically evaluated. Never losing sight of the complex problems that face child therapists, she integrates clinical and developmental research and theory into a comprehensive, up-to-date review of current approaches to conceptualizing play and to doing both therapeutic play work with children and the assessment that necessarily precedes and accompanies it.

Book: My Therapist Says – Advice You Should Probably (Not) Follow

Book Title:

My Therapist Says – Advice You Should Probably (Not) Follow.

Author(s): From the Founders of My Therapist Says.

Year: 2020.

Edition: First (1st).

Publisher: Rock Point.

Type(s): Hardcover and Kindle.

Synopsis:

From the team behind the super-popular Instagram @MyTherapistSays comes this humorous guide that chronicles the exhausting task of navigating the daily, anxiety-ridden struggle that we fondly call life.

Including hilarious memes MTS is known and loved for, along with checklists, prompts, questions from readers, and more, My Therapist Says is the guide you need to achieve your goals, one wrong turn at a time.

Have you ever wanted something, pursued it (albeit not quite as gracefully as you would’ve hoped), failed, and then genuinely asked yourself the question, “Am I delusional?” Well, that’s how I began penning this magnum opus. Like the Buddhist’s have their Tripitaka, you have…moi. And my therapist, though it’s unlikely she’ll admit this in public.

On the receiving end of a ghosting session? Needing a way to leave a work function without looking like a buzzkill? Having a hard time developing amnesia about your last relationship? Fear not, as I cover everything from circumstantial etiquette to blissful delusion when necessary.

So, grab a pen, a box of tissues, a glass of wine, and your bestie, because sht is about to get real. And remember, be yourself, be kind, and all that jazz, unless you’re a Susan. If that’s the case, try to be literally anyone else. Ugh, my therapist hates that I wrote that.

*Susan: Noun and verb. Unpleasant, annoying, and delusional, the Susan is somebody who is literally awful in every way, is liked by no one, but has no clue, no matter how many open clues you give her. If you roll your eyes at this, you’re probably a Susan. Uses: Susaning, Susanism.

For even more on navigating the mystical tornado of life, get the companion colouring book: My Therapist Says…to Colour: Ignore Reality and Colour Over 50 Designs Because You Can’t Even.

Book: Doing Psychotherapy

Book Title:

Doing Psychotherapy: A Trauma and Attachment-Informed Approach.

Author(s): Robin Shapiro.

Year: 2020.

Edition: First (1ed).

Publisher: W.W. Norton & Company.

Type(s): Paperback, Audiobook, and Kindle.

Synopsis:

Most books about doing psychotherapy are tied to particular psychotherapeutic practices. Here, seasoned clinical author Robin Shapiro teaches readers the ins and outs of a trauma-and attachment-informed approach that is not tied to any one model or method.

This book teaches assessment, treatment plans, enhancing the therapeutic relationship and ethics and boundary issues, all within a general framework of attachment theory and trauma. Practical chapters talk about working with attachment problems, grief, depression, cultural differences, affect tolerance, anxiety, addiction, trauma, skill- building, suicidal ideation, psychosis, and the beginning and end of therapy. Filled with examples, suggestions for dialogue and questions for a variety of therapeutic situation, Shapiro’s conversational tone makes the book very relatable.

Early-career therapists will refer to it for years to come and veteran practitioners looking for a refresher (or introduction) to the latest in trauma and attachment work will find it especially useful.

What is Art Therapy?

Introduction

Art therapy (not to be confused with arts therapy, which includes other creative therapies such as drama therapy and music therapy) is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a creative arts therapy profession, originated in the fields of art and psychotherapy and may vary in definition.

There are three main ways that art therapy is employed:

  • The first one is called analytic art therapy. Analytic art therapy is based on the theories that come from analytical psychology, and in more cases, psychoanalysis.
    • Analytic art therapy focuses on the client, the therapist, and the ideas that are transferred between the both of them through art.
  • Another way that art therapy is utilised is art psychotherapy.
    • This approach focuses more on the psychotherapist and their analysis of their clients artwork verbally.
  • The last way art therapy is looked at is through the lens of art as therapy.
    • Some art therapists practicing art as therapy believe that analysing the client’s artwork verbally is not essential, therefore they stress the creation process of the art instead.

In all of these different approaches to art therapy, the art therapist’s client/service user goes on the journey to delve into their inner thoughts and emotions by the use of paint, paper and pen, or even clay.

Art therapy can be used to help people improve cognitive and sensory motor function, self-esteem, self awareness, emotional resilience. It may also aide in resolving conflicts and reduce distress.

Current art therapy includes a vast number of other approaches such as person-centred, cognitive, behaviour, Gestalt, narrative, Adlerian, and family. The tenets of art therapy involve humanism, creativity, reconciling emotional conflicts, fostering self-awareness, and personal growth.

Brief History

In the history of mental health treatment, art therapy (combining studies of psychology and art) emerged much later as a new field. This type of unconventional therapy is used to cultivate self-esteem and awareness, improve cognitive and motor abilities, resolve conflicts or stress, and inspire resilience in patients. It invites sensory, kinaesthetic, perceptual, and sensory symbolisation to address issues that verbal psychotherapy cannot reach. Although art therapy is a relatively young therapeutic discipline, its roots lie in the use of the arts in the ‘moral treatment’ of psychiatric patients in the late 18th century.

Art therapy as a profession began in the mid-20th century, arising independently in English-speaking and European countries. Art had been used at the time for various reasons: communication, inducing creativity in children, and in religious contexts. The early art therapists who published accounts of their work acknowledged the influence of aesthetics, psychiatry, psychoanalysis, rehabilitation, early childhood education, and art education, to varying degrees, on their practices.

The British artist Adrian Hill coined the term art therapy in 1942. Hill, recovering from tuberculosis in a sanatorium, discovered the therapeutic benefits of drawing and painting while convalescing. He wrote that the value of art therapy lay in “completely engrossing the mind (as well as the fingers)…releasing the creative energy of the frequently inhibited patient”, which enabled the patient to “build up a strong defence against his misfortunes”. He suggested artistic work to his fellow patients. That began his art therapy work, which was documented in 1945 in his book, Art Versus Illness.

