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People had little understanding of emotional difficulties and mental disorders. Since this many people were institutionalized and exposed to largely in effected treatments. The development of psychodynamic approaches to psychotherapy by Sigmund Freud, led to the emergence of the first force of psychotherapy.

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Research and practice of B.F Skinner and other modern theorists led to the second force, which was behavioral and cognitive interventions. Behavioral and cognitive approaches integrated and empirically supported.

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Carl Rogers work emerged, which led to the third force, existential-humanistic psychotherapy. Other theorist, such as Perls, Frankl, and others contributed to this force, which emphasis that emotions and sensations and of people taking charge of and finding meaning in their own lives. Furthermore, theses approaches also drew attention to the importance of therapeutic alliance.

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Clinicians are entering the era of the fourth force. First, second, and third forces are integrated in effort to fully understand people. Theories of counseling and psychotherapy have changes in response to the fourth force. New approaches such as narrative therapy, dialectics, and therapies that incorporate Eastern thought and philosophy provide the powerful ways to understand people and their experiences.