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American Therapy: The Rise of Psychotherapy in the United States
From Freud to Zoloft, the first comprehensive history of American Psychotherapy
Fifty percent of Americans will undergo some form of psychotherapy in their lifetimes, but the origins of the field are rarely known to patients. Yet the story of psychotherapy in America brims with colorful characters, intriguing experimental treatments, and intense debates within this community of healers.
American Therapy begins, as psychotherapy itself does, with the monumental figure of Sigmund Freud. The book outlines the basics of Freudian theory and discusses the peculiarly powerful influence of Freud on the world of American mental health. The book moves through the emergence of group therapy, the rise of psychosurgery, the evolution of uniquely American therapies such as Gestalt, rebirthing, and primal scream therapy, and concludes with the modern world of psychopharmacology, cognitive-behavioral therapy, and highly targeted short-term therapies.
For a counseled nation that freely uses terms such as “emotional baggage” and no longer stigmatizes mental health care, American Therapy is a remarkable history of an extraordinary enterprise.
Fifty percent of Americans will undergo some form of psychotherapy in their lifetimes, but the origins of the field are rarely known to patients. Yet the story of psychotherapy in America brims with colorful characters, intriguing experimental treatments, and intense debates within this community of healers.
American Therapy begins, as psychotherapy itself does, with the monumental figure of Sigmund Freud. The book outlines the basics of Freudian theory and discusses the peculiarly powerful influence of Freud on the world of American mental health. The book moves through the emergence of group therapy, the rise of psychosurgery, the evolution of uniquely American therapies such as Gestalt, rebirthing, and primal scream therapy, and concludes with the modern world of psychopharmacology, cognitive-behavioral therapy, and highly targeted short-term therapies.
For a counseled nation that freely uses terms such as “emotional baggage” and no longer stigmatizes mental health care, American Therapy is a remarkable history of an extraordinary enterprise.
368 pages, Hardcover
First published January 1, 2008
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Displaying 1 - 17 of 17 reviews
April 20, 2026
An excellent history of psychotherapy in the U.S. from about 1900-2000. Very accessible and full of important people, institutions, debates, and findings.
If there's one thing that stood out to me from reading this, it's how much has changed without very much actually changing. By this, I mean that, between 1920 and 2020, there have obviously been substantial changes both in our understanding of mental health due to technological and medical developments and in our treatment of it due to training, institutional backing, and paradigm shifts; however, at the same time, we've always known what needs to be done. For example, in the 1920s, many social workers and socially minded psychologists recognized that mental health isn't just a problem with the individual's mind, but also a question of socio-material conditions and justice. Today, counseling psychology, which awkwardly straddles the line between social work and clinical psychology, which itself used to awkwardly straddle social work and psychiatry, claims to be correcting the overemphasis on therapeutic individualism, even though we've known this for about 100 years.
A big part of the problem is siloization, which is as much professional (status and finance) as theoretical: Social work, counseling, clinical psych, and psychiatry see themselves separately and in competition, with different billing, different training, and different models of mental health itself, e.g., interpersonal vs. biochemical, talking vs. pharmacological. And yet, we've known that mental health, together with physical health, is integral and holistic. Ideally, every person would have a team to treat them, but this is logistically impossible. For this reason, it was interesting to read about how the various professions battled each other over the decades and tried to distinguish themselves. Chapter 3 is fascinating in this respect because it shows how much our understanding of psychology has shifted historically; in the '40s and '50s, therapy was the job of psychiatry, while testing was that of "psychology." In other words, "psychology," instead of being a broad category encompassing psychiatry, used to designate researchers who used quantitative measurements. Meanwhile, social workers were struggling to define themselves, even though they were, in my opinion, doing the most commendable work.
This, too, is another example of change without change: Measurement and conceptualization were known to be problems basically since the very birth of these disciplines. In the 1920s, we didn't have great statistical tests; we had poor knowledge of the brain; we kinda just BS'd various tests; we didn't test outcomes rigorously, if at all. Well, 100 years later, we have many pills, all kinds of neuroimaging technology, and the DSM is up to its 5th edition. And yet, for all this, we're still struggling with biological notions of mental illness; the DSM-V is trashed by critics, usually for good reason, with constantly mutating criteria and definitions; eclecticism is still the rage, although it's now called "integration"; and our experimental studies have gotten better, but not great, while struggling with representativeness and over-academicism. Some of this is due to cost, of course; it's expensive to do all this. But I'm not sure how much of it's also due to a lack of momentum/daring, a lack of an integrated theory, etc. Why this stagnation amidst so much progress? Rather paradoxical. This is why I'm inclined to say that, with regard to mental health, we've moved ahead to where we always were. To be sure, it's so much more accessible today, both in terms of affordability and destigmatization, although neither's perfect, with much more to go.
