Well, this may sound surprising, but arguably the first major systematic work written on the subject of psychotherapy was the Therapeutics (To Therapeutikon) of Chrysippus of Soli, the third head of the Stoic school, who lived in the 3rd century BCE. Chrysippus was widely regarded as one of the greatest intellectuals of the ancient world -- up there with Aristotle.
The Therapeutikon was the fourth volume of a four-volume work titled On Passions (Peri Pathon), which can be loosely translated as On Psychopathology. It was remarkably influential. Nearly four centuries after it was written, it was still being cited at length as the dominant text in the field by Galen, the personal physician of Marcus Aurelius. Origen, the Church Father, was still discussing it a century after that. So it was considered a masterwork of psychological therapy for at least five hundred years.
Sadly, today it is lost. However, modern scholars, most notably Prof. Teun Tieleman, have attempted to reconstruct its contents based on fragments and testimonia found in other ancient sources. Seneca appears to draw heavily upon it in On Anger. Cicero draws heavily upon it in the Tusculan Disputations. And Galen, who hated Stoicism, attacks it mercilessly.
Many people today assume that Sigmund Freud was the inventor of psychotherapy. Ironically, Freud didn’t even pioneer modern psychological therapy. He studied therapeutic hypnotism in France at the Nancy School under Bernheim, and at the Salpêtrière in Paris under Charcot. For half a century before Freud, in fact, medical hypnotists had already been pioneering the modern "talking cure."
However, it may surprise many people to learn that psychotherapy existed long before that in the ancient world. The modern compound word "psychotherapy" didn't exist in ancient Greek. But "therapy of the psyche" (therapeia tēs psychēs) was an established technical term for a branch of applied philosophy. Psychotherapy as an institutionalized clinical practice obviously didn't exist in ancient Greece or Rome. However, the concept of a cognitive and philosophical talking cure certainly did.
Although therapeutics of the psyche predates the Stoics, Stoic psychotherapy became its pre-eminent ancient form. It doesn't look much like Freudian psychoanalysis. But you know what it does look quite a lot like? Modern cognitive-behavioural therapy (CBT).
That's not entirely surprising, as Albert Ellis, the original pioneer of CBT (or its main precursor, depending on how you look at it), had read Marcus Aurelius and Epictetus. He quoted the famous line from Epictetus to all of his clients, his students, and in most of his books: "People are disturbed not by events but by their judgments about them." That's not a minor aspect of Stoic psychotherapy or CBT — it's pretty much the central theoretical premise of both.
So what did Chrysippus' Stoic psychotherapy actually look like? Well, I'm working on a book about it right now. It would be a lot to write up in a single post, unfortunately! It's sometimes said that "CBT" should really be a plural ("CBTs") because there are lots of different cognitive and behavioural therapies today. Ancient Stoic psychotherapy is not identical to any one of them (although it clearly has a cousin in Ellis' Rational Emotive Behaviour Therapy or REBT). Rather, it contains concepts and practices that span several different models of modern CBT.
The conceptualization of emotions in terms of specific cognitions is central. Socratic questioning — surprise, surprise! — is important. Alignment of behaviour with core values is integral to any "virtue ethic", especially Stoicism. Mindfulness (prosoche) is foundational.
Crucially, the Stoics developed a sophisticated two-phase model of emotion that directly debunks the popular myth that Stoicism is about suppressing our feelings:
- The Involuntary First Movement (Proto-Passions): The Stoics recognized that our initial reaction to a trigger is not yet a full emotion, but an automatic reflex they called a proto-passion (propatheia). When you are insulted or startled, your heart races, your muscles tense, and an alarming thought flashes into your awareness. Seneca explains that this primitive surge is completely natural, involuntary, and morally indifferent. You cannot stop it through willpower alone, and the Stoics never expected you to.
- The Voluntary Second Movement (Assent): The actual passion (pathos) only occurs if we consciously endorse that initial impression — giving it our voluntary agreement, or what the Stoics called synkatathesis.
This pre-eminent Stoic therapeutic concept is often obscured by translation. Synkatathesis is usually translated as "assent," but psychologically it functions almost identically to what modern therapists in Acceptance and Commitment Therapy (ACT) call cognitive fusion. It means becoming so completely caught up in a thought that we mistake our internal impression for external reality and allow it to dictate our behaviour. Seneca also describes it as "yielding" or "surrendering" to an irrational thought, and being "swept away" by its force.
Stoic therapy is therefore based in something akin to cognitive defusion — learning to step back from our initial impressions, recognize them as mere mental events, and withhold our assent. In the Enchiridion, Epictetus advises that the moment an upsetting impression strikes, our first move should be to tell it: "You are just an impression [an automatic thought], and not at all the thing you claim to represent." Stoic philosophical questioning wasn't an academic debate; it was a practical tool to create cognitive distance and break our fusion with irrational thoughts.
The Stoics considered two types of belief to be central to stressful emotions, especially anger:
- A primary appraisal about how bad or harmful something is: "This man's actions have injured me!"
- A secondary appraisal about how one should respond: "I must retaliate and punish him!"
This ancient formulation is remarkably similar to Richard Lazarus's seminal cognitive model of stress and coping, where emotions are driven by a primary appraisal of threat and a secondary appraisal of coping resources.
In On Anger, Seneca goes further and explicitly frames these two appraisals as rigid "ought" or "should" beliefs: the demand that one ought not to have been injured, joined to the demand that one ought to exact revenge.
The role of rigid demands, or "musts," in Stoic psychotherapy is strikingly prescient of Albert Ellis's REBT and the "tyranny of the shoulds". While modern culture frequently glorifies "righteous anger," Seneca and Ellis both recognized that all anger is founded on these rigid, irrational demands. When we demand that people must never treat us unfairly, and that we must make them suffer when they do, we abandon reason and step into what Seneca called a "temporary madness". (Remember, though, that the Stoics viewed the initial involuntary flash of anger, the proto-passion, as natural, harmless, and indifferent.)
Chrysippus also warned Stoic therapists that when a person is in the acute grip of an emotional crisis, you shouldn't lecture them on high-level Stoic dogma. You soothe the immediate inflammation first by working within their existing worldview before attempting deeper cognitive restructuring. Some evidence suggests Chrysippus believed that it was easier to challenge the secondary judgment, about how one should act, when someone is angry, and to leave disputation of the primary judgment, about how awful something is, until the anger has abated.
So, did Chrysippus invent CBT? Not in the strict sense of inventing a modern clinical practice. But the cognitive architecture of CBT was being systematically mapped out in Athens well over two thousand years ago. And while modern CBT provides invaluable remedial tools to extinguish an acute flare-up of anger, ancient Stoic psychotherapy offers something even bigger: a complete, preventative philosophy of life designed to build genuine emotional resilience. CBT is largely remedial, in other words, and usually a temporary or time-limited practice. Stoicism is preventative, and provides a lasting, indeed, permanent philosophy of life.