The artist Edward Adamson, demobilised after WW2, joined Adrian Hill to extend Hill’s work to the British long stay mental hospitals. Other early proponents of art therapy in Britain include E.M. Lyddiatt, Michael Edwards, Diana Raphael-Halliday and Rita Simon. The British Association of Art Therapists was founded in 1964.

U.S. art therapy pioneers Margaret Naumburg and Edith Kramer began practicing at around the same time as Hill. Naumburg, an educator, asserted that “art therapy is psychoanalytically oriented” and that free art expression “becomes a form of symbolic speech which…leads to an increase in verbalisation in the course of therapy.” Edith Kramer, an artist, pointed out the importance of the creative process, psychological defences, and artistic quality, writing that “sublimation is attained when forms are created that successfully contain…anger, anxiety, or pain.” Other early proponents of art therapy in the United States include Elinor Ulman, Robert “Bob” Ault, and Judith Rubin. The American Art Therapy Association was founded in 1969.

National professional associations of art therapy exist in many countries, including Brazil, Canada, Finland, Lebanon, Israel, Japan, the Netherlands, Romania, South Korea, and Sweden. International networking contributes to the establishment of standards for education and practice.

Diverse perspectives exist on history of art therapy, which complement those that focus on the institutionalisation of art therapy as a profession in Britain and the United States.

Definitions

There are various definitions of the term art therapy.

The British Association of Art Therapists defines art therapy as “a form of psychotherapy that uses art media as its primary mode of expression and communication.”

The American Art Therapy Association defines art therapy as: “an integrative mental health and human services profession that enriches the lives of individuals, families, and communities through active art-making, creative process, applied psychological theory, and human experience within a psychotherapeutic relationship.”

What is Art Therapy Used For?

As a regulated mental health profession, art therapy is employed in many clinical and other settings with diverse populations. It is increasingly recognised as a valid form of therapy. Art therapy can also be found in non-clinical settings, as well as in art studios and in creativity development workshops. Licensing for art therapists can vary from state to state with some recognising art therapy as a separate license and some licensing under a related field such a professional counselling, mental health counsellor. Art therapists must have a master’s degree that includes training on the creative process, psychological development, group therapy, and must complete a clinical internship. Art therapists may also pursue additional credentialing through the Art Therapy Credentials Board. Art therapists work with populations of all ages and with a wide variety of disorders and diseases. Art therapists provide services to children, adolescents, and adults, whether as individuals, couples, families, or groups.

Using their evaluative and psychotherapy skills, art therapists choose materials and interventions appropriate to their clients’ needs and design sessions to achieve therapeutic goals and objectives. They use the creative process to help their clients increase insight, cope with stress, work through traumatic experiences, increase cognitive, memory and neurosensory abilities, improve interpersonal relationships and achieve greater self-fulfilment. The activities an art therapist chooses to do with clients depend on a variety of factors such as their mental state or age. Art therapists may draw upon images from resources such as ARAS (Archive for Research in Archetypal Symbolism) to incorporate historical art and symbols into their work with patients. Depending on the state, province, or country, the term “art therapist” may be reserved for those who are professionals trained in both art and therapy and hold a master or doctoral degree in art therapy or certification in art therapy obtained after a graduate degree in a related field. Other professionals, such as mental health counsellors, social workers, psychologists, and play therapists optionally combine art-making with basic psychotherapeutic modalities in their treatment. Therapists may better understand a client’s absorption of information after assessing elements of their artwork.

A systemic literature review compiled and evaluated different research studies, some of which are listed below. Overall, this survey publication revealed that both the high level of variability (such as incorporating talk therapy) and limited number of studies done with certified art therapists made it difficult to generalise over findings. Despite these limitations, art therapy has, to an extent, proved its efficacy in relieving symptoms and improving quality of life.

General Illness

Art-making is a common activity used by many people to cope with illness. Art and the creative process can alleviate many illnesses (cancer, heart disease, influenza, etc.). This form of therapy helps benefit those who suffer from mental illnesses as well (chronic depression, anxiety disorders, bipolar disorders, etc.). It is difficult to measure the efficacy of art therapy as it treats various mental illnesses to different degrees; although, people can escape the emotional effects of various illness through art making and many creative methods. Sometimes people cannot express the way they feel, as it can be difficult to put into words, and art can help people express their experiences. “During art therapy, people can explore past, present and future experiences using art as a form of coping”. Art can be a refuge for the intense emotions associated with illness; there are no limits to the imagination in finding creative ways to express emotions.

Hospitals have started studying the influence of arts on patient care and found that participants in art programs have better vitals and fewer complications sleeping. Artistic influence does not need to be participation in a programme, but studies have found that a landscape picture in a hospital room had reduced need for narcotic pain killers and less time in recovery at the hospital. In addition, either looking at or creating art in hospitals helped stabilise vital signs, speed up the healing process, and in general, bring a sense of hope and soul to the patient. Family, care workers, doctors and nurses are also positively affected.

Cancer Diagnosis

Many studies have been conducted on the benefits of art therapy on cancer patients. Art therapy has been found to be useful to support patients during the stress of such things as chemotherapy treatment.

Art therapists have conducted studies to understand why some cancer patients turned to art making as a coping mechanism and a tool to creating a positive identity outside of being a cancer patient. Women in the study participated in different art programs ranging from pottery and card making to drawing and painting. The programmes helped them regain an identity outside of having cancer, lessened emotional pain of their on-going fight with cancer, and also giving them hope for the future.

