Alternatives to Analysis

John Blank, at the age of 33, was in many respects a model husband and father. He was also, as it happened, a confirmed, habitual, compulsive transvestite. He had started before he was 12 to dress up in his mother's or his sister's clothes whenever they were away from the house. By the age of puberty, he was hooked.

Service in the Army forced him to give up the habit for a while--a barracks being hardly the place to practice transvestitism. It was a miserable period for John Blank. By the time he got out of the Army and back to a secret wardrobe of women's clothing, he had developed a full-fledged ulcer.

Civilian life and marriage, though they calmed his ulcer, did nothing else to change him. He found, indeed, that he could not have sexual relations with his wife unless he dressed up first. Every now and then, he had an irresistible urge to spend and evening in public in a dress, nylon stockings, high-heeled shoes and a woman's wig.

As he neared his mid-30s, John Blank was almost as unhappy as he had been in the Army. He worried about being arrested some night and losing his job. He wondered how long his wife would put up with him. Above all, he worried about the fact that his son was getting to the age where the boy would surely discover his secret. In addition to being addicted to the strange wardrobe, he was now also addicted to sedatives, which he gulped constantly to soothe his jangling nerves.

In desperation, John Blank sought help from a new kind of treatment, totally different from psychoanalysis in theory and practice: behavior therapy. The treatment prescribed for him was extremely simple. He did not lie on a couch and try to produce free associations about the childhood origins of his compulsion; indeed, he hardly talked to the therapist at all except to explain his problem. On each visit to the therapist's office, he merely undressed, put on a dressing gown and went behind a screen, where his favorite outfit of women's clothing was laid out on a chair. On signal from the therapist, he took off the gown and began dressing in this clothing. At some point, at times soon after he had started, at other times when he was nearly finished, he was rudely interrupted by a jolt of electricity delivered through a grid on the floor. He then, as instructed by the therapist, began to remove the clothes. The shock--or sometimes just the sound of a buzzer--was repeated at intervals, until he had them all off.

At each session in the therapist's office, this process was repeated five times. John Blank never knew when the electric shock would hit him, whether to expect the shock or just the buzzer nor how many times shock or buzzer would be repeated while he pulled off the clothes. After 80 visits to the office, he had had his fill of this kind of nerve-racking waiting for the blow to strike--and the therapist figured he had also lost his taste for women's clothing.

The treatment proved to be a striking success. When the therapist looked him up six months later, John Blank reported that he had not once gone back to his secret wardrobe. He felt better than he had felt in years; his worries were vanishing and he was tapering off his use of sedatives.

• • •

Behavior therapy, which produced such remarkable results for John Blank, is one of many forms of patching, refurbishing and expanding the human psyche that have begun to flourish as the influence of psychoanalysis has waned [see Crisis in Psychoanalysis, Playboy, October 1969]. By the careful count of one observer of the psychotherapeutic scene, there are now no fewer than 200 different schools of thought, most of them very new, on how to make Americans less neurotic, more normal, more "fulfilled" than they have been in the past.

The new schools of thought cover a broad and baffling range, from the commonsensical to the exotic. At one extreme is the growing number of psychiatrists who believe that mental disturbances are caused by faulty brain chemistry and can best be treated with the new personality-control drugs (see Psychochemistry: Personality by Prescription, Playboy, November 1968). Near this end of the scale is behavior therapy, a product of the psychology laboratory. At the opposite end are numerous methods that have no scientific basis at all, such as the mystical tenets of yoga and Zen Buddhism.

Some methods are still based, like psychoanalysis, on a one-to-one meeting of therapist and patient. But the great move today is toward groups--all kinds of groups made up of young and old, men and women, single and married, rich and poor, black and white, sometimes led by professional therapists and sometimes meeting on their own, seeking in various ways to help one another get over their hang-ups. The most publicized branch of the group movement is Esalen Institute, high on a cliff above the Pacific Ocean, where, on almost any day of the year, 20 or 30 people at once can be found running across the magnificent California landscape, singing, shouting, dancing, looking into one another's eyes and otherwise engaging in a mass effort to help their inner feelings bubble to the surface.

There are not only 200 different approaches but roughly 10,000 specific techniques, most of them developed for use in groups. At any given moment of the day, most or all of these techniques are being practiced somewhere. Groups of ordinarily staid businessmen work as if their lives depended on it to build playhouses of index cards; a college professor and an unemployed chorus girl sit back to back on the floor and try to "communicate" with their shoulder muscles; a plump California housewife and an ascetic clergyman stand barefoot on a bed sheet, trying to tune their senses to the feel of the grass beneath; a man who earns $100,000 per year breaks down and weeps in front of a dozen strangers because nobody likes him; another group of strangers, men and women, shed their clothes and plunge naked into a swimming pool with a therapist who believes that nudity frees the emotions. All this varied activity goes on not only by day but often through the night; one of the most popular new approaches is the "group marathon," which continues for 24 hours without interruption or sleep, leaving its members weary and groggy but somehow exhilarated.

