From Freud to Dr. Phil, scholars analyze the rise of psychotherapy in America
Feb. 16, 2009
The first day of class in "The Birth of Psychotherapy," taught by historian Dr. Robert Abzug, begins more like a group therapy session than a graduate seminar course.
Seven graduate students from a variety of disciplines sit around a u-shaped arrangement of tables. After a round of introductions, Abzug, the Oliver H. Radkey Regents Professor of History and director of the Schusterman Center for Jewish Studies, grabs a marker and invites the class to participate in a brainstorm about the cultural meanings of psychotherapy.
After a few tentative suggestions of "treatment" and "couch," one student calls out "Woody Allen" and earns a few laughs. Now the ice is broken and words come faster. "New York." "Jews." "Dreams." "Sublimation." "Oedipus complex." "Ego trip." "Projection." "Transference." "Neurotic." "Repression."
Abzug continues the brainstorm until the whiteboard fills with words. After a quick glance at the collection, he makes a simple observation: though many therapeutic terms from the field of psychotherapy are part of the popular lexicon, no one suggested the word 'healing.'
"Why is that?" he asks. "Perhaps, it's because the psychotherapeutic mission of mental healing is so embedded in our culture we hardly even notice it anymore."
Today, the way we look at the world, how we see ourselves and how we approach problems all have origins in the psychotherapeutic tradition. It is hard to imagine it was only about 110 years ago that Sigmund Freud introduced his "talking cure" to the public to mixed reviews. Now the various forms of psychotherapy derived from his ideas are some of the most influential forms of healing practiced in the 20th and 21st centuries.
Abzug has devoted his recent research and teaching to understanding the rapid growth and cultural meanings of psychotherapy in America. His courses "Psychology and Religion in Modern American Culture" and "The Birth of Psychotherapy" are popular not just with history and psychology majors. They also attract students from the fields of philosophy, religious studies, rhetoric, communication, English and anthropology.
"The question of how this once-revolutionary and controversial approach to healing became so pervasive is an important one," Abzug asserts. "You especially see the profound influence of the ideas and practice of psychotherapy in America. That's due in part to the receptivity of American culture to new forms of healing, but also to the rise of Fascism in Europe."
Germany and Austria had been the centers of psychoanalysis in Europe, and among the Jews who fled to the United States after Adolf Hitler's rise to power were many psychoanalysts and sociologists who were influenced by Freud and other theorists.
"As a result, New York became the de facto capital of psychology," Abzug says. "At the same time, major changes in American Protestant religious life made the idea and techniques of therapy attractive to liberal Christian denominations as an adjunct to pastoral care."
But how did the concept of therapy evolve from Freud, an obscure Austrian neurologist, to the popular mass-market entertainment of the Dr. Phil show?
Like many historians, Abzug has explored this question through the lens of biography. He is in the final stages of writing a book about the life of Rollo May (1909-1994), an influential American psychologist who helped translate psychotherapy concepts to the public. Research for the book was aided by grants from the Guggenheim Foundation and the university.
"I'm interested in people whose individual lives illustrate a larger theme in a culture, or who deal in original ideas," Abzug says. "And May is one of these people. Though Freud's theories of psychoanalysis established the basic idea of therapy, May and other psychologists of the 1940s and 1950s enhanced public acceptance of psychotherapy and helped to shape its everyday practice during the post-World War II era."
May's early work, "The Art of Counseling" (1939) was one of the first practical guides to provide counselors with case studies of patients, now a common practice in many psychotherapy textbooks. May also was an early advocate for the licensing of therapists to practice without a consulting physician.
After earning a doctorate in psychology from Columbia University in 1949, May became a major voice in clinical psychology with his book "The Meaning of Anxiety" (1950) and the national bestseller "Man's Search for Himself" (1953), which drew upon concepts from existential philosophy.
"May argued that people have a thirst for something authentic, but they often don't know themselves well enough to even know what they want," Abzug says. "However, through therapy, they can develop a language for understanding their emotions and their unique selves."
May's subsequent books, including "Existence" (1958), "Love and Will" (1969) and "The Courage to Create" (1975), merged concepts from philosophy, psychoanalysis, theology, art and literature, and continued to capture public attention with the idea that therapy can help people lead more meaningful lives, and not just cure symptoms.
"May rose to prominence during golden age of psychotherapy," Abzug says, "when it had its biggest dreams, its greatest growth as a profession, and a sense of limitlessness about what it could do. Though the golden age may now be over, it is certainly not in decline."
Dr. Art Markman, the Annabel Iron Worsham Centennial Professor of Psychology, agrees with Abzug's assessment. Markman's research spans a range of topics about the way people think and reason. He also is an expert consultant to the Dr. Phil show and writes the blog "Ulterior Motives" for Psychology Today magazine.
"In recent years, psychotherapy has transformed from a boutique product into a mass market phenomenon," Markman says. "Yes, the golden age of therapy is over, in the same sense that the golden age of air travel is over, but every year we break a new record in the number of people who seek therapy."
As more people participate in therapy than ever before, both professors agree there is a need for better education about the history and aims of psychotherapy.
"I can guarantee you're going to run into situations in life where you can't explain why you act as you do, because of the nature of your mind," Markman says. "So it's probably a good idea to learn about psychotherapy from the beginning. Then if you decide you need some treatment, you'll have a better idea of what sort of therapy you should seek.
"Ultimately, Freud was right about the reason we need therapy," Markman adds. "Because so many of the causes of our behavior fall outside our awareness, we need someone who can look at our environment and our upbringing, and help us identify factors that are affecting our behavior."
There certainly are fewer stigmas attached to seeking therapy than there were 50 years ago, Abzug says. And, there are a lot more options for counseling. The diversification of treatment options is further evidence that psychotherapy is not going away any time soon.
"You can see a psychiatrist, a clinical psychologist, a social worker, or a clergy member who might have training as a counselor," Abzug says. "You might even still be able to find a Freudian analyst, though reclining on a couch is no longer required. Whether you pursue therapy one-on-one, in a workshop, with a group or as a couple, is now completely up to you."
Unfortunately, depictions of psychotherapy in film and television do not always provide an accurate picture of what therapy really entails. That's one of the reasons why Markman is on the advisory board for the Dr. Phil show, to provide critical feedback on the show's topics and practices.
"In film and television, you often see the catharsis model of therapy where the trick is to have some sort of breakthrough where you discover some deep emotion," Markman says. "You cry a lot, and after that, you're fine. Life is good and the screen fades to black. But real therapy is hard work. And that doesn't fit conveniently into the one-hour television format."