Chapter 2. A Brief History of Western Psychotherapy 2.

1 Introduction The application of mental health strategies differs widely with culture. Although Western medicine and philosophy have dealt with psychological issues since at least the time of the ancient Greek philosophers, about 500 BC, there is little doubt that various forms of mental healing or shamanism would have began in pre-historic times. The first evidence of belief systems, about 30000 years ago or more, was the advent or cave art and worship, both indicators of mans ...coming into consciousness... (Bolles, 1993; Hearnshaw, 1989, p. 8). More recently the last century has experienced psychotherapy becoming a major industry, with therapeutic services being a common adjunct to the other regular services in the medical profession. In addition there is an enormous educational investment in psychology. It is a ubiquitous university credit at undergraduate level, and in this country sees several universities producing tens of new practitioners into the field each year. Undoubtedly in terms of supply and demand, psychotherapy has come of age, but this study questions whether the training and practice of therapists in a culturally heterogeneous country such as South Africa measures up in regard to appropriateness and relevance. To achieve the goals of this research, this chapter is partly focused on tracing the history of Western and psychotherapy. Although the history of Psychology is well documented (for example Hearnshaw, 1989), the history of Psychotherapy and its derivatives, except for modern psychotherapy, is far less so. Psychotherapy, psychiatry and other forms of mental healing antedate psychology, and for most of recorded history, studies of the why of behaviour has always been somewhat ahead of the art of helping behaviour (Bromberg, 1975).

2.2 History of psychotherapy 2.2.1 Introduction Although the term psychotherapist is relatively new, the work of psychotherapists have no clear-cut beginning and would seem to have been a part of mans world, in various forms, from the earliest of times, perhaps a hundred thousand years ago (Bromberg, 1975). Although there is no proof of this, there is plenty of well informed speculation and suggestive evidence, ranging from the symbols in cave art, human burial and contemporary studies of isolated and primitive human groups. During that protracted timespan, therapeutic interventions would have been

undertaken by many different functionaries like shamans, druids, witches, faith healers and priests. The practice of mental healing would have undoubtedly been undertaken by the entire gamut of practitioners, from ineffective quacks to individuals of inspired genius. The methodologies of these mediums would have differed considerably from each other and from modern interventions, though the wish to cure mental ailments was the golden thread which tied them all together (Bromberg, 1963).

2.2.2 Ancient psychotherapy In the context of this section, ancient refers to mental healing practiced prior to about 2500 years ago. Bromberg (1963) states that mental healing must have started as a self curative process. Modern understanding of the innate human capacity for empathy (Jackson, 1992; Rogers, 1951) would indicate that humans have an intrinsic capacity to offer comfort to other beings in distress. Primitive man lived in a dangerous world, where injury and loss were common currency. Hergenhahn (2001), suggests that prehistoric humans must have been awed by the natural forces in the world, and being equipped with the sophisticated reasoning ability that he had, sought to give meaning to these forces. By attributing human characteristics onto nature (anthromorphism), and considering nature to be alive (animism) some sense might have been made out of thunder, changes in seasons, storms, earthquakes, rain and all other conceivable forces. For prehistoric humans who pondered about their world, at least four colluding evidential aspects might have contributed to their cognitive processes: 1. Anthromorphic and animistic explanations (e.g. the sky is angry); 2. Dreaming brought a surrealism to daily life (e.g. dreaming about people who had died might have created a sense that they still existed); 3. Innate neuropsychological propensity for self-transcendence and meaning making (dAquili & Newberg, 1998) 4. The unpredictability and power of nature; All four could have led to the belief that the earth is alive with powerful emotional forces (gods, or deceased relatives) who control human lives. On some level, well bei g meant appeasing the n forces, and mental strain would have ensued when the forces acted destructively on the people. In such circumstances individuals might have looked inward and to their social functioning in attributing meaning to natural events, including illness. The evidence of amulets found with the earliest of stone tools (Bromberg, 1975) would indicate that a belief in magic and the supernatural goes back to the very beginnings of human development. In a world occupied by gods, spirits and other invisible energies, individuals who could communicate with and influence these forces were