The new brands of therapy and the new group encounters have been sampled by hundreds of thousands more Americans than ever have had any personal experience with psychoanalysis. For one thing, they are far more available. There are more psychiatrists and clinical psychologists using various new methods and techniques of therapy than there ever were analysts in the U. S. As for the groups, these are springing up everywhere; they have even been conducted by television, with everybody within the station's broadcasting range welcome to tune in and take part. For another thing, the new methods are far cheaper. Even the new one-to-one therapy is much less expensive than psychoanalysis, if only because it is faster; the 80-session treatment of John Blank, though far above average for behavior therapy, was still much shorter than the three to five or more years usually required in psychoanalysis. Groups are cheaper yet. It costs nothing at all to organize your own group and as little as $50 to attend a group or marathon led by a professional. You can spend a weekend at Esalen, the holy of holies of the group movement, for as little as $65, including room and board.

Psychoanalysis has never promised its patients very much--only that if they were willing to work long enough and hard enough on the couch, and then the rest of their lives on their own, they might be able to conquer their most crippling conflicts. Most of the new schools of thought, by contrast, have a kind of evangelical optimism and fervor. One of the Esalen psychologists, William C. Schutz, has written a book on Esalen's methods and goals; he calls it Joy and his subtitle is "Expanding Human Awareness." Other terms popular among spokesmen for the new schools are mind expansion, self-realization, self-fulfillment, bodily awareness, personal growth and ecstasy. Spurred on by these slogans and, evidently, by pleasurable experiences in group encounters, quite a few Americans have turned into a new kind of fanatic; they are not alcohol addicts, not heroin addicts but group addicts, eagerly tracking down every new group encounter and rushing to every one that they can possibly attend.

Americans, of course, have had many previous infatuations--in recent years, bowling, astrology, the hula hoop, isometric exercises, jogging, health foods and the drinking man's diet. Are the new alternatives to psychoanalysis also fads, or are they the way of the future? Since the new methods vary so widely, from the fact-conscious products of the psychology laboratory to the hashish-inspired visions of Oriental mystics, from the commonplace to the far-out, there is probably no single answer. An examination of some of the most prominent of the new methods, however, will offer some clues.

Behavior therapy, the newest treatment method with a truly scientific basis, is in large part the creation of Joseph Wolpe, a psychiatrist who teaches at Philadelphia's Temple University School of Medicine. Dr. Wolpe was originally a follower of Freud, but changed his mind after studying the learning theories that have been developed by psychologists; he was particularly influenced (continued on page 142)Alternatives to Analysis(continued from page 134) by the evidence that behavior that is in some way rewarded tends to be repeated, while behavior that is not rewarded or is punished tends to be abandoned. To Dr. Wolpe, a neurotic symptom such as John Blank's transvestitism, far from representing an unconscious conflict, as maintained by Freud, is, in fact, "just a bad habit." It was acquired through some unfortunate quirk of learning and is in some way rewarding to the patient--but it can be eliminated or modified by taking away its reward value.

Dr. Wolpe spends no time at all discussing a patient's childhood or trying to probe into the patient's unconscious mind. Instead, he and his followers make a direct frontal attack on the current problem. John Blank, for example, was treated by associating the wearing of women's clothing with the punishment of electric shock, rather than the reward of whatever kind of pleasurable feelings it previously produced. Similarly, Dr. Wolpe has successfully treated a homosexual by strapping an electrode on the man's calf and showing him pictures of naked men and women. When a man appeared, the electrode produced a shock; when a woman appeared, the electricity went off.

Most people who visit a psychotherapist, however, do not have a simple "bad habit" such as transvestitism or homosexuality. They are more likely to be troubled by anxiety--for example, by a fear of entering an elevator, going to social events, meeting the opposite sex or talking to the boss. For such patients, Dr. Wolpe has developed a method that he calls "desensitization." One of his patients was a 52-year-old housewife terrified by thoughts of death. She had feelings of anxiety every time she saw an ambulance or a hospital, much stronger feelings when she drove past a cemetery and intense fear when she thought of her first husband dead in his coffin. Dr. Wolpe treated her by having her relax completely, then asking her to think about the sight of an ambulance but to stop thinking about it if she began to feel at all anxious. Step by step, he led her to remain relaxed while thinking about all the things that had previously frightened her. By the end of the treatment, she had been fully "desensitized"--the sights and thoughts once associated with anxiety were now associated, instead, with feelings of relaxation.

