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A Brief History Of Psychotherapy - Page 2

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The Profession Booms—1986

With the growth of the therapy profession throughout the 1980s, increasing numbers of psychologists, social workers, counselors, and marriage and family therapists found their way into private practice. With liberal reimbursement from insurance providers and managed care not yet a factor, the era is recalled fondly by many private practitioners today. This item from our May/June 1986 issue clarifies the actual fee structures of the era, which seem generous for the time. Unfortunately, for many, these fees haven’t changed all that much since then.

According to an annual survey of therapist fees conducted by Psychotherapy Finances (PF), the median individual fee for all therapists is now $65 (up $5 from 1984). Among the 1500 psychotherapists surveyed, the average income from full-time private practice is $47,000 with 13 percent having an income over $80,000. Average fees charged varied according to training. Psychologists in the PF survey charged $70 per hour while the average fee among social workers, pastoral counselors and marriage counselors was $60. The survey also indicated substantial income differences between male and female practitioners. While women therapists had an average income of $38,000, men reported mean earnings of nearly $50,000.

The Roots of Depression—1987

In its focus on the immediate encounter in the consulting room and skepticism about inborn determinants of behavior, the family therapy field embraced a kind of interactional determinism. Fixated on the power of social context, especially the family, to shape behavior, the field largely rejected diagnostic formulations and theories that it believed underestimated the human capacity for change. But throughout the ’80s, researchers kept publishing studies that challenged this blank-slate view of human development and the belief that the age-old nature–nurture debate had finally been unequivocally resolved in favor of nurture. It was, as usual, “more complicated than that.”

In 1987, psychiatrist Janice Egeland and colleagues from Yale and M.I.T. released a groundbreaking study identifying bio-chemical anomalies on the chromosomes of one extended Old-Order Amish family with disproportionately high rates for manic-depressive illness. Egeland and her associates, using molecular gene-mapping technology on blood samples drawn from each of the 81-member clan, found DNA markers on a dominant gene conferring a predisposition to manic-depressive illness in the family. Egeland’s research enlivens psychology’s classic “nature vs. nurture” debate. Her study provides the strongest evidence so far for a link between manic depression and a specific bio-chemical factor, something in the blood or “siss im blut,” as the Amish say.

–Mary Sykes Wylie

The Changing of the Guard—1988

By the end of the decade, many of the leading lights who’d pioneered family therapy and been the role models setting the tone for the field had begun to pass on. As the Networker paid its respects to the trailblazers who’d ignited the clinical imagination of a generation of therapists—people like R. D. Laing, Murray Bowen, and Carl Whitaker—there was a palpable sense of the changing of the guard. But it was perhaps the passing of Virginia Satir that stirred the deepest resonance among clinicians who’d been viscerally influenced by her work, which anticipated so much of the mind-body orientation of many approaches today.

Virginia Satir, path-breaking family therapist, writer, teacher, and world-traveling peace advocate, died of cancer September 10th at her home in Menlo Park, California. She was 72. . . .

Satir was an inspired therapist and teacher whose charismatic vitality and extraordinary gift for reaching people made her an inspiration to thousands of students and colleagues. During the ’40s and ’50s, while Freudian psychoanalysis dominated clinical thinking, she was one of the first therapists to work with whole families. In a profession dominated by men, she was the first and, for a long time, the only woman to achieve eminence. According to Frederick Duhl, co-director of the Boston Family Institute, Satir was “the most gifted therapist in the field. She knew human systems with her fingertips. Virginia probably trained more people than any other family therapist alive.”

–Mary Sykes Wylie

Evidence-Based Psychotherapy—1992

While what Lynn Hoffman called “The Great Originals” of family therapy influenced the mental health field largely by their iconoclastic force of personality and fierce sense of conviction about the new perspective they were offering, the therapeutic profession of the 1990s cast a more skeptical eye at new methods that claimed clinical effectiveness. A sufficient research infrastructure had developed in the field that new models were expected to actually offer some data to support their claim, and innovators realized that charisma alone wasn’t enough—they needed to offer empirical evidence if they hoped to convince the sophisticated clinician of the value of their approach.

For the first time, therapists may have a procedure to quickly and effectively desensitize clients to their traumatic memories. When psychologist Francine Shapiro first published her initial study on Eye Movement Desensitization and Reprocessing (EMDR) in 1989, many clinicians were skeptical, but since then some of the most eminent therapists in the trauma and behavior therapy fields have become convinced that EMDR is an important discovery. Among these is behavior therapist Joseph Wolpe, creator of systematic desensitization—one of the most influential methods in the history of psychotherapy. “Shapiro’s technique seems to work with remarkable efficacy in cases of post-traumatic stress disorder [PTSD],” says Wolpe. “While it still has not been studied in a controlled way, the preliminary results have been dramatic. It is much better than anything else we have for treating trauma.”. . .

In contrast to many other promising interventions that never get examined beyond the clinician’s office, EMDR is being closely studied in a number of separate research projects in the United States and in England. It should soon be clear whether EMDR is snake oil or an important addition to the therapist’s armamentarium.

–Laura Markowitz

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