American Therapy: The Rise of Psychotherapy in the United States

As a lay person who has passing knowledge in the fields of psychology and psychiatry, American Therapy was a superb read. Engel writes lucidly with numerous examples both from scholarly literature and from periodical literature - magazines and newspapers - tracing the development of psychotherapy. It was interesting to read how the profession evolved from the realm of psychiatrists to social workers, educational psychologists and clinical psychologists. This book explains the methods of analysis and the history and methods of twelve-step programs such as Alcoholics Anonymous. After I read the book, I could see why a psychoanalyst or psychotherapist might feel uncomfortable or even pessimistic about the profession with Engel's comments about the limits of psychotherapy. He makes the balanced case that neither drugs alone nor years and years of analysis may help a patient. Engel affirms with a tone of optimism that psychotherapists stand (or sit!) in a unique position to help patients to overcome the emotional or psychological obstacles they are facing in their lives. Like his recent book on AIDS (The Epidemic), he tells a good historical story that is relevant and deeply considered.

Engel begins by telling readers that one-on-one doctor-patient psychoanalysis and psychiatry make up a very small portion of American mental health care. Social workers, priests, pastoral counselors, self-help gurus, and support groups (eg. AA) must also be included. WWII greatly altered America's understanding and perception of mental illness when thousands of draftees (about 12%) were found mentally unfit, many other broke down from traumatic stress (about 1 million), and alcoholism rates rose significantly after the war (consumption increased about 30%). Engel contends that psychoanalysis (eg. Freud and interpretation of dreams) does not work. A 1950s study by the American Psychoanalytic Association showed only one in six ultimately were cured; most other studies indicate a nearly 90% remission rate for neurotic patients over five years, with remission rates for those in analysis somewhat lower. On the other hand, Engel believes that psychotherapy (empathetic help in managing one's life) does work - multiple studies over the past half-century have demonstrated that about two-thirds of recipients improve within 6 months. Success rates seem independent of the type of therapy used, though the qualities of the therapist (especially empathy, honesty, and the ability to connect quickly) are more important. Engel also concedes that the exact mechanism by which therapy works has not been identified. Further clouding the issue is the fact that about one-third of all patients achieve spontaneous remission, the conclusion that most mental disorders have a chemical or physiological basis, and that psychotherapy has proven only modestly successful with alcohol or drug abuse. Psychotherapy has lately been challenged by a series of miracle drugs. Research, however, shows that most patients improve more thoroughly when treated with a combination of medication and therapy.

A new book about psychotherapy gives good press to psychodrama, the action method developed by Jacob L. and Zerka Moreno. This is a good thing, since the method, originally developed in the 1920s, has often been relegated to the back of the shelf. Way back. Even experienced mental health professionals and others don't know that Dr. Moreno, a European-born physician, coined the phrase "group psychotherapy" and was a true pioneer in the fields of mental health, marriage counseling, alternative creative arts therapies and other topics that we take for granted today. The book is "American Therapy: The Rise of Psychotherapy in the United States" by Jonathan Engel and contains well-written passage about sociometry, the science of relationships, which was also developed by Moreno. There's particular mention of his work at a New York facility for female juvenile delinquents - as they were called in the early days - and how he rearranged their assigned rooms to create more cooperation and less turmoil after evaluating their relationships. Most of the focus of the book leans to Sigmund Freud, who we consider the originator of modern mental health treatment, and how his ideas spread to the United States, before heading off in new and more practical directions to treat emotional pain. Moreno was one of Freud's first challengers, at around 1912 when he was a young medical student in Vienna. Although Moreno died in 1974, the worlds of psychodrama and sociometry are very much alive not only in the mental health but many other fields, thanks to the efforts of his widow, Zerka, who is in her nineties and still working, and many others. True, author Engel makes some misstatements in other parts of the book, including the incorrect surname of a Vanderbilt University researcher who in 1979 conducted a study that raised questions about the role of specialized training in effective psychotherapy. He was Hans Strupp, not Krupp, and the incorrect reference to three eminent U.S. doctors who were early promoters of Freudian theory. Adolf Meyer and Harry Stack Sullivan were psychiatrists, and James Jackson Putnam was a neurologist; they were not "psychologists." Recommended.

Mr. Engel's ability to relate the history of a topic that is abstract to most is admirable. Engel effortlessly moves from one psycho-therapeutic movement to another in his thorough account of how Americans have viewed, treated, and acted towards mental illness over the past 100 years. Having read many objective accounts of narcotics (including Opium: A History, Cannabis: A History, Psychedelics Encyclopedia, Tobacco: A Cultural History of How an Exotic Plant Seduced Civilization, Shroom: A Cultural History of the Magic Mushroom, and Cocaine: An Unauthorized Biography), Mr. Engel's chapter on narcotics seemed overly dismissive and ignorant of many factors. This inconsistency aside, American Therapy is a great read for anyone wanting to gain a working knowledge of the historical approaches to psychotherapy in America.