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PSYCHOTHERAPY AND COMMUNITY PSYCHOLOGY

EUGENE T. GENDLIN
University of Chicago

A major argument currently divides practicing psychologists: Is psychotherapy irreplaceable or has it been made obsolete by the new emphasis on community, and on the restructuring of social institutions? The very way this question is posed, as an "either-or" makes it seem that one must lose one or the other; one must either remain with office therapy available only to the relatively wealthy few, or one must omit the psychotherapy process in setting up new community patterns.

The thesis of this article is that psychotherapists are challenged to find ways in which the essentials of a psychotherapeutic process can be built into the new community patterns, so that it is provided for many people. As trends are now, it looks very much as though psychotherapy will be denied to all but the wealthy exactly as it has always been in the past. This used to be due to the money, office and middle class character of patients and therapists; from now on it will be because community psychology patterns will exclude the psychotherapy process. The mass of people will lose out exactly as before.

It is quite clear that only psychotherapists can develop modes in which the psychotherapy process can be part of new community patterns. But it is just as clear that psychotherapists cannot do that alone. If community psychology is a restructuring of a community, a school, a hospital, or all of these, then before we can fit the psychotherapy process into these new structures we will have to know what the new structures are. Therefore psychotherapists and community psychologists will have to work together—and at this time that is still a rare occurrence.

Community psychologists tend to come from sociology and social psychology, and tend to have little feeling for what psychotherapy really is. Often they think of it only in their own sociological categories, for example they might define psychotherapy as a process of influencing (much as mass media do). One social psychologist whom I respect, and who is certainly not unfamiliar with psychotherapy, thinks of it as nothing more than the patient acquiring a new and special "generalized other," that is to say when the patient gets into difficulty, he asks himself "What would my therapist do in this situation?" Naturally, if psychotherapy is thought of this way, then restructuring social and community patterns seems not only a much more basic change, but also seems to include everything psychotherapy could provide.

My conclusion is that if we leave community psychology entirely to the community psychologists, they will do many brave things and change many social patterns, they will reorganize arrangements in which people are [Page 68] together this way and that, send them hither instead of yon, but they will forget to provide in all these new roles even one person who will be willing to interact intimately. In all these new activities no one will ever really listen even one hour a month to anyone's feelings and help a person move and change in what he is up against.

Community psychologists would give two answers to this fear: first, they would say that in their new plan everyone will relate intimately with everyone, and hence there is no need for special places, times, or persons. I disagree. We always want everyone to relate intimately, but social psychologists know even better than others that we behave according to the roles we are placed in. If we need to have business, social clubbing, or administration with each other, then we won't have intimate interaction nor much listening unless we set aside a role, a time, and an effort for that quite specifically.

The other answer usually given to the fear that anomie will continue even in the new social patterns, is that "feelings" are situational anyway, and not little things inside an intrapsychic space. I agree very strongly with this view. When what I feel unfolds, when I explicate it, when it comes to me what it is I feel, then it always turns out to be all about my situations, what people did to me, what it means I must now do, why I can't do it, what I'm up against in trying, and so on. But a situational view of "feelings" does not lead to the conclusion that one needn't work with feelings, one can work with the situation instead. Rather, we must see that feelings are how we are in a situation, and this is especially noticeable when we are confused, troubled, stopped, or upset. We feel the situation, but not clearly, not in a way we can lay out in actions we will take, or in words we can say. Therefore anyone interested in how we live in our situations must be interested also in our feelings, especially when these trouble us, and are unclear.

Psychotherapy is a process in which just such a lump of unclear troubling situational feeling "moves," unfolds, clarifies itself and thereby becomes uncramped. There is a recognizable "give" in the felt meanings and simultaneously one suddenly can say what before one couldn't say clearly, and one can begin to envisage possible actions where before one was stumped. One essential of psychotherapy is this movement process of felt meanings, and it can be provided by anyone who is minimally trained and willing to "listen" to a person who isn't making good sense verbally or actionally.

I emphasize this first "essential subprocess" of psychotherapy, because only from psychotherapy do we get the knowledge and training for it. In the world outside of psychotherapy people are invited to say only as much as they can say clearly, and one doesn't pursue what they feel beyond what they can say or know clearly. But it is only in listening to someone beyond that point, that he becomes able to move beyond that point. It takes putting up with an embarrassing silence occasionally, for without such a silence a person cannot focus his attention on what is as yet unclear, what as yet he only feels.

