135-419: Eye movement desensitization and reprocessing ( EMDR ) is a form of psychotherapy that is a recommended treatment for post-traumatic stress disorder (PTSD), but remains controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as PTSD. EMDR involves focusing on traumatic memories in
270-434: A history of exposure to early life developmentally adverse interpersonal trauma such as sexual abuse, physical abuse, violence, traumatic losses or other significant disruption or betrayal of the child's relationships with primary caregivers, which has been postulated as an etiological basis for complex traumatic stress disorders. Diagnosis, treatment planning and outcome are always relational. Since CPTSD or DTD in children
405-530: A medical model and those based on a humanistic model . In the medical model, the client is seen as unwell and the therapist employs their skill to help the client back to health. The extensive use of the DSM-IV , the diagnostic and statistical manual of mental disorders in the United States is an example of a medically exclusive model. The humanistic or non-medical model in contrast strives to depathologise
540-444: A purple hat therapy because any effectiveness is provided by the underlying therapy (or the standard treatment), not from EMDR's distinctive features. There is some evidence that EMDR can be as effective as trauma focused cognitive behavioral therapy (TF-CBT) for treating PTSD, though concerns have been raised about the poor quality of the underlying studies. In a 2021 systematic review of 13 studies, clients had mixed perceptions of
675-405: A 2016, meta-analysis, four out of eight EMDR studies resulted in statistical significance, indicating the potential effectiveness of EMDR in treating certain conditions. Additionally, subjects from two of the studies continued to benefit from the treatment months later. Seven of the studies that employed psychometric tests showed that EMDR led to a reduction in depression symptoms compared to those in
810-631: A consequence of this aspect of CPTSD, when some adults with CPTSD become parents and confront their own children's attachment needs, they may have particular difficulty in responding sensitively especially to their infants' and young children's routine distress — such as during routine separations, despite these parents' best intentions and efforts. Although the great majority of survivors do not abuse others, this difficulty in parenting may have adverse repercussions for their children's social and emotional development if parents with this condition and their children do not receive appropriate treatment. Thus,
945-786: A criterion for reimbursement. Cognitive behavioral therapy , prolonged exposure therapy and dialectical behavioral therapy are well established forms of evidence-based intervention. These treatments are approved and endorsed by the American Psychiatric Association , the American Psychological Association and the Veteran's Administration. While standard evidence-based treatments may be effective for treating standard post-traumatic stress disorder , treating complex PTSD often involves addressing interpersonal relational difficulties and
1080-636: A diagnosis of Enduring Personality Change after Catastrophic Event ( EPCACE ), which was an ancestor of CPTSD. Healthdirect Australia (HDA) and the British National Health Service (NHS) have also acknowledged CPTSD as mental disorder. However, the American Psychiatric Association (APA) has not included CPTSD in the Diagnostic and Statistical Manual of Mental Disorders . It has nonetheless proposed: Disorders of Extreme Stress – not otherwise specified ( DESNOS ) since
1215-502: A different set of symptoms which make it more challenging to treat. For example, "Limited evidence suggests that predominantly cognitive behavioral therapy treatments are effective, but do not suffice to achieve satisfactory end states, especially in Complex PTSD populations." It is widely acknowledged by those who work in the trauma field that there is no one single, standard, 'one size fits all' treatment for complex PTSD. There
1350-518: A different set of symptoms which make it more challenging to treat. The utility of PTSD-derived psychotherapies for assisting children with CPTSD is uncertain. This area of diagnosis and treatment calls for caution in use of the category CPTSD. Julian Ford and Bessel van der Kolk have suggested that CPTSD may not be as useful a category for diagnosis and treatment of children as a proposed category of developmental trauma disorder (DTD). According to Courtois and Ford, for DTD to be diagnosed it requires
1485-459: A differentiation between the diagnostic category of CPTSD and that of PTSD has been suggested. PTSD can exist alongside CPTSD; however a sole diagnosis of PTSD often does not sufficiently encapsulate the breadth of symptoms experienced by those who have experienced prolonged traumatic experience, and therefore CPTSD extends beyond the PTSD parameters. Continuous traumatic stress disorder (CTSD), which
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#17327729388111620-417: A few years later, psychiatrist Aaron T. Beck developed a form of psychotherapy known as cognitive therapy . Both of these included relatively short, structured and present-focused techniques aimed at identifying and changing a person's beliefs, appraisals and reaction-patterns, by contrast with the more long-lasting insight-based approach of psychodynamic or humanistic therapies. Beck's approach used primarily
1755-457: A large variety of individual and social suffering. 25% of those diagnosed with BPD have no known history of childhood neglect or abuse and individuals are six times as likely to develop BPD if they have a relative who was diagnosed so compared to those who do not. One conclusion is that there is a genetic predisposition to BPD unrelated to trauma. Researchers conducting a longitudinal investigation of identical twins found that "genetic factors play
1890-408: A less medical or "professional" focus. Somatotherapy refers to the use of physical changes as injuries and illnesses, and sociotherapy to the use of a person's social environment to effect therapeutic change. Psychotherapy may address spirituality as a significant part of someone's mental / psychological life, and some forms are derived from spiritual philosophies, but practices based on treating
2025-439: A loved one is inherently traumatic. If a traumatic event was life-threatening , but did not result in a death , then it is more likely that the survivor will experience post-traumatic stress symptoms. If a person dies, and the survivor was close to the person who died, then it is more likely that symptoms of grief will also develop. When the death is of a loved one, and was sudden or violent, then both symptoms often coincide. This
2160-593: A major role in individual differences of borderline personality disorder features in Western society." A 2014 study published in the European Journal of Psychotraumatology was able to compare and contrast CPTSD, PTSD, and borderline personality disorder and found that it could distinguish between individual cases of each and when it was co-morbid, arguing for a case of separate diagnoses for each. BPD may be confused with CPTSD by some without proper knowledge of
2295-559: A manner similar to exposure therapy while engaging in side-to-side eye movements or other forms of bilateral stimulation. It is also used for some other psychological conditions. EMDR is recommended for the treatment of PTSD by various government and medical bodies citing varying levels of evidence, including the World Health Organization , the UK National Institute for Health and Care Excellence ,
2430-451: A model with three phases. Not every case will be the same, but the first of phase will emphasize the acquisition and strengthening of adequate coping strategies as well as addressing safety issues and concerns. The next phase would focus on decreasing avoidance of traumatic stimuli and applying coping skills learned in phase one. The care provider may also begin challenging assumptions about the trauma and introducing alternative narratives about