Recently, the school of behavior therapy has been given a new dimension through an experiment conducted by Albert Bandura, a psychologist noted for his studies of the learning process. Dr. Bandura, who teaches at Stanford University, advertised in the local paper for people who were disturbed by a fear of snakes. To his surprise, since Stanford is in the San Francisco metropolitan area and hardly infested with snakes, nearly 100 people responded. To his further surprise, about a third of the volunteers turned out to have diagnosed themselves incorrectly; when actually confronted with a snake, they were not afraid at all (a fact that has led Dr. Bandura to suspect that perhaps many people only think they are neurotic).

From the volunteers, Dr. Bandura finally selected 48 people, both men and women, young and old, who were genuinely terrified of snakes. Among them: a plumber who was afraid to work out doors, a real-estate salesman who could never bring himself to show a house in which there was a pet snake and two members of the Peace Corps who were frightened by the very thought of being assigned to junglecountry. From the Freudian viewpoint, all of them would have been considered victims of deep-seated sexual conflicts, for a snake is the most obvious kind of phallic symbol. Dr. Bandura, however, chose to regard them as the victims of something quite different--namely, a pure-and-simple fear of snakes.

To one third of the volunteers, Dr. Bandura applied the Wolpe desensitization technique. Another third were turned into their own therapists; they were shown how to relax completely (by first tensing and then slackening all the muscles of the body) and asked to watch a moving picture of children and adults approaching and finally playing with snakes, as shown by a projector that the patient himself could stop and turn back if the pictures became disturbing. The remaining third watched through a window while one of Dr. Bandura's colleagues, in the next room, approached a snake, touched it and, after a time, let it crawl around his neck. Once these patients had got up their courage, they were invited in to imitate this procedure.

All the volunteers lost some of their fear of snakes--the third group most quickly and completely of all. Within an average of two hours, indeed, many members of the third group were playing with snakes the way they might play with a puppy. The two other groups, switched to the method of watching through the window, quickly reached the same level of almost complete fearlessness.

The significance of Dr. Bandura's experiment is its indication that at least one kind of neurotic fear can be conquered through the simple process of imitating another person. To psychologists, imitation is one of the most effective forms of learning; babies learn to speak in large part by imitating the sounds their parents make; older children learn to write by imitating the strokes the teacher makes on the blackboard; all of us learn to dial a telephone, play baseball and drive an automobile through imitation. Dr. Bandura's new experiment seems to indicate that people can learn how to be normal instead of neurotic in the same fashion--a finding that may open up an entirely new frontier in psychotherapy.

• • •

Another new kind of treatment, called reality therapy, developed by Los Angeles psychiatrist William Glasser, is of special interest, because it appears to produce good results even though it is the exact opposite of psychoanalysis in every respect. The psychoanalyst speaks of mental illness; Dr. Glasser believes that there is no such thing. The psychoanalyst searches for the origins of the patient's problem; Dr. Glasser believes that there is no point in dealing with past events, because these events are over and done with and cannot be changed. The psychoanalyst tries to remain as neutral and anonymous toward the patient as possible; Dr. Glasser tries to establish a strong, intimate personal relationship. The psychoanalyst looks for the patient's unconscious conflicts and motivations; Dr. Glasser holds that these matters, though perhaps interesting, have nothing to do with helping the patient. The psychoanalyst avoids making any moral judgments of the patient; Dr. Glasser makes the patient face up to the question of whether his behavior is right or wrong, not necessarily in the ultimate moral sense but in terms of social realities and his own desires. ("If a patient says he's a thief and is willing to accept the consequences of being a thief, that's all right," says Dr. Glasser. "I don't judge it, but it's basic to reality therapy for him to judge it.") Finally, the psychoanalyst avoids giving advice, on the theory that the patient should find his own way of living; Dr. Glasser tries to help the patient plan better ways of fulfilling his needs.

The basic problem of all people who require therapy, in Dr. Glasser's view, is that they are "irresponsible." They have never learned, or have forgotten, how to accept the world as it is, take responsibility for their own lives, get along in society and meet their needs while respecting the needs of others. Dr. Glasser worked for many years with the inmates of a California school for delinquent girls; possibly as a result, there is a very down-to-earth and even hard-boiled quality in his thinking. He rejects as "psychiatric garbage" the long, sad stories of unhappy childhoods with which patients often attempt to justify their present inadequacies. "A lot of people," he states, "are looking for excuses. Reality therapy says the hell with the excuses; let's get on with the business of improving our lives."

