Treatment Interventions 349relationships, did much to make psychotherapy responsive to
changing conditions. Among those just mentioned, Rank and
Fromm were not physicians, and both had been trained in
Europe. As time went on, Erik Erikson’s (1950, 1959) inte-
gration of a psychosocial theory of development with Freud’s
psychosexual theory opened psychoanalysis to the concepts
of many of the rebels: an oral stage of trust versus mistrust;
an anal stage of autonomy versus shame and doubt; a phallic
stage of initiative versus guilt; a latency stage of industry ver-
sus inferiority; an adolescent stage of identity versus identity
diffusion; a young-adult stage of intimacy versus isolation; a
middle-adult stage of generativity versus stagnation; and an
old-age stage of integrity versus despair.
The first American psychologist to develop a form of
psychotherapy that was highly influential was Carl Rogers
(1902–1987), who received his PhD in 1931 from Teachers
College, Columbia University, where Leta Hollingworth su-
pervised his clinical experiences with children. He continued
clinical work with children until 1940, when he left to be-
come a professor of psychology at Ohio State University and
later the University of Chicago. By then his clinical work was
mostly with college students. Rogers was heavily influenced
by social worker Jesse Taft and especially by child psychia-
trist and former school psychologist Frederick Allen, who in
turn were much affected by what they had learned from Otto
Rank. Originally, Rogers called his system of psychotherapy
“nondirective” (Rogers, 1942). Later he called it “client-
centered therapy” (Rogers, 1951), and eventually he and his
followers referred to it as “person-centered.” No matter what
it was called, it was distinguished by Rogers’s willingness to
subject it and its practitioners to scientific scrutiny.
Rogers pioneered the recording of therapy sessions so that
they could be analyzed in detail for purposes of research, su-
pervision, and training. He argued that psychotherapy could
become a science and believed there was a discoverable
orderliness as the sessions continued to a successful end.
Hypothesis testing was one of the hallmarks of his approach,
and he tried to make explicit what conditions were essential
for personality change: the therapist’s possession and mani-
festations of unconditional positive regard, accurate empathy,
genuineness, and congruence (Rogers, 1957). A consider-
able research effort was undertaken to measure these attrib-
utes and determine if they indeed were related to effective
therapy. The results of 20 years of research led to the conclu-
sion that the relationship between these attributes and
positive change in patients remained in doubt (Parloff,
Waskow, & Wolfe, 1978).
This period, extending from the 1930s through the 1950s,
was the high-water mark in the prestige of psychotherapy,
especially psychodynamic psychotherapy. In the 1960s,
psychotherapy came under attack from four “revolutions” or
“movements”: (1) community psychology, which argued that
psychotherapy was futile and not provided to those most in
need of it, and that clinicians should direct their efforts to-
ward preventing psychopathology through bringing about
changes in deleterious social policies and conditions (see
the chapter by Wilson, Hayes, Greene, Kelly, & Iscoe in this
volume); (2) humanistic psychology, which emphasized
the importance of present experiences, ongoing events, and
confrontational approaches in groups, as contrasted with
traditional approaches to the individual’s exploration and inte-
gration of the past; (3) the increasing use of drugs, by physi-
cians and by free spirits, to alter moods, regulate behaviors,
and enhance self-esteem and experiences; and (4) behavior
therapy.
It was the English clinician Hans Eysenck who was less
than enthusiastic about clinical psychologists becoming psy-
chotherapists and raised the question of whether scientific
studies had demonstrated the effectiveness of psychotherapy
(Eysenck, 1952). Culling the research and pulling together a
motley group of studies, he concluded that they failed to
demonstrate that control groups were significantly less likely
to improve than groups that received psychotherapy. Al-
though psychotherapists strongly disagreed with his conclu-
sion and manner of arriving at it, the fact remained that it was
their responsibility to prove otherwise.
In South Africa, psychiatrist Joseph Wolpe made use of
Hullian concepts and learning principles to develop proce-
dures that would reduce neurotic symptoms. In essence, he
sought to elicit responses, such as relaxation, that would be
incompatible with or inhibit a symptom, such as anxiety or
fear. (This is similar to the previously discussed decondition-
ing or reconditioning approach of Mary Cover Jones.) After
coming to the United States to spend a year at Stanford Uni-
versity’s Center for Advanced Study in the Behavioral Sci-
ences, Wolpe (1958) published a book, Psychotherapy by
Reciprocal Inhibition,which was hailed by Eysenck as a
promising advance in effective treatment.
Wolpe took a position at the University of Virginia Med-
ical School, and in 1962, along with Salter and Reyna, spon-
sored a conference there that got the behavior therapy ball
rolling (Wolpe, Salter, & Reyna, 1964). The clinical journals
were soon filled with a variety of studies, many of them quite
ingenious, demonstrating the effectiveness of behavioral
approaches.
One of the first of these studies was one by Peter Lang and
David Lazovik (1963) of college students who were identi-
fied by a questionnaire, the Fear Survey Schedule, as being
afraid of snakes. The students were then given a Behavioral
Avoidance Test (BAT) in which they were placed in a room