When we think of psychotherapy today, we often picture a calm conversation between two people, in a therapist’s office or via a screen. One person speaks, the other listens, asks questions and helps to clarify things. It may seem almost self-evident, as if this practice had always existed in this form.
In reality, psychotherapy is the product of a relatively recent history, shaped by insights, mistakes, debates and profound developments. Understanding its origins helps us to better grasp what it is today — and why it can sometimes seem both coherent and fragmented.
Before psychotherapy: understanding mental suffering in a different way
For most of human history, psychological distress was not understood in the same way as it is today. Mental health conditions were often interpreted through religious, moral or medical frameworks that were very different from our own.
People spoke of possession, mood swings and weakness of character. The responses offered reflected these interpretations: religious rituals, isolation and physical treatments that were sometimes violent. The idea that a structured conversation could alleviate mental suffering would have seemed, in many eras, strange or even inadequate.
It was not until the 19th century that things began to change. With the development of modern medicine and the emergence of psychology, a new question arose: what if certain disorders originated not in the body or in an external force, but in the mind itself?
The discovery of the "talking cure"
It is against this backdrop that a key figure emerges: Sigmund Freud.
Freud, a neurologist by training, took an interest in patients presenting with physical symptoms for which no identifiable medical cause could be found. Paralysis, pain, memory loss — very real symptoms, yet with no visible damage. This type of disorder, which was then known as ‘hysteria’, posed a problem for doctors of the time.
Together with his colleagues, Freud explored a new idea: what if these symptoms had a psychological origin? What if thoughts, memories or internal conflicts could manifest themselves through the body?
And so psychoanalysis gradually emerged, often regarded as the first structured form of psychotherapy. The central idea is simple, yet radical for its time: talking can heal.
Freud suggests that certain mental contents — desires, memories, emotions — are repressed out of consciousness because they are too difficult to face. Yet they continue to operate in the background, influencing behaviour and giving rise to symptoms. The therapist’s role is therefore to help the patient access these unconscious contents, particularly through free association (saying whatever comes to mind), dream analysis, and the exploration of the relationship between patient and therapist.
The birth of psychotherapy in psychoanalysis
The impact of psychoanalysis is immense. For several decades, it largely dominated the understanding of the psyche in Europe and the United States. It introduced concepts that are still part of everyday language today: the unconscious, defence mechanisms, and the importance of childhood.
La psychanalyse n’est pas une école unitaire : au fil du temps, plusieurs branches sont apparues, autour de l’école anglaise (object relations theory), des apports de Jacques Lacan, les approches groupalistes, la self psychology etc. Mais toutes ces approches restent orientées par l’inconscient et la libre parole.
« Say whatever comes into your head,
as if you were a traveller who,
sitting in the window of a train,
described the landscape passing by."
Sigmund Freud
Psychoanalysis has also attracted a certain amount of criticism.
On the one hand, some of his theories are difficult to test scientifically: unconscious psychological processes are, by their very nature, not directly observable. It has often been said that the unconscious cannot be detected on an MRI scan (although research in the field of neuropsychoanalysis is increasingly challenging this assumption).
On the other hand, the process can be time-consuming and costly, which risks making it inaccessible to many people.
Nowadays, alongside traditional psychoanalytic practice – which involves several sessions a week – there are forms of psychoanalytically-oriented therapy tailored to the demands of modern life.
However, over time, other approaches have also emerged. These do not replace psychoanalysis and psychoanalytically-inspired practices, but serve to diversify the field.
The behavioural turn: changing how we act
In the mid-20th century, a new school of thought began to gain ground: behaviourism, or behavioural psychology.
Unlike Freud, behaviourists are less interested in the unconscious than in observable behaviour. Their question is not ‘why do you feel that way?’ but rather ‘what do you do, and how can that change?’.
The central idea is that behaviours are learnt — and can therefore be unlearned or modified. This approach gives rise to practical techniques, often used to treat phobias, addictions or certain anxiety disorders.