As a therapist, however, Dr. Glasser radiates a good deal of warmth, and he is regarded with much affection by his former patients, including some of the once toughest of the delinquent girls. His therapy proceeds in three steps. (continued on page 214)Alternatives to Analysis(continued from page 142) First, he attempts to establish what he calls "involvement" with the patient--so that the patient, who in all probability has been feeling friendless, realizes that he is genuinely eager to help. Next, while preserving this close relationship, he begins to ask the patient to examine his behavior for signs that it might be irresponsible and unrealistic. Finally, he tries to help the patient find more responsible and realistic ways of behaving. Throughout this process, he talks almost entirely about behavior, seldom about the patient's motives or feelings. Once the patient can be taught to behave more responsibly even in one small area of his life, Dr. Glasser maintains, this often sets up a chain reaction in which better behavior leads to better attitudes, which lead, in turn, to more forms of better behavior.

Compared with psychoanalytical theory, reality therapy is the height of simplicity; indeed, Dr. Glasser says he could teach any bright young trainee all he needs to know about the theory in a day. Applying it to patients, however, is another matter. As Dr. Glasser puts it, "Psychoanalysis is difficult to learn but easy to practice; reality therapy is easy to learn but difficult to practice." The psychoanalyst mostly listens. The reality therapist engages in an active, close and often exhausting dialog. He must establish a genuine friendship with patients who may resist it, feel a genuine sympathy with their sufferings, yet be tough enough never to let his sympathy divert him from getting along with the hard task of improvement.

Of all the new schools of thought that constitute today's alternatives to psychoanalysis, reality therapy is at the farthest extreme of the plain-spoken, the nonmystical--and the modest. Far from promising joy or ecstasy, Dr. Glasser warns his patients that reality therapy is not even primarily directed toward making them happy. In his opinion, people can find happiness only for themselves; therapy can only give them a reasonable chance at finding it. In his book Reality Therapy, he describes a woman patient, a divorcee, who was given to promiscuous and unhappy love affairs, emotional outbursts and fits of depression; since treatment, she has abandoned her frantic "scrambling for love" and has learned to control her emotions and is depressed less often. She also has found a better job and moved from a shabby furnished room to an apartment. However, she is still a divorcee with few friends, living in a strange city and without much income. Dr. Glasser says bluntly, "No one would describe her as happy, because she hasn't that much to be happy about, but she is no longer painfully unhappy."

• • •

Dr. Glasser is by no means the only member of the new breed of psychotherapists to conclude that the key to successful treatment is a warm, close human relationship between therapist and patient. The same idea has been adopted by many other therapists, including some whose theories are otherwise quite different. It is, indeed, a sort of common denominator that runs through most of today's nonanalytical office therapy. It is also the basic principle behind the various kinds of group activities that have sprung up outside the office setting.

The man responsible for popularizing the idea of the intimate therapist-patient relationship is Carl Rogers, a psychologist who founded what is known as client-centered therapy. This is not one of the newest methods; in fact, it goes back to the early 1940s. But it has been one of the most widely used and influential; and Dr. Rogers, who has now turned his attention from individual treatment to groups, continues to be among the most respected of today's innovators.

Client-centered therapy is based on Dr. Rogers' view of the human personality, which is quite different from the psychoanalytical or any other theory of personality that preceded it. Dr. Rogers believes that each person has a self-image--that is, a picture of himself as having many polarized characteristics, such as brave-cowardly, friendly-unfriendly, aggressive-submissive, ambitious-lazy, and so on. Ideally, the self-image is built up out of clear and honest observation of one's experiences, behavior, thoughts and feelings. In the maladjusted person, however, there are many disturbing conflicts between the self-image and the actual facts; it is these conflicts that explain why he is neurotic.

A simple example of conflict would be this: A man who has an image of himself as completely honest cashes a check at his bank one day, is overpaid ten dollars by the teller and knowingly walks off with the money. He is now caught up in a psychological crisis. One way of meeting it is to face the facts, see clearly that he has committed a dishonest act and admit to himself that, although he is generally a very honest person, he is not above an occasional slip. This is the healthy course; it keeps his image of himself in line with reality. On the other hand, the man may be so afraid of condemnation by society or by his own conscience that he cannot bear to own up to the truth. He may try to deny that he stole the ten dollars by telling himself that he kept the money to avoid embarrassing the teller. Or he may try to justify his action by telling himself that the teller had tried to cheat him in the past. In this case, he tries to maintain a self-image of total and unbending honesty that is simply not in accord with reality.

The well-adjusted person, says Dr. Rogers, is one whose self-image is realistic and flexible, changing constantly to take honest account of new experiences. The maladjusted person has a self-image so rigid that he cannot bear to accept any unpleasant truths; he must set up more and more defenses against reality, resulting in more and more tension and anxiety.

