Theories: An Era of Change and Debate

The decade of the 1970s witnessed an at times confusing but nonetheless stimulating diversity of new theoretical constructs and treatment strategies. By the early 1970s the Freudian psychoanalytic and various psychodynamic theories of personality, including Harry Stack Sullivan’s, were being strenuously challenged by B. F. Skinner (1904-1990) and the behaviorists. Even though Skinner’s ideas about behaviorism were largely set forth in his first book, The Behavior of Organisms (1938), it wasn’t until the ‘70s that behaviorism and Behavior Modification as a treatment strategy became more popular. Open debates were common in psychiatric professional groups between psychodynamic theorists and behaviorists, contesting which approaches were most efficacious for people with mental health problems. Debates continued throughout the decade, and behavioral therapy evolved into other theories of mental health, such as Cognitive Behavioral Therapy (CBT), Aversion Therapy, and systematic desensitization.

Despite the rise in popularity of behavior modification therapies, Harry Stack Sullivan’s interpersonal approach and Carl Rogers’ client-centered therapy, both of which had proved their value in the ‘60s, remained important in the ‘70s. Along with these three therapeutic approaches, namely (1) the basic, time-tested psychoanalytic/psychodynamic therapies, (2) the newer interpersonal and client-centered approaches, and (3) the various behavior modification strategies, a fourth very popular psychotherapy in this decade was CBT, Cognitive Behavior Therapy, an approach developed by Aaron T. Beck. Beck, a psychiatrist, formulated a theory of personality founded on what a person thinks. Based on his contention that mental illness derives from dysfunctional thinking, leading to dysfunctional emotions and behaviors, treatment interventions would focus on changing how a person thinks and feels and what he or she would do based on what he thinks. Beck may be best known for formulating self-report measures for depression and anxiety, the Beck Depression Inventory (BDI), which became one of the most widely used instruments for measuring the severity of depression. (See Aaron T. Beck 1975, Cognitive Therapy and the Emotional Disorders.)

Also important for the Psychiatric Nursing program in terms of theory and practice in this decade were Abraham Maslow’s theory of “self-actualization,” Anna Freud’s work on childhood development, and John Bowlby’s three books on Attachment and Loss (Attachment, Separation: Anxiety and Anger, and Loss: Sadness and Depression). These were instrumental as psychological theories focused on children and developmental theories of health and pathology.

New Modalities

New modalities of therapeutic intervention were also a feature of the ‘70s, including Gestalt Therapy, Family Therapy, and several variations of Group Therapy, notably T-groups for improving working relations in businesses. Similarly designed “sensitivity training” or “encounter” groups were experimented with in other settings.

• Gestalt Therapy. Fritz Perls had articulated Gestalt therapy in the 1950s, but the theory became more popular in the late 1960s and ‘70s. Gestalt therapy sought to enhance awareness of sensation, perception, bodily feelings, emotion, and behavior in the present moment and to thereby facilitate self-acceptance and loving connections with others. (See Perls, Friederick S., Ralph F. Hefferline, and Paul Goodman 1951, Gestalt Therapy: Excitement and Growth in the Human Personality.) Gestalt Therapy “emphasizes personal responsibility and focuses on the individual’s experience in the present moment, the therapist–client relationship, the environmental and social contexts of a person’s life, and the self-regulating adjustments people make as a result of their overall situation.” (https://en.wikipedia.org/wiki/Gestalt_therapy)
• Family Therapy. Family therapy was evolving as a major strategy for improving mild to moderate psychiatric disorders. Therapists would work with families to nurture change and development in interactions between family members. Family therapy might focus on any of many areas, including intergenerational ties and conflicts, social and cultural changes impacting that family, the developmental stages of the family, the emotional climate within the family structure, and equal authority between parents. Some of the best-known articulators of systems theory and this therapeutic innovation were Nathan Ackerman, Virginia Satir, Murray Bowen, Ivan Boszormenyi-Nagy, and Salvador Minuchin.
• Group Therapy. Kurt Lewin (1890-1947), a psychologist, believed that both nature and nurture interact to shape each person. Being one of the first to study group dynamics and organizational development, Lewin emphasized not just theoretical but applied research in the field of psychology and sociology. He coined the term group dynamics in 1947 to describe the way that groups and individuals within groups act and react to changing circumstances. His research and writing on small group communication and group dynamics laid the groundwork for group therapy in the ‘70s. However, while group therapy or group sessions were a common management intervention in mental hospitals, there was little research or outcome studies of these approaches. Often these groups were built on varying psychoanalytic theories, many of which did not easily adapt to groups of people. (https://en.wikipedia.org/wiki/Kurt_Lewin)
• T-groups. An offshoot of group therapy, the T-group (Training group) became popular in the ‘70s and on into the ‘80s. Conflict among workers as well as between management and workers were proving costly to industry. Large businesses would send employees to these training groups to improve worker productivity and product improvement. T-groups became popular elsewhere as well and were sometimes referred to as a sensitivity-training group, human relations training group, or encounter group. In a T-group participants (typically 8-15 people) would learn about themselves, and about small group processes in general, through their interaction with each other. They used feedback, problem solving, and role play to gain insights into themselves, others, and groups.

Data Driven Research and Psychiatric Nursing Curricula

In 1970, Irvin Yalom published his first edition of The Theory and Practice of Group Psychotherapy. He updated his book 6 times by 2020. Yalom described many of the groups that he had led and conducted systematic approaches to group treatment. The books are one of the few treatment approaches based on data driven research.

As these evolving theories of mental health became popular, curricula in psychiatric nursing programs introduced these new theories and therapies to their students. The graduate Psychiatric Nursing Program at the University of Utah began introducing these new theories of personality and mental health in the middle 1970s. (See Shapiro, F., Kaslow, F. W., & Maxfield, L., eds. 2007, “A Brief History of the Field of Family Psychology and Therapy,” in Handbook of EMDR and Family Therapy Processes. https://psycnet.apa.org/record/2007-01569-000.)