Will reason prevail? From classic psychoanalysis to new age therapy.

Half a century ago, I enrolled in my first undergraduate psychology course, and about 45 years ago, at my initial practicum site, I saw my first patient. This brief paper will discuss what I see as a few of the significant changes (for good and bad) over these past 45-50 years. The predominance of psychoanalysis stands out as one of the most vivid realities of the 1950s. Some even boasted, "I'm into my third analysis - the first two were Freudian and now I'm in the second year of a Jungian analysis." Insight was everything; all else was merely palliative. The disciplined light of science was considered beyond the borders of psychoanalytic methods (a view that has been regenerated by current postmodernists and some social constructionists). This gave psychoanalysis an elitist veneer. By 1958 I had grown enamored of behavioral methods and was the first to use the terms "behavior therapy" and "behavior therapist" in a scientific journal (1). Mainstream thinkers in psychiatry and clinical psychology regarded behavioral approaches as naive, mechanistic, symptom-centered, and superficial. Adherents on both sides of the fence went to battle, and many publications addressed the general theme of "behavior therapy versus psychoanalysis." At the same time, the proliferation of literally hundreds of other schools of psychotherapy emerged (2). At that juncture it seemed advisable to emphasize that no one school had all the answers, and I outlined what I saw as the virtues of technical eclecticism - carefully selecting effective techniques form many disciplines without subscribing to the theories that had spawned them (3). Greater numbers of theoreticians and clinicians endorsed systematic eclecticism and psychotherapy integration, and in 1983 the Society for the Exploration of Psychotherapy Integration (SEPI) was founded. Various combinations and amalgams of different treatment methods were debated, and one central question was whether a combination of different theories would generate more robust techniques. In essence, most seemed to agree that theoretical eclecticism would produce confusion rather than enhance treatment outcomes. Nevertheless, whereas the term "eclecticism" had been strongly pejorative, surveys showed that most practitioners were now willing to call themselves "eclectic," and it was considered myopic for individual schools of thought to lay claim to the Truth. Meanwhile, biological psychiatry became a significant force. In 1957, I recall treating a very depressed physician who was self-medicating with large quantities of Methedrine. At the time, my psychodynamic supervisor was urging me to explore the full ramifications of the patient's "anger turned inward." (In today's world, the most likely treatment might be a combination of cognitive therapy and an SSRL) Some time in 1958, during my psychological internship, one of the psychiatrists announced that a new medication had been released (Imipramine) that was as effective as ECT. The spate of anxiolytics, antidepressants, and antipsychotic medications that soon followed gave rise to the discipline of psychopharmacology. More and more psychiatrists gained proficiency in the application of psychotropics. Clinical psychologists became the main purveyors of psychosocial therapies, often in tandem with psychopharmacologists who took responsibility for prescribing medications. There was a significant change in psychoanalysis, partly as a reflection of much more stringent insurance regulations. Those who had decried shortterm therapies as inferior modified their stand. Consequently, the advent of brief psychodynamic therapy offset the decimated enrollments in analytic training institutes and made outcome research more feasible. Meanwhile, behavior therapy developed a more sophisticated social learning-theory framework and advanced a range of elegant techniques. The term cognitivebehavior therapy was coined and widely accepted, and my own work in "multimodal therapy" was offered in an attempt to further broaden the range and add precision to the enterprise (4,5). …