relied upon as mediators between ordinary people and higher beings. Magic, combined with various other disciplines, would seem to dominate as the first therapeutic principle. It relied, as it does today to some extent, on the attitude (faith) of the recipient who hopes for a result, as well as the expectations and participation of the community, and finally the practitioner-recipient relationship. Contemporary placebo studies (Grissom, 1996; Prioleau, Murdock & Brody, 1983) would indicate that expectations alone ensure at least some measure of success. In Southern Africa San and European rock art, dating back thousands of years, there are indications of shamanistic magical rituals from the earliest of times (De Maret, 1994; Lewin, 1991). In Europe, Bromberg (1963) notes that mental healing would have been the task of sorcerers, medicine men, magi and shamans, and closely aligned to supernatural beliefs. He speculates that the shaman/priestly body of knowledge would have with time became crudely entrenched and formalised. Practitioners, sometimes called to the position by virtue of special gifts, were tasked with a range of duties, from divining the weather and undoing sorcery to healing the sick. Ordinary individuals in turn, would have ceded the responsibility of cosmic problems and healing to these shaman priests, who would have relied on their special talents and training to deliver an effective service.

Bates (1983) wrote an unusual novel about a spirit-diviner living in the fourth century (1600 years ago). In the forward to the novel Bates (p. 9) argues that all cultures during all times seem to have developed techniques enabling individuals to transcend the layers of conventional reality and to experience a separate vision. Bates goes on to assert that powerful traditions of sorcery and mysticism were an integral part of clan life, and were almost certainly legacies of prehistoric shamanic healing approaches. In these
primitive societies, amulets were used to defeat evil spirits, and were thought to contain the magical power of sacred animals. Freud (1946) in his classic essay Totem and Taboo described the demons of ancient societies to be nothing more than projections of the individuals own emotional impulses. He thus suggested that a persons power to do evil was displaced onto an outside demon. Freuds view seems rather quaint given the contemporary resurgence of interest and efficacy in both shamanistic (Walsh, 1990) and transpersonal (Cortright, 1997) healing approaches. Bromberg (1963) speculates that these amulets found their way into formal religion, for example the phylacteries of Judaism and the scapular of Catholicism. Early medical writing also contains many references to the use of numbers, charms and amulets to ward off or cure diseases. Early shamans, like their modern counterparts would have relied on their intuition,

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insight and talents in their utilisation of supernatural forces in healing. Some shamans and other magician-healers organised themselves into groups, restricted their numbers and in this way healing became a mytical, divinely inspired art. Foster and Anderson (1978) describe modern shamans as curing by falling into a trance and communicating with spirits and ancestors. They also give accounts of shamans whose protocols would not appear to have changed for centuries, in which the patients are questioned, prodded and sung to in various ways. Bromberg (1975) indicates that early Egyptia n medical writings dating to 5000 B.P., contain instructions for the driving out of demons consisting of a combination prescriptions, advice and magic. Similarly ancient Mesopotamian writings include a strange brew of magical and religious practices.

2.3 Healing in classical Greece The world of medicine was similarly occupied by beliefs in mysticism, magic and the supernatural (Hergenhahn, 2001). Documentary evidence exists (Bromberg, 1963) that some 3400 years ago Hindu physicians prescribed kindness and consideration in alleviating mental suffereing, and appears to have been somewhat ahead of the Greeks in the form of Thales, who some 1000 years later, appeared to have introduced the idea that natural forces and not only supernatural or magic forces played a role in the world. Healing practices thus became inspired by a balance of rationalism and supernaturalism. The rationalism was an important in that for the first time a scientific spirit was brought into mental treatment (Bromberg, 1975). Certainly the most celebrated of the Greek physicians, Hippocrates, disparaged charms and amulets, and believed that nature was ultimately responsible for causing and curing illnesses. He predated Freud by some 2000 years by suggesting sexual roots of neuroses. Although the gods were seen as responsible for sending swarms of malignant spirits, they also relied on plants and herbs, as well as diagnoses through interpretation of dreams. Plato, who believed that mental disease was a combination of physiology, morality and divinity, sensibly suggested a cure through incantations and beautiful reasons (Bromberg, 1975). The Greek practitioner Celsus made an impact on psychiatric treatment with his practical approach including recommendations of treating psychoses by ...good hope... storytelling...praising...pointing out that the very things which trouble him there may be cause of rejoicing rather than solicitude.. Bromberg, 1963, p. 30 This intervention indicates the early roots of several modern therapeutic techniques (for example positive regard and reframing), though for more serious situations, Celsus recommended a