For the most part, Engel remains pretty objective, but there are times when, maybe for personal reasons—though he'd probably say it's rather out of respect for truth—he'll release his candor, which could be off-putting to some. Personally, I think it's kinda justified at times, like when he writes about Melanie Klein or Thomas Szaz. For the former, he didn't even need to criticize her; he lets her writing speak for her, which would've been enough (LOL). The latter he calls "a paranoid kook who was sloppy with his facts" (186), and indirectly likens him to a "Neville Chamberlain of the psychological world" and an "unintentional catalyst of evil" (260). (To be fair, Engel shortly after concedes some points to the anti-psychiatrists and civil libertarians.)
Overall, a good read that I'd recommend to professionals and laymen alike, in order to understand where the profession came from, how it transformed over time, and the politics of it all. While it's unlikely, I wish he'd write a revised 2nd edition that would cover up until now, since the 2010s and 2020s have changed so much: Social media, counseling/coaching, teletherapy, COVID, and A.I.
If there's one thing that stood out to me from reading this, it's how much has changed without very much actually changing. By this, I mean that, between 1920 and 2020, there have obviously been substantial changes both in our understanding of mental health due to technological and medical developments and in our treatment of it due to training, institutional backing, and paradigm shifts; however, at the same time, we've always known what needs to be done. For example, in the 1920s, many social workers and socially minded psychologists recognized that mental health isn't just a problem with the individual's mind, but also a question of socio-material conditions and justice. Today, counseling psychology, which awkwardly straddles the line between social work and clinical psychology, which itself used to awkwardly straddle social work and psychiatry, claims to be correcting the overemphasis on therapeutic individualism, even though we've known this for about 100 years.
A big part of the problem is siloization, which is as much professional (status and finance) as theoretical: Social work, counseling, clinical psych, and psychiatry see themselves separately and in competition, with different billing, different training, and different models of mental health itself, e.g., interpersonal vs. biochemical, talking vs. pharmacological. And yet, we've known that mental health, together with physical health, is integral and holistic. Ideally, every person would have a team to treat them, but this is logistically impossible. For this reason, it was interesting to read about how the various professions battled each other over the decades and tried to distinguish themselves. Chapter 3 is fascinating in this respect because it shows how much our understanding of psychology has shifted historically; in the '40s and '50s, therapy was the job of psychiatry, while testing was that of "psychology." In other words, "psychology," instead of being a broad category encompassing psychiatry, used to designate researchers who used quantitative measurements. Meanwhile, social workers were struggling to define themselves, even though they were, in my opinion, doing the most commendable work.
This, too, is another example of change without change: Measurement and conceptualization were known to be problems basically since the very birth of these disciplines. In the 1920s, we didn't have great statistical tests; we had poor knowledge of the brain; we kinda just BS'd various tests; we didn't test outcomes rigorously, if at all. Well, 100 years later, we have many pills, all kinds of neuroimaging technology, and the DSM is up to its 5th edition. And yet, for all this, we're still struggling with biological notions of mental illness; the DSM-V is trashed by critics, usually for good reason, with constantly mutating criteria and definitions; eclecticism is still the rage, although it's now called "integration"; and our experimental studies have gotten better, but not great, while struggling with representativeness and over-academicism. Some of this is due to cost, of course; it's expensive to do all this. But I'm not sure how much of it's also due to a lack of momentum/daring, a lack of an integrated theory, etc. Why this stagnation amidst so much progress? Rather paradoxical. This is why I'm inclined to say that, with regard to mental health, we've moved ahead to where we always were. To be sure, it's so much more accessible today, both in terms of affordability and destigmatization, although neither's perfect, with much more to go.
