The Story of Psychology (117 page)

Perls’s technique for achieving this was vigorously confrontational and often harsh, and included a variety of “experiments,” “games,” and “gimmicks” designed to provoke, challenge, and force the patient to acknowledge the truth about his or her feelings. In filmed episodes of therapy, Perls seems at times almost sadistic, but with some patients he was very effective. Gestalt therapy was popular and deemed important in humanistic circles during the 1960s and 1970s; today it plays only a very minor part in the world of psychotherapy.

Transactional analysis:
TA was in vogue in the 1960s and is the only recognized psychotherapy to have been the subject of two books on the national best-seller list for over a year (Eric Berne’s
Games People Play
and Thomas A. Harris’s
I’m Okay—You’re Okay
). TA is based on dynamic principles, is concerned with interpersonal behavior, and deals with neurotic problems on a “rational” basis—not, however, through reasoning, like RET and cognitive therapy. It works through the therapist’s interpretations of which of three ego states are responsible for a particular behavior by the patient.

These ego states or selves are the ways in which the patient acts in his or her “transactions.” In any given transaction—the basic unit of social interaction—each person behaves toward another either as Child (the child self, largely emotional, that remains embedded within each of us), Parent (the set of precepts and beliefs—the “shoulds” and “should nots”—we internalized from our childhood perceptions of our parents), or Adult (the cognitive self, the mature and rational ego).

Although the three ego states are based on unconscious feelings, in TA the therapist deals with them on a conscious level, pointing out the ways in which the patient and the people he or she is dealing with are either communicating successfully or engaging in “crossed transactions.” The therapist also spells out the many “games”—fraudulent or ulterior transactions that conceal the real meaning of the interaction— they play in their inappropriate roles. Patients learn to recognize which self they are being in their transactions with others (and with the therapist), and which the others are being with them. Under the therapist’s guidance, they learn to utilize their Child for fun but have their Adult in charge of their serious behavior.
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Today, TA is one of many special techniques used occasionally by some therapists.

Interpersonal psychotherapy:
This short-term insight-oriented (psycho-dynamic) therapy has proven particularly useful in treating depression. It focuses on the client’s current relationships with peers and family members and aims to discover how what happens in them is connected to the client’s mood; its goal is to improve the way those relationships work on the assumption that this will improve the client’s emotional state. The therapist helps the client think about the consequences of how he or she behaves in those relationships, alter those actions, improve communication and openness with the others, and thus modify the relationships in a beneficial fashion, all toward the end of relieving the client’s symptoms.
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Group, couples, and family therapy:
These are not specific therapeutic techniques but “modalities”; a modality is a type of therapy classified by the unit of treatment (individual, couple, family, group).

Group therapy:
At least a hundred varieties exist or have existed; new ones appear every year, but many soon die out.

In the 1960s and 1970s, in keeping with the spirit of the times and the idealization of communes, “encounter groups” flourished and the group milieu was seen in humanistic circles as more therapeutic than one-on-one therapy. Later, the general view came to be that group therapy is useful primarily for interpersonal and social problems, although it does also address internal ones; members of a group provide one another with support and empathy as well as with feedback on how the social self each presents is perceived and which aspects of it are welcomed and which not.
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Group activities can range from discussion of one another’s problems and self-revelation to role playing, and from group support of a grieving or troubled member to group attack of a member whose behavior is objectionable. In most groups the therapist steers interactions to some extent and actively intervenes to prevent the group from attacking a member destructively.

Groups range in size, although most therapists consider eight an ideal number. They usually meet once a week, cost only a fraction of what individual therapy costs, and last anywhere from eight weeks to years, depending on their goals and the therapists’ orientations. Group psychotherapy used to be an American specialty but now is practiced in many countries; there are still, however, more group therapists in this country than any other. The American Group Psychotherapy Association
has close to three thousand members; probably ten times that many therapists not in the association conduct groups at least part of the time.
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Couples therapy:
Couples therapy was originally known as marriage counseling but today often proceeds at a deeper level than old-time counseling and is offered not only to married couples but to premarital, extramarital, and homosexual couples, all of whom have somewhat similar relationship problems.

The therapist’s role in couples therapy is a tightrope act: If he or she is perceived by either member of the couple as siding with the other member, the therapy may be abruptly broken off. The therapist therefore seeks to avoid transferences that would generate strong feelings by either client; acts as interpreter, adviser, and teacher; and stresses that the troubled relationship, not either individual, is the client.

The therapist solicits information and makes interpretations; teaches communications skills and problem solving; plays back to the couple how they sound and look in their interaction (“Are you aware that you sat as far apart as possible?”); brings up sensitive issues that they avoid discussing with each other but can safely fight about in the relative safety of the therapist’s office; and assigns homework to teach them new and more satisfying patterns of behavior. Couples therapy is usually conducted on a weekly basis, and most problems can be resolved in a year or less. In some cases, the partners in couples therapy recognize that what one or both really want is the end of the relationship. In that case, the therapist sometimes is able to help them separate cooperatively rather than combatively and minimize the damage to themselves and to the children, if there are any.
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Family therapy:
Family therapy was developed almost simultaneously in several different places in the United States in the 1950s, most notably in Palo Alto and New York. Its basic assumption is that psychological symptoms and difficulties of all sorts stem from faulty relationships within the family rather than from individual intrapsychic mechanisms (although these are not ruled out).