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mixture of tortures including flogging and starvation. Some 500 years later, Galen suggested the notion of different temperaments (Phlegmatic, Sanguine, Choleric, Melancholic) which impacted on human behaviour, and is considered the earliest attempt at classifying psychological functioning. The importance of the early Greeks, was that they established a forum for open rational debate, and contrary views were not only tolerated but encouraged. Unfortunately this was not maintained, and for many centuries after Aristotle, people appeared to lapse into intellectual complacency, and were seemingly not revived until the Renaissance about 1800 years later (about 1450 1600) (Hergenhahn, 2001).

2.4 Post Christian healing The first millennium (incorporating the Greco-Roman period (2100 B.P 1600 B.P) and the Dark ages (1600 B.P. 100B.P.)) offered little of value in the treatment of the mentally ill. Hergenhahn (2001) notes that the philosophical movements of Skepticism (suspension of judgment as all truth is dogma) and Cynicism (withdrawal from the world, especially the material world) lent themselves to scholastic immobilisation. The mentally ill appeared to have suffered considerably and were seen as being occupied by demons and ostracised. The Christian doctrine which took hold 2000 years ago was a departure from more antagonistic cults (like Zoroastriansim, Magna Mater and Mitras), which were hybrid beliefs derived from Greek and Roma sources. Christianity advocated tolerance, love and compassion and although the message was often distorted and even defiled (witness the Crusades some 1000 years after Jesus) its philosophical roots were derived from Plato (St. Paul studied Greek philosophy) except in a major departure, he placed faith above reason. For early Christians humans struggled to be close to God as they were driven by sinful bodily urges. Hergenhahn (2001, p. 64) describes how Emperor Constantines vision (of a cross with the words by this sign conquer) in 312 and the subsequent battle victory entrenched the power of Christianity by promoting its widespread acceptance. The writings of St. Augustine, characterised by a belief that man had animal instincts which contained a divine spark, and that the forces inside man were at war with each other, became the established Christian worldview for the next 1000 years. In regard to healing, religion, psychotherapy and faith became increasingly mixed. Religion was not psychotherapy, yet in many ways its functions considerably overlapped. During these times, known as the Dark ages, medical folklore, pagan wizardry and religious faith combined to form a cocktail of health interventions which reflected all three, for example some curious remedial concoctions of plants and herbs were prescribed as being drunk from a church bell (Bromberg, 1963). A type of common sense rational approach coexisted with church ideology which busied itself with exorcisms as a psychotherapeutic methodology. People

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were either seen as believers or heretics, and as the churchs influence spread, heretics were dealt with in the harshest possible ways. As a result there were less heretics, and the church and its authorities, like the pope, became the center of gravity of most peoples lives. Outside of the Western world, Hebrew and Arabic scholars continued to make progress in pondering the world. The Muslim scholar Avicenna was an intellectual child prodigy who became a physician and whose text on medicine was used for the next 500 years. He speculated on psychological functioning and advocated that in addition to the five external senses, humans also had seven interior senses, including common sense, retentive imagination and estimative power. Maimonides, the Jewish talmudic scholar (born 1135) commented on how emotional experiences effect the body (psychosomatically) and considered inner reflection and examination as the optimal solution to distress. He was an intellectual who attempted to reconcile Jewish philosophy with Aristetolian writing. Something of a maverick, he admonished those who placed faith over reason, arguing that beliefs needed to be based on knowledge, and even biblical tracts which were demonstrably false, should be rejected (Hergenhahn, 2001). During the middle ages (1000 1450), with the relative absence of science and the strong influence of the church, faith healing became the dominant medium for mental healing, with monarchs considered to possess special healing powers of touch. Monasteries became central players in medicine, and were amongst the first in Europe, from as early as the thirteenth century in Belgium, to establish institutions exclusively for mental patients. The monastic tradition of health incorporated principles of loving care and the spirit of humanitarianism. In 1275 Bartholomew printed a nineteen volume encyclopaedia De Proprietatibus Rerum (Of the nature of things), of which the entire volume 7 dealt with mental illness. It appears to have been the DSM of its time, advocating such remedies as stillness, comfort and music. It steered completely away from demonology and magic, which was triumphant given the hysteria of witchhunts and the extent to which witchcraft was the outstanding abnormality of the times. Bromberg (1975) argues that the mentally ill became the victims of most witchcraft accusations, a view supported by Ross (1995) who suggests that they were likely to have confessed to all kinds of crimes. Christian believers in their zeal to take up the cudgels of demonology, appear to have abandoned their ethics for aggression, and targeted the mentally ill as possessed. This totally swamped and undid the work of monastic humanitarian approach and created a setback for rational psychotherapy of up to 300 years.