The basic technique of client-centered therapy is to provide an atmosphere of great warmth and empathetic understanding in which the patient feels free to begin exploring his true thoughts and feelings and to discover and remedy the conflicts. In Dr. Rogers' many years of treating individual patients, he attempted at all times to be a sensitive and understanding friend to the patient, displaying complete acceptance of all aspects of the patient's personality. As the patient began to feel freer to discuss what he considered to be his faults, Dr. Rogers never acted surprised and never criticized; he was totally permissive toward even the cruelest expressions of hostility or the strangest sexual fantasies. As he has said, his aim was to offer constant assurance that he regarded the patient "as a person of unconditional self-worth; of value, no matter what his condition, his behavior or his feelings." Given this kind of unqualified support, the patient gradually came to acknowledge his true thoughts and feelings, learned for the first time what he was really like and began to revise his self-image in line with reality. As with the rest of the treatment, its conclusion was also permissive; Dr. Rogers let the patient himself decide when it was successful and could end.

To many people who hear about client centered therapy for the first time, it sounds downright dangerous. If everybody were encouraged to be completely himself, it seems only natural to ask, how could society survive the sudden appearance of hordes of self-seeking, brawling, murderous, lustful, rapacious brutes? A psychoanalyst would certainly worry, for, according to Freud, the human psyche has a dark and evil side; one of man's basic instinctual drives, constantly struggling for expression, is the blind urge to annihilate anyone who dares try to keep him from getting his own way in all matters, large and small. Dr. Rogers' therapy, however, is based on the optimistic assumption that all human beings, if only they have the chance, will grow in the direction of social cooperation. "The individual has a very strong drive toward wholesome self-actualization," he says. "What we have to do is give him a climate in which this can thrive."

• • •

Providing a climate in which the human psyche can thrive is also the general purpose of the various kinds of encounter groups that have come to dominate, in sheer numbers, at least, the American psychotherapeutic scene. The group movement has expanded rapidly in the past few years; new Esalen-type centers have opened in all parts of the nation; the professionals who are experienced at conducting groups receive more invitations, from all kinds of people in all kinds of cities and towns, than they can possibly accept. Yet, though it seems to have sprung up almost overnight, the movement actually began more than 20 years ago and struggled along inconspicuously for a long time before achieving sudden popularity.

The strange thing about the group is that nobody invented it; its birth was strictly an accident. The event took place at a conference, held in Connecticut in 1946, on the training of community leaders. Among the professors and Government officials present was the late, highly regarded social psychologist Kurt Lewin, a tireless student of group dynamics (the processes through which groups are formed, go about their business and succeed or fail). With him. Dr. Lewin had brought four members of his research staff--not to participate in the conference but to study it by recording their observations of how individual delegates and their committees behaved and reacted to one another. Somebody suggested that the findings of the four researchers, if presented in the evening when there was no other conference activity, might be a valuable form of feedback that would help the people at the conference judge their own effectiveness and work together more smoothly and efficiently. The first evening, only a few people showed up; these few were so excited by the feedback that the word quickly spread and next evening, everybody was there. After that, the original purpose of the conference was almost forgotten, as the delegates became absorbed in such questions as how each of them looked to the others, how they succeeded or failed at communicating their ideas and how committee decisions were influenced by the interplay of personalities (what a psychologist might call the "interpersonal relationships") among committee members.

The unexpected turn taken by the Connecticut conference seemed to prove that people are fascinated by their behavior in groups--also that, if they are helped to understand their behavior, they tend to become more open, more honest, more aware of their own feelings and more spontaneous. Hot on the trail of something new in human experience, some of the conference leaders quickly set up a nonprofit institute called the National Training Laboratories, to refine the techniques of group self-studies and promote their widespread use.

N. T. L. describes itself as being in the business of encouraging social change through sensitivity training--that is, the attempt to teach people to become more aware of their own feelings and motives and the feelings and motives of others, and thus to become more perceptive, open-minded, understanding and creative members of the organizations to which they belong. (N. T. L.'s first groups were for psychologists and other educators; it since has expanded into group training for corporation executives, administrators and teachers in public school systems and universities and community leaders.) Its method is the T group, the T standing for training.

In a typical T group, 12 to 14 business executives meet with a professional leader from N. T. L. The leader announces that the group will gather at certain specified times--say, for six hours a day over a five-day period--to try to learn about the forces that influence the behavior of individuals and groups; the learning will come from the members' own behavior, reactions and feelings; there are no rules of procedure and the group is free to go about the task in any way it sees fit; the leader will try to help the members learn from their experiences in the group but will make no attempt to direct or influence their activities.

To most businessmen, used to attending meetings with a formal agenda and conventions with a formal program, the T-group leader's announcement is a surprising and even frightening introduction to a whole new world in which the ordinary rules of conduct are suspended; there are no lines of authority and each individual must make his own way without benefit of guidelines or corporate title. What usually results, after an initial confusion and hesitation, is a remarkably frank group discussion in which individual members feel perfectly free to reveal their own deepest problems and their opinions of one another, whether affectionate or hostile. Given the candid atmosphere of the group and the honest feedback on how their behavior appears to others, the members often become aware of feelings, fears, guilts, desires and frustrations they had previously concealed even from themselves. Abraham Maslow, a past president of the American Psychological Association who has conducted T groups, says, "It's very hard to believe in sober minutes that a dozen utter strangers will suddenly let all their defenses clatter to the floor like old shoes--but I've seen it happen."