It has the advantage of being more directly measurable and often having a quicker effect. However, it is also criticised for failing to take account of emotional and subjective complexity.
The cognitive revolution: changing how we think
In the 1960s and 1970s, a significant development took place: the incorporation of thoughts into the behavioural model. This marked the emergence of cognitive therapies, followed by cognitive-behavioural therapies (CBT).
The idea is that our emotions and behaviour are strongly influenced by our thoughts — particularly by automatic thought patterns, which can sometimes be biased or rigid.
For example, a person might interpret a failure as proof that they are ‘incapable’, which fuels anxiety or depression. By working on these thoughts — identifying them, questioning them, reframing them — it becomes possible to change the emotional experience.
CBT is rapidly becoming one of the most widely studied and used approaches, not least because it is based on structured protocols and measurable outcomes. However, contrary to popular belief, cognitive-behavioural approaches neither deny the existence nor the importance of unconscious mental processes: the concept of the cognitive unconscious lies at the heart of their theory. It is simply not the focus of therapeutic work.
The humanistic approach: understanding the whole person
At the same time, another tradition was emerging, based on a different philosophy: the humanist approach.
Figures such as Carl Rogers emphasise the individual’s subjective experience, rather than symptoms that need to be corrected.
From this perspective, every individual possesses a natural capacity for growth and self-understanding. The therapist’s role is not to interpret or direct, but to create an environment conducive to this exploration — one based on empathy, authenticity and unconditional acceptance. This approach has a profound influence on the practice of psychotherapy, particularly by emphasising the importance of the therapeutic relationship.
A diverse landscape
Nowadays, psychotherapy is not limited to a single school of thought. It comprises a range of approaches, which can sometimes differ greatly in their methods and underlying assumptions.
For example:
- Therapies based on psychoanalysis (psychodynamic)
- Cognitive behavioural therapies (CBT)
- Existential and humanist approaches
- More recent approaches such as ACT (Acceptance and Commitment Therapy) or EMDR
- Family, couples and group therapy…
- Short- and long-term treatment therapies…
I will discuss some of these therapies in more detail in this blog.
At first glance, this diversity may give the impression of a lack of consistency. How can all these methods coexist? Are they all effective? Do they contradict one another?
The more things change… the more they stay the same
Despite their differences, these approaches share certain fundamental elements.
Firstly, they all recognise that thoughts, emotions and behaviours are interconnected. Secondly, they are based on the idea that change is possible — that mental and relational patterns are not set in stone.
Above all, however, research has highlighted a key point: the quality of the relationship between therapist and patient is one of the most important factors for success, regardless of the approach used.
In other words, the method matters, but the way it is implemented often matters even more.
Why this history is important today
Understanding the history of psychotherapy helps us to avoid two common oversimplifications.
The first is the belief that there is a single ‘right’ method that works for everyone. In reality, different approaches reflect different ways of understanding the human mind — and each may be relevant in certain contexts.
The second is to view therapy as something vague or arbitrary. On the contrary, it is the result of over a century of reflection, experimentation and development. It is neither an exact science nor simply a matter of interpretation. It lies somewhere between the two.
An ever-evolving practice
Finally, it is important to note that psychotherapy continues to evolve.
New technologies are transforming access to care, with the development of online therapy. Advances in neuroscience are deepening our understanding of the mechanisms of change. New approaches are emerging, often by combining existing elements. Rather than a static system, psychotherapy resembles a dynamic field that adapts to the knowledge and needs of its time.
In conclusion
Psychotherapy did not emerge from a single defining moment, but rather from a gradual process. From Sigmund Freud’s exploration of the unconscious to more structured contemporary approaches, it has evolved by incorporating different perspectives.
This diversity may seem confusing, but it reflects a simple reality: understanding the human mind is a complex task that cannot be reduced to a single theory.
And that is perhaps the most important point to bear in mind. Psychotherapy is not a single method, but a range of approaches — sometimes complementary, sometimes competing — all seeking to answer the same question: How can we better understand what is going on inside us, and how can that change?