2565-413: A multi-modal approach. It has been suggested that treatment for complex PTSD should differ from treatment for PTSD by focusing on problems that cause more functional impairment than the PTSD symptoms. These problems include emotional dysregulation, dissociation , and interpersonal problems. Six suggested core components of complex trauma treatment include: The above components can be conceptualized as
2700-415: A new diagnosis of Complex Post-Traumatic Stress Disorder (CPTSD) was needed to describe the symptoms and psychological and emotional effects of long-term trauma. The World Health Organization (WHO)'s International Statistical Classification of Diseases has included CPTSD since its eleventh revision that was published in 2018 and came into effect in 2022 ( ICD-11 ). The previous edition ( ICD-10 ) proposed
2835-493: A period of internship which is only open to physicians or titulars of a master's degree in psychology or psychoanalysis. Austria and Switzerland (2011) have laws that recognize multi-disciplinary functional approaches. In the United Kingdom, the government and Health and Care Professions Council considered mandatory legal registration but decided that it was best left to professional bodies to regulate themselves, so
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#17327729388112970-759: A person change behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's well-being and mental health , to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills . Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Certain types of psychotherapy are considered evidence-based for treating some diagnosed mental disorders ; other types have been criticized as pseudoscience . There are hundreds of psychotherapy techniques, some being minor variations; others are based on very different conceptions of psychology. Most involve one-to-one sessions, between
3105-684: A primary treatment for numerous disorders. A "third wave" of cognitive and behavioral therapies developed, including acceptance and commitment therapy and dialectical behavior therapy , which expanded the concepts to other disorders and/or added novel components and mindfulness exercises. However the "third wave" concept has been criticized as not essentially different from other therapies and having roots in earlier ones as well. Counseling methods developed include solution-focused therapy and systemic coaching . Postmodern psychotherapies such as narrative therapy and coherence therapy do not impose definitions of mental health and illness, but rather see
3240-493: A pseudoscientific purple hat therapy (i.e., only as effective as its underlying therapeutic methods without any contribution from its distinctive add-ons). EMDR adds a number of non-scientific practices to exposure therapy . EMDR is classified as one of the "power therapies" alongside thought field therapy , Emotional Freedom Techniques and others – so called because these therapies are marketed as being superior to established therapies which preceded them. EMDR
3375-621: A psychotherapy permit by completing certain educational and practice requirements; their professional oversight is provided by their own professional orders. Some other professionals who were practising psychotherapy before the current system came into force continue to hold psychotherapy permits alone. On 1 July 2019, Ontario's Missing Persons Act came into effect, with the purpose of giving police more power to investigate missing persons. It allows police to require (as opposed to permit) health professionals, including psychotherapists, to share otherwise confidential documents about their client, if there
3510-553: A result of the intensity of the traumatic bond — in which someone becomes tightly biochemically bound to someone who abuses them and the responses they learned to survive, navigate and deal with the abuse they suffered then become automatic responses, embedded in their personality over the years of trauma — a normal reaction to an abnormal situation. While standard evidence-based treatments may be effective for treating post-traumatic stress disorder , treating complex PTSD often involves addressing interpersonal relational difficulties and
3645-623: A similar restriction on the title "psychotherapist", which may only be used by professionals who have gone through a post-graduate training in psychotherapy and then applied for a licence, issued by the National Board of Health and Welfare . Legislation in France restricts the use of the title "psychotherapist" to professionals on the National Register of Psychotherapists, which requires a training in clinical psychopathology and
3780-453: A small number of sessions over a few weeks or months may be classified as brief therapy (or short-term therapy), others, where regular sessions take place for years, may be classified as long-term. Some practitioners distinguish between more "uncovering" (or " depth ") approaches and more "supportive" psychotherapy. Uncovering psychotherapy emphasizes facilitating the client's insight into the roots of their difficulties. The best-known example
3915-469: A specific psychotherapy; or (in some cases) academic or scientifically trained professionals. In addition to the training, many countries require psychotherapist to register with a professional body in order to be permitted to offer services. Psychiatrists are trained first as physicians, and as such they may prescribe prescription medication ; and specialist psychiatric training begins after medical school in psychiatric residencies: however, their specialty
4050-456: A technique of " evenly-suspended attention " to avoid becoming overly focused on specific details during sessions, as he believed extensive note-taking could interfere with the therapeutic process. This tension between accurate documentation and the therapeutic relationship continued to shape early discussions on clinical documentation. As the field of psychotherapy grew, standardized note-taking practices emerged to promote consistency and improve
4185-418: A trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive beliefs related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure or (d) homework." Shapiro was criticized for repeatedly increasing the length and expense of training and certification, allegedly in response to
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4320-551: A year-long internship at an accredited psychiatric institution, six months of clinical work at an outpatient facility, 600 hours of supervised psychotherapy in an outpatient setting, and at least 600 hours of theoretical seminars. Social workers may complete the specialist training for child and teenage clients. Similarly in Italy, the practice of psychotherapy is restricted to graduates in psychology or medicine who have completed four years of recognised specialist training. Sweden has
4455-804: Is a stress-related mental disorder generally occurring in response to complex traumas , i.e., commonly prolonged or repetitive exposures to a series of traumatic events , within which individuals perceive little or no chance to escape. In the ICD-11 classification, C-PTSD is a category of post-traumatic stress disorder (PTSD) with three additional clusters of significant symptoms: emotional dysregulation , negative self-beliefs (e.g., feelings of shame, guilt, failure for wrong reasons), and interpersonal difficulties. Examples of C-PTSD's symptoms are prolonged feelings of terror, worthlessness, helplessness, distortions in identity or sense of self , and hypervigilance . C-PTSD's symptoms share some similarities with
4590-463: Is a house of card built on nothing". EMDR has been characterised as a modern-day mesmerism , as the therapies have striking resemblances, from the sole inventor who devises the system while out walking, to the large business empire built on exaggerated claims. In the case of EMDR, these have included the suggestions that EMDR could drain violence from society and be useful in treating cancer and HIV/AIDS . Psychology historian Luis Cordón has compared
4725-454: Is a lack of research to classify these approaches as evidence based. Some of these additional interventions and modalities include: Though acceptance of the idea of complex PTSD has increased with mental health professionals, the fundamental research required for the proper validation of a new disorder is insufficient as of 2013. The disorder was proposed under the name DES-NOS (Disorder of Extreme Stress Not Otherwise Specified) for inclusion in
