The Good Therapist

MANY THERAPISTS THESE DAYS FEEL A LITTLE LIKE hurricane victims watching the roof of an entire profession being blown off. They wonder balefully (and loudly) if their corner of civilization is facing extinction, if their way of life and the worldview that defines psychotherapy will be reduced to rubble when the storm is over. But if the last 70 years are any indication, they should take heart from the study of history.

The culture of therapy in America has gone through periods of dramatic change every 15 or 20 years with almost clock-like regularity, as succeeding generations of therapists respond to the evolving Zeitgeist while stamping their own imprint on prevailing social mores. With each succeeding wave of change, the old line invariably denounced the rising party with variations of the same accusation the new people were betraying the hallowed principles of the True Therapy. Even so, something that everybody agreed to call psychotherapy not only survived, but grew more robust and complex with each passing mini-revolution, as therapists continually re-invented themselves and their metier to keep up with the times. “But it’s never been this bad,” the current crop of storm-tossed victims can be heard to cry. Maybe. And yet, it seems fair to say that the ambivalent love affair between American society and psychotherapy has gone on too long almost a hundred years for either party to get along very well without the other at this late date. Now an old married couple, even while bickering and sniping, they are probably inextricably bound up in each other’s identity therapy has become as American as apple pie.

When psychotherapy first made it big in American culture, however, it was still a very. European phenomenon. While psychoanalysis had inspired a small, elite group of followers among artists, writers and intellectuals during the 1920s, it was the waves of analytically trained refugees from European fascism and terror during the ’30s who brought to a much wider audience a darker vision of human possibilities than was consonant with the traditional American ethos of optimism, pragmatism and patriotic boosterism. Subdued by the Great Depression, disillusioned with the trustworthiness of their economic and political institutions, many educated Americans resonated to the message of the Freudians that the only real and dependable source of truth was the inner self of the individual.

The newly arrived European analyst who had seen a civilization being destroyed by the evil impulses buried in the Id knew this kind of therapeutic work was often deeply unsettling digging into these deep caverns of the psyche inevitably unearthed a host of terrors. The Good Therapist of this era was the Brave Archaeologist brushing aside the curse and forging directly into the tomb of the mummy. Like Indiana Jones, she or he was as much pioneer and explorer as gentleperson and scholar. And the therapeutic virtues of this archetypal therapist were deep seriousness, courage and relentless determination in the pursuit of healing truth.

In time, fascination with mummy-finding waned though the image is still venerated by some therapists today along with the grim days of the Depression and World War II. After a decade and a half, Americans wanted and believed again in uplift: they had beat the Depression and won the war; their factories were churning out goods and the whole world was buying; their writers and artists and filmmakers and TV producers were re-designing the lineaments of Western culture. Who had time for deep internal introspection? Who needed it?

The Good American Therapist of the post-war era of the ’50s was the Coach, the can-do specialist the behavioral therapist, the humanistic therapist, the family therapist who focused on what was changeable in the present and possible for the future. Unlike the Archaeologist, who was suspicious of change not based on unraveling the past, the Coach believed that most people could transform themselves, and at a good clip, if only they were given the right skills for the life game. Some of these clinicians were clearly activists, like Virginia Satir or Albert Ellis, exhorting or even physically patting, hugging, touching, pushing and pulling clients into shape, while others were more passively supportive, like Carl Rogers. But all believed in the endless possibilities of change once clients took themselves firmly in hand and got with the program, which, they believed democratically, practically anybody could do. During the same era, a competing image of the Good Therapist was run up the flagpole, but not many people saluted. At a famous conference in Boulder, Colorado, in 1952, a group of clinical psychologists came up with the Scientist/Practitioner as the ideal therapist. This clinician, in their view, was above all, a person of science and of intellectual skepticism, who took no unproved assertions as given, accepted no global claims for any clinical method that had not been closely scrutinized and empirically

proved its validity. In the booming America of the ’50s and early ’60s, however, this ideal hardly caused a ripple outside the rarefied air of university psychology departments. It was too cautious, not nearly expansive, positive or dynamic enough for the impatient therapeutic optimists, who much preferred compiling statistics and jump-starting clients to doing controlled experiments.

But in the recurring cycle of history, the exuberant faith in the glory of the American Dream that subtly informed the therapists of the ’50s gave way to the righteous anger and political protests of the ’60s and ’70s, and the shared suspicion of millions that the power and prestige of the American colossus was not necessarily good for many of its people. Not only public polity, but the private institution of the family with its newly uncovered secrets of incest, violence, sexist domination was damned as emotionally and spiritually oppressive, entombing the human potential for joyous freedom and spontaneous creativity. The Good Therapist was now the Liberationist. The most fervent prophets for a better, more humane society were a variegated posse of therapeutic critics of the status quo, both hard and soft the hard ones, like R.D. Laing (the American wing of the mental-health protest movement took him as its own savior even though he was British), excoriating everything about double-binding, madness-inducing Western civilization; the softer ones, like Fritz

Perls, concentrating on the potential for personal growth and transcendence above all that was left-brain and oppressive about modern civilization. Hard or soft, the Liberationist Therapist felt a duty to “underthrow the establishment,” as one left-wing wit put it meaning, that the real revolutionary burrowed from within, just like a therapist. For this particular Good Therapist, the goal was the client’s liberation from social conformity, conventional morality and psychic repression. As was always the case, therapists whose style emanated from previous trends deplored the new age, grumbling about the childish immaturity, professional irresponsibility and rootless anarchy of the new generation of therapists. But the old guard wouldn’t have long to wait for the next cycle to turn.

