The Revolution in Psychotherapy

David Elkins, PhD
11
283

“Techniques are fine.  The only problem is that they leave out the client, the therapist, and the relationship.”

Evidence converging from numerous fields is showing that humans have evolved to give and receive emotional healing through social networks. Psychotherapy, then, can be seen from this perspective as a manifestation of our capacity – endowed by evolution – to heal each other.  As my new book, The Human Elements of Psychotherapy:  A Nonmedical Model of Emotional Healing,(1) explores the mounting evidence that points toward a revolution taking place in contemporary psychotherapy, I believe it will be of interest to MIA’s “community for those interested in rethinking psychiatric care.”(2)

Since the time of Freud, the field of psychotherapy has assumed that modalities and techniques were the instruments of change in psychotherapy. But the evidence is mounting that modalities and techniques have relatively little to do with effectiveness; evidence shows that it is the human elements of psychotherapy that are the most potent agents of healing.(3)

I hope that the book will show clinicians, clinical researchers, psychotherapy students, and the general public that therapists are not “junior physicians” wielding medical-like techniques and tools but, rather, caring healers who are in fact especially skilled in employing the best  tools we have ever had: connecting and interacting with clients in ways that help heal their emotional difficulties. With so many millennia of experience in giving and receiving emotionally healing through social means, why are humans so quick to subordinate this capacity to the latest “scientific technique”?

The book highlights “moral treatment,” which arose in Europe in the early 1800s in opposition to the view in the 1700s that those with severe psychological problems were “brutes” that had to be controlled. Moral treatment provided patients with a safe environment, employing non-professionals to support and interact with them, and provided the opportunity to participate in activities designed to support physical, emotional, and spiritual well-being.

Moral treatment was a humane – and effective(4) – alternative to the brutal “medical” treatments of the day.  However, many physicians were concerned about its popularity, as well as its effectiveness.  To the extent that moral treatment showed that non-professionals were more effective than physicians in curing insanity and that kindness, respect, and support were more effective than medical treatments, its presence threatened to undermine the rationale upon which physicians’ “expertise,” and hence their influence, rested.  In time, physicians undermined moral treatment and put medical treatments back at the center.

Nevertheless, moral treatment’s outcomes in various centers and hospitals in Europe and America showed that psychosocial support, not medical techniques, was the most potent agent of healing.

One has to wonder what would happen if the billions of dollars that we pour into psychiatric hospitals and psychiatric drugs were redirected to build home-like centers where those with severe psychological problems could interact on a daily basis with kind, caring staff.  Increasing evidence suggests that human connection and social interaction are potent healing agents for those with severe emotional problems.

Is it possible that the “mental health system” in the U.S. has it all wrong and that emotional healing occurs primarily through social means? That is, through human connection and social interaction with individuals who know how to extend empathy, support, and care in ways that heal? How much more efficient, effective, safe and health-giving will our system be if we can identify these “common factors” of our social well-being, and build a system that truly rests on this knowledge?  The Human Elements of Psychotherapy:  A Nonmedical Model of Emotional Healing seeks to help us explore the potential of this reality.

 

 

References:

  1. Elkins, D. N. (2016). The human elements of psychotherapy:  A nonmedical model of emotional healing. APA Press.
  2. Whitaker, R. (2002). Madinamerica.com, “About Us.”Cambridge, MA: Perseus.
  3. Sprenkle, D. H., Davis, S. D., & Lebow, J. L. (2009). Common factors in couple and family therapy: The overlooked foundation for effective practice. Guilford Press.
  4. Whitaker, R. (2010). Mad in America: Bad science, bad medicine, and the enduring mistreatment of the mentally ill. Basic Books.

 

11 COMMENTS

  1. Thanks for this excellent article.

    In answer to this: “Is it possible that the “mental health system” in the U.S. has it all wrong and that emotional healing occurs primarily through social means?”

    Of course the US mental health system has it wrong. It’s clear given how poor mental health outcomes remain in our country: as Whitaker documented, the medical approach to emotional suffering of the last 30 years hasn’t worked, measured in proportion of people disabled and use of drugs, and the situation is actually worsening. It’s saddening that this question even has to be asked. Healing from emotional distress has always occurred primarily through social interpersonal means.

    The period from 1980-2015 can be viewed as one in which greedy American psychiatrists misled the public about life problems being illnesses treatable via drugs, and then propogated their false illness model worldwide. That lie is now being exposed.Your book looks like a forward development of books like The Heart and Soul of Change by Barry Duncan, which collects research showing that it’s the quality of the relationship between two people rather than the technical nature of the therapy which is most crucial to improvement in “symptoms” and to satisfaction on the part of the client. What Saul Rosenzweig said about all human-relationship based approaches being winners and all deserving prizes is still true.

