The psychotherapy of the next millennium

How do you imagine the psychotherapy of the next millennium?

I think there is a division in the discipline. On one side, there are those who do psychotherapy under court order: it is the judges who decide that people must undergo it, or else they will go to prison. The therapist then becomes an agent of the State; he keeps people from disturbing the public peace. This approach represents a very widespread kind of psychotherapy in the United States. On the other side, another very marked psychotherapeutic trend is the one that seeks to make people happier, healthier, more interesting, with richer lives. I think therapy is heading in both directions: the State will try to use it for purposes of control, and at the same time some therapists will try to practice a humanistic psychotherapy that helps people live better.

So, what will the psychotherapy of the future be? I am not very sure, but I think, judging by what we observe today, that these two trends will persist and develop.

On change and power

Another theme is change. Why, or how, do people change in psychotherapy?

What a question! I think that, often, they don’t change. The therapist must possess specific skills, acquired in a training focused on a psychotherapy oriented toward achieving change. You can have patients who talk about their problems and reflect on their lives without ever overcoming their symptoms or their family crises. Very often, I think the conflict is resolved by including someone else in the situation one wants to change, so as to approach it interactionally, within the relational frame. When the therapist notices that his client, say a married woman, is not engaging in the ongoing therapy, perhaps he should bring the husband onto the therapeutic stage and look into whether he has something to do with the fact that the wife is not engaging in the therapeutic work. I think it is the inclusion of another family member, or, as here, of the other spouse, that produces change.

In my view, the question to be resolved is how to produce that change as quickly as possible, rather than producing it in one particular way. I have no recipes for changing people; I think it depends both on the problems they present, on the social situation they are immersed in and on the power the therapist has to produce changes.

We come to an important word: power.

Oh yes! Power is an important theme, and in particular the power of the State. In the United States, when an individual uses drugs, the judges send him to therapy. They use their authority to decide about that person’s life, and they do so through a therapist. A great deal of power is exercised over drug addicts and over perpetrators of sexual or physical abuse.

Emotion in psychotherapy

Bateson once wrote that emotion was a “dormitive” concept. What do you think of emotion in therapy?

I think it is a mistake to ask patients how they feel: that only provides a kind of metaphor, and what appears in this way is a simulation. For feelings to surface, the organization of the relational structure has to be changed. Most directive interventions, such as paradox, provoke emotions that the therapist can then observe and use to restructure the patterns of interaction, which will eventually produce the changes being sought.

This view stands in opposition to the theory of repression, according to which whoever expresses his emotion changes. It was on the basis of such ideas that people were helped to express their emotions. Personally, I don’t believe that changes anyone. Perhaps it changes the way people talk about it, and perhaps they learn to behave as if they were angry; but I definitely do not agree with the idea that by acting on emotion one produces change. I think rather that by acting on the organization, the organization in turn acts on the emotion and produces change.

Bateson, Weakland, Erickson: at the origins

In the early years of working with the group of John Weakland, Gregory Bateson and Bill Fry, did you imagine that the development of the research you were carrying out would lead to a theory as important as systemic thinking?

I don’t think so. What I can say about it is that Bateson was an anthropologist (my wife is an anthropologist), and one of the things that characterize members of that discipline is that they observe, fundamentally, without seeking to modify. So Bateson was not interested in producing changes; he only wanted to understand the way human beings live, interact and develop. Since we were studying how to do therapy while practicing it, we didn’t really want to change it, but rather to understand it. That is how a delightful collaboration was established among all of us: Bateson was so tolerant that, whatever John Weakland and I wanted to examine or explore, hypnosis for example, he encouraged us to do it, even though he was not really interested in the practice of hypnosis, but in the phenomenon itself. In fact, it was he who introduced us to Milton Erickson.

In any case, our project dealt on one side with hypnosis and, on the other, with the psychotherapeutic approach to schizophrenia. Bateson, from his anthropological viewpoint, did not really care about transforming anything in those situations, but he wanted to know what they were about.

During my stays in Palo Alto, my supervisor at the Mental Research Institute was precisely John Weakland. What was your experience with Milton Erickson, on that trip to Phoenix you made with your colleague John Weakland?

It was a rich experience. Milton Erickson embodied the new paths of clinical psychology. He was a kind of prodigy in the fifties, when psychotherapy was going through a period of great change: from intrapsychic and psychodynamic, it was becoming directive, turned outward, and involved the clients’ relatives or entire families. That is precisely what Erickson was doing at the time: he was developing a very directive approach, centered on change and on the relationships between the members of a couple or a family.

Since we were studying the parallel between hypnosis and schizophrenia, it was wonderful to study with Erickson, the world’s foremost authority on hypnosis. We examined his way of thinking about therapy, and that had a great impact on what we were doing, which in turn influenced those who collaborated or trained with us.

In 1948, Erickson was not known as a family therapist, but he was listed in professional directories as a psychiatrist and family counselor. That orientation, strongly turned toward the family, helped us work on this theme, guided by one of the pillars of directive therapy.