4860-514: Is a long term mental health condition which is often difficult and relatively expensive to treat and often requires several years of psychotherapy, modes of intervention and treatment by highly skilled, mental health professionals who specialize in trauma informed modalities designed to process and integrate childhood trauma memories for the purposes of mitigating symptoms and improving the survivor's quality of life. Delaying therapy for people with complex PTSD, whether intentionally or not, can exacerbate
4995-540: Is a regulated activity which is restricted to psychologists, medical doctors, and holders of a psychotherapy permit issued by the Ordre des psychologues du Québec, the Quebec order of psychologists. Members of certain specified professions, including social workers , couple and family therapists, occupational therapists , guidance counsellors , criminologists , sexologists , psychoeducators , and registered nurses may obtain
5130-485: Is also no clear consensus regarding the best treatment among the greater mental health professional community which included clinical psychologists, social workers, licensed therapists (MFTs) and psychiatrists. Although most trauma neuroscientifically informed practitioners understand the importance of utilizing a combination of both 'top down' and 'bottom up' interventions as well as including somatic interventions (sensorimotor psychotherapy or somatic experiencing or yoga) for
5265-511: Is classical psychoanalysis. Supportive psychotherapy by contrast stresses strengthening the client's coping mechanisms and often providing encouragement and advice, as well as reality-testing and limit-setting where necessary. Depending on the client's issues and situation, a more supportive or more uncovering approach may be optimal. These psychotherapies, also known as " experiential ", are based on humanistic psychology and emerged in reaction to both behaviorism and psychoanalysis, being dubbed
5400-425: Is completed at a postgraduate level, often at a master's degree (or doctoral) level, over four years, with significant supervised practice and clinical placements. Mental health professionals that choose to specialize in psychotherapeutic work also require a program of continuing professional education after basic professional training. A listing of the extensive professional competencies of a European psychotherapist
5535-500: Is in mental disorders or forms of mental illness. Clinical psychologists have specialist doctoral degrees in psychology with some clinical and research components. Other clinical practitioners, social workers , mental health counselors, pastoral counselors, and nurses with a specialization in mental health, also often conduct psychotherapy. Many of the wide variety of psychotherapy training programs and institutional settings are multi-professional. In most countries, psychotherapy training
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5670-420: Is likely in children exposed to community violence. For CPTSD to manifest traumatic grief, the violence would occur under conditions of captivity, loss of control and disempowerment, coinciding with the death of a friend or loved one in life-threatening circumstances. This again is most likely for children and stepchildren who experience prolonged domestic or chronic community violence that ultimately results in
5805-499: Is more likely that she developed EMDR out of her experience with neuro-linguistic programming . Fuelled by marketing hype, EMDR was taken up enthusiastically by therapists even while scientists remained skeptical. By 2012 more than 60,000 therapists had been trained in its use. Psychotherapy Psychotherapy (also psychological therapy , talk therapy , or talking therapy ) is the use of psychological methods, particularly when based on regular personal interaction , to help
5940-413: Is neither included in the diagnosis of dissociative disorder nor in that of PTSD in the current DSM-5 (2013). Individuals with Complex PTSD also demonstrate lasting personality disturbances with a significant risk of revictimization . Six clusters of symptoms have been suggested for diagnosis of CPTSD: Experiences in these areas may include: CPTSD was considered for inclusion in the DSM-IV but
6075-547: Is often caused by chronic maltreatment, neglect or abuse in a care-giving relationship the first element of the biopsychosocial system to address is that relationship. This invariably involves some sort of child protection agency. This both widens the range of support that can be given to the child but also the complexity of the situation, since the agency's statutory legal obligations may then need to be enforced. A number of practical, therapeutic and ethical principles for assessment and intervention have been developed and explored in
6210-405: Is often dubbed as a "talking therapy" or "talk therapy", particularly for a general audience, though not all forms of psychotherapy rely on verbal communication . Children or adults who do not engage in verbal communication (or not in the usual way) are not excluded from psychotherapy; indeed some types are designed for such cases. The American Psychological Association adopted a resolution on
6345-555: Is often regarded as crucial to psychotherapy. Common factors theory addresses this and other core aspects thought to be responsible for effective psychotherapy. Sigmund Freud (1856–1939), a Viennese neurologist who studied with Jean-Martin Charcot in 1885, is often considered the father of modern psychotherapy. His methods included analyzing his patient's dreams in search of important hidden insights into their unconscious minds. Other major elements of his methods, which changed throughout
6480-463: Is probably the first journal to use the term. Thus psychotherapy initially meant "the treatment of disease by psychic or hypnotic influence, or by suggestion". Sigmund Freud visited the Nancy School and his early neurological practice involved the use of hypnotism. However following the work of his mentor Josef Breuer —in particular a case where symptoms appeared partially resolved by what
6615-469: Is reason to believe their client is missing. Some have expressed concern that this legislation undermines psychotherapy confidentiality and could be abused maliciously by police, while others have praised the act for how it respects privacy and includes checks and balances. Psychotherapy can be said to have been practiced through the ages, as medics, philosophers, spiritual practitioners and people in general used psychological methods to heal others. In
6750-478: Is the human givens approach, introduced in 1998–99. It is a solution-focused intervention based on identifying emotional needs—such as for security, autonomy and social connection—and using various educational and psychological methods to help people meet those needs more fully or appropriately. Insight-oriented psychotherapies focus on revealing or interpreting unconscious processes. Most commonly referring to psychodynamic therapy , of which psychoanalysis
6885-1049: Is the child's caregiver who causes the trauma. The diagnosis of PTSD does not take into account how the developmental stages of children may affect their symptoms and how trauma can affect a child's development. The term developmental trauma disorder ( DTD ) has been proposed as the childhood equivalent of CPTSD. This developmental form of trauma places children at risk for developing psychiatric and medical disorders. Bessel van der Kolk explains DTD as numerous encounters with interpersonal trauma such as physical assault, sexual assault, violence or death. It can also be brought on by subjective events such as abandonment, betrayal, defeat or shame. Repeated traumatization during childhood leads to symptoms that differ from those described for PTSD. Cook and others describe symptoms and behavioral characteristics in seven domains: Adults with CPTSD have sometimes experienced prolonged interpersonal traumatization beginning in childhood, rather than, or as well as, in adulthood. These early injuries interrupt
