In the first wave of psychotherapy people like Sigmund Freud and John Bowlby theorised that if people could understand where their behaviours were originating they could change and redirect their lives. They saw these drives as often being “unconscious” and concluded they had been formed from early relationships with parents. The main objective of this treatment was to help patients achieve “insight”.

Insight is understanding and recognising where these unconscious drives come from and being aware when they are ‘triggered’ so that one can resist automatic thought and behavioural patterns and thus choose to respond differently. Some people felt that these therapies took too long and were ineffective.

In the second wave of therapies, people like Albert Ellis and Aaron Beck decided that it mattered less where a particular behaviour was coming from as how one could change it. Thoughts and behaviours were thought of as being able to be reprogrammed through exercises and practice.

Ellis had practised psychoanalysis for six years and experienced it to be less effective than what he calls the ‘sensible philosophies’ he had been previously using to reduce emotional upsets and increase sense of fulfilment in life.

For Ellis, the problem with the first wave of therapies lied in their obsession about people’s early histories and therefore the ignorance of the beliefs people use to seriously upset themselves about their life events. On the basis of several ancient philosophies including those of the Asians, Confucius, Guatama Buddha, Lao-Tsu, Epicurus, Epictetus, Marcus Aurelius and some modern philosophies such as the likes of Spinoza, Kant, Dewey, Santayana and Russell, he founded the Rational Emotive Behaviour Therapy (REBT) in 1955. Others in this school like Richard Bandler and John Grinder combined goal setting and hypnotherapy into a results oriented treatment called Neuro-linguistic Programming(NLP).

REBT in particular was the first of the cognitive-behaviour therapies that focused on thinking, feelings, and actions as the main sources of ’emotional’ disturbances which called for an attitude change to reduce disturbed emotions and behaviours. Bandler and Ellis were quite blunt in their dismissal of ‘insight’ saying that the only thing that mattered was that someone feels happier, not whether they understood why. These were very practically oriented therapies that sought to work quickly and effectively.

In the latest wave of therapies focus seems to have switched from the past and the present to the future. Therapies grounded in empirical studies like Positive Psychology and Acceptance and Commitment Therapy (ACT) spend more time looking forward asking people to identify where they are going. Dr. Martin Seligman viewed as the father of contemporary Positive Psychology, argued that the field of psychology had unduly focused on the negative aspects of our life experience. “Before World War II, psychology had three distinct missions: curing mental illness, making the lives of all people more productive and fulfilling, and identifying and nurturing high talent,” and shortly after World War II this focus shifted to primarily treating mental illness, Seligman explains. Consequently, having studied ‘learned helplessness’ to be a psychological condition in his experiments, Seligman in collaboration with Christopher Peterson went onto create Character Strengths and Virtues, intended to serve as the positive counterpart to Diagnostic and Statistical Manual of Mental Disorders (DSM), which highlights making use of non-hierarchical signature strengths to contribute towards happiness rather than defining happiness as a lack of disorder.

The idea is that if we have a clear road map of where we are going we will find it easier to see if our behaviours are in line with these goals.

They are also trying to help people transcend their problems rather than being so focussed on specific symptoms, as the second wave therapies inherently were. At the same time, these therapies also seem to be trying to carry over some of the aspects of the practical second wave therapies too so they also try and offer immediate symptomatic relief.

Working in a primary care setting we tend to be on the front line of people’s mental health problems. We are the place that people come to when there is a crisis so it is perhaps easy to understand that we would have a bias towards the second and third wave of treatments as our priority is to put the fire out and start rebuilding.

This isn’t to say that the first wave of therapies don’t have their place. When someone is out of the crisis and back on track, there are some aspects of interpersonal relationships which are very well addressed by those first wave therapies.

It is common place to compare all these psychological developments with each other, but perhaps we could all take a cue from positive psychology and see that we have a variety of powerful tools at hand. Whilst some may be more appropriate and effective at different stages of treatment, this does not mean other therapies are not helpful nor does it take away from their individual value.

Robin Lefever

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