It would not be difficult to train people for this role, for this therapeutic essential. While we cannot hope to provide office-like psychotherapy in the community, we can certainly expect to train people to provide—not psychotherapy, whatever that is—but certain essential subprocesses, for example the one I just defined as "listening beyond the point where things are clear to a person."

There are several such easily definable "subprocesses" of psychotherapy which we can train people to do, if a role for such people were built into any of the community programs.

Another psychotherapeutic "subprocess" is a certain honest interaction which enables any individual to live his difficulties within an interaction in which he is responded to, so that at one and the same time he can perceive himself more clearly in the response and can also feel unhurt and welcomed forward. He can then attempt something new and better right then and there in the moment of being honestly responded to. As all therapists know, this sort of interacting takes a little more training and experience than the first "subprocess" I outlined, but we also know that it doesn't require a university education. Again, I want to emphasize that we learn this mode of interaction from psychotherapy, and that my friends in community psychology do not know of it as a trainable mode of interaction. [Page 69] Neither sociology nor the everyday world encourages this mode of interaction, and therefore new institutional and social programs will not have it any more than old ones do, unless we build it in quite consciously by defining some roles for it and some times for it.

But what would be an example of "building in" psychotherapy subprocesses into community programs? Goodman ( in press) trains high school seniors to spend part of a day each week with emotionally disturbed sixth graders. If this new program succeeds, it can become a "built in" pattern in the school system, an activity regularly offered to selected high school seniors, and a relationship regularly offered to sixth graders. Of course, Goodman's program is built into the old school system, but why would new school patterns not lend themselves equally well to including something of this sort?

To build psychotherapy in, and to define and train in "subprocesses" (rather than the whole office pattern), we are thinking not of Ph.D. or M.D. therapists, but of ordinary people who can select and be selected for such roles. These are not "sub-professionals." That idea doesn't go far enough. "Sub-professionals" are a group of pseudo-professionals added on at the bottom of our professional helping hierarchy. We need them, but the pay is too low at the bottom, and the status of "sub" or "pseudo" is unattractive. What is worse than these limitations, the sub-professional idea makes for an artificial situation, a tense and less than human framework which professional therapists know very well from having had to overcome it. Subprofessionals are in the old role, although they are new personnel. I favor adding new personnel, but we need new roles as well. The high school senior in the above example is a new therapeutic role.

Recent studies claim that more than half the population is "in need of psychotherapy." This shows that "we will never have enough professionals." The conclusion is therefore not to train a few more, but to recognize that psychotherapeutic process involves something everyone needs. Shall we train half our population to be therapists? Which half? If everyone needs an intimate relationship, and if everyone should have someone available when he needs to work through his unclearly felt situations, then why not build the roles and times into the social fabric itself? But this can be done only if the need for it is recognized, and it is viewed as something quite specific, definable, and trainable.

Psychotherapeutic subprocesses will not be available in any new social structure unless they are deliberately built in and trained for. I have already said how little education and training I believe is required—but it does require some. It will not occur if there is no training, effort, planning, and roles defined for it.

What is needed is the creation of new patterns, new roles which ordinary people can learn to adopt. The role of a high school senior "older brother" described above is an example. Here are some other examples: In Illinois we have been planning to define and train some persons in the community as (a special sort of) community workers who work both in the hospital and in the community. They can therefore begin to work with patients still in the hospital, later meet them in the community to connect them with a new job, church group, living quarters, and social group. Because they work both places but belong to the community, these workers could easily return the patient to the hospital if necessary without losing contact with him. They could therefore also try to get patients out into the community long before they are strictly speaking "ready for it," so that they can become ready.

Still another pattern, one we have tried, ( Gendlin 1961; Rogers 1968) is "ward availability." We noted that a large well-staffed "mental hospital" has quite a lot of different staffs and staff roles, yet none of these roles is being available to the patient for helpful listening and interacting. Of course, among aides, nurses, O.T. and R.T. people, psychologists, social workers, psychiatrists, there are always some who do this, but it isn't what they are supposed to do and it must be done apologetically on the side. We provided a "ward-available" person and found that less than half time (16 hours per week) made quite a difference on a ward of 24 patients. Ordinary people can learn to be ward-available.