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2.5 The middle ages Medieval Western medicine was a bizarre cacophony of ritual, religion and magic. A typical ritual, described by Hammond-Tooke (1989), was a cure for heartache which involved crossing a garter over the patients ears and saying nine times Help in the name of God. In the fourteenth to sixteenth centurys witchcraft emerged as an important illustration of psychotherapeutic adaptation to a social phenomenon. In a similar manner to how Freudian psychoanalysis had synergy with Victorian sexual repression, demonology was the psychological modality of its time and labeled nonconformity, antisocialism, psychosis and schizophrenia as witch-creed. There seem to have been at least two main waves of witchhunting , one in the early 14th century, then possibly as a result of the introduction of syphilis (Ross, 1995), in the mid 16th century. Witches were burned and tortured in mass, and the humanitarian monastic treatment of the mentally ill all but disappeared. In possibly much the same way that the medical model has dominated the treatment of diseases for hundreds of years since, demonology was the treatment of choice for the treatment of witches. Ludicrous laws were passed to assess whether a suspected person was a witch or not. In the swim-test for example someone thought to be a witch was dunked into a river. If they drowned and floated to the top of the water, they were considered innocent, if they stayed under for long enough and survived they were tortured until they confessed. It was only in 1631 that the absurd reasoning behind this was challenged. The reformist German monk, Father Spee, similarly spoke out strongly against the use of torture to acquire a confession (Bromberg, 1963). It was with the renaissance whic h began in the 17th century, and the developments in science, that a new liberalism and rationalism slowly again took hold. The renaissance brought with it major developments in philosophy, literature, art, astronomy, mathematics and architecture, and this new spirit of rational enquiry saw some decline in reliance of supernatural explanations. In this time of new intellectualism, psychology had been paying increasing attention to issues like perception and memory, as well as grappling with the centuries old philosophical debates of the mind-body problem, which still rage today. The new thoughts in regard to psychology and mental functioning helped the development of the treatment of mental illnesses, though unfortunately this happened slowly. New discoveries which were ushered into the seventeenth century with the invention of the microscope and new-found understanding of chemistry, gave impetus to medicine in general, and this did help in rethinking the attitudes towards mental health. The printing press fuelled the scientific revolution by distributing new knowledge, and Bromberg (1963) indicates that whilst in the sixteenth century there were some 250 printed items on

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psychiatric treatment, the next century saw this take an exponential leap to 1800 items. The rapid institutionalisation of knowledge in the establishment of universities, helped consolidate the medical treatment process, and gave new authority and status to medical practitioners. Although these beginnings of empirical study mark an important milestone, paganistic and magic cures of mental illness remained strongly sought after underground practices well into the 18th century.

2.6 The age of reason In 1774 the English government brought all mental institutions under state control. Fortunately , the bouts of insanity suffered by King George III brought treatment of the insane from being a medical curiosity to center-stage. The ineffectual manner in which highly renowned physicians treated the king, drew considerable attention to the treatment of madmen in general. This helped turn the tide, and was supported by such people as French sanatorium administrator Dr Phillippe Pinel. He took a courageous step in 1793 when he set about unchaining people who had been chained up for up to forty years and who could no longer walk, as well as releasing people who had been kept in dungeons for decades. He spoke to them, encouraged them and was kind to them. Inmates who had been thought of as highly dangerous were seen to be harmless. Pinels Treatise on Insanity described the insane as people who were ill and could be treated. He suggested that only physicians who were kind and humane should work with the insane. In England and America Pinels influence was felt, but many did not accept his views (Bromberg, 1963). There was substantial experimentation with mental problems which continued throughout most of the eighteenth century. For example the American physician, Benjamin Rush, utilised bloodletting and keeping patients awake and standing for days on end. Dr Cox in London reduced patients mania, by placing them in a cage on a pulley and spinning them through extreme nausea. This would last a few days, and generally include abundant vomiting (Bromberg, 1963 p.88) but after which the generally pale and nauseous patients often reported greatly reduced mania. Although spinning became popular, the complementary treatment, immobilisation also found favour with many. Again a cage was used, but with this device, the patient was trapped into a single position, and kept there without injury, for extended periods. Because bleeding could not be performed whilst patents where straight-jacketed, a tranquillising chair was used. The patients was strapped firmly in this, head placed in a box, and maniacs would be bled until their reason returned or their pulse diminished virtually to the point of death. Rush describes a case in which after several hours of bleeding in such a device the ferocious look of the maniac was changed to