In a study involving women facing cancer-related difficulties such as fear, pain, altered social relationships, etc., it was found that:

Engaging in different types of visual art (textiles, card making, collage, pottery, watercolour, acrylics) helped these women in 4 major ways. First, it helped them focus on positive life experiences, relieving their ongoing preoccupation with cancer. Second, it enhanced their self-worth and identity by providing them with opportunities to demonstrate continuity, challenge, and achievement. Third, it enabled them to maintain a social identity that resisted being defined by cancer. Finally, it allowed them to express their feelings in a symbolic manner, especially during chemotherapy.

Another study showed those who participated in these types of activities were discharged earlier than those who did not participate.

Furthermore, another study revealed the healing effects of art therapy on female breast cancer patients. Studies revealed that relatively short-term art therapy interventions significantly improved patients’ emotional states and perceived symptoms.

Studies have also shown how the emotional distress of cancer patients has been reduced when utilising the creative process. The women made drawings of themselves throughout the treatment process while also doing yoga and meditating; these actions combined helped to alleviate some symptoms.

Another study looked at the efficacy of mindfulness-based art therapy, combining meditation with art, on a large study with 111 participants. The study used measurements such as quality of life, physical symptoms, depression, and anxiety to evaluate the efficacy of the intervention. This yielded optimistic results that there was a significant decrease in distress and significant improvement in quality of life.

A review of 12 studies investigating the use of art therapy in cancer patients by Wood, Molassiotis, and Payne (2010) investigated the symptoms of emotional, social, physical, global functioning, and spiritual controls of cancer patients. They found that art therapy can improve the process of psychological readjustment to the change, loss, and uncertainty associated with surviving cancer. It was also suggested that art therapy can provide a sense of “meaning-making” because of the physical act of creating the art. When given five individual sessions of art therapy once per week, art therapy was shown to be useful for personal empowerment by helping the cancer patients understand their own boundaries in relation to the needs of other people. In turn, those who had art therapy treatment felt more connected to others and found social interaction more enjoyable than individuals who did not receive art therapy treatment. Furthermore, art therapy improved motivation levels, abilities to discuss emotional and physical health, general well-being, and increased global quality of life in cancer patients.

In sum, relatively short-term intervention of art therapy that is individualised to various patients has the potential to significantly improve emotional state and quality of life, while reducing perceived symptoms relating to the cancer diagnosis.

Disaster Relief

Art therapy has been used in a variety of traumatic experiences, including disaster relief and crisis intervention. Art therapists have worked with children, adolescents and adults after natural and manmade disasters, encouraging them to make art in response to their experiences. Some suggested strategies for working with victims of disaster include: assessing for distress or posttraumatic stress disorder (PTSD), normalising feelings, modelling coping skills, promoting relaxation skills, establishing a social support network, and increasing a sense of security and stability.

Dementia

While art therapy helps with behavioural issues, it does not appear to affect worsening mental abilities. Tentative evidence supports benefits with respect to quality of life. Art therapy had no clear results on affecting memory or emotional well being scales. However, Alzheimer’s association states art and music can enrich people’s lives and allow for self expression.

Autism

Art therapy is increasingly recognised to help address challenges of people with autism, as evidenced through these sources. Art therapy may address core symptoms of the autism spectrum disorder by promoting sensory regulation, supporting psychomotor development and facilitating communication. Art therapy is also thought to promote emotional and mental growth by allowing self expression, visual communication, and creativity.

Schizophrenia

A 2005 systematic review of art therapy as an add on treatment for schizophrenia found unclear effects. Studies reveal that cognitive behavioural therapy has proven to be most effective for this disorder.

Geriatric Patients

Studies conducted by Regev reveal that geriatric art therapy has been significantly useful in helping depression for the elderly, although not particularly successful among dementia patients. Group therapy versus individual sessions proved to be more effective.

Trauma and Children

Art therapy may alleviate trauma-induced emotions, such as shame and anger. It is also likely to increase trauma survivors’ sense of empowerment and control by encouraging children to make choices in their artwork. Art therapy in addition to psychotherapy offered more reduction in trauma symptoms than just psychotherapy alone.

Because traumatic memories are encoded visually, creating art may be the most effective way to access them. Through art therapy, children may be able to make more sense of their traumatic experiences and form accurate trauma narratives. Gradual exposure to these narratives may reduce trauma-induced symptoms, such as flashbacks and nightmares. Repetition of directives reduces anxiety, and visually creating narratives help clients build coping skills and balanced nervous system responses. This only works in long-term art therapy interventions.

Children who have experienced trauma may benefit from group art therapy. The group format is effective in helping survivors develop relationships with others who have experienced similar situations. Group art therapy may also be beneficial in helping children with trauma regain trust and social self-esteem. Usually, participants who undergo art therapy through group interventions have positive experiences and give their internal feelings validation.

Veterans and Post-Traumatic Stress Disorder

Art therapy has an established history of being used to treat veterans, with the American Art Therapy Association documenting its use as early as 1945. As with other sources of trauma, combat veterans may benefit from art therapy to access memories and to engage with treatment. A 2016 randomised control trial found that art therapy in conjunction with cognitive processing therapy (CPT) was more beneficial than CPT alone. Walter Reed Army Medical Centre, the National Intrepid Centre of Excellence and other Veteran Association institutions use art therapy to help veterans with PTSD.

Eating Disorders

Art therapy may help people with anorexia with weight improvements and may help with depression level. Traumatic or negative childhood experiences can result in unintentionally harmful coping mechanisms, such as eating disorders. As a result, clients may be cut off from their emotions, self-rejecting, and detached from their strengths. Art therapy may provide an outlet for exploring these inaccessible strengths and emotions; this is important because persons with eating disorders may not know how to vocalise their emotions.

Art therapy may be beneficial for clients with eating disorders because clients can create visual representations with art material of progress made, represent alterations to the body, and provide a nonthreatening method of acting out impulses. Individuals with eating disorders tend to rely heavily on defence mechanisms to feel a sense of control; it is important that clients feel a sense of authority over their art products through freedom of expression and controllable art materials. Through controllable media, such as pencils, markers, and coloured pencils, along with freedom of choice with the media, clients with eating disorders can create boundaries around unsettling themes.