• • •

Out of the T group have risen the other kinds of shoulder rubbing and psyche baring, usually called encounter groups, that take place at Esalen and other centers and under the direction of individual leaders throughout the country. Whereas the members of T groups usually have a good deal in common in their working-day lives, the members of encounter groups usually do not; they get together haphazardly from all walks of life. What takes place, however, is quite similar to the activity of the T group. Members of encounter groups tend to let down their defenses, reveal their self-doubts and tell each other frankly what they like and do not like about one another. There are occasional flare-ups of hostility and moments of deep affection. There is a good deal of laughter--also, to a greater extent than in T groups, a good deal of weeping.

Why are people so willing--even eager--to bare their souls to strangers? Dr. Rogers says it is a sign of the times, something that could never have happened at an earlier stage of history. "When a man is scrambling very hard to get his three meals a day," says Dr. Rogers, "he doesn't have time to feel alienated from his fellow human beings. Now that we have the affluent society, we do have the time and we realize that we are alone and lonely, lacking deep contacts with others. We begin to say, 'I wish there were someone I could talk to honestly; I wish someone cared about me.'" Charles Seashore, a psychologist with N. T. L., says, "There's a kind of immaturity and thwarted growth in all of us. As human beings, we have all kinds of potentialities--to be warm or standoffish, loving or hostile, open or suspicious, enthusiastic or constrained, adventuresome or cautious, emotional or reserved. But our society rewards some of these traits and discourages others, and most of us wind up as adults with just one or two stereotyped responses that we display automatically to all the hundreds of different situations in which we find ourselves. The popularity of groups rests on the fact that most of us feel deprived; probably 85 to 95 percent of us feel that we're not as close to people as we'd like to be, or that we're not as open and honest about our feelings, or that we have an anxiety over submitting to or exercising authority, or that our lives are too boxed in and narrowly predictable from day to day. Since the group encourages intimacy, honesty and adventure, it's a great experience even if its effects are only temporary."

Is the group a form of therapy? Dr. Maslow says no: "Although I'm very impressed with groups, I don't think they can help with serious problems--only minor hang-ups. A neurosis just won't fade away at a T group or a weekend marathon." The N. T. L. staff is careful to call its aim not therapy but "personal learning and personal growth." Dr. Seashore points out that he himself once experienced what he considered a therapeutic breakthrough in a T group--but that it occurred in the 139th group he attended or conducted, a figure hardly likely to be reached by nonprofessionals.

Dr. Rogers, on the other hand, has no doubt that the group is a form of therapy and a highly effective form, at that; he has come to believe that 20 hours in a group are more effective than 20 hours of one-to-one treatment. The secret of the groups he thinks, is that "it gives people permission to be helpful to one another"--a privilege that is not generally available in society and that is grasped eagerly and often with great skill, resulting in very much the same kind of support offered in client-centered therapy. In one way, says Dr. Rogers, the group is superior to client-centered therapy as he practiced it in the past; this is the fact that members of the group freely express their negative as well as their positive feelings toward one another. Thus, each person in the group is at times deeply liked and supported for his good qualities and, at other times, confronted with harsh criticism of the bad, a push-pull process that seems to speed awareness of the true self. If Dr. Rogers returned to one-to-one practice, he says, he would be very free to give his patients constant feed-back on his inner reactions to them, pro or con.

• • •

Whether the encounter group should properly be called therapy or just a form of education, it certainly does something for people. At the Western Behavioral Sciences Institute, psychologists gathered interviews from 1000 people who had taken part in groups; these people agreed almost unanimously that they had greatly enjoyed the experience and had been profoundly influenced; typical comments were, "It was the most important thing that ever happened to me" and "It changed my whole life." What, exactly, about the group had produced this effect? As the psychologists had expected, the one thing mentioned most frequently was some particularly dramatic example of deep exchange of understanding and emotion between two or more members of the group--sometimes an incident in which they themselves had taken part, sometimes an incident that they had merely observed (another example, perhaps, of Dr. Bandura's learning through imitation). To the psychologists' surprise, however, these outstanding incidents did not necessarily involve the therapist who led the group; in fact, the therapist was responsible for no more of them than anybody else. To psychologist Richard Farson this suggested a strange possibility: To the extent that the encounter group is therapeutic, is it a form of therapy that requires no therapist? In other words, can a group succeed without a professional leader?