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an agreeable aspect (Bromberg, 1963, p. 90). Several other reports suggest that when all else had failed, instilling the fear of death in the patient by torture and threats would often lead to mental improvement. The new intellectual reasoning was fermented by such great thinkers as Newton (science), Smith (economics), Descartes and Spinoza (philosophy). New scientific discoveries helped inspire expert and lay opinion alike, and the clockwork world was the dominant force in science. This indicated that the world was thought of as giant machine which worked according to basic physical laws which in time would all be fully understood. The attitude that took root had major implications for the future of science, and by implication psychology. Scientific absolutism was revered to such an extent, that what could not be experimentally verified, was dismissed to the sidelines. Learned individuals in many fields set about cataloguing, classifying and ordering the world in a diverse range of fields, from medicine and zoology to botany and paleontology (Bromberg, 1963 p.121). In regard to psychology and psychotherapy, discoveries of the functioning of nerve impulses went a long way to explaining hysterical disturbances. There was also a move to change the foul, rat infested and overcrowded lunatick houses of England. The result was a hospital exclusively for the insane at Williamsburg, which although still kept its inmates in chains, offered a significantly superior environment. Juan Luis Vives became an activist for the insane and the conditions of their custody. He managed to have many mentally classified patients separated from being kept with criminals or in workhouses. However a change which furthered to undermine Vives work, was the gradual handing over of insane institutions to wardens which would beat madmen into submission. Although there was better understanding regarding the workings of the mind and body, medical practitioners appeared particularly perplexed when it came to the treatment of the psychologically disturbed. Models of treatment swung erratically between punishment and kindness, with most approaches being abandoned soon after they were launched. Although such trial and error made it a particularly hazardous time to be mentally ill. In the early nineteenth century, one theory of psychological therapy was that morbid preoccupations had to be driven from the mind (Bromberg, 1975). Devices and bloodletting faded and psychiatric textbooks started addressing how the practitioner could outwit the patient. One psychiatrist report how he cured an opium addiction by placing an artificial snake into the patients snuff box. Therapy was being applied to the mind, and crude classical conditioning was used to some effect. For example Dr Leuret, the French physician describes throwing cold water

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onto a patient every time he uttered a delusional idea. Leuret also tried to enter the world of his patients, not in a particularly empathic way, but by attempting to shock them into reality. If they were delusional, he acted even more delusional, if they were morose he would feign extreme lethargy. It is unfortunately unrecorded how effective Dr. Leuret was in his endeavors. As the century wore on, there was general increasing social support for humanitarian treatment of mental cases, and the management of asylums became a focal point of interest (Bromberg 1975). The mentally ill were viewed for the first time as curable and there was a rapid increase in the number of institutions built in Europe and America. There remained substantial resistance to not keeping patients chained, and various humanitarian restraints were developed. Psychiatrists who experimented with keeping patients unrestrained experienced social backlashes, as lay people mostly thought of the insane as belonging to a lower order of humanity. In private hospitals the situation was generally far better, and patients were taken for walks, entertained and encouraged to participate in a variety of occupational activities. There was a vast gulf between the mentally ill who could afford private care and those who were designated to the far inferior government institutions. Many jails in America still housed the insane with criminals, and crusaders like Dorothea Dix, lobbied for legislation which created special institutions for the insane, ultimately succeeding in making it illegal to have the mentally deficient kept with criminals. In 1805 the first journal devoted to mental disturbances appeared, and 50 years later there were several highly respected publications dealing with the subje ct. Physicians also began seeing the diseased mind like any other diseased organ, and advances in the knowledge of cellular pathology helped with the understanding of brain disorders. With the humanitarian movement there was a significant increase in the release rates of those who had been sensitively managed. Several well respected physicians reported success rates of over eighty percent. The perception that mental difficulties were curable became increasingly accepted, to the extent that eventually all cases were regarded as curable. There was intense competition between institutions in reporting their successes, but once more universal criteria for success became entrenched, the reported success rates dropped to about fifty percent (Bromberg, 1975). A landmark event in the treatment of mental health, was the published series of propositions cited by the Association of Medical Superintendents of American Institutions for the Insane. The