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#17327729388117020-442: Is the goal of existential therapy . Existential therapy is in turn philosophically associated with phenomenology . Person-centered therapy , also known as client-centered, focuses on the therapist showing openness, empathy and "unconditional positive regard", to help clients express and develop their own self . Humanistic Psychodrama (HPD) is based on the human image of humanistic psychology. So all rules and methods follow
7155-480: Is the oldest and most intensive form, these applications of depth psychology encourage the verbalization of all the patient's thoughts, including free associations , fantasies, and dreams, from which the analyst formulates the nature of the past and present unconscious conflicts which are causing the patient's symptoms and character problems. Complex post-traumatic stress disorder Complex post-traumatic stress disorder ( CPTSD , sometimes hyphenated C-PTSD )
7290-561: Is typically undertaken in a series of sessions with a trained therapist. The number of sessions can vary depending on the progress made. A typical EMDR therapy session lasts from 60 to 90 minutes. The person being treated is asked to recall an image, phrase, and emotion that represent a level of distress related to a trigger while generating one of several types of bilateral sensory input, such as side-to-side eye movements or hand tapping. The 2013 World Health Organization practice guideline says that "Like cognitive behavioral therapy (CBT) with
7425-462: Is well established that the development of dissociative identity disorder among women is often associated with early childhood sexual abuse. One of the current challenges faced by many survivors of complex trauma (or developmental trauma disorder) is support for treatment since many of the current therapies are relatively expensive and not all forms of therapy or intervention are reimbursed by insurance companies who use evidence-based practice as
7560-633: Is what currently is referred to in the field of traumatology as 'trauma informed' which has become the rationale which has influenced the development of new treatments specifically targeting those with childhood developmental trauma. Martin Teicher, a Harvard psychiatrist and researcher, has suggested that the development of specific complex trauma related symptomatology (and in fact the development of many adult onset psychopathologies) may be connected to gender differences and at what stage of childhood development trauma, abuse or neglect occurred. For example, it
7695-462: The DSM-IV but was rejected by members of the Diagnostic and Statistical Manual of Mental Disorders (DSM) committee of the American Psychiatric Association for lack of sufficient diagnostic validity research. Chief among the stated limitations was a study which showed that 95% of individuals who could be diagnosed with the proposed DES-NOS were also diagnosable with PTSD, raising questions about
7830-423: The DSM-IV , which is a mental disorder close to CPTSD. The diagnosis of PTSD was originally given to adults who had suffered because of a single-event trauma (e.g., during a war , rape ). However, the situation for many children is quite different. Children can suffer chronic trauma such as maltreatment, family violence, dysfunction, or a disruption in attachment to their primary caregiver. In many cases, it
7965-734: The Professional Standards Authority for Health and Social Care (PSA) launched an Accredited Voluntary Registers scheme. Counseling and psychotherapy are not protected titles in the United Kingdom. Counsellors and psychotherapists who have trained and qualify to a certain standard (usually a level 4 Diploma) can apply to be members of the professional bodies who are listed on the PSA Accredited Registers. In some states, counselors or therapists must be licensed to use certain words and titles on self-identification or advertising. In some other states,
8100-459: The Western tradition , by the 19th century, a moral treatment movement (then meaning morale or mental) developed based on non-invasive non-restraint therapeutic methods. Another influential movement was started by Franz Mesmer (1734–1815) and his student Armand-Marie-Jacques de Chastenet, Marquis of Puységur (1751–1825). Called Mesmerism or animal magnetism, it would have a strong influence on
8235-923: The human givens approach. A survey of over 2,500 US therapists in 2006 revealed the most utilized models of therapy and the ten most influential therapists of the previous quarter-century. The practice of documenting psychotherapy sessions originated in the late 19th century with early pioneers in psychoanalysis . Sigmund Freud , often referred to as the father of psychoanalysis, was known for his meticulous record-keeping, which he used to study patient progress and deepen his understanding of human psychology. In his correspondence with Wilhelm Fleiss , Freud described his habit of taking daily notes to track his patients' progress, and he sometimes shared his observations with colleagues to discuss emerging theories and techniques. While Freud valued thorough documentation, he also recognized its potential drawbacks. In his Recommendations to Physicians Practicing Psycho-Analysis , he suggested
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#17327729388118370-542: The psyche 's conscious / unconscious influence on external relationships and the self. Sessions tended to number into the hundreds over several years. Behaviorism developed in the 1920s, and behavior modification as a therapy became popularized in the 1950s and 1960s. Notable contributors were Joseph Wolpe in South Africa, M.B. Shapiro and Hans Eysenck in Britain, and John B. Watson and B.F. Skinner in
8505-566: The socratic method , and links have been drawn between ancient stoic philosophy and these cognitive therapies. Cognitive and behavioral therapy approaches were increasingly combined and grouped under the umbrella term cognitive behavioral therapy (CBT) in the 1970s. Many approaches within CBT are oriented towards active/directive yet collaborative empiricism (a form of reality-testing), and assessing and modifying core beliefs and dysfunctional schemas. These approaches gained widespread acceptance as
8640-468: The therapeutic relationship . However, the first stage of establishing safety must always include a thorough evaluation of the surroundings, which might include abusive relationships. This stage might involve the need for major life changes for some patients. Securing a safe environment requires strategic attention to the patient's economic and social ecosystem. The patient must become aware of her own resources for practical and emotional support as well as
8775-564: The "third force". They are primarily concerned with the human development and needs of the individual, with an emphasis on subjective meaning, a rejection of determinism , and a concern for positive growth rather than pathology . Some posit an inherent human capacity to maximize potential, "the self-actualizing tendency"; the task of therapy is to create a relational environment where this tendency might flourish. Humanistic psychology can, in turn, be rooted in existentialism —the belief that human beings can only find meaning by creating it. This
8910-688: The 1990 Strasbourg Declaration on Psychotherapy, which is dedicated to establishing an independent profession of psychotherapy in Europe, with pan-European standards. The EAP has already made significant contacts with the European Union & European Commission towards this end. Given that the European Union has a primary policy about the free movement of labor within Europe, European legislation can overrule national regulations that are, in essence, forms of restrictive practices. In Germany,
9045-565: The 2013 World Health Organization practice guideline: "This therapy [EMDR] is based on the idea that negative thoughts, feelings and behaviours are the result of unprocessed memories." This proposed mechanism has no known scientific basis. Several other possible mechanisms have been proposed: Bilateral stimulation is a generalization of the left and right repetitive eye movement technique first used by Shapiro. Alternative stimuli include auditory stimuli that alternate between left and right speakers or headphones and physical stimuli such as tapping of