Another systematic literature review found conclusive evidence that art therapy resulted in significant weight loss in patients with obesity, as well as helping with a range of psychological symptoms.

Ongoing Daily Challenges

Those who do not suffer from a mental illness or physical disease were also tested, these patients have ongoing daily challenges such as high-intensity jobs, financial constraints, and other personal issues. Findings revealed that art therapy reduces levels of stress and burnout related to patients’ professions.

Containment

The term containment, within art therapy and other therapeutic settings, has been used to describe what the client/service user can experience within the safety and privacy of a trusting relationship between client and counsellor. This term has also been equated, within art therapy research, with the holding or confining of an issue within the boundaries of visual expression, like a border or the circumference of a mandala. The creation of mandalas for symptom regulation is not a new approach within the field of art therapy, and numerous studies have been conducted in order to assess their efficacy.[

What is the Purpose of Art Therapy?

The purpose of art therapy is essentially one of healing. Art therapy can be successfully applied to clients with physical, mental or emotional problems, diseases and disorders. Any type of visual art and art medium can be employed within the therapeutic process, including painting, drawing, sculpting, photography, and digital art. Art therapy may include creative exercises such as drawing or painting a certain emotion, creative journaling, or freestyle creation.

One proposed learning mechanism is through the increased excitation, and as a consequence, strengthening of neuronal connections.

Outline of a Typical Session

Art therapy can take place in a variety of different settings. Art therapists may vary the goals of art therapy and the way they provide art therapy, depending upon the institution’s or client’s/service user’s needs. After an assessment of the client’s strengths and needs, art therapy may be offered in either an individual or group format, according to which is better suited to the person. Art therapist Dr. Ellen G. Horovitz wrote, “My responsibilities vary from job to job. It is wholly different when one works as a consultant or in an agency as opposed to private practice. In private practice, it becomes more complex and far reaching. If you are the primary therapist then your responsibilities can swing from the spectrum of social work to the primary care of the patient. This includes dovetailing with physicians, judges, family members, and sometimes even community members that might be important in the caretaking of the individual.” Like other psychotherapists in private practice, some art therapists find it important to ensure, for the therapeutic relationship, that the sessions occur each week in the same space and at the same time.

Art therapy is often offered in schools as a form of therapy for children because of their creativity and interest in art as a means of expression. Art therapy can benefit children with a variety of issues, such as learning disabilities, speech and language disorders, behavioural disorders, and other emotional disturbances that might be hindering a child’s learning. Similar to other psychologists that work in schools, art therapists should be able to diagnose the problems facing their student clients, and individualize treatment and interventions. Art therapists work closely with teachers and parents in order to implement their therapy strategies.

Art-Based Assessments

Art therapists and other professionals use art-based assessments to evaluate emotional, cognitive, and developmental conditions. There are also many psychological assessments that utilise artmaking to analyse various types of mental functioning (Betts, 2005). Art therapists and other professionals are educated to administer and interpret these assessments, most of which rely on simple directives and a standardised array of art materials (Malchiodi 1998, 2003; Betts, 2005). The first drawing assessment for psychological purposes was created in 1906 by German psychiatrist Fritz Mohr (Malchiodi 1998). In 1926, researcher Florence Goodenough created a drawing test to measure the intelligence in children called the Draw-A-Man Test (Malchiodi 1998). The key to interpreting the Draw-A-Man Test was that the more details a child incorporated into the drawing, the MORE intelligent they were (Malchiodi, 1998). Goodenough and other researchers realised the test had just as much to do with personality as it did intelligence (Malchiodi, 1998). Several other psychiatric art assessments were created in the 1940s, and have been used ever since (Malchiodi 1998).

Notwithstanding, many art therapists eschew diagnostic testing and indeed some writers (Hogan 1997) question the validity of therapists making interpretative assumptions. More recent literature, however, highlights the utility of standardised approaches to treatment planning and clinical decision-making, such as is evidenced through this source. Below are some examples of art therapy assessments:

  • Mandala Assessment Research Instrument:
    • In this assessment, a person is asked to select a card from a deck with different mandalas (designs enclosed in a geometric shape) and then must choose a colour from a set of coloured cards.
    • The person is then asked to draw the mandala from the card they choose with an oil pastel of the colour of their choice.
    • The artist is then asked to explain if there were any meanings, experiences, or related information related to the mandala they drew.
    • This test is based on the beliefs of Joan Kellogg, who sees a recurring correlation between the images, pattern and shapes in the mandalas that people draw and the personalities of the artists.
    • This test assesses and gives clues to a person’s psychological progressions and their current psychological condition (Malchiodi 1998).
    • The mandala originates in Buddhism; its connections with spirituality help us to see links with transpersonal art.
  • House-Tree-Person:
    • In the house-tree-person test, the client/service user is asked to first draw a house, then a tree, then a person, and is asked several questions about each.
    • As of 2014, this test had not been well-validated.

Outsider Art

The relation between the fields of art therapy and outsider art has been widely debated. The term ‘art brut’ was first coined by French artist Jean Dubuffet to describe art created outside the boundaries of official culture. Dubuffet used the term ‘art brut’ to focus on artistic practice by insane-asylum patients. The English translation “outsider art” was first used by art critic Roger Cardinal in 1972.

Both terms have been criticized because of their social and personal impact on both patients and artists. Art therapy professionals have been accused of not putting enough emphasis on the artistic value and meaning of the artist’s works, considering them only from a medical perspective. This led to the misconception of the whole outsider art practice, while addressing therapeutical issues within the field of aesthetical discussion. Outsider Art, on the contrary, has been negatively judged because of the labelling of the artists’ work, i.e. the equation artist = genius = insane. Moreover, the business-related issues on the term outsider art carry some misunderstandings. While the outsider artist is part of a specific art system, which can add a positive value to both the artist’s work as well as his personal development, it can also imprison him within the boundaries of the system itself.

What is Therapy?

