Publication Trends in Psychotherapy: Bibliometric Analysis of the Past 5 Decades

Next, each brand was analyzed by decade, beginning with 1970–1979 and ending with 2010–2019, to search for trends and patterns over time (Table 2). From 1970 to 1979, articles about BT were published in the largest number of journal articles, followed by articles about psychoanalysis and family systems therapy. From 1980 to 1989, family systems therapy, psychoanalysis, and BT had the largest number of peer-reviewed publications. From 1990 to 1999, psychoanalysis, family systems therapy, and CBT were published in the largest numbers of journal articles. From 2000 to 2009, CBT, psychoanalysis, and family systems therapy had the largest number of peer-reviewed publications. From 2010 to 2019, CBT, psychoanalysis, and meditation and mindfulness were the top three most published psychotherapy brands. Overall, BT, psychoanalysis, family systems therapy, cognitive therapy, and CBT were consistently in the top 10 most published psychotherapy brands rankings from 1970 to 2019.

Some psychotherapy brands were listed in the top 10 in the early decades but dropped in ranking over time (Table 2). For example, problem-solving therapy was ranked 10th from 1970 to 1979, but did not make the top 10 after that time. Humanistic and/or Rogerian therapy were sixth during the 1970s, ninth during the 1980s, 10th during the 1990s, 10th during the 2000s, and did not appear in the 2010s. Rational emotive BT decreased in the rankings each decade until dropping out of the top 10 psychotherapy brands for the decades spanning 2000–2009 and 2010–2019. Finally, experiential and/or Gestalt therapy dropped out of the top 10 by 2010–2019.

Some psychotherapy brands did not appear in the top 10 during the earlier decades but did so later. Interpersonal psychotherapy entered the top 10 list in 1980–1989 and stayed consistently in the bottom three (ranking eighth, ninth, or 10th) until 2000–2009, after which it fell below 10th in 2010–2019. Eye movement desensitization and reprocessing (EMDR) did not appear in the top 10 rankings until 2000–2009. Dialectical behavior therapy (DBT) first appeared on the charts in 2010–2019 in the ninth position. Meditation and mindfulness first appeared as the third-most published therapy in 2010–2019, having not made the top 10 ranking at all before then. Finally, ACT appeared first as number eight on the top 10 list during 2010–2019.

Some well-known psychotherapies, such as attachment, exposure and response prevention, and motivational interviewing, did not appear in the top 10 in any decade. More recently popularized psychotherapies, such as compassion-focused therapy, emotion-focused therapy, functional analytic psychotherapy, prolonged exposure therapy, schema-focused therapy, seeking safety, social skills training, and transference-focused therapy never made it to the top 10 (Tables 1 and 2). Figure 1 shows the trends across 5 decades for the top 10 psychotherapy brands during 2010–2019.

CBT was the brand with the largest number of articles published in the past 50 years, followed by psychoanalysis, family systems therapy, BT, and CT. Interestingly, these top five psychotherapy brands comprised almost 78% of all publications, illustrating clear dominance of a few psychotherapy brands in the literature. Moreover, three brands accounted for half of the total number of articles among the 30 brands selected, illustrating the sizable dominance of a few psychotherapy brands. Although the top 10 psychotherapy brands accounted for almost 99% of all articles during the first 4 decades analyzed, they accounted for a slightly smaller percentage (90%) of the overall published articles in the past decade. This result suggests that the articles published during 2010–2019 have included psychotherapy brands beyond the main ones. The relationship between societal changes and developments in psychotherapy have been poignantly discussed from a historical perspective (22–24). Thus, analyzing publication trends across decades, and their relation to changes within the field and in the social context, may lend additional clarity to understanding the evolution of psychotherapy in the past 50 years.

The most salient trend observed was that the psychotherapy brands (BT, CBT, CT, family systems therapy, psychoanalysis, and psychodynamic therapy) that have dominated for the past 50 years have remained in the top 10 rankings across all 5 decades. This trend may be due to several factors within the field of psychotherapy, such as societal changes; health policies; pressure from insurance companies; and preferences by treatment recipients, their parents and caretakers (24), and state institutions (23). This study, however, focused on four factors that may have contributed to developments in psychotherapy: the power of tradition in learning and training, therapist preferences, reports of positive outcomes or efficacy, and dissemination strategies. These four factors may have each contributed differently to the maintenance of the five dominant psychotherapy brands in the top 10 ranking of number of publications.