By the early ’80s, the beginning of the Reagan years, the Decade of Greed, third-party reimbursement for psychotherapy had become as lucrative and dependable a cash source as agricultural subsidies, and the ideal therapist was no longer a lean and hungry quester after a better world, but a portly and successful professional, a well-paid expert on the human drama every bit as deserving of respect and prestige as the physicians on whose model his or her own career was based. Any doubts about the therapist’s credentials as a member in good standing of the health care establishment could be laid to rest by one look into DSM-III, the heavy tome that legitimized the medical reality of the various syndromes and conditions that therapists “treated.”

While they might have depended on official psychiatric labeling for the de jure legitimacy that got them paid, but in the de facto privacy of their offices, many therapists engaged in an orgy of non-medical eclecticism that often seemed unrelated to their external identification with the professional healthcare world. It was the rare clinician who adhered to a single model or theory and didn’t describe her or his practice as “eclectic,” meaning an idiosyncratic, ad hoc blend of psychodynamic, cognitive and behavioral modes, with maybe a heavy salting of hypnotherapy, family systems and gestalt. What really mattered to therapists during this era far more than their identification with any particular theory, method or philosophy was their freedom to define a personal therapeutic metier for themselves. Thanks to the largesse of the reimbursement system, therapists during this all-too-brief era could afford to be both Artists and Entrepreneurs at the same time they had the best of both worlds. An ordinarily Good Therapist a conventional Artist-Entrepreneur, who hadn’t yet hit the big time could maintain a comfortable, even affluent, lifestyle creating a highly personal “product” for every client, while striving for ever-more-authentic expression of his or her own individual style. A “great” therapist, on the other hand, was the equivalent of the artist discovered by Time magazine; perks of mega success were workshop tours Milton sold out weeks in advance, a long  waiting list of client’s a  reverent gaggle of followers, TV interviews and maybe even a best-seller. Famous or not, few therapists could complain during this Gilded Age; the  Liberationists of the`60s may have thought they understood liberation, but never before or since have therapists actually lived such charmed lives embodying personal freedom, professional self-realization and economic autonomy.

It couldn’t last, and it didn’t. The orgy of therapeutic over-indulgence ended with the stiff hangover of the ’90s, the Era of Hard Knocks, not only for therapists, but for many other professionals, as well. Engineers, architects, lawyers, teachers, middle-management executives, government employees, even formerly sacrosanct physicians and military personnel are all feeling the cold wind of institutional devolution. With corporations and government agencies all hell-bent on downsizing, anybody with a plausible sounding plan for economizing gets a good hearing from the administrative bean counters of America. Thus, cost-cutting strategies of managed care both the reasonable and the draconian have penetrated to virtually every corner of the mental health field, much to the dread and outrage of therapists, who are being booted out of therapy heaven in droves by an apparently merciless deity of the bottom line. Nevermore, they bemoan to each other, will they practice freely and independently; evermore will they feel the beady eyes of the corporate case reviewer scrutinizing every intervention, every minute of their practices.

Adding insult to injury, therapists are finding that there is not much sympathy for their plight from a public disenchanted with their profession. At a time when the old stigma about seeking therapy has just about vanished, therapists, like welfare mothers and illegal immigrants, have themselves become scapegoats and symbols for everything that is wrong in America. The backlash against the recovered memories movement has promulgated an image of therapists as hysterical witch hunters who break up families, while a growing little army of writers and commentators accuse them of inventing, for their own selfish ends, a culture of whining victimization that undermines personal moral responsibility and individual autonomy.

Ironically, this distrust of the therapeutic professions couldn’t come at a worse time, not only for therapists, but for a society that appears to need therapists more than ever. At no point in American history has there been such an unraveling of family and community, which once constituted a dependable emotional safety net for most of the population. More and more people are adrift, alienated, anxious and seeking therapeutic help for their unhappiness. The rate of depression has increased for each successive generation since World War II and depression strikes at earlier and earlier ages. Nearly half of American families have had a member in psychotherapy; if the profession has boomed over the last 30 years, it is at least partly because in troubled times, therapists, like lawyers, are in heavy demand by troubled people.

Meanwhile, most therapists who came of professional age in an era of unlimited private practice find themselves repeating history, regarding their profession from the bottom of another evolutionary cycle, just the way their predecessors have done every 15 or 20 years for over half a century. And like their forebears, they thrash around uncomfortably, complain bitterly about the demise of civilization as they know it or deny the reality of the inevitable, struggle to find some reasonable way to fit square pegs into round holes, experiment with postmodern therapies, contemplate new careers. But as the saying goes, the threat of execution concentrates the mind wonderfully, and from the current ferment, new reconfigurations of therapy and transformed definitions of the Good Therapist are once again evolving. Nobody knows yet what this coming turn-of-the-century therapeutic paragon, still in the R & D stage, will look like. In the

following pages, established therapists every one committed not only to surviving, but to bringing good therapy into the 21st century will describe, each from a different perspective, what might be called eternal therapeutic verities, qualities of heart and mind without which no therapeutic work worth the name is even possible. Taken together, these essays are an attempt to define something that way back in pre-postmodern times, used to be called “good character” an amalgam of traditional personal and ethical qualities that as much as theory, technique and professional training may be said to form the core of effective clinical practice at the end of this century.

The professional costume worn by the therapist of the ’90s is bound to look different than the one worn 30 or even 10 years ago, but the heart and mind of the emerging Good Therapist, even if hidden beneath those newfangled threads, would be instantly recognized by worthy counterparts of past generations. It’s hard to imagine that the Good Therapist, faced with the need to dump some of those old Nehru suits, ‘will not do what he or she would probably advise a client to do in the same circumstances take some time to mourn the loss of a beloved standby, and then begin experimenting with a new look.