9180-477: The 21st century there were over a thousand different named psychotherapies—some being minor variations while others are based on very different conceptions of psychology, ethics (how to live) or technique. In practice therapy is often not of one pure type but draws from a number of perspectives and schools—known as an integrative or eclectic approach. The importance of the therapeutic relationship , also known as therapeutic alliance, between client and therapist
9315-543: The American Psychological Association requires its members to adhere to its published Ethical Principles of Psychologists and Code of Conduct . The American Board of Professional Psychology examines and certifies "psychologists who demonstrate competence in approved specialty areas in professional psychology". Regulation of psychotherapy is in the jurisdiction of, and varies among, the provinces and territories. In Quebec , psychotherapy
9450-557: The Australian National Health and Medical Research Council , and the US Departments of Veteran Affairs and Defense . The US National Institute of Medicine found insufficient evidence to recommend EMDR. The American Psychological Association suggests EMDR may be useful for treating adult PTSD. Treatment guidelines note EMDR effectiveness is statistically the same as trauma-focused behavioral therapy, and
9585-620: The Australian National Health and Medical Research Council notes that this may be due to including most of the core elements of cognitive behavioral therapy (CBT). There is debate about how the therapy works and whether it is more effective than other established treatments. The eye movements have been criticized as having no scientific basis. The founder promoted the therapy for the treatment of PTSD, and proponents employed untestable hypotheses to explain negative results in controlled studies. EMDR has been characterized as
9720-638: The Influence of the Mind upon the Body in Health and Disease , in which he also proposed making a science of animal magnetism . Hippolyte Bernheim and colleagues in the " Nancy School" developed the concept of "psychotherapy" in the sense of using the mind to heal the body through hypnotism , yet further. Charles Lloyd Tuckey's 1889 work, Psycho-therapeutics, or Treatment by Hypnotism and Suggestion popularized
9855-462: The United States. Behavioral therapy approaches relied on principles of operant conditioning , classical conditioning and social learning theory to bring about therapeutic change in observable symptoms. The approach became commonly used for phobias , as well as other disorders. Some therapeutic approaches developed out of the European school of existential philosophy . Concerned mainly with
9990-457: The approach, like Fritz and Laura Perls in the creation of Gestalt therapy , as well as Marshall Rosenberg, founder of Nonviolent Communication , and Eric Berne , founder of transactional analysis . Later these fields of psychotherapy would become what is known as humanistic psychotherapy today. Self-help groups and books became widespread. During the 1950s, Albert Ellis originated rational emotive behavior therapy (REBT). Independently
10125-408: The axioms of humanistic psychology. The HPD sees itself as development-oriented psychotherapy and has completely moved away from the psychoanalytic catharsis theory. Self-awareness and self-realization are essential aspects in the therapeutic process. Subjective experiences, feelings and thoughts and one's own experiences are the starting point for a change or reorientation in experience and behavior in
10260-459: The client and therapist, but some are conducted with groups , including families . Psychotherapists may be mental health professionals such as psychiatrists, psychologists, mental health nurses, clinical social workers, marriage and family therapists, or professional counselors. Psychotherapists may also come from a variety of other backgrounds, and depending on the jurisdiction may be legally regulated, voluntarily regulated or unregulated (and
10395-579: The complex writings of existential philosophers (e.g., Søren Kierkegaard , Jean-Paul Sartre , Gabriel Marcel , Martin Heidegger , Friedrich Nietzsche ). The uniqueness of the patient-therapist relationship thus also forms a vehicle for therapeutic inquiry. A related body of thought in psychotherapy started in the 1950s with Carl Rogers . Based also on the works of Abraham Maslow and his hierarchy of human needs , Rogers brought person-centered psychotherapy into mainstream focus. The primary requirement
10530-424: The components of the interaction that actually work. Investigation into EMDR has been characterised by poor-quality studies, rather than tightly-controlled trials that could justify or falsify the mechanisms that have been proposed to support it. Novella writes that the research quantity nevertheless means that EMDR has claimed a place among accepted treatments and is "not likely going away anytime soon, even though it
10665-534: The condition. There is no one treatment which has been designed specifically for use with the adult complex PTSD population (with the exception of component based psychotherapy ) there are many therapeutic interventions used by mental health professionals to treat PTSD. As of February 2017 , the American Psychological Association PTSD Guideline Development Panel (GDP) strongly recommends
10800-407: The confidentiality and narrative depth that are essential to psychotherapy. Mental health professionals continue to explore best practices for balancing structured documentation with the more nuanced narrative elements that are critical in psychotherapy. There are hundreds of psychotherapy approaches or schools of thought. By 1980 there were more than 250; by 1996 more than 450; and at the start of
10935-503: The death of friends and loved ones. The phenomenon of the increased risk of violence and death of stepchildren is referred to as the Cinderella effect . CPTSD may share some symptoms with both PTSD and borderline personality disorder (BPD). However, there is enough evidence to also differentiate CPTSD from borderline personality disorder. It may help to understand the intersection of attachment theory with CPTSD and BPD if one reads
11070-415: The development of a robust sense of self and of others. Because physical and emotional pain or neglect was often inflicted by attachment figures such as caregivers or other siblings, these individuals may develop a sense that they are fundamentally flawed and that others cannot be relied upon. This can become a pervasive way of relating to others in adult life, described as insecure attachment . This symptom
11205-702: The direction of more self-acceptance and satisfaction. Dealing with the biography of the individual is closely related to the sociometry of the group. Gestalt therapy , originally called "concentration therapy", is an existential/experiential form that facilitates awareness in the various contexts of life, by moving from talking about relatively remote situations to action and direct current experience. Derived from various influences, including an overhaul of psychoanalysis, it stands on top of essentially four load-bearing theoretical walls: phenomenological method , dialogical relationship, field-theoretical strategies, and experimental freedom. A briefer form of humanistic therapy
11340-480: The documentation process in psychotherapy. Electronic health records (EHRs) introduced significant benefits, such as enhanced accessibility and organization of patient records. Despite initial concerns about privacy and data security, studies have found that EHRs can increase documentation completeness, which improves information sharing and, ultimately, the quality of patient care. Digital note-taking also introduced new challenges, particularly in terms of maintaining
11475-596: The effect size of EMDR for PTSD is comparable to other evidence-based treatments, but that the strength of evidence was of a low quality, indicating that the effect sizes achieved are associated with substantial uncertainty. A 2018 systematic review found moderate strength of evidence supporting the effectiveness of EMDR in reducing symptoms of PTSD and depression, as well as increasing the likelihood of patients losing their PTSD diagnosis. Many randomized trials of EMDR have been criticized for poor control groups, small sample sizes, and other methodological flaws. It has been called