Dr. Farson's idea of experimenting with leaderless groups was opposed by every therapist he knew. Without professional guidance, he was warned, members of the group would quickly be at one another's throats. Nonetheless, he went ahead, though with extreme caution. The first leaderless group was watched anxiously by two professional therapists behind a one-way see-through mirror, ready to intervene quickly if the group got stalled or out of hand. As it turned out, the two observers were unneeded. In fact, every time the group seemed on the verge of serious trouble, the two therapists were amazed to see some completely untrained member step in and do exactly what they themselves would have done. With this reassurance, Dr. Farson then set up a full-scale experiment comparing leaderless groups with groups led by professional therapists. It developed that the leaderless groups, even when composed of people who had never before taken part in an encounter, behaved very much like the led groups; their members got right down to business, avoided excess hostility and did a good job of helping one another. To Dr. Farson, the experiment suggests a startling answer to the problem of how the nation can possibly train enough therapists for all the people who need help. "It may turn out," he says, "that our greatest resource for solving human problems is the very people who have the problems."

One immediate result of Dr. Farson's experiment has been a do-it-yourself kit for nonprofessionals eager to organize their own groups. The kit was created largely by a young psychologist named Betty Berzon, a former associate of Dr. Farson at the Western Behavioral Sciences Institute; it is a set of tape recordings, each running about an hour and a half, designed to be played by a group that will hold eight meetings. For each session, the voice on the tape suggests various activities that have been found helpful in groups. For example, all members but one are asked to form a tight circle, into which the missing members then tries to break. Or the members are asked to write down, anonymously, some secret of which they are ashamed; the slips are shuffled and handed out; each member, in turn, then reads the paper he has drawn and discusses how it might feel to have such a secret. Following each suggestion, the tape goes silent, to give the group time to carry out the instructions; then the voice returns with something new. The recordings are called Encountertapes and are manufactured by the Human Development Institute of Atlanta, a subsidiary of Bell & Howell (an indication that the group movement has grown big enough to interest the multimillion-dollar corporation world).

"What we've done," says Miss Berzon, "is package the group experience and make it available to schools, churches and industries. This takes it out of the esoteric centers like Esalen and right into the mainstream of everyday life." Miss Berzon was one of the several thousand people marooned for three days at New York's Kennedy Airport by an unexpected snowstorm last winter. Listening to the incessant bulletins over the airport loud-speakers, and watching her frustrated fellow travelers grow increasingly bored and glassy-eyed, she kept grieving at the lost opportunity for playing her Encountertapes over the speakers and turning an ordeal into a delightful mass initiation into the marvels of the encounter group. She can never pass a tall office building without thinking of it as a place where a public-address system and a single set of Encountertapes could bring the group experience to many thousands of people at a time.

Even enthusiasts such as Miss Berzon, however, concede that the group has one serious defect for which no remedy is as yet apparent. It is one thing to confess your secrets, pour out your angers and break into tears among a few people gathered expressly in behalf of this kind of free and frank communication; it is quite another thing to do so at home or in the office. Says Miss Berzon, "Once you've had this taste of honey--once you've had the opportunity to really relate in depth to other people--it's hard to go back to the cocktail-party kind of superficiality. But everyday life isn't like the group. And your family, your boss and your friends probably have a vested interest in keeping you just as you've always been. So the effect tends to get dissipated when you go home." Says Dr. Farson, "People feel they're changed by the group, but no matter how you observe them, test them or question their families and friends, you don't find any significant changes in their actual behavior. The reason is that what happens in the group is something that a person can't make happen anywhere else."

Trying to transfer the atmosphere of the group into real life can, in fact, be downright dangerous. One businessman who attended a T group reports, "I learned that I had been making myself miserable by bottling up my hostilities and being overpolite to everybody, so I decided to change all that. Three days later, I realized that I was losing my customers, my employees and my wife-- and I changed back in a hurry." Dr. Glasser, who is skeptical of encounter groups, says, "They're based on a false premise. Until all people are open and honest at all times, it's unrealistic to think that you can be--without getting hurt."

In one way or another, most leaders of the group movement are now grappling with this problem. Many of them believe that the solution is to expand the movement, through Encountertapes and the establishment of hundreds of new Esalens, until millions of Americans have had group training of one kind or another; these millions will then reshape society into a sort of single big, happy, uninhibited, affectionate, turned-on encounter group. But as one skeptical psychologist has said, "There are a lot of religious overtones to the movement; these people are like the early Christians, who thought that all of society's problems would vanish as soon as everybody became a Christian."