Introduction

A therapy or medical treatment (often abbreviated tx, Tx, or Tx) is the attempted remediation of a health problem, usually following a medical diagnosis.

As a rule, each therapy has indications and contraindications. There are many different types of therapy. Not all therapies are effective. Many therapies can produce unwanted adverse effects.

Treatment and therapy are generally considered synonyms. However, in the context of mental health, the term therapy may refer specifically to psychotherapy.

Semantic Field

The words care, therapy, treatment, and intervention overlap in a semantic field, and thus they can be synonymous depending on context. Moving rightward through that order, the connotative level of holism decreases and the level of specificity (to concrete instances) increases. Thus, in health care contexts (where its senses are always noncount), the word care tends to imply a broad idea of everything done to protect or improve someone’s health (for example, as in the terms preventive care and primary care, which connote ongoing action), although it sometimes implies a narrower idea (for example, in the simplest cases of wound care or post-anaesthesia care, a few particular steps are sufficient, and the patient’s interaction with that provider is soon finished).

In contrast, the word intervention tends to be specific and concrete, and thus the word is often countable; for example, one instance of cardiac catheterisation is one intervention performed, and coronary care (noncount) can require a series of interventions (count). At the extreme, the piling on of such countable interventions amounts to interventionism, a flawed model of care lacking holistic circumspection – merely treating discrete problems (in billable increments) rather than maintaining health. Therapy and treatment, in the middle of the semantic field, can connote either the holism of care or the discreteness of intervention, with context conveying the intent in each use. Accordingly, they can be used in both noncount and count senses (for example, therapy for chronic kidney disease can involve several dialysis treatments per week).

The words aceology and iamatology are obscure and obsolete synonyms referring to the study of therapies.

The English word therapy comes via Latin therapīa from Greek: θεραπεία and literally means “curing” or “healing”.

Types of Therapies

By Chronology, Priority, or Intensity

Levels of Care

Levels of care classify health care into categories of chronology, priority, or intensity, as follows:

  • Emergency care handles medical emergencies and is a first point of contact or intake for less serious problems, which can be referred to other levels of care as appropriate.
  • Intensive care, also called critical care, is care for extremely ill or injured patients.
    • It thus requires high resource intensity, knowledge, and skill, as well as quick decision making.
  • Ambulatory care is care provided on an outpatient basis.
    • Typically patients can walk into and out of the clinic under their own power (hence “ambulatory”), usually on the same day.
  • Home care is care at home, including care from providers (such as physicians, nurses, and home health aides) making house calls, care from caregivers such as family members, and patient self-care.
  • Primary care is meant to be the main kind of care in general, and ideally a medical home that unifies care across referred providers.
  • Secondary care is care provided by medical specialists and other health professionals who generally do not have first contact with patients, for example, cardiologists, urologists and dermatologists.
    • A patient reaches secondary care as a next step from primary care, typically by provider referral although sometimes by patient self-initiative.
  • Tertiary care is specialised consultative care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital.
  • Follow-up care is additional care during or after convalescence.
    • Aftercare is generally synonymous with follow-up care.
  • End-of-life care is care near the end of one’s life. It often includes the following:
    • Palliative care is supportive care, most especially (but not necessarily) near the end of life.
    • Hospice care is palliative care very near the end of life when cure is very unlikely.
      • Its main goal is comfort, both physical and mental.

Lines of Therapy

Treatment decisions often follow formal or informal algorithmic guidelines. Treatment options can often be ranked or prioritised into lines of therapy: first-line therapy, second-line therapy, third-line therapy, and so on.

First-line therapy (sometimes called induction therapy, primary therapy, or front-line therapy) is the first therapy that will be tried. Its priority over other options is usually either:

  • Formally recommended on the basis of clinical trial evidence for its best-available combination of efficacy, safety, and tolerability; or
  • Chosen based on the clinical experience of the physician.

If a first-line therapy either fails to resolve the issue or produces intolerable side effects, additional (second-line) therapies may be substituted or added to the treatment regimen, followed by third-line therapies, and so on.

An example of a context in which the formalisation of treatment algorithms and the ranking of lines of therapy is very extensive is chemotherapy regimens. Because of the great difficulty in successfully treating some forms of cancer, one line after another may be tried. In oncology the count of therapy lines may reach 10 or even 20.

Often multiple therapies may be tried simultaneously (combination therapy or polytherapy). Thus combination chemotherapy is also called polychemotherapy, whereas chemotherapy with one agent at a time is called single-agent therapy or monotherapy.

Adjuvant therapy is therapy given in addition to the primary, main, or initial treatment, but simultaneously (as opposed to second-line therapy). Neoadjuvant therapy is therapy that is begun before the main therapy. Thus one can consider surgical excision of a tumour as the first-line therapy for a certain type and stage of cancer even though radiotherapy is used before it; the radiotherapy is neoadjuvant (chronologically first but not primary in the sense of the main event). Premedication is conceptually not far from this, but the words are not interchangeable; cytotoxic drugs to put a tumour “on the ropes” before surgery delivers the “knockout punch” are called neoadjuvant chemotherapy, not premedication, whereas things like anaesthetics or prophylactic antibiotics before dental surgery are called premedication.

Step therapy or stepladder therapy is a specific type of prioritisation by lines of therapy. It is controversial in American health care because unlike conventional decision-making about what constitutes first-line, second-line, and third-line therapy, which in the US reflects safety and efficacy first and cost only according to the patient’s wishes, step therapy attempts to mix cost containment by someone other than the patient (third-party payers) into the algorithm. Therapy freedom and the negotiation between individual and group rights are involved.

