Dr. Miller is a pediatrician whose practice is in Hemet, California.
This article appeared in the Christian Century May 25, 1977, p. 504. Copyright by the Christian Century Foundation and used by permission. Current articles and subscription information can be found at www.christiancentury.org. This material was prepared for Religion Online by Ted & Winnie Brock.
The popular works of Carl Rogers, Fritz Perls and Eric Berne are being embraced as major therapeutic systems, useful in pastoral-care work, but these thearapies, although popular, are demonstrably inadequate. They are no more scientific, or validated, than Emile Coué or Dianetics.
Most clergy think of themselves as counselors; as a physician I have shared many patients with ministers. The seminary bookstores are filled with works on therapy, and these studies of psychology and the helping arts seem to be taken very seriously by most ministers; the books in widespread use are thought to represent the “state of the art.”
Unfortunately, these therapies, although popular, are demonstrably inadequate. The best-selling works of three men who seem to be most influential deserve especially close scrutiny: Carl Rogers’s Becoming Partners (Delacorte, 1972), Fritz Pens’s In and Out of the Garbage Pail (Real People Press, 1969), and Eric Berne’s Games People Play (Grove, 1964). Each of the authors makes clear that his work, although popular, is not a popularization. All three best sellers have certain characteristics which I find extremely disturbing.
The most fundamental criticism I offer is that these texts are not really texts as such. They are no more scientific, or validated, than Emile Coué or Dianetics. This is the most basic of problems, for if the theories and presuppositions from which we work will not stand serious examination, our efforts as counselors -- no matter how well meant -- must suffer. We are compelled to ask, how was this material chosen in the first place? The broader question that is continually troubling must also be raised: Is the breakdown between psychology and organized religion really that severe?
All three authors under discussion here are terribly naïve fact-gatherers. Their patient samples are totally unselected; they believe, and don’t seek to substantiate, whatever patients tell them. In fact, no solid evidence exists to prove that their treatments work, except in the sense of healings in the revivalist’s tent. Not one of the three has ever employed controlled trials. For example, in Becoming Partners Carl Rogers states flatly, “I began to interview some couples.” Where did he get them? Why did he choose them? The reader is never told. Failing to check out their information or to follow through with their patients, these therapists rely on unsubstantiated data to construct their theories in isolation.
Consider the way in which Rogers presents the last marriage described in his book: “The partners seem to have acquired a wisdom from which each of us may learn. . . . They are listening to the internal rhythms of their own organisms to determine what their behavior and the relationship will be . . . the core of this continually blossoming security is, to me, marriage at its best.” In point of fact, no evidence whatsoever is offered to prove that this couple was maritally successful in any way; actually a great deal of evidence exists to the contrary. Denise and Eric (the couple) could have been, as the English say, “stark raving bonkers,” held together by massive doses of tranquilizers just to get through their interview with Rogers. We don’t know; Rogers doesn’t know or doesn’t say. He doesn’t see them over a span of time, he doesn’t visit their home, and he doesn’t interview their children or any of the participants in the several affairs they describe. He totally ignores the possibility of two of the oldest effects known to physicians: the placebo effect and the halo effect. (In the first, the fact that I, the healer, say you will be better often makes you better, even in the face of severe organic pain. The halo effect makes you want to say whatever will please the healer.)
Rogers reports, simply on the basis of this one interview, that Denise and Eric display “marriage at its best.” Is this really the case? We are told that Denise has had several mental breakdowns -- for which society is blamed, although the causal connection is not amplified. We are also told that the couple gets into “basic encounter groups . . . grass, LSD . . . experimenting with relationships with other people outside the marriage.” According to Rogers, “marijuana has changed Eric from a highly rational intellectual sort to one who appreciated his whole self.” In effect, Rogers is claiming that drugs do alter personality, but he offers neither explanation nor proof.
Why are Denise and Eric still together? We are told that “Bioenergetics, Yoga, and Karma” are holding the relationship together. Having spent some time in a Buddhist monastery, I feel qualified to say that any self-respecting Buddhist monk would die laughing over the use of Karma in this book.
Rogers seems especially fond of discussing sex -- in this case the “free interrelationships” which Eric and Denise experience. He claims that “all four people have to be very grown-up before it becomes even possible” to have multiple sexual relationships. The connection between this kind of sex experience and being grown up is obscure, and Rogers does not enlighten us.
