Story of Psychology - Morton Hunt [371]
Despite the growing numbers of clinical psychologists, about two thirds of the demand for psychotherapy is, as already mentioned, met by others: two thirds of the nation’s 45,000 psychiatrists who spend much of their time in private practice; 96,000 clinical social workers, most of whom practice some psychotherapy in agency and hospital settings but some of whom do so in private practice; 80,000 certified clinical mental health counselors; 3,000 pastoral counselors; and an unknown number of other people who call themselves psychotherapists—the use of the term is not controlled by law in most states—and who have anywhere from a fair amount of training to none at all.8
Psychotherapists in all these disciplines now treat a far broader spectrum of patients than ever. (“Patients” is the term used by psychiatrists and psychologists; many other therapists call them “clients” to avoid the medical connotations of the word “patient.” The terms in this context are synonymous.)
Formerly, psychotherapy was used chiefly with people whose contact with reality was unimpaired but who suffered from anxiety, phobias, obsessions and compulsions, hysteria, hypochondriasis, physical problems of psychological origin—in short, all those said to have neuroses.* Today, many people seek psychotherapeutic help for marital conflict, parent-child problems, job-related troubles, loneliness, shyness, failure to succeed, and indeed anything that comes under the general heading of “problems of living.”
In addition, psychotics, who used to be treated by prolonged soaking in tepid water, insulin or electroconvulsive shocks, and even lobotomy but rarely by psychotherapy—which often couldn’t reach them—are now brought back to reality or lifted out of the depths of depression by psychoactive drugs and thereby enabled to benefit from psychotherapy. In the 1950s, well over half a million people were locked away in the nation’s state mental hospitals; since the introduction of chlorpromazine and other psychoactive drugs in the middle of that decade, the number has declined radically, to fewer than 44,000.9 A majority of the kinds of patients who formerly were confined now live in the community, and their mental disorders are treated in community mental health centers by means of medication and psychotherapy.
Although psychotherapy has thus grown vastly in influence and acceptability, it has long been assailed both by those who regard psychology as a spurious science and those who regard psychotherapy as a spurious healing art.
One line of attack has stressed that clinical psychologists and other psychotherapists themselves admit that what they do is more intuitive than rational, more an art than a science. Many academic and research psychologists have therefore long held that psychotherapy is unworthy to be called a part of their science. In 1956, a psychologist, David Bakan, wrote in American Psychologist, a publication of the American Psychological Association:
There is a prevailing sense of the scientific untenability of clinical psychology [i.e., psychotherapy] among many psychologists. Frequently, clinical psychology is envisaged as an art; or if the critic is inclined to be more critical, it may be conceived of as an attempt to obtain knowledge mystically and effect changes magically.10
A few years later the psychologists Marvin Kahn and Sebastian Santostefano