The Emmanuel Movement: (Boston, 1904-1929): The Origins of Group Treatment and the Assault on Lay Psychotherapy

The obvious, at times, is hard to see. The Boston-based “Emmanuel Movement” stands out in the annals of twentieth-century American history as the archetype of “medically supervised religious psychotherapy”—with emphasis on the juxtaposition of the words “medically” and “religious,” and with a knowing whisper about “psychoanalysis.” Most active during the decade before World War I, it was a forerunner of both the “chaplaincy training” and “pastoral counseling” movements, as well as a spur for what would later become the “psychosomatic” movement. I have always known that bits and pieces of this well-thought-out program later influenced peer-led group therapy, especially that for alcoholism. Somehow, though, I never quite put together all the pieces. Sanford Gifford has.

This meaty but easily read volume guides us through the quaint but confusing story of how an authoritarian, pragmatically minded internist, Dr. Joseph H. Pratt, managed to team up with two energetic, psychologically trained Episcopal priests to run a program for the “outdoor treatment” of tuberculosis; of how this spawned the priests’ program for the treatment of nervous disorders; and of how Pratt reemerged, years later, as a pioneer in group therapy per se. Previous historians have focused on the Emmanuel Movement’s sophisticated use of medical referral of patients to religious therapists for Freudian-oriented psychotherapy—and on all the controversies that that collision of factors could provide. The key, Gifford tells us, is to grasp the Emmanuel Movement as a “combined method of group and individual psychotherapy” (p. 1, italics mine), and to appreciate the movement’s use of “weekly group meetings” as an innovative and integral part of the program. Contemporary critics’ lack of either praise or condemnation of the group meetings may be what led earlier historians astray.

The complexity of the characters involved adds to the difficulty in sorting out this story. I will never forget—and apparently neither will Gifford—the one and only time we crossed paths: in the midst of an interview we were jointly conducting about the founder of the Emmanuel Movement, an elderly female physician stood up and almost bodily threw us out the door! The episode stands out as unique in my career and apparently in Gifford’s, too (on p. 107 the date should be 1973 rather than 1978; this is the only typographical error I found). Some of Gifford’s comments about Pratt, however, suggest that had we had the chance to interview the founder of the “class method,” that, too, might have earned us a rapid trip to the outside. Pratt, for example, firmly believed that those seeking his help should submit to his will, and Gifford quotes a contemporary physician to the effect that Pratt’s patients “got well not wholly because they wanted to get well, but largely because he wanted them to” (p. 57).

Given these difficult personalities, Gifford has done a masterful job of piecing together the elements and then sketching the broad picture. He has done this especially well for those characters, such as Pratt and alcoholism therapist Courtney Baylor, who were still active in the later years of the story. He has even managed to tease out the role of the Emmanuel Movement as “whipping boy” for disgruntled physicians seeking to nip “lay” (i.e., nonmedical) psychotherapy in the bud.

This is, I repeat, an easy book to read. Gifford writes as if he is a lecturer keeping his eye on the listeners in the back row, anticipating the questions to be raised and trying to answer them in advance. He connects with the reader, and this thin volume can be recommended to physicians and historians alike.