Psychotherapy on the Road to ... Where? </nyt_headline>
ANAHEIM, Calif. - The small car careered toward a pile of barrels labeled "Danger TNT," then turned sharply, ramming through a mock brick wall and into a dark tunnel. A light appeared ahead, coming fast and head-on. A locomotive whistled.
"Uh-oh," said one of the passengers, Dr. Martin Seligman, a psychologist and a pioneer in the study of positive emotions.
But in a moment, the car scudded safely under the light, out through the swinging doors of Mr. Toad's Wild Ride and into the warm, clear light that seemed to radiate from the Southern California pavement.
"Well," Dr. Seligman said. "I don't know that I expected to be doing that."
One of several prominent therapists who agreed to visit Disneyland at the invitation of this reporter, Dr. Seligman was here in mid-December for a conference on the state of psychotherapy, its current challenges and its future. And a wild ride it was.
The question is, How to get to Tomorrowland?
Because it was clear at this landmark meeting that, although the participants agreed it was a time for bold action, psychotherapists were deeply divided over whether that action should be guided by the cool logic of science or a spirit of humanistic activism. The answer will determine not only what psychotherapy means, many experts said, but its place in the 21st century.
"In the 1960's and 1970's, we had these characters like Carl Rogers, Minuchin, Frankl; psychotherapy felt like a social movement, and you just wanted to be a part of it," said Dr. Jeffrey Zeig, a psychologist who heads the Milton H. Erickson Foundation, which every five years since 1980 has sponsored the conference in honor of Dr. Erickson, a pioneer in the use of hypnosis and brief therapy techniques.
"Now," Dr. Zeig continued, "well, therapists are becoming more like technicians, and we're trying to find the common denominator from the different schools and methods to see what works best, and where to go from here."
The meeting brought together some 9,000 psychologists, social workers and students, along with many of the world's most celebrated living therapists, among them the psychoanalyst Dr. Otto Kernberg, the Hungarian-born psychiatrist and skeptic Dr. Thomas Szasz, and Dr. Albert Bandura, the pioneer in self-directed behavior change.
"This is like a rock concert for most of us," said Peggy Fitzgerald, 56, a social worker and teacher from Sacramento, holding up a program covered in autographs. Ms. Fitzgerald said she attended war protests during the 1960's, and "this has some of that same feeling."
Calls to arms rang through several conference halls. In the opening convocation, Dr. Hunter "Patch" Adams - the charismatic therapist played on screen by Robin Williams - displayed on a giant projection screen photos from around the world of burned children, starving children, diseased children, some lying in their own filth.
He called for a "last stand of loving care" to prevail over the misery in the world, its wars and "our fascistic government." Overcome by his own message, Dr. Adams eventually fell to the floor of the stage in tears.
Many in the audience of thousands were deeply moved; many others were bewildered. Some left the arena.
At the conference, many said they found it heartening that psychotherapy was finding some scientific support.
For example, cognitive therapy, in which people learn practical thought-management techniques to dispel self-defeating assumptions and soothe anxieties, has proved itself in many studies.
The therapy, some participants said, has even attracted the attention of the Nobel Committee. The two men who developed it, Dr. Albert Ellis, a psychologist in New York, and Dr. Aaron Beck, a psychiatrist at the University of Pennsylvania, brought crowds to their feet.
A frequent theme of the meeting was that therapists could not only relieve anxieties and despair but help clients realize a truly fulfilling life - an idea based on emerging research.
In his talk, Dr. Seligman spelled out the principles of this vision, called positive psychology. By learning to express gratitude, to savor the day's pleasures and to nurture native strengths, a people can become more absorbed in their daily lives and satisfied with them, his research has suggested.
A just-completed study at the University of Pennsylvania found that these techniques relieved the symptoms of depression better than other widely applied therapies, Dr. Seligman told the audience.
"The zeit is really geisting on this idea right now," said Dr. Seligman, who has consulted with the military on how to incorporate his methods.
Dr. Dan Siegel, a child psychiatrist at the University of California, Los Angeles, was one of several speakers to emphasize how psychotherapy changes the wiring of the brain. For example, he said, brain imaging findings suggest that secure social interactions foster the integration of disparate parts of the brain.
"When I'm telling you my feelings, discussing memories, in this close relationship, I'm achieving better neurological integration," Dr. Siegel said. "I'm repairing the connections in the brain."
Many therapists at the conference said that if the field did not incorporate more scientifically testable principles, its future was bleak.
Using vague, unstandardized methods to assist troubled clients "should be prosecutable" in some cases, said Dr. Marsha Linehan of the University of Washington, who has developed a well-studied method of treating suicidal patients.
Yet it was also apparent in several demonstrations of the spellbinding thing itself - artful psychotherapy - that some things will be difficult, if not impossible, to standardize.
Dr. Donald Meichenbaum, research director of the Melissa Institute for Violence Prevention and Treatment in Miami, showed a film of the first session he conducted with a woman who was suicidal months after witnessing her boyfriend die in a traffic accident. After gently prompting her to talk about the accident, Dr. Meichenbaum then zeroed in on something he had noticed when the woman entered his office: she was clutching a cassette tape.
He asked about the tape and learned that it was a recording of her late boyfriend's voice, expressing love for her. "I play it over and over, and it makes me so depressed," said the woman, in a tiny voice.
And here Dr. Meichenbaum stopped the film and addressed the audience.
"The tape!" he said. "When during the session do you go for the cassette tape? What do you do with the tape?"
For several long moments not a creature stirred, not even a laptop mouse. This community of therapists was now trying to save a soul, a person who was alone and did not want to live. What to do with the tape?
"Consider between now and the next time I see you, in two days, consider whether you would be willing to play the tape," Dr. Meichenbaum went on to say he had told the woman. "I would be privileged and honored" to hear it.
"Why?" he now asked, turning to the audience. "Because it not only increases the likelihood she'll return but empowers her to come back" and take an active role in therapy. Which is exactly what she did, he said.
"Now, is any research study ever going to tell you exactly the right thing to do when your client comes in with a tape of her dead lover's voice?" Dr. Meichenbaum asked.
Most of the audience of more than 1,000 people wandered out of the talk wide-eyed. One, Terrina Picarello, 40, a marriage and family therapist from Greensboro, N.C., said, "That is what you come for: inspiration."
Ms. Picarello said that the conference was well worth the money she spent, more than $800 in fees and travel, and the week she had taken off to attend, even though she found some of the presentations on marriage counseling disappointing.
"Way too much talking by the therapist, I thought," she said, after one of them. "It seemed so old-fashioned, like it was drawn from another era."
And there was the rub. As psychotherapy struggles to define itself for an age of podcasts and terror alerts, it will need ideas, thinkers, leaders. Yet the luminaries here, many of whom rose to prominence three decades ago, were making their way off the stage. And it was not clear who, or what, would take their place.
Across the street at Disneyland, where just about any metaphor is available for the taking, Dr. Siegel was working out the meaning of the park for himself. A native of Los Angeles, he has many memories of visiting as a child, perhaps nowhere more so than the circular drive in front of Sleeping Beauty's Castle.
"The circle of choice," he said, looking around. "This is where you decide, where you think about your mood and which way you want to go - to Frontierland, Tomorrowland."
By all appearances in Anaheim, the field of psychotherapy has arrived at the circle of choice.