Talking Therapies: A Descriptive Map

The phrase talking therapy covers approaches that developed at different times, from different assumptions, and often in explicit opposition to one another. What follows is a map of those differences as a matter of intellectual history. It is a description of a field of ideas and carries no recommendation about any individual's circumstances.

The psychodynamic family

The oldest group descends from late nineteenth and early twentieth-century clinical writing. Its organising assumption is that a good deal of mental life is not available to introspection, that early relationships shape later patterns, and that the relationship between the two people in the room is itself informative. Its characteristic method is extended open-ended conversation.

The behavioural and cognitive family

The second group grew out of learning theory and then, from the middle of the century, out of work on thought and interpretation. Its organising assumption is that current patterns of behaviour and of appraisal can be addressed directly, without a reconstruction of their origins. Its characteristic method is structured, time-limited and explicit about goals, which also made it the family most amenable to trial-based evaluation.

The humanistic family

The third group formed in the middle of the century partly as a reaction against both of the others. Its organising assumption is that the conditions of the relationship, particularly acceptance and accurate understanding, are what matter, and that the person is the authority on their own experience. Its characteristic method is non-directive.

The systemic family

The fourth group shifted the unit of attention from the individual to the family or wider system, on the assumption that patterns are maintained by the relationships around a person rather than located inside them. Its characteristic method involves more than one person in the room.

The convergence argument

A long-running debate concerns how much the differences matter. One position holds that the specific techniques carry the effect. Another holds that factors common to all of them, the working relationship, a shared account of the problem, and the expectation of change, carry most of it. The evidence has been read both ways for decades, and the argument is one of the more interesting in the field precisely because it has not resolved.

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