Behavior: A Therapist in Every Corner

“All the experts are here, and none of them agree,” burbled a psychiatric nurse. She was one of 7,000 people who attended the Evolution of Psychotherapy Conference last week in Phoenix, which was billed by its organizers as “probably the largest gathering ever devoted to the practice of psychotherapy.” Part trade show, part ecumenical conference, the meeting drew participants from 29 countries and dozens of therapeutic splinter groups. Jeffrey Zeig, the director of Phoenix’s Milton H. Erickson Foundation, which helped sponsor the event, counted 15 major schools of thought on the program, plus Thomas Szasz, a psychiatrist who does not believe that mental illness even exists.

Szasz met the venerable Freudian Bruno Bettelheim, 82, for the first time, patted him on the back and called him “one of the few people at this | conference that I respect,” thus indicating how far therapeutic ecumenism has to go. Among the other visiting stars who had never met were Human-Potential Guru Carl Rogers and Joseph Wolpe, one of the founders of behavior therapy. Wolpe found the talk about therapeutic unity resistible. Zeig, in his opening address, referred to “the great ballet of differences” in the field, but Wolpe called it a “babble of conflicting voices.” Wolpe complained about the proliferating forms of alleged cures, “with a new crop every year from California.” He plugged his own form of therapy as being scientific, adding the commonplace but wounding remark that there is only one science of chemistry because chemistry can prove something, whereas psychotherapy cannot.

Many of the conference’s faculty members, which included such internationally known stars as Rollo May, Albert Ellis and R.D. Laing, said they were astonished by the turnout. All 7,000 participants needed to have a professional degree of some kind or at least be enrolled in a graduate program, and 3,000 applicants were turned away for lack of space. “Why are you all here?” Jay Haley, director of the Family Therapy Institute in Washington, plaintively asked one of the conventiongoers. “We want to see you all before you die” was the response. Other stars on hand included the grandchildren of such giants as Sigmund Freud, Carl Jung and Alfred Adler. Sophie Freud is a professor of social work at Simmons College in Boston; Dieter Baumann, a Jungian analyst in Zurich; and Margot Adler, a reporter for National Public Radio.

The problem of making sense of the field was painfully apparent during a panel on schizophrenia when three of the four members said that the disease was nonexistent. Family Therapist Carl Whitaker said, “The problem is that you have a disease, but the disease is abnormal integrity, loyalty to a view of the world that the schizophrenic is willing to stake his life on.” Szasz saw schizophrenia as a “legal-cultural fiction.” Said he: “It’s useful to Mr. and Mrs. Hinckley to think of their son as schizophrenic when he’s really just a bum.”

R.D. Laing, the favorite shrink of student rebels in the ’60s, retains his romantic opinion of schizophrenics as brave victims who are defying a cruel culture. He suggested that many people are diagnosed as schizophrenic simply because they sleep during the day and stay awake at night. Schizophrenia did not exist until the word was invented, he said. That was too much for Judd | Marmor, a former president of the American Psychiatric Association. He called the panel a “travesty.” At a later panel, a woman in the audience asked Laing how he would deal with schizophrenics. Laing bobbed and weaved for 27 minutes and finally offered the only treatment possible for people he does not view as sick: “I treat them exactly the same way I treat anybody else. I conduct myself by the ordinary rules of courtesy and politeness.”

Virginia Satir, a freewheeling family therapist in Palo Alto, Calif., was probably the top attraction, luring more than 2,200 to a workshop, a discussion of her techniques, which she illustrated with a videotape. Satir is a peppy speaker with murky ideas, who often opens a session by asking members of the audience to embrace those next to them. Said one colleague: “She can fill any auditorium in the country, but she has great difficulty conceptualizing.”

Jay Haley spoke about his “shaggy-dog” technique: get the patient to make an absolute commitment to change, then guarantee a cure but do not tell the patient what it is for several weeks. “Once you postpone, you never lose them as patients,” he said. “They have to find out what the cure is.” One bulimic who ate in binges and threw up five to 25 times a day was told she would be cured if she gave the therapist a penny the first time she vomited and doubled the sum each time she threw up. Says Haley: “They quickly figure out that it doubles so fast that they can owe the therapist hundreds of thousands of dollars in a few days, so they stop.”

Zeig wisely urged the conference speakers to use English instead of professional jargon. Most complied, but there was still much talk of “accessing the self.” The closest thing to a central idea was that the patient, or client, already has the answer to the problem deep within, and the therapist simply helps bring it out.

Zeig thought that the conference had helped produce some “baby steps” toward unifying the world of therapy. “Ten years ago,” he said, “these people wouldn’t even have sat down together.” The obstacles to consensus may have been best illustrated at one contentious panel when the moderator tried to wrap things up by saying that at least everyone agreed on the need for honesty in therapy. Szasz, ever the ankle biter at conventions, interrupted to declare that many patients want dishonesty, and the therapeutic business ought to provide it.