Nor does he offer any analysis of the couple’s other actions, which are described as “drinking a lot” and engaging in a “quadruple alliance.” Eric describes himself as, at one point, “drinking heavily . . . crawling under the bed . . . and screaming . . . and clawing at the carpet. . . . I did no work, no responsibility . . .” Surely some analysis is indicated, but Rogers offers none. Many more examples could be given, but these from Rogers seem to me representative of the unscientific approach of all three of the therapists under scrutiny.
The Grandiose Factor
A second criticism must be made: as a result of naïveté and other factors in their own psychologies, the three authors’ therapies become ego trips for them as therapists. Listen to Dr. Perls in In and Out of the Garbage Pail: “I accomplished the next step after Freud in the history of Psychiatry, and this step spells efficiency. . . . I speedily ‘cured’ every psychogenic asthma I came across . . . in most cases there was . . . a fear of making those wild exhaling noises that go along with orgasm. . . . I have a number of so-called miraculous cures. . . .” As a pediatrician with more than 100 asthmatics in my practice, I wish that Perls had communicated his curative technique to someone before he died. My five-year-old patients in particular, wheezing after family fights, obviously need the more sophisticated grasp of orgasm which Dr. Perls apparently provided to his clients.
Perls continues: “I am used to relying on my often uncanny intuition. . . . [I] am beginning to assume a place in history.” Speaking of therapy sessions, he says: “Each time I succeeded within 10-20 minutes to get to the essence of each person, even to re-integrate some disowned material. This has become routine, child’s play. . . . I believe that I am the best therapist for any type of neurosis in the states, maybe in the world.”
Berne, in his way, is more grandiose than Pens. In Games People Play, he says that one of his games is the cause of schizophrenia: “If the family game . . . is analyzed to demonstrate that the schizophrenic behavior was and is specifically undertaken to counter this game, partial or total remission occurs in a properly prepared patient.” The central problem of all interpretative therapies, however, is that when the therapist analyzes something to demonstrate it, to use Berne’s words, usually nothing changes in the patient’s life. Our mental hospitals are full of schizophrenics, major tranquilizers sell by the trainload, and here we have a cure. Unfortunately, no description of exactly how it was effected was published before Berne died. How one might induce “total remission” through interpretation remains elusive.
Another criticism I would make is that the theories which these three men present are full of obvious inconsistencies and unstated assumptions. The concept of the unconscious is implicit in their work, but it is never explicitly defined by any of the three, nor is it related to any established body of knowledge. For examples of this problem, let’s continue with Berne. He describes his games as a “recurring set of transactions . . . superficially plausible, with a concealed motivation. . . . Every game is basically dishonest.” With this single statement he is already in trouble, for later he states that “raising children is primarily a matter of teaching them what games to play.” Aside from the philosophical implications of the idea that bringing up children is dishonest, this can hardly be taken as a serious view of child-raising and its problems.
Berne, however, is quite serious: “Games . . . form the basic structure for the emotional dynamics of each family. . . . [the child’s] favored games also determine his ultimate destiny, . . the payoffs on his marriage and career, and the circumstances surrounding his death.” And all of this is basically “dishonest.”
If Berne actually means that the unconscious is very powerful, he should say so, and he should document his position. He does not discuss why “dishonest” functions are so powerful. In fact, he doesn’t even define “dishonest” (or most of his other terms, for that matter), and the word is left to bear its popular meaning.
Berne’s view of child-rearing ignores the complexity of most of the real issues and problems. If he is literally correct, and our child-raising methods are basically dishonest, we cannot instill decency, honesty, and love of God, because our efforts are corrupted and based on illusion. The sweeping generality of his statements is worth some serious examination.
Berne’s second major concept is that of ego-states; he says that our behavior patterns, with their associated feelings, are “a limited repertoire . . . which are psychological realities. . . [the products of] the human brain . . . are organized and stored in the form of ego-states.” These he calls Parent, Adult and Child, and they correspond to a modern superego, ego and id, although Freud never bound these mechanistic concepts to specific developmental figures. Berne does: “Parent, Adult, and Child represent real people who now exist or who once existed, who have legal names and civic identities.” The crux here is, what does “represent” mean?