The role of tradition may be particularly relevant for the psychotherapy brands that originated several years before the 5 decades included in this study (i.e., psychoanalysis [25] and BT [26, 27]). As a psychotherapy brand develops, it is taught to new generations, and those trained in the model likely prefer it, leading in turn to more publications, with all these factors contributing to its continued dissemination. CT originated later (in the late 1960s) (28) with a strong emphasis on research. It became probably the most studied form of psychotherapy (29) and, as this study found, the most published type of psychotherapy in the past 50 years. Although several critiques have been made about the low quality of studies, poor outcomes (30), and lack of support for its mechanisms of change (31), CT has also been proposed as the gold standard of psychotherapy (32). If tradition, preferences, and research support lead to recognition in the field, these features may produce a “rich get richer” phenomenon, such that when psychotherapy brands become more popularized, they begin to receive more funding, which results in more publications and increases their visibility. Distinction in how much each factor has contributed to each of the dominant psychotherapy brands may be difficult to parse and may require a more in-depth discussion that is beyond the scope of this study. Similarly, another factor that may have influenced this trend of dominance is that our search was restricted to the English language, which may have favored the psychotherapeutic approaches of English-speaking countries or approaches in non-English-speaking countries that have been more likely to be published in English. (These and other limitations are discussed below.)

Some psychotherapy brands appeared in the top 10 in the early decades, but then declined in ranking. These include humanistic and/or Rogerian therapy, problem-solving therapy, rational emotive BT, and experiential and/or Gestalt therapy. This result may be explained by at least three factors. First, other newer psychotherapy brands may have incorporated aspects of these older models and added novel components, thus diminishing use of the original brand. For example, many aspects of rational emotive BT are reflected in CBT. Second, these brands may have been less preferred by therapists, compared with other traditional approaches, such as psychodynamic therapy, or novel approaches, such as CT. For example, Rogerian and humanistic approaches were developed mostly outside the academic environment (22). In light of this origin, fewer training opportunities on these approaches may have been offered within graduate schools, thus reducing opportunities for them to become preferred therapeutic approaches for new generations of therapists. Additionally, insurance companies and health care organizations may have influenced therapists’ choices, because therapists are required to be specific about treatments billed to insurance and often must use time-limited, manualized treatments (22) that approaches such as Rogerian and humanistic therapy did not do. Third, the evidence-based treatment movement may have favored some psychotherapy brands that were better suited, if not outright favored, by the advocates of that movement. Indeed, during the 1980s, National Institute of Mental Health review committees stated they “would no longer consider grant proposals unless the research used both a manualized randomized controlled trial design and DSM-III diagnostic categories” (23). The evidence-based movement became popular during the 1990s (33) and consolidated during the 2000s (34). Most of the psychotherapy brands that dropped out of the top 10 did not have a strong emphasis on research and declined in ranking during the 1990s and 2000s. In comparison, most of the psychotherapy brands that remain in the top 10 in number of publications tend to be more structured and manualized (e.g., BT) and thus more suitable for research than less structured approaches.

The final trend observed was that some psychotherapies were developed and/or increased their number of publications in recent decades (i.e., meditation and mindfulness, DBT, ACT, and EMDR). For psychotherapy brands that were already established, this increase in number of publications may be explained by at least three factors within the field of psychotherapy and one major change in the social context. First, as mentioned before, the shift toward evidence-based approaches may be a contributing factor. Second, during the 1990s and 2000s, some psychotherapies were developed and demonstrated evidence of efficacy in the treatment of disorders that were previously less responsive to treatment, such as DBT for borderline personality disorder (35) or ACT for chronic pain (36). Third, as some psychotherapies show efficacy in the treatment of specific disorders, they may start to be applied more widely to other disorders, such as DBT for substance use (37, 38).

In addition, a social factor may have contributed to the rapid dissemination of these psychotherapy brands: the emergence of communication and information technologies. Specifically, the Internet became public and free in 1993 (39), Google was launched in 1998 (40), and social media emerged in the 2000s (e.g., Facebook was launched in 2004) (41).

The mindfulness movement represents an interesting phenomenon to be considered through the lens of the social media era. Although mindfulness has been practiced for more than 2,500 years, it did not appear in the top 10 published psychotherapies during the 1970s–2000s, and it suddenly ranked third in number of publications in the 2010s. The striking appearance of this therapy demonstrates the most salient growth in rank for all psychotherapies across the 5 decades and boasts an increase of 542 times the number of publications it received in the past decade. It is possible that its increased popularity in the psychotherapy field may have been due to a combination of empirical support and ease of dissemination. Mindfulness began to gain popularity in Western psychotherapies and in the media after Jon Kabat-Zinn published his first book and made his first TV appearance in the early 1990s (42, 43). Although mindfulness-based techniques have shown evidence of utility (e.g., mindfulness-based CT has been shown efficacious in relapse prevention for depression) (44), they have been overpromoted relative to the strength of evidence (45, 46), and concerns have been expressed about cultural misappropriation, where the philosophical underpinnings of the practice are not fully honored or respected (47). Another possible explanation for the substantial increase of mindfulness-based publications is that this therapy has been characterized as an approach that can be practiced by nonprofessionals, that may impose less stigma compared with treatments that target specific disorders (e.g., DBT for borderline personality disorder), that can be used for general well-being, and that can be engaged with in multiple settings (e.g., classrooms, offices).

