Magazine article Family Therapy Networker

Around the Network: Who's Running the Show?

Magazine article Family Therapy Networker

Around the Network: Who's Running the Show?

Article excerpt

NOT IN ALL THE YEARS, SINCE the culture of psychotherapy hit the big time in the early 1950s has the field been so besieged by serious threats to its economic viability, clinical freedom and professional integrity. As everybody knows, the benevolent angel of insurance reimbursement has become the grand inquisitor of managed care. Gone forever are the days when therapists could practice at will any one of the estimated 400 different models of therapy and get paid on demand, exempt from skeptical external oversight or the responsibility to provide empirical evidence for the validation of their methods. Indeed, there is very little that's "private" about private practice anymore. In these days of managed care hegemony, few clinicians can still think of their offices as their castles-sacrosanct little kingdoms in which they enjoy the traditional four freedoms of therapeutic practice: freedom to choose their own clients, freedom to decide their own clinical methods, freedom to determine the length of treatment, and freedom to set their own fees.

Money is not the only worm in the golden apple of old-time therapeutic practice. Books citing the irrelevance, incompetence, venality and even downright criminality of therapists have become this year's literary growth industry, aimed at a mass market of apparently disillusioned therapy consumers. At the same time, a plethora of outcome research studies paints a troubling picture of the profession, finding virtually no empirical evidence that any one therapy model is significantly more or less effective than any other.

Finally, as if this weren't enough bad news, therapists over the past 10 or 15 years have been made to realize just how culture bound, parochial and downright discriminatory some of their most cherished theories and models actually have been. Critics from what might be called "the populations traditional therapy forgot" women, people of color, lesbians and gays, ethnic and religious minorities have made it abundantly clear that much that has passed for the universal truths of "mankind" are in fact, far more limited and provisional than most therapists previously cared to consider.

Certainly, the field is undergoing the most thorough crisis in its history, but, as the old Chinese ideogram says, a crisis is the conjunction of danger and opportunity. Paradoxically, just when the profession's own self-confidence is at a low ebb, there has rarely been a greater, nor more obvious, social and personal need for the therapeutic voice, however it is defined, than there is today. Seldom in our history have individual men and women been so driven, in work and in their personal lives, by anxiety, loneliness, alienation and desperation; seldom has the well-being and cohesion of marriages and families been so threatened by an apparently hostile culture; seldom have communities and cities been so riven with violence, poverty, fear and hopelessness.

The need for what therapists can do help people become a little wiser, more aware, better connected to others, less afraid, angry and lonely has never been more compelling, and clinicians must find not only the courage and will to grapple with the perils of their own individual work lives, but the imagination to redefine their profession for a world that is radically unlike the relatively simpler, less-violated human environment of 35 or 40 years ago. At the same time that they renew themselves, clinicians must maintain those ancient qualities that make therapy a peculiarly healing craft: the ability to listen deeply and artfully, to evoke hope, desire and imagination where only despair has reigned, to take people into a circle of care and protection and then know when to let them go into their own, independent being.

At the 18th Annual Family Therapy Network Symposium "Who's Running the Show? The Future of Practice in an Age of Accountability" on March 23-25, 1995 in Washington D.C. we will endeavor to square this circle. …

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