Source: Marks, S. (2017) "Psychotherapy in Historical Perspective," History of the Human Sciences, 30(2), 3–16.
Tags: psychotherapy, history of psychology, psy-disciplines, clinical epistemology, therapeutic relationship, historiography, moral treatment, CBT, integrative therapy
Difficulty: Intermediate | Prerequisites: Basic familiarity with major schools of psychology (psychoanalysis, behaviourism, humanistic psychology). Some awareness of the distinction between psychiatry and psychotherapy is helpful.
This article is an introduction to a special issue of History of the Human Sciences focused on the history of psychotherapy. It sits at the intersection of the history of science, the philosophy of mind, and clinical psychology. The core argument is that historians have largely neglected psychotherapy as a subject, even though clinicians, critics, and social theorists have all used history to make claims about what therapy is and what it should do. Understanding the historical and political context in which therapies developed matters because it reveals that therapeutic approaches are never "value-free" techniques; they carry assumptions about the mind, the self, and society. If you are studying the psy-disciplines, this material connects the dots between therapeutic practice and broader social, political, and ethical questions.
Psychotherapy has been interpreted in radically different ways, from ancient soul-healing to modern technology of self-regulation, yet historians have paid surprisingly little attention to how most therapeutic approaches developed. This neglect makes therapies look like neutral scientific tools when they are shaped by social, economic, and political forces. The article maps out how history has been used (and misused) to legitimise or critique psychotherapy.
Psychotherapy
A broad umbrella term coined in the late 19th century, covering a wide range of practices aimed at treating psychological distress through interpersonal or cognitive means. The term now shelters many different, sometimes contradictory, theoretical traditions.
Think of it as: any structured "talking" or relational intervention for mental health, but what counts as psychotherapy varies enormously depending on who you ask.
Psy-disciplines
A collective label for the professional fields of psychology, psychiatry, psychotherapy, and psychoanalysis. Used by historians and sociologists (especially Nikolas Rose) to group these professions together when analysing their social influence.
In simple terms, this means: all the professional fields that claim authority over the mind, behaviour, and mental health.
Clinical epistemology
The study of how clinical professions (like psychotherapy) produce, validate, and justify their knowledge claims, including what counts as "evidence" or "science" in a given therapeutic tradition.
Think of it as: asking "how do therapists know what they know, and why do they trust it?"
Integration / eclecticism (in psychotherapy)
A trend since the 1980s in which therapists draw on multiple theoretical traditions rather than adhering rigidly to one school. "Integrative therapy" blends frameworks deliberately; "eclectic" therapy picks techniques pragmatically from wherever they seem useful.
In simple terms, this means: instead of being purely psychoanalytic or purely behavioural, a therapist mixes and matches approaches to suit the client.
Cognitive Behavioural Therapy (CBT)
A therapy combining cognitive approaches (changing thought patterns) with behavioural techniques (changing actions). Itself a product of integration between two previously separate traditions. CBT's "third wave" further merged it with practices like mindfulness meditation and schema therapy.
Think of it as: the most prominent modern example of therapeutic integration, which has itself continued to absorb new techniques.
Therapeutic relationship
The interpersonal dynamic between therapist and client, widely regarded as central to therapeutic outcomes. Different schools conceptualise it differently: psychoanalysis emphasises transference; humanistic therapy emphasises empathy and unconditional positive regard; some behavioural approaches historically downplayed it.
In simple terms, this means: the quality of the connection between therapist and client, and how that connection is theorised.
Psychotherapy has been cast in at least four fundamentally different ways:
An ancient method of healing, the "care of the soul," traceable to Greek antiquity
A distinctly modern practice born at the end of the 18th century, linked to social coercion and bourgeois values
A technology of autonomy and self-regulation essential to liberal democracies
A form of religious practice dressed up in the language of medical science
These competing definitions are not trivial. Each carries assumptions about what therapy does, whom it serves, and whether it is a force for liberation or control.
The term "psychotherapy" itself was coined in the late 19th century, but practitioners and critics routinely project the concept backwards in time.
By 2004, approximately 30 million Americans (14.3% of the population) had accessed therapy in the preceding two years.
The American Psychological Association estimated 200,000–250,000 psychotherapists in the USA, plus 100,000 counsellors and 50,000 marriage/family therapists, compared with only 41,000 psychiatrists.
In Britain, the NHS launched the Increasing Access to Psychological Therapies (IAPT) initiative in 2008, justified largely by arguments about economic productivity.
These figures show that psychotherapy is not a niche activity. It shapes how millions of people understand themselves and their distress.
By the late 20th century, the sheer breadth of practices called "psychotherapy" alarmed even some practitioners. Jan Ehrenwald (1991) described a field "headed in all directions at once," from Freudian analysis to gestalt therapy, screaming cures, nude marathons, biofeedback, and transcendental meditation.
Since the 1980s, the response has been a move towards integration and eclecticism, an effort to transcend dogmatic adherence to any single school.