Others are making a more direct attempt to bring the group and everyday life closer together. The National Training Laboratories, for example, has made some significant changes in the way it organizes its T groups. One N. T. L. psychologist says, "We used to be willing to take just one person from a business organization; we'd get him all revved up and then send him back to office colleagues and a job that hadn't changed a bit. Now we try to get at least two men from the firm, so that they can support each other after they go back. And what we really like is to have many people from the same company and work with the management to open up the lines of communication and creativity; we're trying to change the climate of the big organizations, such as corporations and universities, in which people are embedded." Dr. Farson has been thinking about what he calls "social architecture." a possible new science of the future. "If you want to help people transcend themselves," he says, "you've got to rearrange the social situations in which they constantly find themselves--the job, family, school and church." Thus, the attempt to heal and bolster the human psyche, having already expanded from couch to group, seems likely to expand further into all kinds of social situations. What started as Freud's first modest efforts to help a few hysterical patients has indeed come a long way.

Some other Alternatives to Psychoanalysis

In addition to the types of psychotherapy discussed in the text, there is a wide variety of other methods available.

(Note: Some forms of psychotherapy use the Freudian technique of having the patient free associate while in a relaxed position, usually on a couch, but reject Freud's theories of the structure of the mind and the causes of personality disorders. Others retain the Freudian theory but use different methods of therapy; still others have abandoned both the theory and the practice of psychoanalysis. These brief and necessarily simplified descriptions emphasize the ways, theoretical or practical, in which various psychotherapies most sharply depart from classical psychoanalysis.)

Chemotherapy concentrates on chemical imbalances in the nervous system that may be the causes or the results of mental disorders and attempts to treat these disorders with drugs such as tranquilizers and psychedelics. Chemotherapy may be used as an aid to other kinds of psychotherapy, and is often effective in dealing with severe psychoses. (See Psychochemistry: Personality by Prescription, Playboy, November 1968.)

Directive Psychotherapy assumes that the patient is not in a condition to work through his own problems or to establish therapeutic goals, and the therapist undertakes these responsibilities. The therapist uses any technique that seems indicated and tries to base his plan of action on all available scientific knowledge.

Existential Therapy is based on the existentialist philosophical belief that each individual has to choose his values and decide the meaning of his life. The therapist attempts to achieve an authentic, spontaneous relationship with the patient to help him discover his free will and make his choices.

Experiential Therapy is a system in which therapist and patient jointly enter the patient's fantasy world, often acting out fantasies together. The resulting emotional experiences aim at re-educating the patient on the deepest level of his psyche.

General Semantics postulates that neurotic behavior results from unrealistic use of words, especially the error of identifying the word with the object for which it stands. The therapist tries to teach the patient to use language more accurately and realistically in thinking and communicating, thereby achieving a more effective orientation.

Gestalt Therapy focuses on the patient's difficulty in forming meaningful, organized "wholes" (referred to by the German word Gestalt) out of experiences that have left him with unresolved problems. Through encounters between therapist and patient, usually in the presence of a group, the therapy seeks to restore the individual's fragmented integrity of thinking, feeling and acting so that he can regain contact with reality and resume personality growth.

Horneyan Psychology was developed by Karen Horney, who believed that neurosis springs from basic anxiety acquired in childhood. Horneyan therapy aims to overthrow the idealized self-image the patient is trying to live up to, making him face his actual self and release his potential for healthy personality development.

Hypnotherapy uses hypnosis to increase the patient's suggestibility and to lift repressions, to remove neurotic symptoms when they prevent progress in therapy or to persuade the patient to adopt more constructive general attitudes.

Interpersonal Psychology locates the causes of personality disorders in the relations between the individual and society rather than in purely internal psychological developments and aims at improving interpersonal attitudes and relations.

Learning-Theory Therapy treats mental disorders as self-defeating behavior patterns that the individual has learned to rely on when he feels anxiety. The therapist applies all available scientifically discovered principles of learning to make the patient unlearn these patterns and to countercondition him against the attitudes that produced them.

Orgonomy is based on the theory of Wilhelm Reich that there is a specific energy--called orgone--that accounts for life. Reichian therapy combines psychoanalysis with manipulation of the patient's body in order to remove muscular armor--muscular attitudes an individual develops to block emotions and organ sensations.

Psychodrama is a form of improvised play-acting of certain roles and dramatic incidents resembling those situations that produce problems for the patient in his daily life. The purpose is to provide the patient with both theoretical insight and corrective emotional experience. This acting out is often conducted before an audience.

Rational-Emotive Therapy, developed by Albert Ellis, asserts that emotional disturbance arises when individuals mentally reiterate unrealistic, illogical, self-defeating thoughts. The therapist identifies these thoughts, argues against them and persuades the patient to undertake actions that will disprove the undesirable beliefs and, hence, strip them of their power.

Transactional Analysis postulates that all interpersonal communications spring from specific ego states called Parent, Adult and Child. The therapist attempts to identify the ego state producing each communication from the patient with the aim of discovering the plan the individual has unconsciously chosen for his life and of replacing it, if necessary, with a more realistic and constructive one. Transactional analysts prefer to work with groups.