By Intent

Therapy TypeDescription
Abortive Therapy1. A therapy that is intended to stop a medical condition from progressing any further.
2. A medication taken at the earliest signs of a disease, such as an analgesic taken at the very first symptoms of a migraine headache to prevent it from getting worse, is an abortive therapy.
3. Compare abortifacients, which abort a pregnancy.
Bridge Therapy1. A therapy that figuratively provides a bridge to another step or phase, crossing over some immediate chasm (challenge).
2. In contrast with destination therapy (see below), which is the final therapy in cases where clinically appropriate.
Consolidation Therapy1. A therapy given to consolidate the gains from induction therapy. In cancer, this means chasing after any malignant cells that may be left.
Curative Therapy1. A therapy with curative intent, that is, one that seeks to cure the root cause of a disorder.
2. Also known as etiotropic therapy.
Definitive Therapy1. A therapy that may be final, superior to others, curative, or all of those.
Destination Therapy1. A therapy that is the final destination rather than a bridge to another therapy.
2. Usually refers to ventricular assist devices to keep the existing heart going, not just until a heart transplant can occur, but for the rest of the patient’s life expectancy.
Empiric Therapy1. A therapy given on an empiric basis; that is, one given according to a clinician’s educated guess despite uncertainty about the illness’s causative factors.
2. For example, empiric antibiotic therapy administers a broad-spectrum antibiotic immediately on the basis of a good chance (given the history, physical examination findings, and risk factors present) that the illness is bacterial and will respond to that drug (even though the bacterial species or variant is not yet known).
Gold Standard Therapy1. A therapy that is definitive, just as a gold standard diagnostic test is a definitive test.
Investigational Therapy1. An experimental therapy. Use of experimental therapies must be ethically justified, because by definition they raise the question of standard of care.
2. Physicians have autonomy to provide empirical care (such as off-label care) according to their experience and clinical judgment, but the autonomy has limits that preclude quackery.
3. Thus it may be necessary to design a clinical trial around the new therapy and to use the therapy only per a formal protocol.
4. Sometimes shorthand phrases such as “treated on protocol” imply not just “treated according to a plan” but specifically “treated with investigational therapy”.
Maintenance Therapy1. A therapy taken during disease remission to prevent relapse.
Palliative TherapySee supportive therapy (below) for connotative distinctions.
Preventive Therapy (Prophylactic Therapy)1. A therapy that is intended to prevent a medical condition from occurring (also known as prophylaxis).
2. For example, many vaccines prevent infectious diseases.
Salvage Therapy (Rescue Therapy)1. A therapy tried after others have failed; it may be a “last-line” therapy.
Stepdown Therapy1. Therapy that tapers the dosage gradually rather than abruptly cutting it off.
2. For example, a switch from intravenous to oral antibiotics as an infection is brought under control steps down the intensity of therapy.
Supportive Therapy1. A therapy that does not treat or improve the underlying condition, but instead increases the patient’s comfort, also called symptomatic treatment (see there for more information).
2. For example, supportive care for flu, colds, or gastrointestinal upset can include rest, fluids, and over the counter pain relievers; those things do not treat the cause, but they treat the symptoms and thus provide relief.
3. Supportive therapy may be palliative therapy (palliative care).
4. The two terms are sometimes synonymous, but palliative care often specifically refers to serious illness and end-of-life care.
5. Therapy may be categorised as having curative intent (when it is possible to eliminate the disease) or palliative intent (when eliminating the disease is impossible and the focus shifts to minimizing the distress that it causes).
6. The two are often contradistinguished (mutually exclusive) in some contexts (such as the management of some cancers), but they are not inherently mutually exclusive; often a therapy can be both curative and palliative simultaneously.
7. Supportive psychotherapy aims to support the patient by alleviating the worst of the symptoms, with the expectation that definitive therapy can follow later if possible.
Systemic Therapy1. A therapy that is systemic.
2. In the physiological sense, this means affecting the whole body (rather than being local or locoregional), whether via systemic administration, systemic effect, or both.
3. Systemic therapy in the psychotherapeutic sense seeks to address people not only on the individual level but also as people in relationships, dealing with the interactions of groups.

By Therapy Composition

Treatments can be classified according to the method of treatment:

  • By Matter:
    • By drugs: pharmacotherapy, chemotherapy (also, medical therapy often means specifically pharmacotherapy).
    • By medical devices: implantation.
      • Cardiac resynchronisation therapy.
    • By specific molecules: molecular therapy (although most drugs are specific molecules, molecular medicine refers in particular to medicine relying on molecular biology).
      • By specific biomolecular targets: targeted therapy.
        • Molecular chaperone therapy.
      • By chelation: chelation therapy
    • By specific chemical elements:
      • By metals:
        • By heavy metals:
        • By gold: chrysotherapy (aurotherapy).
        • By platinum-containing drugs: platin therapy.
        • By biometals:
          • By lithium: lithium therapy.
          • By potassium: potassium supplementation.
          • By magnesium: magnesium supplementation.
          • By chromium: chromium supplementation; phonemic neurological hypochromium therapy.
          • By copper: copper supplementation.
      • By non-metals:
        • By diatomic oxygen: oxygen therapy, hyperbaric oxygen therapy (hyperbaric medicine).
        • Transdermal continuous oxygen therapy.
        • By triatomic oxygen (ozone): ozone therapy.
        • By fluoride: fluoride therapy.
        • By other gases: medical gas therapy.
    • By water:
      • Hydrotherapy.
      • Aquatic therapy.
      • Rehydration therapy.
        • Oral rehydration therapy.
      • Water cure (therapy).
    • By biological materials (biogenic substances, biomolecules, biotic materials, natural products), including their synthetic equivalents: biotherapy.
      • By whole organisms.
        • By viruses: virotherapy.
        • By bacteriophages: phage therapy.
        • By animal interaction: see animal interaction section.
      • By constituents or products of organisms.
        • By plant parts or extracts (but many drugs are derived from plants, even when the term phytotherapy is not used).
          • Scientific type: phytotherapy.
          • Traditional (prescientific) type: herbalism.
        • By animal parts: quackery involving shark fins, tiger parts, and so on, often driving threat or endangerment of species.
        • By genes: gene therapy.
          • Gene therapy for epilepsy.
          • Gene therapy for osteoarthritis.
          • Gene therapy for colour blindness.
          • Gene therapy of the human retina.
          • Gene therapy in Parkinson’s disease.
        • By epigenetics: epigenetic therapy.
        • By proteins: protein therapy (but many drugs are proteins despite not being called protein therapy).
        • By enzymes: enzyme replacement therapy.
        • By hormones: hormone therapy.
          • Hormonal therapy (oncology).
          • Hormone replacement therapy.
            • Oestrogen replacement therapy.
            • Androgen replacement therapy.
            • Hormone replacement therapy (menopause).
            • Hormone replacement therapy (transgender).
              • Hormone replacement therapy (male-to-female).
              • Hormone replacement therapy (female-to-male).
          • Antihormone therapy.
            • Androgen deprivation therapy.
        • By whole cells: cell therapy (cytotherapy).
          • By stem cells: stem cell therapy.
          • By immune cells: see immune system products below.
        • By immune system products: immunotherapy, host modulatory therapy.
          • By immune cells:
            • T-cell vaccination.
            • Cell transfer therapy.
            • Autologous immune enhancement therapy.
            • TK cell therapy.
          • By humoral immune factors: antibody therapy.
            • By whole serum: serotherapy, including antiserum therapy.
            • By immunoglobulins: immunoglobulin therapy.
              • By monoclonal antibodies: monoclonal antibody therapy.
      • By urine: urine therapy (some scientific forms; many prescientific or pseudoscientific forms).
      • By food and dietary choices:
        • Medical nutrition therapy.
        • Grape therapy (quackery).
    • By salts (but many drugs are the salts of organic acids, even when drug therapy is not called by names reflecting that).
      • By salts in the air.
        • By natural dry salt air: “taking the cure” in desert locales (especially common in prescientific medicine; for example, one 19th-century way to treat tuberculosis).
        • By artificial dry salt air:
          • Low-humidity forms of speleotherapy.
          • Negative air ionisation therapy.
        • By moist salt air:
          • By natural moist salt air: seaside cure (especially common in prescientific medicine).
          • By artificial moist salt air: water vapor forms of speleotherapy.
        • By salts in the water.
          • By mineral water: spa cure (“taking the waters”) (especially common in prescientific medicine).
          • By seawater: seaside cure (especially common in prescientific medicine).
    • By aroma: aromatherapy.
    • By other materials with mechanism of action unknown.
      • By occlusion with duct tape: duct tape occlusion therapy.
  • By Energy:
    • By electric energy as electric current: electrotherapy, electroconvulsive therapy:
      • Transcranial magnetic stimulation.
    • By magnetic energy:
      • Magnet therapy.
      • Pulsed electromagnetic field therapy.
      • Magnetic resonance therapy.
    • By electromagnetic radiation (EMR):
      • By light: light therapy (phototherapy).
        • Ultraviolet light therapy.
          • PUVA therapy.
        • Photodynamic therapy.
          • Photothermal therapy.
          • Cytoluminescent therapy.
        • Blood irradiation therapy.
        • By darkness: dark therapy.
        • By lasers: laser therapy.
          • Low level laser therapy.
      • By gamma rays: radiosurgery.
        • Gamma Knife radiosurgery.
        • Stereotactic radiation therapy.
        • Cobalt therapy.
      • By radiation generally: radiation therapy (radiotherapy).
        • Intraoperative radiation therapy.
        • By EMR particles:
          • Particle therapy.
            • Proton therapy.
            • Electron therapy.
              • Intraoperative electron radiation therapy.
              • Auger therapy.
            • Neutron therapy.
              • Fast neutron therapy.
              • Neutron capture therapy of cancer.
        • By radioisotopes emitting EMR:
          • By nuclear medicine.
          • By brachytherapy.
      • Quackery type: electromagnetic therapy (alternative medicine).
    • By mechanical: manual therapy as massotherapy and therapy by exercise as in physiotherapy and exercise therapy.
      • Inversion therapy.
    • By sound:
      • By ultrasound:
        • Ultrasonic lithotripsy.
          • Extracorporeal shock wave lithotripsy.
          • Extracorporeal shockwave therapy.
        • Sonodynamic therapy.
      • By music: music therapy.
        • Neurologic music therapy.
    • By temperature.
      • By heat: heat therapy (thermotherapy).
        • By moderately elevated ambient temperatures: hyperthermia therapy.
          • By dry warm surroundings: Waon therapy.
          • By dry or humid warm surroundings: sauna, including infrared sauna, for sweat therapy
      • By cold:
        • By extreme cold to specific tissue volumes: cryotherapy.
        • By ice and compression: cold compression therapy.
        • By ambient cold: hypothermia therapy for neonatal encephalopathy.
      • By hot and cold alternation: contrast bath therapy.
  • By Procedure and Human Interaction:
    • Surgery.
    • By counselling, such as psychotherapy (refer to list of psychotherapies).
      • Systemic therapy.
      • By group psychotherapy.
    • By cognitive behavioural therapy.
      • By cognitive therapy.
      • By behaviour therapy.
        • By dialectical behaviour therapy.
      • By cognitive emotional behavioural therapy.
    • By cognitive rehabilitation therapy.
    • By family therapy.
    • By education.
      • By psychoeducation.
      • By information therapy.
    • By physical therapy/occupational therapy, vision therapy, massage therapy, chiropractic or acupuncture.
    • By lifestyle modifications, such as avoiding unhealthy food or maintaining a predictable sleep schedule.
    • By coaching.
  • By Animal Interaction:
    • By pets, assistance animals, or working animals: animal-assisted therapy.
      • By horses: equine therapy, hippotherapy.
      • By dogs: pet therapy with therapy dogs, including grief therapy dogs.
      • By cats: pet therapy with therapy cats.
    • By fish: ichthyotherapy (wading with fish), aquarium therapy (watching fish).
    • By maggots: maggot therapy.
    • By worms:
      • By internal worms: helminthic therapy.
      • By leeches: leech therapy.
    • By immersion: animal bath.
  • By Meditation:
    • By mindfulness: mindfulness-based cognitive therapy.
  • By Reading:
    • By bibliotherapy.
  • By Creativity:
    • By expression: expressive therapy.
      • By writing: writing therapy.
        • Journal therapy.
    • By play: play therapy.
    • By art: art therapy.
      • Sensory art therapy.
      • Comic book therapy.
    • By gardening: horticultural therapy.
    • By dance: dance therapy.
    • By drama: drama therapy.
    • By recreation: recreational therapy.
    • By music: music therapy.
  • By Sleeping and Waking:
    • By deep sleep: deep sleep therapy.
    • By waking: wake therapy.

