Psychotherapy across the Atlantic

Psychotherapists fill a unique niche in western society. They are tasked with the care of emotional lives when those lives have become rocky and troubled. Neither the government nor medicine nor the church is particularly good at meeting this need, so this is a crucial function. Every therapist I have ever met believed that theirs is a noble calling. They rarely, if ever, question the intrinsic and self-evident goodness of what they do.

The new special issue of History of the Human Sciences, edited by Sarah Marks, focuses on psychotherapy in Europe. Articles range across the twentieth century, tracing psychoanalysis in Greece, the transnational shaping of Yugoslav psychotherapy, hypnosis in Hungary, the role of suggestion in Soviet medicine, mindfulness in Britain, and Dialectical Behaviour Therapy in Sweden. In parallel, History of Psychology have published a special issue on psychotherapy in the Americas, edited by Rachael Rosner. Here, Marks and Rosner discuss the authors’ contributions, and what’s at stake when writing about the history of psychotherapy.

Sarah Marks (SM): Perhaps we can start by tracing how the idea for these issues came about. You and I first met at a conference at University College London in 2013 organised by myself and Sonu Shamdasani on the history of psychotherapy – but the idea for these parallel issues came from you: what was the motivation behind the idea, and the particular focus of Europe and the Americas?

Rachael Rosner (RR): Your conference was a watershed moment for me personally. For years I had been trying to figure out where the history of psychotherapy belonged. The history of science? The history of medicine? The history of the social, behavioral and human sciences? Psychotherapy straddles all of them, but from the standpoint of historians asking shared questions, there wasn’t yet a home base. Your conference was an important step in that direction.

Rachael Rosner

Sonu followed in 2016 with a mini think-tank on transcultural histories of psychotherapy, which you and I attended. Felicity Callard (who had been at the 2013 conference) had just assumed co-editorship of History of the Human Sciences and Nadine Weidman had just become editor of History of Psychology. It seemed like Felicity and Nadine would likely encourage good work coming out of this nascent community. So the idea just clicked that you and I might guest-edit coordinated issues as a way of continuing the momentum. The idea was inspired by a strategy National Institutes of Health researchers had used in the late 1960s to nurture psychotherapy researchers. They published the proceedings of a workshops on psychotherapy research methods in two journals simultaneously, American Psychologist and Archives of General Psychiatry. I thought we might try something similar. Thankfully, you, Nadine and Felicity were enthusiastic. Your expertise was in European psychotherapy and mine in American, so we would focus on those regions. But this was just a starting point. Excellent work is being done on the history of psychotherapy in Asia and India and, hopefully soon also, in Africa.

SM: Both of these issues try to put the question of place at the centre of the debate – both in terms of local specificities, and the transfer of knowledge and practice across borders and cultures. For Europe, it’s curious how much long-term continuity there was despite the geopolitical divisions of the Cold War – practices including hypnosis, suggestion and group psychoanalysis which emerged in Western and Central Europe in the earlier half of the century remained in play in different parts of Eastern Europe well into the 1960s and 1970s. And we also see the crucial importance of transatlantic connections in both directions, especially from America to Europe in recent years. How did transnational and transcultural stories play out within the Americas?

RR: What is astonishing is how many of the innovations in the Americas were local improvisations on European trends. It’s not surprising that this transfer of knowledge happened within psychoanalysis, but our special issue illustrates that it was happening in other domains too. In Argentina, as Alejandro Dagfal shows, French ideas consistently spurred psychotherapeutic innovations. Jennifer Lambe’s and Cristiana Facchinetti’s and Alexander Jabert’s pieces also show the French influence, in this case among followers of French spiritualist Alan Kardec (Kardecian Spiritists). Erica Dyck’s and Patrick Farrell’s paper on LSD therapy tells the story of a disaffected British psychiatrist who found support in the isolation of the Canadian prairies. In America the trans-Atlantic trends were more heterogenous and reciprocal. British psychotherapists played a huge role in catapulting American Aaron Beck to stardom, just as Beck’s CBT helped British clinicians gain advantage with the NHS. The only article in our special issue that doesn’t follow the transcultural theme is Deborah Weinstein’s account of how family therapists in America embraced the removal of homosexuality from the Diagnostic and Statistical Manual of Mental Disorder (DSM-III) and came to normalize both homosexuality and gay families.

SM: We know that many forms of psychotherapeutic have long been entangled with religious or spiritual practices, right back to the Quaker Tuke family at the York Retreat in the 1890s – and Matthew Drage shows in HHS that Buddhism has remained a significant driving force in the transmission of mindfulness practice in Britain, even as it has become bound up with cognitive science and evidence-based outcomes studies in recent years. It seems that religion played an even more central role in psychotherapy – albeit in slightly different ways – in North and South America in the 20th Century. Could you tell us more about what your authors found in relation to this?

RR: Yes, you’re right. Psychotherapies in the Americas tapped deeply into spiritual trends right from the beginning.David Schmit’s biography of Warren Felt Evans, founder of the Mind Cure movement, takes the story of religion and psychotherapy in America farther back even than Eric Caplan’s work. Americans continued to embrace the religious aspect, even if they didn’t always recognize it as such. Carl Rogers was a minister before he became a psychologist, for instance, and client-centered therapy was as much an expression of religious as psychological imperatives; immigrant psychoanalysts who made such a big mark on American psychotherapy, like Erich Fromm, Erik Erikson and Victor Frankl, were also fully engaged with religious questions. When D. T. Suzuki brought his Buddhist practices to America mid-century, Erich Fromm and behavior therapist Albert J. (Mickey) Stunkard were hugely enthusiastic. These are just some examples of how the religious impulse remained strong throughout the history of American psychotherapy. We might imagine that Catholicism would come into play, especially in Central and South American psychotherapies, and there is scholarship to suggest as much. But the big surprise in our special issue was Kardecian Spiritism in Cuba and Brazil. Kardecian Spiritism had no presence at all in North America. So this is an exciting line of research.  