For the most part, Engel remains pretty objective, but there are times when, maybe for personal reasons—though he'd probably say it's rather out of respect for truth—he'll release his candor, which could be off-putting to some. Personally, I think it's kinda justified at times, like when he writes about Melanie Klein or Thomas Szaz. For the former, he didn't even need to criticize her; he lets her writing speak for her, which would've been enough (LOL). The latter he calls "a paranoid kook who was sloppy with his facts" (186), and indirectly likens him to a "Neville Chamberlain of the psychological world" and an "unintentional catalyst of evil" (260). (To be fair, Engel shortly after concedes some points to the anti-psychiatrists and civil libertarians.)
Overall, a good read that I'd recommend to professionals and laymen alike, in order to understand where the profession came from, how it transformed over time, and the politics of it all. While it's unlikely, I wish he'd write a revised 2nd edition that would cover up until now, since the 2010s and 2020s have changed so much: Social media, counseling/coaching, teletherapy, COVID, and A.I.
Read
June 9, 2024I thought this was a fascinating historical look at therapy in America from the early 1900s until 2000. Lots of facts and details. Other reviews rightly point out that if this isn't a topic you are deeply interested in, at times it will feel a very dry read. I thought the chapter organization was good, if not consistent, sometimes pulled around diagnosis, sometimes around theoretical approach.
Probably the most interesting thread for me to follow throughout the book was the waxing and waning of how much emphasis to put on the therapy as solution/self-realization, and then where boundaries got drawn each decade between social work, psychology, psychiatry, and physicians' responsibilities to the mental health of clients/patients. A
Probably the most interesting thread for me to follow throughout the book was the waxing and waning of how much emphasis to put on the therapy as solution/self-realization, and then where boundaries got drawn each decade between social work, psychology, psychiatry, and physicians' responsibilities to the mental health of clients/patients. A
March 3, 2021
Plus: Provided a comprehensive narrative account of the broad range of psychotherapies. I'm better read than average in this area and there were lots of things I learned
Minus:
- Not much of an interpretive framework or connection to broader social/cultural contexts. Pretty much one-damn-thing-after another history.
- Lack of subtlety and nuance at many points.
- A really bad concluding chapter on biopsych and pharma. You don't have to agree with all the controversies and critiques of biomedicine and the pharma industry out there, but as some of them had gotten A LOT of attention well before this book was published you can't simply ignore them.
Minus:
- Not much of an interpretive framework or connection to broader social/cultural contexts. Pretty much one-damn-thing-after another history.
- Lack of subtlety and nuance at many points.
- A really bad concluding chapter on biopsych and pharma. You don't have to agree with all the controversies and critiques of biomedicine and the pharma industry out there, but as some of them had gotten A LOT of attention well before this book was published you can't simply ignore them.
January 7, 2019
It's an informative book, especially for a Psych student or someone very interested in the subject. It helps to have a background on basic Psych 101. A little dry and difficult to follow at times so I couldn't finish it entirely- I got bored and sleepy.
January 11, 2009
American Therapy: The Rise of Psychotherapy in the United States reads like a well-written history text, well, because it is one. While perhaps not the best reading selection for a brain that is, like mine, in a state of pre-holiday scatter, the book provides an often fascinating account of the history of therapy in the United States, including not just key figures and movements within the field, but also the uniquely American characteristics that have influenced psychotherapy.
Engel, the author of several other histories, including The Epidemic: A Global History of AIDS, begins his chronology with a chapter summarizing the life, theories, and influences of Freud, who only visited the United States once, but whose ideas have enjoyed notable popularity here. When we see a therapist, read a self-help book, or seek out counseling from an advisor of a religious or other affiliation, the modern chronology of the therapy we receive begins with Freud. The patient lying down on the sofa in the New Yorker cartoon? That’s Freud. The id and the ego? That’s Freud, too. The idea that what women really want is to kill their mothers and marry their fathers? Oy, Freud.
Thankfully for our relationships with our mothers, Freudian psychotherapy has come to be regarded, as Engel writes in the afterword, “highly significant within the spectrum of intellectual history, but with little relevance to our best understandings of the human mind.” Freud’s ideas were amalgamated with those of others, including Meyer, Sullivan, and Karen Horney, whom, Engel writes of the latter, was called “the first feminist psychologist.” Horney, being a woman herself, naturally wrote about the experiences of girls and women, as well as boys and men, and found that parental love had a lot to do with psychological trauma and neuroses.
