The meanings of psychotherapy

Daniel Hack Tuke first used the word 'psychotherapeutics' in 1872 (Ellenberger, 1970, p. 765). He defined the term psychotherapy in his dictionary (Tuke, 1892), published twenty years later, as 'treatment of disease by the influence of the mind on the body'. Advances in the field of the behavioural sciences and other events in the twentieth century have led to changes in the meanings of psychotherapy but there is still no consensus of opinion. Wolberg (1977), for instance, lists as many as thirty-six meanings and then adds his own, noting with some exasperation that 'few words in the lexicon of mental health field are as ambiguous as the term psychotherapy'. As a major activity or, to some, as the very raison d'etre of psychiatry, psychotherapy seems to be easier to practise than to define. What do we mean when we say that we are engaged in psychotherapy with bur patients? A few general remarks about semantics may help to clarify the issue. Any living language is in a state of flux. Concepts change and words alter their meaning with the passage of time, so that there is a complex interaction between a historical epoch and the meaning of words. The vicissitudes in the definition of psychotherapy reflect, in one way or another, the history of behavioural science. No pretence is made of this being an essay on either the history of psychotherapy or semantics per se; at best, it is the history of a term. In addition, it should be pointed out that if psychotherapy were to be defined simply as a 'talking cure', then its origins would necessarily have to be traced back to the period when man first used words for their healing power. Even in the distant past the value of words was acknowledged. Most societies, primitive and modern, share a belief in the power and sanctity of the word. Words could summon gods, destroy and, at times, heal. It is important here to note the distinction between ' primitive healing' and' scientific therapy' (Ellenberger, 1970, p. 47). The etymology of psychotherapy (Greek psyche = mind, and therapy = treatment) clearly categorizes it as a treatment modality. The search for the origins of psychotherapy qua treatment to alleviate symptoms or cure disease is confined to the period when man aimed to identify putative psychological factor(s) in disease (Walker, 1959). Failure to take this distinction into account would be like searching for the origins of surgery at the time when man first used a sharp instrument on another human being. The stated purpose of this editorial is, then, broadly speaking, semantic. There are, however, wider implications. The ambiguity of the term psychotherapy has led to mental health professionals finding themselves engaged in a variety of activities all under the general rubric of psychotherapeutics. Over and above the few 'orthodox' varieties, such as 'supportive psychotherapy' and 'psychoanalytical psychotherapy', a recent consumer's guide (Herink, 1980) lists as many as 250 forms of 'psychotherapy'. It is, furthermore, impossible to estimate the full range of activities that take place in the privacy of psychotherapeutic practice and to know whether there is anything common to these psychotherapeutic variants. Needless to say, this ambiguity is a source of bewilderment to consumers and research workers alike, and renders the profession vulnerable to criticism. A secondary aim of this editorial is to outline the historical roots of our present confusion regarding the meaning of psychotherapy. The next section adumbrates changes in the meaning of psychotherapy and is followed by a discussion of some implications of these changes. Ancient Greek thought contained seminal ideas regarding the 'therapy of the word'; there are several references to the healing power of words in the Homeric epics and in the writings of various Greek philosophers. Indeed, ancient Greek culture is largely credited with having transformed scientific medicine from muta ars, art without words, into a discipline which uses words therapeutically. However, if one focuses on Greek medicine, rather than on the rest of ancient Greek literature, a