The Psychotherapy of Hope: The Legacy of Persuasion and Healing

Preface

Preface The history of psychotherapy encompasses periods of solid and universal acceptance as well as times of discredit and obscurity. The fortunes of the field rise and fall in relation to developments in science and medicine, social organization , politics, and other approaches aimed at regulating and moderating human experience. In our tumultuous era, psychotherapy necessarily must reexamine its creeds, goals, and technical approaches to find its proper place in the theoretical, didactic, and clinical landscape. The work of Jerome D. Frank, for fifty years a professor of psychiatry at the Johns Hopkins University School of Medicine, first catalyzed and now shapes much of the continual reassessment that characterizes psychotherapy as a research and clinical discipline. Frank’s ideas, developed and promulgated through three editions of his classic book Persuasion and Healing: A Comparative Study of Psychotherapy, engendered a quiet revolution in twentieth-century psychotherapy . His incisive critique of the principles and practice of psychoanalysis in the American psychiatry of the 1950s helped dislodge Freud’s disciples from their position of dominance. Applying the methods of academic psychology to the real-world problems of psychiatry and medicine, Frank refused to accept the impossibility of doing research on feelings and emotions, entities once considered “unmeasurable” and therefore beyond the reach of objective evaluation . His research replaced unprovable suppositions about unconscious determinants of behavior with empirical data, and his exquisite scholarly common sense forged a coherent link with wise clinical intuition. In the process, Frank identified features common to all forms of psychotherapy, as well as qualities common to those who respond to it. For some critics, Frank’s theses, in particular his deconstruction of the extravagant claims of various brands of psychotherapy, contributed to the decline of psychotherapy as both a useful social activity and a valid medical treatment. We believe that the opposite is true: Frank’s integrity, empiricism, and openmindedness helped sustain psychotherapy as an acceptable treatment for recOf course the first thing to do was to make a grand survey of the country she was going to travel through. —Through the Looking Glass xvi Preface ognized forms of distress. In an age that demands scientific proof of the validity of professional endeavor, rigorous scrutiny of psychotherapy serves both to foster improvements in technique and outcome and, at a broader level, to confirm its legitimacy. Given the many controversies that characterize the field, assigning an appropriate role for psychotherapy among the contemporary healing arts is a never-ending process. This volume, The Psychotherapy of Hope: The Legacy of "Persuasion and Healing," is a collection of original, stand-alone essays about psychotherapy that are intended to contribute to this effort by updating Frank’s ideas (1961, 1973; Frank and Frank 1991) for a new generation of researchers and practitioners. From Persuasion and Healing to The Psychotherapy of Hope The first edition of Persuasion and Healing addressed issues thrown into prominence by seismic shifts in then-prevailing academic, medical, and general American culture. It appeared at a time when psychoanalysis enjoyed great popularity as treatment for both defined mental illness and unspecified distress . Behind a confident facade, definitions of what constituted a psychiatric disorder, classifications of psychopathology, and the development of several professions dedicated to its treatment were in profound flux. Even as the superstructure of psychoanalysis grew grander and more expansive, the supporting pillars—underlying theories of “neurosis” and the social support offered by training institutes—were crumbling under the weight of new information, new forms of training, and new sociocultural realities. Frank, assigned to teach psychotherapy and psychopathology to medical students, psychology graduate students, and psychiatrists in training, sought to solve basic problems: What is (and is not) psychotherapy? Does it “work”? How does it work? Whom does it help or harm? Frank did not consider these merely rhetorical questions, and his answers to them still command respect. Psychotherapy, he concluded, is a form of relationship between healers of culturally assigned status and sufferers with culturally acknowledged forms of distress, conducted in a defined context. It indubitably “works,” a statement that could be proved by scientific research, identification of forms of psychotherapy in a wide variety of cultures, and persistence of psychotherapeutic activities throughout history. The mechanisms of therapy, the subject of Frank’s own research, include the mobilization of expectant faith, Preface xvii or hope, the encouragement of mastery, and the reinterpretation of personal experience facilitated by emotional arousal. In general, psychotherapy most benefits people, however distressed...