More than a century ago, Sigmund Freud shocked the medical establishment of his day by suggesting that mental illness was caused by childhood physical and sexual abuse. Neither the medical establishment, believing that all psychological disturbances were physiological and hereditary in origin, nor Victorian society was willing to peer into the dark closet of unpalatable family secrets that Freud had opened. Nor was either willing to accept his radical idea that family violence might be the key to later psychological suffering.
Six years after his professional colleagues blasted his paper on the long-term psychological damage stemming from real injuries inflicted by parents on their own children, Freud recanted. He proposed, instead, that the source of hysteria and other mental problems emerged from children's own unresolved inner fantasies about what they imagined their parents had done to them. For the next half-century, psychotherapy would essentially ignore actual interactions between family members and concentrate almost exclusively on the private, inner world of the individual. Not until the 1950s did the family therapy movement once again insist that personal relationships--between parents and children, wives and husbands, friends and coworkers--were the key to understanding human emotional life.
As family therapists, our fundamental assumption, indeed the central point of our professional existence, has been to change, heal and restore interpersonal relationships. I consider myself an early Freudian for believing that disturbed human interactions cause most psychological problems--anxiety, depression, psychosomatic symptoms, so-called "psychotic" behavior--and also that healthy, positive human interactions provide their cure. For some time, however, I have worried that too many clinicians who call themselves family therapists seem to be taking the family back out of therapy--seeing individuals and talking to them about their families. Interviewing an individual, even while thinking interactionally, is not family therapy. As a family therapist, I consider it an essential feature of my job to bring relatives, friends and even coworkers together in the therapy session to discover how they interact with one another and help shape one another's lives.
But even as family therapy seems in danger of being redefined out of existence, the very profession of therapy itself seems in grave danger, in spite of the temptation to be lulled into assuming that we have long since won the battle for recognition and acceptance. Recently, I experienced a shocking reminder of just how false this sense of security is, when the clinical director of our program at the Family Therapy Institute spoke with the head of the mental health department of a large local hospital--a man who had always strongly promoted community psychiatry and family systems thinking. Our clinical director asked him what he thought about organizing a training program in family therapy for the mental health professionals on his staff. "Therapy?" the man answered. "What is that? Are people still doing that stuff?" The only training clinicians at his mental health facility receive, and at so many others that I hear of these days, is in pharmacology and managed care--what might be called the new psychological discipline of "meds and money."
Freud's psychological theories radically challenged the standard medicalized view of the neurologists and psychiatrists of his time, who believed talking about a patient's childhood experiences would no more cure emotional problems than it would heal tuberculosis or set a broken leg. Today, we seem to be coming full circle to pre-Freudian neurology, as we watch many mental health professionals rushing to embrace an ever more medicalized view of psychological suffering. The American Psychiatric Association (APA) has virtually cast psychotherapy from its canon, and probably could not even afford to exist at all without financial support from the pharmaceutical companies. …