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Evolution of Psychotherapy: The Third Conference
Am J Psychiatry 1999;156:1462-a-1463.
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Washington, D.C.

edited by Jeffrey K. Zeig, Ph.D. New York, Brunner/Mazel, 1996, 358 pp., $69.95.

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This book consists of the proceedings of a conference held in 1995 under the sponsorship of the Milton Erickson Foundation. This was the third in a series of similar conferences held in 1985 and 1990. Aside from being asked to concentrate on their own development as therapists, the participants were given no other guidance (nor does the book contain any reference to the findings of the previous conferences), so that what we get in this big book (26 contributions with discussions) is not a coherent account of how and why psychotherapy has evolved but a series of articles in which some of the participants trace their own development and most simply deal with the topic they have chosen to discuss. It is of interest and indicative of the tone of the conference that many of the presenters who trace their development describe their initial immersion in psychoanalysis, followed by dissatisfaction and disillusion and then by their discovery of the particular different form of psychotherapy that they now espouse.

Given the limited space available for this review, I shall be able only to summarize the contents of the volume along with comments about some of the papers, followed by a discussion of the volume as a whole, its strengths and disadvantages.

The first section, Analytic Therapies, contains two excellent articles by Otto Kernberg and Judd Marmor. Kernberg, the only mainstream psychoanalyst contributor, presents a balanced and scholarly review of the convergences and divergences among the analytic schools. The convergences are characterized by less conflict among the schools, greater attention to the present situation, and a less "counter" view of the relationship between therapist and patient. Kernberg also enumerates the differences that identify these schools as separate. Judd Marmor, in his usual engaging and persuasive fashion, describes how he tried psychoanalysis, found it wanting, and went on to develop his own much more interactive, broad-based form of therapy.

The next section, Cognitive Behavioral Approaches, opens with an authoritative account of its main tenets by Aaron Beck, who can be considered its originator. Also in this section I was impressed by the article by Donald Michenbaum, in sharp contrast to the rather bellicose presentation by Albert Ellis, also in this section. I noted considerable similarities between Michenbaum and Judd Marmor. Section 3, Contemporary Approaches, contains accounts by William Glaser of his reality therapy and by Alexander Lowen of his bioenergetics, both of which seem to be of rather limited value.

Section 4, Ericksonian Approaches, contains a theoretical article on hypnotherapy by Ernest Rossi and an expansion and appreciation of Milton Erickson’s contribution by Jeffrey Zeig. A thoughtful discussion of this article by Otto Kernberg points out similarities and differences between this approach and psychoanalysis. The next section, Experiential Approaches, contains several articles, of which I found the one by James Bugenthal thought-provoking. This is a general discussion of the place of psychotherapy in our society and what Bugenthal views with alarm as a fundamental schism between those who see the human as a machine to be fixed (DSM-IV types) and those who see humanity as possessing more transcendent value. Psychotherapy is applicable only for these latter. In this section, also, Mary McClure Goulding’s account of her reaction to the death of her husband is quite moving.

Section 6, Family Therapist, is graced by the contributions of two eminencies in the field—Jay Haley and Salvador Minuchin. Haley demolishes psychoanalysis in an almost mocking fashion while imposing limited confidence in behavioral and family therapy, and Minuchin gives a fine historical and personal account of the development of the family therapy in which he has been so much involved. Cloe Madanes takes the rather unusual approach of introducing a moral dimension into psychotherapy. In section 7, Philosophical Approaches, Thomas Szasz uses this venue to continue his attack on psychiatry and medicine by affirming that psychoanalysis and psychotherapy have been killed by being made into "treatments" by psychiatrists rather than by being maintained in their proper place as a dialogue of the soul between two people.

The last section, State of the Art, contains a valuable contribution by Stella Chess in which she reviews her research with Alexander Thomas as well as formulations about the importance of considering temperament, the inborn differences between people, as a potent but certainly not the exclusive determinant of human behavior.

With the exception of its rather inadequate and dismissive attitude toward current psychoanalytic and psychodynamic approaches, which are certainly more interesting and sophisticated than this book could suggest, Evolution of Psychotherapy presents a panoramic view of the state and practice of psychotherapy in the United States today. What can I, a veteran psychiatrist whose career has been principally in psychotherapy, say of the picture it presents? Certainly, as reflected by the many energetic contributions by leaders in the field, psychotherapy is alive and flourishing. It seems to fit the needs of many people. However, this book also raises some significant questions. For one, although there are a few negative comments (such as Salvador Minuchin’s glum remark about the value of psychotherapy), most contributors are quite optimistic about the results of treatment based on their own methods, in spite of the fact that these methods are all very different from each other, and there is practically no effort to differentiate and specify what methods are good for what particular condition. In fact, one does not get a very clear idea of what brings a person into the care of a psychotherapist, except for a rather universal rejection of medical criteria. Beck offers a meta-analysis of studies reporting the results of cognitive therapy, but otherwise there is little about results in general or outcome studies. There are a few exasperated comments about managed care, but no attempt to cope with how changing economic conditions have influenced psychotherapeutic practice.

Despite the above caveats, I can recommend Evolution of Psychotherapy as a lively, comprehensive, and informative discussion of the field of psychotherapy as it is currently offered in the United States today.




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