Fads and Truths

Written By Terry Potente, LCSW

Like all human endeavors, the practice of psychotherapy has ups and downs, trends and reactions. Since the expanding practice of psychotherapy began in cities at mid 20th century, much has come and gone and come back again. Prior to the professionalization of psychotherapy, mental health treatment was handled by a medicine man, minister, midwife or wise person in the local community who knew the troubled person and the context of the problem. The relationship was intense, personal and often a mix of religion and theater. This is still the norm in many parts of the world.

Universally, an essential element in mental health treatment is the relationship of therapist to client. In the early post war years, psychoanalysis was the trend and the therapist was a figure in the background. Passive, unexpressive, the relationship of the therapist to patient was that of a mirror or blank slate. In extreme reaction to that model came innovators. For example, Murray Bowen out of Georgetown and Salvatore Minuchin out of Philadelphia developed schools in which the therapist was directive, involved, opinionated, and quite intrusive. and often dramatic. The persona and role of the therapist was large. Bowen would hospitalize entire families to challenge behavior and communication patterns of family members. Munuchin set up reenactments in which he would direct the action and responses of family members. Individual psychiatric hospitalization or medication was considered extremely passé.

With another turn of events, the concept of "chemical imbalance" defined mental health problems and medication became the therapist with the actual therapist as a prescriber or a referral to a prescriber of meds. The act of talking to a therapist was considered a fairly useless means of treating mental illness or mental problems, very passé. very undramatic and "scientific".

Yet there was always a counter culture of practice. Virginia Satir, flamboyant and caring, promoted healthy relationships as the key to mental health even in the face of insults by peers. Jungians continued to practice deep, spiritually based, talk therapy. Relationship between client/patient and therapist was the important element. The more intuitive, relational style was sought out by seekers but wasn't considered "scientific" by the medical elite. Yet therapists, perhaps guiltily at times, sought a deeply relational practice, in which empathy, attachment and atunement made the work more satisfying and intuitively successful.

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