Of course, if we put psychotherapy and community psychology together along something like these lines, we will have to contend not only with the prejudices and blind spots of community psychologists, but equally or [Page 70] more so with the prejudices and blind spots of psychotherapists. Here are a few. Psychotherapists often believe that if you can't take a person on for good and ever, don't talk to him even for a few minutes. (Yet we all know that one talk with a helpful person can help an incarcerated and isolated patient. Even a few minutes in which he finds himself "making sense" can be a major forward-propelling event.) Psychotherapists often believe that their skill requires so much training that none except themselves should be permitted to do anything like it. They often believe, too, that too much supervision will be needed, if new psychotherapy-like roles are defined for more ordinary people. (Yet they also fear for their jobs. But if we will need thousands of supervisory people, the well trained therapist will be more in demand than ever.) Above all, clinical psychologists are trained to be office-bound, they are often intensely uncomfortable even in the waiting room, let alone in the community, or on an open ward, or in a block club meeting. (But this discomfort is soon overcome, one need only be willing to be ill at ease and not useful for a short period during which one learns what is needed.)

There are also theoretical prejudices to be overcome. For example, most therapists believe that therapy can do anything: if the patient is only made psychologically well, he will find a job, a wife, a home, friends, and so on. They believe that if only Ho Chi Minh and Johnson could sit down together with a therapist, they would soon "understand each other" and then we would have peace. Not only does this miss the situational nature of "feelings" which I cited earlier, it misses the whole structural level entirely. One must realize that poor people have no purely psychological problems, they are confronted with a whole unlivable situation inclusive both of how it is and how they are. People who need jobs have to be helped with both as one unit, or they won't find or hold a job. There are economic, racial, community and family reasons why a man can't find a job. There is a structural level of analysis. Therapy does not solve economic problems. It doesn't solve structural problems.

Take labor-management bargaining as another example of the structural level which psychotherapists so often ignore. Some thought that if a therapeutic sort of person were provided in a labor management dispute, this would help avoid a strike. But labor-management bargaining is a social process which has a certain structure as it develops over time. The bargainers must begin by making nearly impossible claims. Then there must be a period of "floating a package" where the two sides feel each other out. An area of possible agreement is sensed and information is exchanged about what could or could not possibly be considered. When the two sides are very near agreement, then there must first be a crisis. Unless there is a crisis, neither side is sure it dragged the other side as far as it could, and the labor rank and file can't be sure they weren't sold out. If you place a therapeutic type of person into this situation, (especially if he isn't aware of the pre-determined structure of the bargaining process) he will prevent the process from happening properly, and there will be either no agreement, or one which neither side will eventually accept, and there will be a strike. ( Douglas, 1957)

Psychotherapy alone will not get patients out of the mental hospitals. For many years therapists in mental hospitals have discovered painfully that to get even one patient well, they have had to work with the patient, the aides, the nurses, the superintendent, the patient's family, the vocational people to help him begin to work when he "isn't ready," the social worker to discuss release when he isn't ready, the landlady in the community, the community's attitudes ("He burned a barn down eight years ago, they don't want to see him back there."), a prospective employer, etc.

Psychotherapists have long sighed and agreed that to get one hospital patient well, "you'd have to change the whole system." By this they meant "it is impossible. . . ." but community psychology is the attempt to do exactly that.

There are structural reasons in the very nature of what a hospital is, which will keep patients as they are. Therapists are likely to miss this fact and see only that all the individual staff members themselves need therapy. But, successful therapy for this one difficult nurse will only lead to her going to a better [Page 71] job while the hospital remains the same. Let us restructure the very idea of "hospital," and set up instead some small community centers in which disturbed people can stay. There nurses will no longer relate never to patients and only to other nurses, there will only be one nurse. Perhaps there won't even be a role such as "nurse." But similarly, the "psychologist" in such a setting neither gives tests, nor does office therapy. Perhaps there isn't a "psychologist" role at all, but some community people trained to help the patient with the whole situation he is up against—someone trained in the "subprocesses" of psychotherapy. But if there is no one like that, if there is only the small clinic instead of the large hospital, only the "out to the community" shove instead of the "they must stay in forever" attitude, if there are only social clubs and job-training, it won't work either!

Group therapy contributes a major "subprocess" I haven't yet mentioned, largely because here the subprocesses are best known. I want to mention it as an example of how one can draw certain essentials from psychotherapy and train people in that, without committing them to the long term responsibilities, exclusiveness, psychological focus, and small numbers which therapy involves. From group therapy have come T groups, marathon groups, encounter groups, sensitivity groups, brainstorming groups . . . all using a certain essential from group therapy, the way in which people respond to each other, and become aware of how they interact toward each other. It is now well known that one need not exclusively delve into intrapsychic personality troubles in order to get the advantages of this sort of group process. For example, a group of advertising men spending a day to brainstorm ideas for an ad, respond to each other acceptantly (any idea, no matter how it may sound at first, is gone into). In a so-called "sensitivity" group self-awareness is learned from the ongoing interaction, not from what people say about themselves.