Even though the family may come in with an “identified patient”—a scapegoat or supposedly sick member on whom the family blames its troubles—the therapist regards the family as the patient, or, to be more precise, the family’s interactions, rules, roles, relationships, and organization.
All these make up the “family system”; family therapy draws heavily on systems theory, which was borrowed and adapted from biology. In systems theory terms, the family members may be either overly or insufficiently involved with one another; cut off from outside influences by rigid family boundaries; conversely, lacking in a sense of familial belonging because of vague family boundaries; and so on.
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The therapist diagnoses the family’s problems in systems theory terms by means of genograms (diagrams of family patterns over three generations), by determining what the alliances are within the family, and by using other methods special to family therapy. There are several schools of family therapy, each of which has developed its own intervention techniques. Family therapy is offered not only privately but in clinics and community mental health centers.

The American Association for Marriage and Family Therapy now has more than 23,000 members, who come from various disciplines and have met the association’s requirement of training and supervised postgraduate experience as marriage and family therapists. Many other thousands of psychotherapists, who may or may not have had extensive training in marital and family therapy, call themselves marital and family therapists—the term is not controlled by law in most states—to indicate that they deal with couples and family problems as well as individual ones.
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Odds and ends:
In addition to all the above, a large selection of other brands of therapy is available, at least in America’s major cities and particularly in California. Some are strange but based on sound psychology; others are even stranger and based on pseudo-scientific or mystical ideas. All told, they are essentially trifling in their contribution to mental health treatment. A random sample:

Primal theory
requires the client to engage in prolonged screaming in order to release infantile rage. The client is taught to do this at home when necessary.

Morita therapy
, developed in Japan, is based on Zen principles and begins with four to seven days of total bed rest, isolation, and sensory deprivation. Thereafter, the patient is taught to accept his feelings and symptoms and to live actively in the present, directing his thinking away from himself and toward the world around him.

Ordeal therapy
assigns the patient to a task or situation worse than the presenting problem, such as getting up in the middle of the night, every night, to exercise.

Paradoxical prescription
, employed to break down powerful resistances, consists of telling the patient to keep on with his problem behavior or even to step it up. The permission to do the impermissible is supposed to defuse it, rob it of its perverse value, and lead to a breakthrough.

Positive psychology
, discussed in an earlier chapter, is an umbrella term for a therapeutic regimen that, while not ignoring what is known about human suffering and disorders, stresses positive emotions, positive character traits, peak experiences, and an understanding of happiness. It has been widely publicized by its originator, Martin Seligman, but accounts for only a minuscule percentage of psychotherapy patients.

Hypnosis
or, more precisely, post-hypnotic suggestion, sometimes helps people control their smoking or overeating, overcome stage fright, and deal temporarily with other undesirable traits.

EMDR (Eye Movement Desensitization and Reprocessing):
After several initial stages of preparation, the client focuses on the image of the cause of the disorder and moves his/her eyes back and forth following the therapist’s fingers as they move across his/her field of vision for twenty to thirty seconds or more. This is repeated a number of times during the session. It is supposed to eliminate the influence of the source of the image.

est (Erhard Seminars Training)
, popular in the 1970s, consisted of two weekends spent in a ballroom (at a cost of $250). Bathroom privileges were denied except at official breaks, and the audience was subjected to a day-long barrage of abuse by the leaders (“You are all assholes… You’re nothing but a goddamn machine”). When the clients were sufficiently exhausted and humiliated, the secret of life was revealed: You
are
a machine, cannot be anything but, and can be happy only by being what you are. Werner Erhard stopped holding sessions in 1991, but a firm called Landmark Forum continues to run est-type meetings.

Special-purpose workshops
last half a day or all day, and sometimes for a whole weekend, with time out only for food, toilet use, and sleep. Lectures, group therapy, sensitivity training, and other activities are all used
to deal with feelings and emotional symptoms stemming from a problem the attenders share: child abuse, incest, spousal abuse, fear of revealing oneself, and many others.

And all those others:
What shall we call them? Well, let’s not call them anything but merely mention a few in passing: orgone therapy (in which the patient sits in a special box that supposedly collects a curative energy pervading the universe), dance therapy, past lives therapy, miracles therapy, healing through visionary experience, aromatherapy, mindfulness, therapeutic touch… but it is time to call a halt. We have gone beyond the bounds of science, even though many people think of these fringe activities as psychotherapies based on psychology.

In his autobiography, the late H. J. Eysenck proudly termed himself “rebel with a cause.” Indeed, many causes. After leaving Germany for England in his youth, he enthusiastically laid about him in sundry educational, political, and scientific battles, even while making solid contributions in several areas of psychology. Long a professor and researcher at the Institute of Psychiatry, University of London, and with an impressive list of published and widely cited contributions on intelligence, testing, and personality, he, like Ellis (but on a serious plane), was always a resolutely cheerful bad boy of psychology.

None of his imbroglios was more heated than the one brought about by his historic assault on psychotherapy in 1952. Eysenck had always been contemptuous of psychotherapy, which he felt was unsupported by any scientific evidence. To prove the point he reviewed the data of nineteen studies reporting the results of psychotherapy and came to some shocking conclusions. The different studies claimed “improvement” in as few as 39 percent and as many as 77 percent of the cases, a range so broad as to justify suspicion, he said, that something was amiss. Far worse, Eysenck added up the findings and calculated that, on average, 66 percent of the patients had improved—and then cited other studies reporting that of neurotic patients who had custodial care but no psychotherapy, 66 to 72 percent had improved. His conclusion: There was no evidence that psychotherapy was responsible for its supposed effects. His radical corollary to that conclusion: All training in psychotherapy should be abandoned forthwith.
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