CBT is itself a product of integration (cognitive + behavioural). Its "third wave" incorporated mindfulness, schema therapy, and EMDR (Eye Movement Desensitisation and Reprocessing).
Integration raises important questions: what happens when you gather competing models of mind and behaviour under one roof? The umbrella term "psychotherapy" can conceal deep ontological disagreements between approaches.
This rapprochement contrasts sharply with the bitter clashes of the mid-20th century, when psychoanalysts and behaviourists were barely on speaking terms.
Historians have paid far less attention to psychotherapy than to psychiatry, despite therapy's enormous societal reach.
Clinicians have used history enthusiastically, but often to legitimise and celebrate their own profession rather than to interrogate it critically.
When the historical development of a therapy is obscured, it can appear to be a neutral, value-free technique that emerged outside of any social or political context. This is rarely the case.
There are ethical implications: when a therapy carries significant authority (backed by the state, for example), transparency about its origins and assumptions becomes a matter of public concern.
The IAPT programme in Britain is a concrete example of how psychotherapy intersects with politics. The programme was justified by economic arguments (getting people back to work), not purely clinical ones. Understanding this context changes how you evaluate the programme's priorities and limitations.
Students often assume psychotherapy is a single, unified discipline. It is not. The term covers hundreds of distinct approaches with fundamentally different models of the mind.
Students sometimes treat CBT as though it has always existed in its current form. CBT is itself a historical product of integration between cognitive and behavioural traditions, and it continues to evolve.
It is common to assume that psychotherapy is purely a scientific enterprise. Many of its traditions have roots in philosophy, religion, and rhetoric, and the criteria for what counts as "evidence" have shifted significantly over time.
Students often conflate psychiatry and psychotherapy. Psychiatry is a medical specialty (with prescribing authority); psychotherapy is a broader field practised by psychologists, counsellors, social workers, and others, as well as some psychiatrists.
⚠️ The distinction between psychiatry and psychotherapy, and the relative scale of each profession, is frequently tested.
⚠️ Know the key dates: the term "psychotherapy" was coined in the late 19th century; integration/eclecticism rose from the 1980s; IAPT launched in 2008.
⚠️ Be prepared to explain why the history of psychotherapy matters ethically, not just intellectually. The argument about transparency and authority is central.
⚠️ The idea that "psychotherapy" acts as a gloss concealing ontological differences is a recurring exam theme.
True or false: The term "psychotherapy" has been in use since ancient Greece.
Fill in the blank: By 2004, approximately ____% of the American population had accessed therapy in the previous two years.
True or false: CBT was always a unified approach from its inception.
Fill in the blank: The trend since the 1980s towards drawing on multiple therapeutic traditions is known as _______ and _______.
True or false: Historians have paid more attention to psychotherapy than to psychiatry.
Q: Why does Marks argue that the history of psychotherapy has been neglected, and what are the consequences of that neglect?
A: Marks argues that historians have largely focused on psychiatry and psychoanalysis while overlooking the development of most other therapeutic approaches. The consequence is that therapies appear to be value-free, scientifically neutral techniques, when in reality they were shaped by social, economic, and political forces. This has ethical implications for transparency, particularly where therapies are backed by state authority.
Q: What is meant by the claim that "psychotherapy" acts as a "gloss"?
A: The umbrella term "psychotherapy" provides a shared professional label for practitioners who may hold fundamentally incompatible views about the mind, behaviour, and the nature of healing. By sheltering all these approaches under one word, the term conceals the ontological disagreements and historical conflicts between them.
Q: How does the rise of integration and eclecticism since the 1980s contrast with earlier professional dynamics?
A: Earlier decades (especially the 1950s) were marked by fierce clashes between schools, such as psychoanalysis and behaviourism, and even internal feuds within psychoanalysis. Since the 1980s, there has been a move towards dialogue and pragmatic blending of approaches, exemplified by CBT's "third wave" and the rise of integrative therapy. This rapprochement is unprecedented, though many clinicians still identify strongly with specific traditions.
Q: Give two examples showing that psychotherapy is shaped by political or economic forces, not just clinical evidence.
A: (1) Britain's IAPT programme was justified primarily by economic arguments about improving national productivity, not purely by clinical outcomes. (2) Erwin Stransky's SAR therapy in interwar Vienna was designed explicitly to reflect a hierarchical, authoritarian political worldview within the consulting room.
This material connects directly to the study of abnormal psychology and clinical practice: understanding why certain therapies dominate (e.g. CBT in the NHS) requires grasping the political and historical forces behind their adoption, not just their clinical evidence base. It also links to the philosophy of science, particularly questions about what counts as "evidence" in psychology and how those standards have shifted. If you are studying social psychology, the idea that therapy shapes how people understand themselves (not just how they are treated) is a recurring theme.
Related Terms / Search Tags: psychotherapy history, psy-disciplines, clinical epistemology, history of CBT, therapeutic integration, eclecticism, IAPT, history of mental health, philosophy of psychotherapy, historiography of psychology, moral treatment, psychiatry vs psychotherapy