11610-497: The effectiveness of EMDR therapy. EMDR has been tested on a variety of other mental health conditions with mixed results. Many proposals of EMDR efficacy share an assumption that, as Shapiro posited, when a traumatic or very negative event occurs, information processing of the experience in memory may be incomplete. The trauma causes a disruption of normal adaptive information processing, which results in unprocessed information being dysfunctionally held in memory networks. According to
11745-420: The effectiveness of psychotherapy in 2012 based on a definition developed by American psychologist John C. Norcross : "Psychotherapy is the informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles for the purpose of assisting people to modify their behaviors, cognitions, emotions, and/or other personal characteristics in directions that
11880-451: The effects of ongoing exposure to life threats in high-risk occupations such as police, fire and emergency services . It has also been used to describe ongoing relationship trauma frequently experienced by people leaving relationships which involved intimate partner violence. Traumatic grief or complicated mourning are conditions where trauma and grief coincide. There are conceptual links between trauma and bereavement since loss of
12015-476: The field: Judith Lewis Herman, in her book, Trauma and Recovery , proposed a complex trauma recovery model that occurs in three stages: Herman believes recovery can only occur within a healing relationship and only if the survivor is empowered by that relationship. This healing relationship need not be romantic or sexual in the colloquial sense of "relationship", however, and can also include relationships with friends, co-workers, one's relatives or children, and
12150-468: The following for the treatment of PTSD: The American Psychological Association also conditionally recommends While these treatments have been recommended, there is still a lack of research on the best and most efficacious treatments for complex PTSD. Psychological therapies such as cognitive behavioural therapy, eye movement desensitisation and reprocessing therapy are effective in treating CPTSD symptoms like PTSD, depression and anxiety. For example, in
12285-645: The following opinion of Bessel A. van der Kolk together with an understanding drawn from a description of BPD: Uncontrollable disruptions or distortions of attachment bonds precede the development of post-traumatic stress syndromes. People seek increased attachment in the face of danger. Adults, as well as children, may develop strong emotional ties with people who intermittently harass , beat, and, threaten them. The persistence of these attachment bonds leads to confusion of pain and love. Trauma can be repeated on behavioural, emotional, physiologic , and neuroendocrinologic levels. Repetition on these different levels causes
12420-439: The goal of therapy as something constructed by the client and therapist in a social context. Systemic therapy also developed, which focuses on family and group dynamics—and transpersonal psychology , which focuses on the spiritual facet of human experience. Other orientations developed in the last three decades include feminist therapy , brief therapy , somatic psychology , expressive therapy , applied positive psychology and
12555-507: The human condition. The therapist attempts to create a relational environment conducive to experiential learning and help build the client's confidence in their own natural process resulting in a deeper understanding of themselves. The therapist may see themselves as a facilitator/helper. Another distinction is between individual one-to-one therapy sessions, and group psychotherapy , including couples therapy and family therapy . Therapies are sometimes classified according to their duration;
12690-445: The individual as well as the societal level, "dissociation from the acknowledgement of the severe impact of childhood abuse on the developing brain leads to inadequate provision of services. Assimilation into treatment models of the emerging affective neuroscience of adverse experience could help to redress the balance by shifting the focus from top-down regulation to bottom-up, body-based processing." Complex post trauma stress disorder
12825-476: The individual's ability to develop and preserve a sense of meaning and purpose throughout life, major contributors to the field (e.g., Irvin Yalom , Rollo May ) and Europe ( Viktor Frankl , Ludwig Binswanger , Medard Boss , R.D.Laing , Emmy van Deurzen ) attempted to create therapies sensitive to common "life crises" springing from the essential bleakness of human self-awareness, previously accessible only through
12960-401: The needs of different therapeutic approaches, formats like DAP (Data, Assessment, Plan) and BIRP (Behavior, Intervention, Response, Plan) were introduced. These standardized approaches enabled better communication between providers, facilitated treatment planning, and ensured accountability and continuity of care. The advent of digital tools in the late 20th and early 21st centuries transformed
13095-421: The observed symptoms in borderline personality disorder , dissociative identity disorder , and somatization disorder . Judith Lewis Herman of Harvard University was the first psychiatrist and scholar to conceptualise Complex Post-Traumatic Stress Disorder (CPTSD) as a (new) mental health condition in 1992, within her book Trauma & Recovery and an accompanying article. In 1988, Herman suggested that
13230-756: The participants deem desirable". Influential editions of a work by psychiatrist Jerome Frank defined psychotherapy as a healing relationship using socially authorized methods in a series of contacts primarily involving words, acts and rituals—which Frank regarded as forms of persuasion and rhetoric . Historically, psychotherapy has sometimes meant "interpretative" (i.e. Freudian ) methods, namely psychoanalysis , in contrast with other methods to treat psychiatric disorders such as behavior modification. Some definitions of counseling overlap with psychotherapy (particularly in non-directive client-centered approaches), or counseling may refer to guidance for everyday problems in specific areas, typically for shorter durations with
13365-400: The patient, Bertha Pappenheim , dubbed a " talking cure "—Freud began focusing on conditions that appeared to have psychological causes originating in childhood experiences and the unconscious mind . He went on to develop techniques such as free association , dream interpretation , transference and analysis of the id, ego and superego . His popular reputation as the father of psychotherapy
13500-487: The placebo group. Like EMDR, the other therapies are especially effective for complex trauma related to domestic violence and less effective when the condition is related to experiences of war or childhood sexual abuse. Mindfulness and relaxation is effective for PTSD symptoms, emotion regulation and interpersonal problems for people whose complex trauma is related to sexual abuse. Many commonly used treatments are considered complementary or alternative since there still
13635-417: The popularity of EMDR to that of other cult-like pseudosciences, facilitated communication and thought field therapy . A parody website advertising "sudotherapy" created by a fictional "Fatima Shekel" appeared on the internet in the 1990s. Proponents of EMDR described the website as libelous, since the website contained an image of a pair of shifting eyes following a cat named "Sudo", and "Fatima Shekel" has
13770-578: The practice of psychotherapy for adults is restricted to qualified psychologists and physicians (including psychiatrists) who have completed several years of specialist practical training and certification in psychotherapy. As psychoanalysis, psychodynamic therapy, and cognitive behavioral therapy meet the requirements of German health insurance companies, mental health professionals regularly opt for one of these three specializations in their postgraduate training. For psychologists, this includes three years of full-time practical training (4,200 hours), encompassing