Sarah V. Marks

SM: You yourself have done considerable work on the history of Cognitive Behavioural Therapy (CBT) in America, especially in relation to the work of Aaron Beck. Could you tell us a bit more about how you have started to write this in to the broader history of psychotherapy?

RR: Beck’s Cognitive Therapy (CT) can be difficult to grasp from the standpoint of the history of the human sciences because there is little in it that speaks to the subjective or the emotional—his ideas don’t intersect with art, literature, philosophy, the linguistic turn, etc. This lack of intersection, however, is also what makes Beck’s CT interesting historically. CT flourished at the turn of the 21st century in the U.S. and the U.K. precisely because of tensions between objectivity and subjectivity. Most psychoanalysts by then were plunging even deeper into the subjective, under the influence of Lacan, Foucault, and others. But the vast majority of non-analytic therapists—largely psychologists and social workers—were making a mad dash in the opposite direction, to objectivity. The rise of the Randomised Control Trial meant that therapists seeking federal research funding or reimbursement for treatment had no choice but to embrace objectivity. Beck was in the right place at the right time. He had been plying CT since the early 1960, with only moderate success. But now, suddenly, by 1985 or so, CT and CBT were the gold standard. They met the clinical, economic and research needs of a large number of therapists. Interestingly, the supremacy of the objective didn’t mean that Beck’s followers abdicated the subjective. They have rather been engaged in a subtle dance between objectivity and subjectivity that is fascinating to study historically.

SM: I’m aware that you’re writing a biography at the moment – could you say a bit about the challenges and rewards of biography as a genre?

RR: Historians of science often malign biography as soft scholarship. Mike Sokal has done a good job challenging this assumption, but there’s more work to do. One of the major challenges of writing biography is convincing historians that the argument is not parochial or hagiographical. That’s a tall order. I believe that biography is uniquely well-suited to the history of psychotherapy. Psychotherapy actually defies the categories historians use for bracketing our subject matter. I do not believe that psychotherapy is in fact a sub-genre of medicine, or science, the behavioral sciences, religion, psychology, or anything else. No profession has managed to corner the market on its practice. Psychotherapy is, rather, a historical chameleon. Maybe “shape shifter” is a more accurate description. Psychotherapy quickly assumes the characteristics, colors, virtues and temperament of the person practicing it—whether that person is a doctor, a minister, a rabbi, a mystic, a housewife, a psychologist or a brush salesman. Each iteration is unique to the practitioner. Biography taps into that idiographic quality. We can write social, cultural, intellectual, and other kinds of histories of psychotherapy, and they are all worthwhile. But biographies get to the core of psychotherapy because they get to the core of the person who is practicing it. Several years ago I attended the annual conference of BIO (Biographer’s International Organization), and the keynote speaker remarked that what she loves about biography is that it  is experience in our shared humanity. Biographers are trying to make emotional contact, to have a shared experience, with their subjects. I love that.

SM: Like a number of my colleagues, you write from the perspective of the humanities and historical research, but you also have a background in the clinical world, and you believe strongly in the importance of writing for an audience of practitioners. Could you tell us a bit more about why this is important, and what is at stake when writing histories for this readership?

RR: I became a historian, in part, in order to agitate clinicians. The back-story is that my father was a clinical psychologist who had trained at the University of Chicago in the 1960s with people like Roy Grinker, Jr. and Bruno Bettelheim. Carl Rogers had just left Chicago, but his influence there was still very strong. Our home library included books by Freud, Jung, Fromm, Bettllheim, Rogers and others, all of whom I read avidly. I had intended to become a clinical psychologist like my father, but it became clear during my training that I was not cut out for clinical practice. Clinicians were making all kinds of assumptions about human nature I wasn’t prepared to make. They were being trained to solve problems, not to think critically, but thinking critically seemed to be where I lived. I’d been in search of a mechanism through which to bring that kind of critical inquiry to the community of clinicians about whom I cared so much. The History and Theory Area in the Department of Psychology at York University (Toronto), where I did my Ph.D. under Dr. Raymond Fancher, offered that kind of mechanism. History as practiced there was all about engaging psychologists in difficult conversations about what they do and why.

Psychotherapists fill a unique niche in western society. They are tasked with the care of emotional lives when those lives have become rocky and troubled. Neither the government nor medicine nor the church is particularly good at meeting this need, so this is a crucial function. Every therapist I have ever met, including my father, believed that theirs is a noble calling. They rarely, if ever, question the intrinsic and self-evident goodness of what they do. But to my mind it’s crucial that they do just that—or run the risk of doing harm. Sadly, I know too many stories where therapists’ over-confidence made matters worse for a patient, not better. This is a situation ripe for historical agitation, for inviting therapists to ask hard questions and, in the process, to take a more circumspect and thoughtful stance in their work.

Rachael Rosner works as an independent scholar. Her most recent articles include ‘Manualizing psychotherapy: Aaron T. Beck and the origins of Cognitive Therapy of Depression’ in The European Journal of Counselling and Psychotherapy, and ‘The Splendid Isolation of Aaron T. Beck” in Isis.

Sarah Marks is a postdoctoral researcher at Birkbeck, University of London and Reviews Editor for History of the Human Sciences. She writes on the psy-disciplines during the Cold War, and currently works with the Wellcome-funded Hidden Persuaders project.