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propositions were added to over a period of time and were completed by 1875. Of its 20 propositions, important ones were: 1. Insanity is a disease - to which everyone is liable 2. Properly and promptly treated, it is about as curable as most other serious diseases. 4. It is humanity, economy and expediency for every state to make ample and good provision for the insane. 14. Abundant means for occupation and amusement should be provided. (Bromberg, 1963, p. 108) The recommendations were revolutionary, although there remained some confusion regarding etiology and symptoms. The way in which social commentators brought blame to bear on the haste of life...in our railway age and other stress inducing changes of the Industrial revolution, rings a modern bell. This was the start of paying some attention to the emotional state of the individual, and although superficially glossed over, some attention was at last being placed on the individuals struggle within the environment. Clinical descriptions varied markedly, and there was little attempt, even at national levels to establish a consistency of thought in regard to mental disorders. Bromberg (1975) reports that it was only by the end of the 18th century that Kraepelin published a comprehensive treatise which conceptualised the history, course and prognosis of various disorders. The more concrete disciplines of medicine, anatomy and physiology developed more quickly than treatment of the mentally ill and the less tangible fields of psychology and psychotherapy. There was a general trend towards increasing rationalism in dealing with the mental issues, though in a modern light the techniques appear crude. People with emotional difficulties would generally be treated by physicians, who would basically attempt to badger their patients into supplanting unhealthy thought or ideas with moral precepts. Parallel to this intellectualism however, faith and magic healing still had a large number of adherents though its form had changed. It disguised itself as scientific through schools like phrenology - the study of cranial shape and protuberances - and during the early part of the 19th century the medical fraternity was rife with quacks and charlatans (Bromberg, 1963).

2.7 Induced sleep Bromberg (1975) details how Franz Mesmer became famous through using techniques of magnetism and also stumbled across hypnotism of which the early versions where known as somnambulism. The use of induced sleep spread rapidly and were seized upon by physicians and

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healers of all reputations. It wasnt long before it found utility as an operation anesthetic though its use was controversial. Much in the same way that alternative medicines are viewed currently, hypnotism had its advocates and detractors. Scientists had some difficulty explaining hypnotism and it generated many hypotheses most of which centered around states of consciousness. This opened up important psychotherapeutic principles, because it brought into focus that cognitions and behaviour can operate at different levels of awareness. This became the foundation of Freuds work which heralded in the age of modern psychotherapy. It was however finally up to one Professor James Braid to give hypnotism a respectability. His status in the medical community in London helped the credibility of his hypnotic experiments, culminating in his 1842 paper entitled Practical Essay on the Curative Agency of Neuro Hypnotism. He published and gave case studies on hypnotisms efficacy in the treatment of such paralysis, rheumatism, deafness and migraine (Bromberg, 1963). Although The British Medical Association tolerated Braids work, they were openly ambivalent. Braid himself was unsure of the mechanisms of hypnotism, but speculated that patients seemed to be susceptible in line with their expectations, an observation which might have been somewhat ahead of its time.