13905-411: The purposes of processing and integrating trauma memories. Survivors with complex trauma often struggle to find a mental health professional who is properly trained in trauma informed practices. They can also be challenging to receive adequate treatment and services to treat a mental health condition which is not universally recognized or well understood by general practitioners. Allistair and Hull echo
14040-564: The quality of patient care. One major advancement was the introduction of SOAP notes in the 1960s, developed by Dr. Lawrence Weed to structure clinical notes in four categories: Subjective, Objective, Assessment, and Plan. This framework became widely used in both medical and mental health settings, offering a structured yet flexible approach to documentation that supported clinical reasoning and treatment planning. Progress notes also gained prominence in mental health, tracking clients’ clinical status and treatment progress across sessions. To meet
14175-775: The realistic dangers and vulnerabilities in her social situation. Many patients are unable to move forward in their recovery because of their present involvement in unsafe or oppressive relationships. In order to gain their autonomy and their peace of mind, survivors may have to make difficult and painful life choices. Battered women may lose their homes, their friends, and their livelihood. Survivors of childhood abuse may lose their families. Political refugees may lose their homes and their homeland. The social obstacles to recovery are not generally recognized, but they must be identified and adequately addressed in order for recovery to proceed. Complex trauma means complex reactions and this leads to complex treatments. Hence, treatment for CPTSD requires
14310-495: The regulation and delivery of psychotherapy. Several countries have no regulation of the practice or no protection of the title. Some have a system of voluntary registration, with independent professional organizations, while other countries attempt to restrict the practice of psychotherapy to 'mental health professionals' (psychologists and psychiatrists) with state-certified training. The titles that are protected also vary. The European Association for Psychotherapy (EAP) established
14445-438: The regulatory psychotherapeutic organizations' codes of ethical practice. Examples of when it is typically accepted to break confidentiality include when the therapist has knowledge that a child or elder is being physically abused; when there is a direct, clear and imminent threat of serious physical harm to self or to a specific individual. As of 2015, there are still a lot of variations between different European countries about
14580-546: The relatively large numbers of American combat veterans of the Vietnam War who were seeking treatment for the lingering effects of combat stress. In the 1980s, various researchers and clinicians suggested that PTSD might also accurately describe the sequelae of such traumas as child sexual abuse and domestic abuse. However, it was soon suggested that PTSD failed to account for the cluster of symptoms that were often observed in cases of prolonged abuse, particularly that which
14715-449: The restrictions on practice are more closely associated with the charging of fees. Licensing and regulation are performed by various states. Presentation of practice as licensed, but without such a license, is generally illegal. Without a license, for example, a practitioner cannot bill insurance companies. Information about state licensure of psychologists is provided by the American Psychological Association . In addition to state laws,
14850-691: The results of controlled trials that cast doubt on EMDR's efficacy. This included requiring the completion of an EMDR training program in order to be qualified to administer EMDR properly after researchers using the initial written instructions found no difference between no-eye-movement control groups and EMDR-as-written experimental groups. Further changes in training requirements and/or the definition of EMDR included requiring level II training when researchers with level I training still found no difference between eye-movement experimental groups and no-eye-movement controls and deeming "alternate forms of bilateral stimulation" (such as finger-tapping) as variants of EMDR by
14985-442: The rise of dynamic psychology and psychiatry as well as theories about hypnosis . In 1853, Walter Cooper Dendy introduced the term "psycho-therapeia" regarding how physicians might influence the mental states of patients and thus their bodily ailments, for example by creating opposing emotions to promote mental balance. Daniel Hack Tuke cited the term and wrote about "psycho-therapeutics" in 1872 in his book Illustrations of
15120-669: The same initials as EMDR's founder, Francine Shapiro. However, no legal action took place against the website or its founders, who are likely protected by American First Amendment protections. EMDR was invented by Francine Shapiro in 1987. In a workshop, Shapiro related how the idea of the therapy came to her while she was taking a walk in the woods, and discerned she had been able to cope better with disturbing thoughts when also experiencing saccadic eye movements. Psychologist Gerald Rosen has expressed doubt about this description, saying that people are normally not aware of this type of eye movement. Gerald Rosen and Bruce Grimley suggest that it
15255-453: The same treatment. Therefore, treatment is generally tailored to the individual. Recent neuroscientific research has shed some light on the impact that severe childhood abuse and neglect (trauma) has on a child's developing brain, specifically as it relates to the development in brain structures, function and connectivity among children from infancy to adulthood. This understanding of the neurophysiological underpinning of complex trauma phenomena
15390-484: The second congress of experimental psychology, van Eeden attempted to take the credit for the term psychotherapy and to distance the term from hypnosis. In 1896, the German journal Zeitschrift für Hypnotismus, Suggestionstherapie, Suggestionslehre und verwandte psychologische Forschungen changed its name to Zeitschrift für Hypnotismus, Psychotherapie sowie andere psychophysiologische und psychopathologische Forschungen, which
15525-471: The sentiment of many other trauma neuroscience researchers (including Bessel van der Kolk and Bruce D. Perry ) who argue: Complex presentations are often excluded from studies because they do not fit neatly into the simple nosological categorisations required for research power. This means that the most severe disorders are not studied adequately and patients most affected by early trauma are often not recognised by services. Both historically and currently, at
15660-712: The spiritual as a separate dimension are not necessarily considered as traditional or 'legitimate' forms of psychotherapy. Psychotherapy may be delivered in person (one on one, or with couples, or in groups) or via telephone counseling or online counseling (see also § Telepsychotherapy ). There have also been developments in computer-assisted therapy, such as virtual reality therapy for behavioral exposure, multimedia programs to teach cognitive techniques, and handheld devices for improved monitoring or putting ideas into practice (see also § Computer-supported ). Most forms of psychotherapy use spoken conversation . Some also use various other forms of communication such as
15795-667: The systems of family treatment hold esteem. A portion of the thoughts emerging from therapy are presently pervasive and some are a piece of the tool set of ordinary clinical practice. They are not just medications, they additionally help to understand complex conduct. Therapy may address specific forms of diagnosable mental illness , or everyday problems in managing or maintaining interpersonal relationships or meeting personal goals. A course of therapy may happen before, during or after pharmacotherapy (e.g. taking psychiatric medication ). Psychotherapies are categorized in several different ways. A distinction can be made between those based on
