Qu’est-ce qu’une psychothérapie aujourd’hui ? Du psychothérapeute au « psybot » : vers une nouvelle définition

Abstract

Objective

One hundred and fifty years after the word first appeared in the English lexicon, how can we still talk about “psychotherapy” today? While the original aims and methods of the concept of “psychotherapy” appeared simple and generic, namely “to heal through the mind,” our contemporary psychiatry and psychology have developed a multitude of “psychotherapies”, which generally present themselves as distinct. This makes it difficult for patients and their families to find their way around, difficult for our psychiatric interns and psychology master's students to orient themselves, and difficult for our administrative authorities to get involved.

Method

As they appear to us to be fundamental to the very essence and future of the notion of “psychotherapy,” in order to approach its definition, we call upon the language sciences: (i) lexico-bibliographical, by analyzing the scientific literature in international databases and, more generally, specialized psychological and psychiatric language; (ii) psycholinguistics, with reference to the clinical sciences of language; (iii) computerized linguistics, as the recent deployment of artificial intelligence in the field of mental health invites us to do, at both diagnostic and therapeutic levels, with the emergence of psybots. Our final objective will be to propose a synthesis and redefinition of the notion of psychotherapy for contemporary psychiatry and clinical psychology.

Results

The majority of sources indicate that psychotherapy is widely used to treat psychiatric illnesses, psychological and psychosomatic disorders, and existential suffering. The notions of the unconscious and awareness, the place of verbal and non-verbal languages, and the importance of the patient–practitioner relationship are the most widely accepted. The somatic approach and group psychotherapy are mentioned less frequently. The organization of sessions is rarely mentioned, as is the status of the therapist or the idea that the therapist's uniqueness is a central element of the treatment. The need for specific training for the practitioner was mentioned more often, as was the possibility of combining psychotherapy with pharmacological or environmental therapies. With regard to the evaluation of treatment, the notion of defining an objective (global or focal) is mentioned only incidentally, as is the importance of scientific validity, in particular taking into account the risk of undesirable effects.

Discussion

The dynamic notion of therapeutic processes or mechanisms is rarely mentioned, yet the study of change processes could help to define psychotherapies. The evaluation of psychotherapeutic practices would be capable of federating “psychotherapy” on the basis of a common foundation and, building on this, opening up to the possible specificities of “psychotherapies” according to their indications and/or methods. Although considerable investment has been made in the evaluation of psychotherapies and in neuroscience, over the last 25 years there has been little change in psychotherapeutic practice in the field, and no specific biomarkers have been identified. At the same time, over the last three years, linguomarkers have been developing at breakneck speed in the field of psychological health, inviting the language sciences to gain a better grasp of the notion of psychotherapy, in particular through interlocutory analysis. The development of logician models and artificial intelligence methods, coupled with the exponential increase in the computing power of personal computers, is paving the way for automated language processing applied to psychotherapy. Artificial intelligences are beginning to identify biomarkers in mental health, with the aim of creating scientifically evaluated care by psybots.

Conclusion

What is psychotherapy today? With the aim of improving well-being, psychotherapy is a set of methods that can be combined in various ways to alleviate psychiatric illnesses and/or psychological disorders and/or existential suffering. The therapeutic objectives and the means devised to “make people feel better” are most often agreed between the patient requesting treatment (or requiring treatment without consent when legally applicable) and the practitioner who responds. Therapies may be collective, bringing together several patients (couples therapy, family therapy, group therapy such as debriefing, for example) and one or more practitioners (co-therapist, institutional psychotherapy). Medical diagnosis and psychological assessment remain interdependent with care. While most psychotherapies are effective, given the current state of scientific knowledge, the theoretical concepts on which psychotherapies are based (psychoanalytical, cognitive, humanist, existential, etc.) do not seem to be strictly in line with the practices known under the same name, which may be associated or even integrated with each other, either spontaneously or in a formalized way. A current trend is to consider existing therapeutic areas as therapeutic tools. Expression and verbal association, exposure, awareness correlating with the reconstruction of representations, and putting into practice the will to change, appear to be the main frameworks structuring psychotherapies. In other words, psychotherapies have factors of efficacy that are common to all of them, and factors that are specific to each, the latter deserving to be better axiomatized. The risk of undesirable effects must be taken into account (aggravation of avoidance behavior, re-traumatization, increase in passive-dependent personality traits, etc.). In all psychotherapy, the role of verbal language appears to be predominant, even in the absence of vocalized language, such as when associated with other forms of expression such as the pictorial arts, bodily or theatrical expression, or a relationship with an animal. Psychotherapy consists mainly of monological interaction (with oneself) and dialogical interaction (with a clinician) that alleviates human suffering through verbal actions that harmonize networks of representations. It can be scientifically characterized (and therefore evaluated) using lexical-semantic, syntactic, and pragmatic linguomarkers. But at the same time, every therapist's practice is singular in that it seeks to adapt to the patient's uniqueness, and therefore does not fit solely into a logic of normativity, on the contrary. Psychotherapists (mostly doctors and psychologists) are specially trained in psychotherapeutic practice and respect the regulatory and ethical framework of their profession. Ideally, they should benefit from supervision, particularly in situations where the patient has little choice of practitioner (in a refugee camp, in an operational military environment, etc.). Treatment is usually organized in sessions, the length and pace of which are adapted to the problem. Depending on the medical and economic model in each country, therapy sessions may be partially or fully reimbursed. Psychotherapy can be combined with other therapeutic approaches, particularly pharmacological (antidepressants, mood regulators, etc.), neuropsychological (mainly cognitive remediation) and environmental (dietary hygiene rules, sick leave, etc.). Increasingly, conversational robots or psybots are offering basic and complementary care for emotional regulation, sophrology, therapeutic compliance, etc. Psychotherapy remains an anthropological notion, difficult to define in a few sentences, in as much as it aims to soothe the torments arising from human nature, in its philosophical entirety, but also the singular, intimate torments of each being whose brain and networks of representations remain unique. The tensions arising from our networks of representations characterize them to such an extent that they can be considered homeostatic, if they do not cause suffering. Psychotherapy therefore requires this permanent adaptation, this co-constructive intelligence with the patient, the results of which can never be totally certain, because it is through this very continuous creation, which is always unstable, always in the process of becoming, even when the treatment has been completed, that psychotherapy is constructed.