    On the other hand I am biased toward psychodynamic-psychoanalytic approaches and think their approach goes a little bit deeper than some approaches like CBT, especially for psychotic and borderline mental states (not that I think these are illnesses). Still that doesn’t mean that the elements that cure psychotic or borderline conditions are not the same across different psychotherapies: (accurate) insights, empathy, feeling safe and loved, feeling able to help someone else in return, having meaningful life activities to engage in, developing friendships and romantic relationships using the therapeutic relationship as a mdoel, etc.

  2. Thanks for the unique article, you’re probably 100% right.

    “…build home-like centers where those with severe psychological problems could interact on a daily basis with kind, caring staff..” – and the user’s could maybe take over these centres and help set up some more, a lot of people are out in the cold and can’t get in.

    I’m sure Recovery spending wouldn’t just save on “mental illness” spending – but release lots of funding as well.

  3. “Nevertheless, moral treatment’s outcomes in various centers and hospitals in Europe and America showed that psychosocial support, not medical techniques, was the most potent agent of healing.”

    While the latest science from the field of “psychophysiology” shows us the hidden agent of facial nerves and muscles, by which psychosocial support, affects the human heart. Although, one has to take a multi-disciplinary approach to research, in order to find such highly relevant literature, rather than just reading the material of particular self-interest.

    While in the context of that oft repeated phrase, these days, a continuum of human experience. I note the success of trails using the love molecule oxytocin, to revive the “social engagement system” (Porges, 2011) of people diagnosed as Autistic. While, as a continuum of human experience, perhaps all of us, could be diagnosed as suffering from Reactive Attachment Disorder, as developmental neuroscience, now suggests of our early life experience. A continuum of human experience, described by R.D. Laing, as how: we are all in posthypnotic trance induced in early infancy.

    I suspect that psychosocial sense of self, is heading towards a realization of this phenomena, as myopically focused brain research, continues to fail in its utopian quest for the cause of so-called mental illness. Hopefully, the devil of self-interest or banality of evil, as Hannah Arendt calls the bloody minded mediocrity of the average human being, will come to a profound realization, soon.

    • “I suspect that psychosocial sense of self, is heading towards a realization of this phenomena, as myopically focused brain research, continues to fail in its utopian quest for the cause of so-called mental illness. Hopefully, the devil of self-interest or banality of evil, as Hannah Arendt calls the bloody minded mediocrity of the average human being, will come to a profound realization, soon.”

      Perfect, and so beautifully stated.

      • Hi Alex, thanks for kind words of support.

        In my own trial of the visionary mind, as Dr John Weir Perry suggests of the extreme sensory awareness that plagues the highly sensitive soul. I believe that 2040 will begin a species realization of what we are, in our journey towards wholeness, as one tribe, with an inevitable Cosmic destiny.

        • To end the illusion of separation would certainly bring wonderful change, although no doubt it will throw a lot of people off because it is such a radical shift in paradigm and perception. There is a lot of resistance to Oneness right now, in favor of the familiar and programmed duality and power struggling; but I, for one, look forward to the perspective of unity consciousness catching on. As long as we are going in that direction, I’m on board.

  4. Thank you, David, this is very helpful and important. The flip side, of course, is that we live in a world of constant alienation and low-level trauma. Consider the typical isolation of American households, and the fact that to connect most of us must get into two-thousand pound chunks of steal that indirectly kill people across the globe and directly flatten creatures along the road. We need connected, loving, respectful alternatives at all levels.

    You remind me of a beautiful piece of writing by Barry Lopez that I will share here. It’s a story called “Traveling with Bo Ling,” about a Viet Nam vet and the Viet Namese woman he married and who was disfigured in the war. Here is the end of the story.

    “The wages of trauma, as I have written it out in my life, is anger. The resolution of that anger, say the therapists, breaks the grip of the traumatic event. But to resolve the anger–and this I got onmy own–it’s necessary to love. It’s not enough just to arrive at a place where no one, not even yourself, is to blame.

    You have to go further.

    For several years now Bo Long, from her own perspective, has also been telling me this. To wash out the anger, she ways, fall in love. Be in love with peach, she says, its summer juice running down your bare chest. Be in love with the sound of your brother’s truck as it pulls up to the curb on a summer night with supper just ready on the table. Be in love with me, she says, when my fingers move slowly across her small belly.

    Reengage your innocence here, in the Dresden of my face, she says.”