2.8 The beginnings of modern psychotherapy Bromberg (1975) records how hypnotism in France was taken up by the eminent neurologist Jean Charcot. He was an exemplary scientist, did thorough documentation, and brought hypnosis under his rigid scrutiny. In his work he experimented with hypnotic impact on the relatively common condition of hysterical seizures. He was a highly respected teacher and an international interest in hypnosis soon spread with Charcot being its international authority. As usual there were detractors who could not induce the hypnotic state or replicate his work. Debates raged in the 1880s as to whether hypnosis was physiological or psychological with most opinion settling for the psychological, through the use of suggestion. This evolved to where the direct suggestion of symptom disappearance became the standard therapeutic goal in the 1890s. There was speculation that the transfer of suggestion from the hypnotist to the patient, activated the patients own will and auto-suggestion. It was also shown relatively soon after that patients would not transcend their own moral and ethical boundaries in fulfilling hypnotic suggestions. Some clinicians who were less successful with hypnosis experimented whether auto-suggestion could make a therapeutic impact without hypnosis. One of the leaders in this type of therapy was Emile Coue who would engage in a persuasive banter with his patients, urging them to go home and get better. He would persist in making the same suggestion over and over and reported a high level of success. It was also noted that the quality of the rapport between patient and therapist

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impacted directly on the success of the treatment, and useful attention was drawn for the first time onto the nature of the therapeutic relationship. There had been intellectual discussion regarding the nature of the unconscious going back to Hartmann, as early as 1868. Hypnosiss focus on the nature of cognitive functioning however, brought increasing attention to the structure of the psychological mind, and a more thorough exploration of conscious and unconscious behaviour. Hypnosis was a perfect vehicle for access into the unconscious as patients recalled long-forgotten memories and even revealed multiple personalities (Bromberg, 1963). This prepared the way for the early speculation of how emotions could influence and drive thoughts and behaviour from the hidden recesses of the unconscious. Hysterics were common patients in the therapeutic community and their behaviour was explained in terms of dissociation a state in which fixed ideas were pushed into the subconscious where they continued to pursue their own development, manifesting as symptoms such as convulsions and paralysis. Hypnosis was seen as a way of dealing with these symptoms, by introducing new ideas into the unconscious which would through a similar mechanism, counter the fixed ideas. Although widely used, hypnosis was equally widely disclaimed. Its considerable utility with hysterics however, ensured that it was the focus of considerable academic attention. At one such demonstration of the treatment of a hysterical patient by Charcot at the Salpetriere, a young Viennese doctor by the name of Sigmund Freud was in attendance. Freud was so taken by the hypnotic treatment process that he returned to Vienna and began work with his colleague Josef Breuer on studying hypnosis and hysteria. In the historic case of Anna O, Breuer found it necessary to take the patient back to an original traumatic event under hypnosis in order to achieve symptomatic relief . Freud observed that the painful events from which the trauma originated were turned away from consciousness time and time again by internal psychic forces which served to defend the person. Freud had experienced some difficulty in inducing the hypnotic trance and experimented with various other methods of penetrating the patients defences, finally settling on talking and free association. Freud was a tenacious scientist who pursued his research almost religiously. His enormous contribution laid the foundation for modern psychotherapy and his influence is still seen today in almost every theoretical and practical model of psychotherapeutic intervention. 2.9 Summary The history detailed above indicates that Western psychotherapy grew firstly out of magic and supernaturalism. It was then highly influenced by the church in the guise of religious consultation

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and faith-healing. Ritual healing, for example with its use of charms and amulets often went hand in hand with prayer, and the repetition of obscure liturgical names. For a time there was thus an unlikely symbiosis between the religious, the mystical and magic. Although the final major influence was through rationalism, science and medicine, Hearnshaw (1989 p.149) makes the point that philosophers, including Plato and Aristotle, and more recently, Spinoza (1600), considered illness, including mental illness to be caused amongst other things by ... supernatural intrusions caused by celestial or demonic inf luences. Hammond-Tooke (p. 43) states that this was because disease was viewed as a ... foreign presence in the body needing to be conjured or exorcised. Medicine did finally succumb to rationalism, and the allopathic Western medical epistemology remains scientifically based. Methods and medicines which have not undergone rigid scientific scrutiny and empirical testing are generally disregarded by adherents of this approach. These kind of parameters shape the disciplines which dominate the modern medical world, and influence the way Western trained practitioners attend to their various crafts. The philosophical approach of training therapeutic practitioners at South African universities derives from the so-called Boulder Model in which the therapist was regarded both as a scientist and practitioner (Benjamin & Baker, 2000). The scientific worldview is but one of several, and other cultures have established other ways and means of thinking about such complex issues as human behaviour. These worldviews fundamentally differ in regard to their bases of what they know, and how they know what they know, and hence developed differing approaches to pathology and healing.

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