Book: Acceptance and Commitment Therapy (A.C.T.)

Book Title:

Acceptance and Commitment Therapy (A.C.T.): Workbook to Get Out From Anxiety, Relieve Depression, and Break Free From Stress and Worry, for a Newfound Mental Health.

Author(s): Gerald Paul Clifford.

Year: 2020.

Edition: First (1st).

Publisher: Independently Published.

Type(s): Paperback and Kindle.

Synopsis:

Life can present many challenges, some of which can be incredibly difficult to overcome. When these more troubling challenges arise, it can feel impossible to know how to navigate them and the many experiences they bring.

You may feel worried about your thoughts, emotions, behaviours, or all three. Especially when these parts of your experience seem hijacked by anxiety, anger, fear, frustration, depression, or other difficult emotions, it can be overwhelming to navigate them and the many behavioural experiences they bring.

Acceptance and Commitment Therapy (A.C.T) is a type of psychotherapy that relies on talk therapy techniques to assist you with achieving a more functional state in your life. By adjusting your perspective, increasing your awareness, and taking intentional action, you deepen your ability to recognise and navigate your emotions.

Book: Cognitive Analytic Therapy and Borderline Personality Disorder

Book Title:

Cognitive Analytic Therapy and Borderline Personality Disorder : The Model and the Method

Author(s): Anthony Ryle.

Year: 1997.

Edition: First (1st).

Publisher: John Wiley & Sons.

Type(s): Paperback and Kindle.

Synopsis:

Borderline Personality Disorder patients are impulsive, unstable and destructive, hurting themselves and those around them, including those who seek to help them. This has resulted in a widespread reluctance to treat them and a pessimism about treatment.

In the experience of the authors this pessimism is unjustified, because for many patients a relatively brief intervention can be effective in cost-benefit terms as well as human terms. The interventions illustrated here have been used to treat outpatients for 15 years.

The results indicate that treatments can achieve clinically significant changes in the course of 16 24 sessions, in a substantial proportion of patients. While CAT shares some ideas and methods with other approaches, it introduces many new features and is uniquely integrated at both the theoretical and practical level. The early joint reformulation of patients problems serves to contain destructiveness and to create a working alliance. Also, the use of reformulation to teach self-reflection and avoid collusive responses from the therapist, throughout the therapy, represents a powerful new technique.

The book offers a critical appraisal of current ideas and practices, contrasting with these the ways in which CAT mobilises the patient s own resources. The authors argue that CAT should have a place in any service seeking to help these difficult patients.

Book: Introducing Cognitive Analytic Therapy

Book Title:

Introducing Cognitive Analytic Therapy: Principles and Practice of a Relational Approach to Mental Health.

Author(s): Anthony Ryle and Ian B. Kerr.

Year: 2020.

Edition: Second (2nd).

Publisher: Wiley.

Type(s): Paperback and Kindle.

Synopsis:

Cognitive Analytic Therapy (CAT) is an increasingly popular approach to therapy that is now widely recognised as a genuinely integrative and fundamentally relational model of psychotherapy. This new edition of the definitive text to CAT offers a systematic and comprehensive introduction to its origins, development, and practice. It also provides a fully updated overview of developments in the theory, research, and applications of CAT, including clarification and re-statement of basic concepts, such as reciprocal roles and reciprocal role procedures, as well as extensions into new areas of expertise.

Introducing Cognitive Analytic Therapy: Principles and Practice of a Relational Approach to Mental Health, 2nd Edition starts with a brief account of the scope and focus of CAT and how it evolved and explains the main features of its practice. It next offers a brief account of a relatively straightforward therapy to give readers a sense of the unfolding structure and style of a time-limited CAT. Following that are chapters that consider the normal and abnormal development of the Self and that introduce influential concepts from Vygotskian, Bakhtinian and developmental psychology. Subsequent chapters describe selection and assessment; reformulation; the course of therapy; the ‘ideal model’ of therapist activity and its relation to the supervision of therapists; applications of CAT in various patient groups and settings and in treating personality type disorders; use in ‘reflective practice’; a CAT perspective on the ‘difficult’ patient; and systemic and ‘contextual’ approaches.

  • Presents an updated introduction and overview of the principles and practice of cognitive analytic therapy (CAT).
  • Updates the first edition with developments from the last decade, in which CAT theory has deepened and the approach has been applied to new patient groups and extended far beyond its roots.
  • Includes detailed, applicable ‘how to’ descriptions of CAT in practice.
  • Includes references to CAT published works and suggestions for further reading within each chapter.
  • Includes a glossary of terms and several appendices containing the CAT Psychotherapy File; a summary of CAT competences extracted from Roth and Pilling; the Personality Structure Questionnaire; and a description of repertory grid basics and their use in CAT.
  • Co-written by the creator of the CAT model, Anthony Ryle, in collaboration with leading CAT practitioner, trainer, and researcher, Ian B. Kerr.

Introducing Cognitive Analytic Therapy is the definitive book for CAT practitioners and CAT trainees at skills, practitioner, and psychotherapy levels. It should also be of considerable interest and relevance to mental health professionals of all orientations, including clinical psychologists, psychiatrists, counselors, mental health nurses, to those working in forensic and various institutional settings, and to a range of other health care and social work professionals.