But, to date, such groups are rarely provided as a continuing, life-sustaining mode for people to organize and to live and work together. The current pattern is the "workshop," the week-end, the six weeks' "course," and the accent is on training, not on living. I believe, however, that the time is coming when communities will organize in small reference groups in which ordinary people can provide therapeutic subprocesses to each other. Only in this mode would community action sustain people and add to their strength, instead of calling them to dull meetings which drain them of the little reserve energy they have. One of the main complaints of community organizers these days is that the poor won't come. But that is because the poor cannot afford the sort of activities that only drain them further and do not sustain them immediately. Again, here, the structural and political level, while perfectly essential, requires inter-human psychotherapeutic subprocesses that are equally essential, though they must be adapted into the structural patterns that obtain, or are planned.

Community psychology is a new field in which many different ways are being discussed and tried. The following is a chart of the various models along two continua: 1) How far into the community does a program reach? 2) What new populations does it involve?

1) The following are arranged from least to most reaching into the community:

• a) A center in the community refers people to mental health services in the city. (In this plan all but two or three mental health professionals remain inside their own setting, and their work remains unchanged.)
• b) Crisis and suicide prevention centers are set up, which at any hour of the day or night refer people to pre-arranged mental health professionals. (In this plan the mental health professionals remain inside their offices, but have adapted their procedures to short term, immediate and emergency needs.)
• c) A center sends consultants to agencies, schools, prisons, community organizations. (The mental health professional belongs to his own setting, but works as an individual somewhere in the community.)
• d) A community program has mental health professionals on its own staff, devising new service programs within the community. (In this plan the community has at least partial control, and a whole program is developed: for example a job retraining program that includes both therapeutic and economic services.
• e) Professionals working with community individuals and groups take on "understudies," individuals from the community who can be "co-therapists" for a while. Since at least some of these "understudies" do develop some competence of their own, this develops the community's own resources. (This plan focuses on training local people instead of bringing in outsiders only.)

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• f) The community institutions themselves are restructured; for example, a "hospital" is broken up into new arrangements that are not hospitals at all, but new patterns of foster homes backed up by a half-way house or a small community center with a few beds, and whole families, not patients are worked with. Or a school is restructured to be a community center as much for parents as for children, and the lines between teachers, parents, counselors, etc. are erased in favor of different newly defined roles.
• g) Entirely new community institutional patterns are set up, rather than restructuring old ones. For example, in one city I know of, everyone in one neighborhood belongs to a small "process group," a new "institution." Much as, today, we have an "institution" known as friendship, which patterns and explains some of our relations with individuals, and everyone is expected to have a friend, so this community developed "process groups" for everyone. This community went on to set up some financial and marketing agencies of its own, and has been strong enough to influence legislation.

2) The second way of organizing the many current plans and projects is to ask–what new segments of the population are involved? Here we must include both those newly served, and those newly doing the serving. New programs serve the difficult populations (drug addicts as in Synanon, the retarded, alcoholics, the aged, prisoners, delinquents, as well as problem-defined populations such as teenagers, street gangs, unemployables, underachieving school children, unwed mothers). On the other side, training in therapeutic skills (however named) is being given to managers, teachers, ministers (who are expected to remain in their original roles but with more sensitivity). Training is also being given to less well educated, lower class, community representatives, housewives, volunteers (who are expected to assume a "sub-professional" role). Finally, as I have already said, of greatest interest are roles which are not copies of the professional role, but are new roles for new segments of the population. In society every individual has many roles at different times and places. At some time and place essential therapeutic subprocesses can be extended to everyone.

Client, server, and mutuality roles can be adapted in many ways.

The new programs and new populations I have charted here offer psychotherapists great opportunities to develop new patterns in which the essentials of psychotherapy can be made available. Perhaps the only requirement is that there be a designated time and place for therapeutic roles.

The two continua of my chart (new programs and new populations) come together at the apex where new community programs include everyone who can and wishes.

Specific psychotherapeutic processes must be built into the society, into the social fabric, in patterns available to everyone. Otherwise "changing the social structure" will mean only rearranging people while alienation remains unchanged.