15930-428: The tendency to be revictimized . Most importantly, there is a loss of a coherent sense of self: this loss, and the ensuing symptom profile, most pointedly differentiates CPTSD from PTSD. CPTSD is also characterized by attachment disorder , particularly the pervasive insecure , or disorganized-type attachment . DSM-IV (1994) dissociative disorders and PTSD do not include insecure attachment in their criteria. As
16065-449: The term itself may be protected or not). The term psychotherapy is derived from Ancient Greek psyche ( ψυχή meaning "breath; spirit; soul") and therapeia ( θεραπεία "healing; medical treatment"). The Oxford English Dictionary defines it as "The treatment of disorders of the mind or personality by psychological means...", however, in earlier use, it denoted the treatment of disease through hypnotic suggestion. Psychotherapy
16200-672: The therapist's hands or tapping devices. Most meta-analyses have found that the inclusion of bilateral eye-movements within EMDR makes little or no difference to its effect. Meta-analyses have also described a high risk of allegiance bias in EMDR studies. One 2013 meta-analysis with fewer exclusion criteria found a moderate effect. EMDR has been characterized as pseudoscience , because the underlying theory and primary therapeutic mechanism are unfalsifiable and non-scientific. EMDR's founder and other practitioners have used untestable hypotheses to explain studies which show no effect. The results of
16335-447: The therapy are non-specific, especially if directed eye movements are irrelevant to the results. When these movements are removed, what remains is a broadly therapeutic interaction and deceptive marketing. According to Yale neurologist Steven Novella : [T]he false specificity of these treatments is a massive clinical distraction. Time and effort are wasted clinically in studying, perfecting, and using these methods, rather than focusing on
16470-473: The time a study found no difference between EMDR and a finger-tapping control group. Such changes in definition and training for EMDR have been described as "ad hoc moves [made] when confronted by embarrassing data". EMDR is controversial within the psychological community. It is used by some practitioners for trauma therapy and in the treatment of complex post-traumatic stress disorder . A Cochrane systematic review comparing EMDR with other psychotherapies in
16605-399: The trauma. The final phase would consist of solidifying what has previously been learned and transferring these strategies to future stressful events. In practice, the forms of treatment and intervention varies from individual to individual since there is a wide spectrum of childhood experiences of developmental trauma and symptomatology and not all survivors respond positively, uniformly, to
16740-412: The treatment of Chronic PTSD found EMDR to be just as effective as TF-CBT and more effective than the other non-TF-CBT psychotherapies. Caution was urged interpreting the results due to low numbers in included studies, risk of researcher bias , high drop-out rates, and overall "very low" quality of evidence for the comparisons with other psychotherapies. A 2016 systematic review and meta-analysis found that
16875-417: The two conditions because those with BPD also tend to have PTSD or to have some history of trauma. In Trauma and Recovery , Herman expresses the additional concern that patients with CPTSD frequently risk being misunderstood as inherently ' dependent ', ' masochistic ', or ' self-defeating ', comparing this attitude to the historical misdiagnosis of female hysteria . However, those who develop CPTSD do so as
17010-558: The work of the Nancy School in English. Also in 1889 a clinic used the word in its title for the first time, when Frederik van Eeden and Albert Willem van Renterghem in Amsterdam renamed theirs "Clinique de Psycho-thérapeutique Suggestive" after visiting Nancy. During this time, travelling stage hypnosis became popular, and such activities added to the scientific controversies around the use of hypnosis in medicine. Also in 1892, at
17145-485: The written word, artwork , drama , narrative story or music. Psychotherapy with children and their parents often involves play , dramatization (i.e. role-play), and drawing, with a co-constructed narrative from these non-verbal and displaced modes of interacting. Psychotherapists traditionally may be mental health professionals like psychologists and psychiatrists; professionals from other backgrounds (family therapists, social workers, nurses, etc.) who have trained in
17280-411: The years, included identification of childhood sexuality, the role of anxiety as a manifestation of inner conflict, the differentiation of parts of the psyche (id, ego, superego), transference and countertransference (the patient's projections onto the therapist, and the therapist's emotional responses to that). Some of his concepts were too broad to be amenable to empirical testing and invalidation, and he
17415-654: Was critiqued for this by Jaspers. Numerous major figures elaborated and refined Freud's therapeutic techniques including Melanie Klein, Donald Winnicott, and others. Since the 1960s, however, the use of Freudian-based analysis for the treatment of mental disorders has declined substantially. Different types of psychotherapy have been created along with the advent of clinical trials to test them scientifically. These incorporate subjective treatments (after Beck), behavioral treatments (after Skinner and Wolpe) and additional time-constrained and centered structures, for example, interpersonal psychotherapy. In youth issue and in schizophrenia,
17550-500: Was developed by the European Association of Psychotherapy (EAP) in 2013. As sensitive and deeply personal topics are often discussed during psychotherapy, therapists are expected, and usually legally bound, to respect client or patient confidentiality. The critical importance of client confidentiality —and the limited circumstances in which it may need to be broken for the protection of clients or others—is enshrined in
17685-516: Was established by his use of the distinct term " psychoanalysis ", tied to an overarching system of theories and methods, and by the effective work of his followers in rewriting history. Many theorists, including Alfred Adler , Carl Jung , Karen Horney , Anna Freud , Otto Rank , Erik Erikson , Melanie Klein and Heinz Kohut , built upon Freud's fundamental ideas and often developed their own systems of psychotherapy. These were all later categorized as psychodynamic , meaning anything that involved
17820-669: Was excluded from the 1994 publication. It was also excluded from the DSM-5 , which lists post-traumatic stress disorder. The ICD-11 has included CPTSD since its initial publication in 2018 and an official psychometrics exists for assessing the ICD-11 CPTSD, which is the International Trauma Questionnaire (ITQ). Post-traumatic stress disorder (PTSD) was included in the DSM-III (1980), mainly due to
17955-407: Was introduced into the trauma literature by Gill Straker in 1987, differs from CPTSD. It was originally used by South African clinicians to describe the effects of exposure to frequent, high levels of violence usually associated with civil conflict and political repression . The term is applicable to the effects of exposure to contexts in which gang violence and crime are endemic as well as to
18090-405: Was perpetrated against children by caregivers during multiple childhood and adolescent developmental stages. Such patients were often extremely difficult to treat with established methods. PTSD descriptions fail to capture some of the core characteristics of CPTSD. These elements include captivity, psychological fragmentation, the loss of a sense of safety, trust, and self-worth, as well as
18225-424: Was that the client receive three core "conditions" from his counselor or therapist: unconditional positive regard, sometimes described as "prizing" the client's humanity; congruence [authenticity/genuineness/transparency]; and empathic understanding . This type of interaction was thought to enable clients to fully experience and express themselves, and thus develop according to their innate potential. Others developed
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