No experimental evidence exists that such a division is, in fact, reality-based. The logic becomes absurd. If the Parent is the whole parent, then “a person is likely to incorporate into his own Parent ego-state his parents’ Parent, Adult, and Child, the babysitter’s Parent, Adult, and Child, and so forth.” The number of ego-state subdivisions required-becomes geometrically ridiculous.
In labeling the Child ego-state, Berne sticks with Rousseau: “In the child reside creativity and spontaneous drive and enjoyment. . . . before, unless, and until they are corrupted, most infants seem to be loving. . . .” Yes, children are certainly spontaneous and loving; they are also selfish and have poor control over their hostilities. Studies of creativity indicate that it is a highly complex function, in no sense childlike as Berne uses the term.
Berne also credits the Child ego-state with “the real living of real intimacy” and maintains that, “after the close intimacy with the mother is over,” the individual is perpetually “striving for continued physical intimacy in the infant style.” Since Berne also says that intimacy -- his goal -- means “the spontaneous candidness of an aware person,” he is thus placing the goals of the personality in the stage of infancy. One could develop the argument that intimacy as Berne describes it is psychic regression; one could also cite Jung: “The failure of liberation from the mother is death.”
Another problem with Berne’s thinking is that the so-called Adult functions have no role to play in our maturation. Berne says that mature people keep their Adult (his definition is literally “data-processor”) in control. To most of us, maturity involves love, care, perhaps self-sacrifice -- concepts not covered by “data processing.” In fact, valid concepts of adult maturation are desperately needed, but Berne provides none.
Society as Villain
I would advance still another criticism: the social-political community is assumed by the three authors to be a constant that requires neither maintenance nor effort; the survival of culture does not concern them, and its forms are generally seen as villainous. Rogers, for example, says: “Marriage and the nuclear family constitute a failing . . . way of life. . . . We need experiments . . . exploration into new approaches.” Perhaps we need an understanding of our failures. Rogers continues, “ In this book we see . . . [that] a vast laboratory in just these problems is being conducted by our young people.” Never have I seen “laboratory” used in this way. Our children are not laboratory subjects; the term implies experimental controls and conscious hypotheses, and none of these is present in the casual experiments of the young.
Society is the villain, according to Rogers, and the agents of society can solve our problems. “We need a changed attitude in teachers. . . . if all [teaching] personnel could simply recognize and accept the fact that they are fallible persons . . . our educational system would be revolutionized overnight. . . Gone would be the steady, unchanging infallible mask which is the most prized possession of every teacher. . . . we could free these parents from . . . the whole crippling and imprisoning bit.”
Do we really think teachers are the cause of the present woes? Are teachers more rigid than doctors or ministers? How much more influential are they?
The fact is that one’s most basic personality structure is formed in the first five years of life and merely modified by later accretions. In most cases parents rear children until age five (although there is certainly a move away from this, to what effect we do not yet know). By saying that if teachers change, we then can change, Rogers is actually saying that we are not finally responsible for what we do. It is the Holocaust game of finding a scapegoat. A little evasion and a little violence make wonderful partners.
Children and Their World
Rogers, Perls and Berne make another assumption which is open to criticism: what you do is not relevant to what you say. Consider the effect of such an approach on our children. A poet said, “Children learn what they live.” No student of human behavior, until now, has ever challenged that. But Rogers says, in speaking of communes: “There are a number of paternal persons, men and women, who take a hand in [the child’s upbringing]. . . . he does not receive consistent treatment, but he lives in a world of real adults, to whose idiosyncracies he must adjust while finding psychological room for himself. . . . young children accept quite readily the fact that their parents may be sleeping with different partners. Children accept their world as it is.”
Rogers is oversimplifying the situation; who the parents are sleeping with hardly covers the psychological spectrum involved in learning to accept the world. More important, children do not “accept their world as it is” -- not without a great deal of trauma and pain. Adjusting to the “idiosyncracies” of “real adults,” as Rogers puts it, is the problem, not the solution.
“Children accept their world as it is.” Ask the Vietnamese children about that. Ask your own. Do they have any choice? Most basically, has anybody checked?