Finally, use of the Internet has influenced marketing, which in turn may have facilitated the branding of psychotherapies in more recent years. More specifically, some psychotherapy brands have gained attention through the availability of trainings and workshops or by selling products to accompany treatment (e.g., “megapulsars” for brain stimulation in EMDR) (48).

Understanding the trends of the past 50 years can help psychologists anticipate what may happen in upcoming years. Because events in the social context have influenced trends in psychotherapy publications, and because society has entered an era where big data and new technologies have become ubiquitous, it is possible that these changes will transform the delivery methods of psychotherapies (49). Additionally, changes in diagnostic classifications may require adjustments in the types of psychotherapies delivered. These three possible trends are explained below.

This study was limited by several factors that should be addressed in future research. First, although most search terms were the same for different psychotherapy brands, some adaptations were needed (as described in the Methods section). For example, it was not feasible to search for BT separate from CBT, in part due to the nature of the search terms. Multiple attempts were made to address this issue; however, no option completely solved the problem. Thus, the total number of articles for BT therapy may have been deflated. Although this method may have yielded some minor deviations in the therapy brand rankings, the overarching trends were still captured. Additionally, the electronic database searches were conducted only on PsycINFO and PubMed (Medline full text); thus, journal articles written in English and published in journals not included in those databases were not counted. Publications in other languages and databases (e.g., Scielo or Redalyc) were also not included and should be considered for future bibliometric analyses. Because language is usually linked to geographical regions, the current results may mostly represent English-speaking countries, and publications from other countries or regions may yield other outcomes. For example, Argentina is a Spanish-speaking country with the highest number of psychologists per capita in the world (75), and most psychologists in Buenos Aires identify as psychoanalysts (76).

Second, our searches focused specifically on psychology and psychotherapy and therefore were not exhaustive of the entire field. For example, the final search terms did not include “counseling,” were applied only to article titles (i.e., not abstracts or bodies of text), and included only 30 psychotherapy brands, which may have limited the total number of articles. Although overlaps exist between counseling and psychotherapy, “counseling” was excluded so that searches were restricted to psychology and therapy. Therefore, each brand in the final search was related to psychotherapy only, and these findings may not generalize to the field of counseling. Searching psychotherapy brands that were specifically written or addressed in the title may have narrowed the results, but this approach ensured that the article focused specifically on the brand of psychotherapy. Searches that also included key terms in the abstract would have increased sensitivity but made it much more difficult to be sure that the article focused on the therapy brand. Finally, the 30 psychotherapy brands were selected by the authors and informed by lists of psychotherapy brands previously published (12, 20, 34). There may be other psychotherapy brands that were not included in the searches. However, the chance of having excluded psychotherapy brands that would have placed in the top 10 is minimal, and therefore it is unlikely that they would have influenced the top 10 rankings by decade.

Third, the system used to identify psychotherapy brands published in journals during the past 5 decades may have underestimated some brands, such as integrative and multicultural psychotherapies (77). The challenge in identifying such brands is the sizable diversity of names used to refer to integrative and multicultural approaches. The same can be said of feminist approaches. Furthermore, some brands, such as Gestalt, evolved or were subsumed into other brands, including experiential or emotion-focused therapy.

Fourth, because of the gap between the treatments examined in research compared with the treatments used in practice (78), our findings may not reflect psychotherapy trends in clinical practice. Fifth, this study focused on number of articles, a metric that does not reflect the quality or strength of the evidence reported in each publication. Comparing the total number of publications to the number of randomized controlled trials (RCTs) would have provided some insight regarding the quality of the publications by psychotherapy brand; however, the term “RCT” was used little until the 1990s. Future studies could focus on more recent years and compare the trends of RCTs to all other articles published to explore possible discrepancies in quality of evidence gathered, number of publications, and trends in clinical practice. Finally, future studies should analyze publication trends by combining different psychotherapy brands with behavioral intervention technologies, such as Internet intervention, chatbots, virtual reality, augmented reality, and smartphone apps.