I spent the first three decades of my career as a psychologist focused on therapy, especially various forms of brief therapy--learning, researching, teaching, and supervising--and participating in the exciting initial phase of two therapy movements: the behavior therapy movement and the family therapy/systems movement.
Those were heady times. The political and social ferment of the 1960s and 1970s affected therapy along with other social institutions. Psychologists, psychiatrists, social workers, and individuals from other fields all crossed disciplinary boundaries to exchange ideas and try out new approaches to helping people in distress.
Things have changed since then. Just as psychoanalysis broke up into competing schools of thought, training institutes, and orthodoxies earlier in the twentieth century, the same processes of division and ossification came to affect the behavior therapy and systems movements. Similarly, within academia, the different professions went their separate ways, creating, assigning, and teaching their own literatures, and coping with larger social forces. Managed care, lawsuits, defensive practice, and issues of insurance reimbursement all contributed to stifle innovation.
Within academia, there is also social pressure to be up-to-date. Reference lists need citations from recent publications, so recency may wind up trumping quality in assigned readings. The positive side of this pressure is that new ideas (when they exist) and new research will be made available to therapists-in-training. The negative side, however, is that a kind of disciplinary amnesia sets in, and students are left unexposed to significant ideas or the intellectual history of their disciplines and professions.
I’d like to devote this piece to acknowledging a few of the seminal therapy innovators whose writings influenced therapy practice and research, including my own, and to calling attention to a few influential books that no longer have an audience. Interestingly, only one of these books was an assigned text in my doctoral program. My inference from this is that people who are serious about becoming therapists cannot rely only on formal training and assigned readings. They need to also pursue their own path toward intellectual development.
I’ll begin with Persuasion and Healing: A Comparative Study of Psychotherapy by Jerome Frank (1909-2005). Frank, a psychologist and psychiatrist, pointed out elements that therapy has in common with the placebo effect, religious revivalism, and brainwashing. Originally published in 1961 (though there were two subsequent editions), the book was a stimulus for my first book, Placebo Therapy: A Practical Guide to Social Influence in Psychotherapy. Time does fly. Can it really be 42 years since Placebo Therapy came out in 1973?
Jay Haley (1923-2007), who had a master’s degree in communications and who worked with Gregory Bateson and others in developing the double bind theory of schizophrenia, studied communications in schizophrenia, hypnosis, and therapy, and was a leading figure in the systems movement, in family therapy, and in developing a strategic approach to therapy. Haley, like behavior therapists who came after him, viewed therapists as active interveners in changing problem behavior and candid evaluators of the effects of their interventions. Rather than counseling patience, he encouraged therapists to try something different when what they were doing wasn’t working. His 1963 book Strategies of Psychotherapy introduced paradoxical interventions to the field and also laid the groundwork for his future contributions to family therapy.
Haley also introduced the work of the psychiatrist Milton Erickson (1901-1980) to his readers and students. Erickson was a remarkable clinical innovator in both therapy and hypnosis, and something of a showman, but he was not so good in his clinical writings at explaining what he was doing and why. In addition, his ideas about hypnosis, while not interfering with his clinical interventions, were not consistent with hypnosis research. Haley performed a real service in his 1973 book, Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson, M.D., by bringing order to the creative chaos of Erickson’s clinical work. He was able to do so by viewing Erickson’s cases and interventions in terms of the family life cycle.
Leonard Krasner (1924-2007) was one of the founding figures of behavior therapy, and was a postdoctoral supervisor of mine. The long introductory chapter of his 1965 book Case Studies in Behavior Modification, written with his co-author and co-editor Leonard Ullmann (1930-2008), was the first time in my training that I read something connecting the scientific substance of psychology with actual clinical practice. The book was an assigned reading in a Psychotherapy Research course.
What Case Studies in Behavior Modification did for theory, Behavior Therapy Techniques: A Guide to the Treatment of Neuroses did for practice. This 1966 book, co-authored by the psychologist and clinical innovator Arnold Lazarus (1932-2013) and the psychiatrist and inventor of the technique of systematic desensitization, Joseph Wolpe (1915-1997), was a how-to guide for beginning therapists like me. The field was so new at the time that experienced supervision was hard to come by, and this book gave therapists concrete ideas to try out with their clients and see if they worked.
These clinicians made important contributions. It is a shame that it is possible to get a PhD in clinical psychology without having read anything they have written, and, in some programs, never even to have heard of them.
Jay Haley in the early 1990's, Bethesda, Maryland, photograph by James Keim
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