Are these inarticulate and involuntary family members ever considered? Most of the families in Rogers’s practice have children. In this “great social laboratory,” what has become of them? Perls, although he discusses intimate aspects of his marriage and indicates that he has children, never talks about them. Berne, as we have seen, says child-raising is primarily training in dishonesty, but he offers no evidence and does not develop these concepts as they apply to children.
How Did We Get Here?
These three famous and influential therapists claim to represent a major advance in understanding humanity and see themselves as authors of major theoretical and practical systems. Their works have been embraced as such -- this despite the serious inadequacies discussed here. If my charges are correct, how did we become followers of these systems? How did we get where we are? We got there in three ways.
First, the medical profession has failed dismally to communicate to any other discipline what it does know about human behavior. The best minds of the medical profession rarely write popular articles and almost never write nonpopular articles for other professionals such as ministers. It’s too much work for too little pay.
Second, considerable confusion exists as to what fundamental psychological doctrines are and how they are to be stated. This problem will not resolve itself right away, but some theories are generally agreed upon, and these don’t get communicated. Even Freudians and Jungians, for example, agree on certain basics concerning the existence, powers, and general role of the unconscious. The three authors, however, never discuss these ideas; as a result, disciplines whose focus is not medical/psychiatric are being sold a shoddy bit of goods. This advocacy of superficial and transitory treatments continues, then, partly because there is not a hard core of agreed-upon concepts.
Another factor then enters in: when the guidelines aren’t clear, popular beliefs tend to mirror what the popular mind wants. I’ve suggested that what our authors want is acting-out: do it first, think about it later. Perls even says, “You are responsible only for yourself” and remarks that he is “not willing to take full responsibility for my sexual development.” He exults in his “reputation as being both a dirty old man and a guru,” talks about his romantic affairs throughout his book, and does not exclude them from the arena of his professional life. He describes comforting a grief-stricken girl, for example: “The sobbing subsides and she presses closer and the stroking gets out of rhythm and slides over the hips and over the breasts. . . . These attitudes toward responsibility are two-edged: they can bring some liberation, but they can also lead to serious abuses. Perls in particular seemingly cannot distinguish, nor does his system.
Briefly and tentatively, let me suggest ways to improve the therapeutic tools that ministers use. In the first place, a serious attempt at interdisciplinary communication must be made. This effort will be difficult; the problem is motivation. Few psychiatrists think they need ministers, and most ministers I have met seem to think they do a pretty good job of counseling. (I suspect that they measure their success by the amount of overt gratitude received rather than by more objective means.) Consequently, their failures recede comfortably into the background.
In attempting to generate motivation for better communication, may I suggest that ministers have certain therapeutic advantages? Ministers have access to a fellowship. It may not be moving in the hoped-for directions, but it is there, and it is at least somewhat representative of the community. I would not underestimate this resource; I spend a great deal of time trying to find something comparable for patients of no religious persuasion.
Furthermore (and I am tiptoeing into theology), ministers can offer forgiveness -- and as a genuine commodity at that. As a physician I can’t do this, although I can direct people to the concept.
All of this revolves around a third problem: Who is to do what to whom? Richard Neuhaus, writing in The Christian Century (February 2-9), says, “Many in the seminaries, are training to be counselors, therapists, group facilitators. . . .” Exactly. Furthermore, there are psychologists, psychiatrists, psychiatric social workers and so on. The problem of defining professional roles will be a lot closer to solution if we can agree on uniform standards of excellence.
I have one final suggestion: let’s work toward less preoccupation with systems and use methods that are simpler and more human -- such as sitting and listening. Some years ago, a group of psychiatrists had a group of medical students do “supportive therapy” in 20-minute sessions. Since the students weren’t specifically trained in therapy, they were simply to sit and listen. No interpretations were offered to the patients. The results, as measured by reasonably careful follow-tip studies, showed that most of the patients made marked improvement. This should give us pause. Sitting and listening is a fundamental service, as old as humankind. There is, to be sure, also a place for interpretation and advice.
I hope that this discussion will provoke further reevaluation of the importance and validity of the psychological systems treated here. I have deliberately left out of the discussion such topics as ethics and the Christian family -- although I have talked about responsibility, both for one’s own adult behavior and for helping one’s children develop the essential emotional equipment with which to face life. In my opinion these are psychological fundamentals. If they are also seen as ethical fundamentals, we may already be in an area where the two disciplines, medicine and the ministry, are on common ground.