Numerous other individuals in this field have influenced it since Freud’s death in 1939, but just as influential were the cultural phenomena. Because war never fails in creating psychological trauma, psychotherapy enjoyed an increase in popularity and demand after World War II. Also, twentieth-century trends in addiction—to alcohol and other substances—prompted often-futile searches for effective treatments; one result was an increase in group therapy thanks to the success of Alcoholics Anonymous. Engel also devotes a chapter to narcissism, which he notes has both influenced and thwarted the field.
In addition to the rise of psychotherapy, there has been a fall, and Engel writes that, since the 1980s, “psychotherapy has reached a certain stasis” as the focus in treatment of mental illness has turned to pharmaceuticals such as Prozac, Zoloft, and Paxil. However, patients who receive therapy, in addition to medication, tend to function better than those on drugs alone, and Engel concludes that American therapy in the twenty-first century is “eclectic,” made up of social workers, counselors, and licensed therapists. And with Americans’ tendency to feel entitled—to happiness, success, wealth, and opportunity—we are well served to utilize these resources, lest we crumple under the weight of our own vague ambitions. Oy.
Review by Jonelle Seitz
Engel, the author of several other histories, including The Epidemic: A Global History of AIDS, begins his chronology with a chapter summarizing the life, theories, and influences of Freud, who only visited the United States once, but whose ideas have enjoyed notable popularity here. When we see a therapist, read a self-help book, or seek out counseling from an advisor of a religious or other affiliation, the modern chronology of the therapy we receive begins with Freud. The patient lying down on the sofa in the New Yorker cartoon? That’s Freud. The id and the ego? That’s Freud, too. The idea that what women really want is to kill their mothers and marry their fathers? Oy, Freud.
Thankfully for our relationships with our mothers, Freudian psychotherapy has come to be regarded, as Engel writes in the afterword, “highly significant within the spectrum of intellectual history, but with little relevance to our best understandings of the human mind.” Freud’s ideas were amalgamated with those of others, including Meyer, Sullivan, and Karen Horney, whom, Engel writes of the latter, was called “the first feminist psychologist.” Horney, being a woman herself, naturally wrote about the experiences of girls and women, as well as boys and men, and found that parental love had a lot to do with psychological trauma and neuroses.
Numerous other individuals in this field have influenced it since Freud’s death in 1939, but just as influential were the cultural phenomena. Because war never fails in creating psychological trauma, psychotherapy enjoyed an increase in popularity and demand after World War II. Also, twentieth-century trends in addiction—to alcohol and other substances—prompted often-futile searches for effective treatments; one result was an increase in group therapy thanks to the success of Alcoholics Anonymous. Engel also devotes a chapter to narcissism, which he notes has both influenced and thwarted the field.
In addition to the rise of psychotherapy, there has been a fall, and Engel writes that, since the 1980s, “psychotherapy has reached a certain stasis” as the focus in treatment of mental illness has turned to pharmaceuticals such as Prozac, Zoloft, and Paxil. However, patients who receive therapy, in addition to medication, tend to function better than those on drugs alone, and Engel concludes that American therapy in the twenty-first century is “eclectic,” made up of social workers, counselors, and licensed therapists. And with Americans’ tendency to feel entitled—to happiness, success, wealth, and opportunity—we are well served to utilize these resources, lest we crumple under the weight of our own vague ambitions. Oy.
Review by Jonelle Seitz
July 15, 2014
I picked up this read in the dollar bin when Borders was going out of business several years ago, and had yet to actually read it now three long years into my doctoral training in clinical psychology. I am glad I have waited thus long to pick it up, as I can now appropriately critique it's value in the significance it places upon the different movements within the psychological community over the past 100+ years. First of all, I feel that this was generally a good historical overview of the rise of psychotherapy in the United States, yet I feel that it tends to focus on the massive amount of debunked Freudian beliefs rather than focusing on the positive aspects of psychotherapy, and not psychoanalysis, affect treatment. In addition, it completely glosses over the importance of the growth of assessment and assessment-based tools in the field, which are integral to the rise of psychologists as practitioners and independent contractors within the field. I do like the author's discussion of the use of social workers and alcohol/narcotics treatment. However, my two biggest critiques are as follows: 1) the failure of the author to consistently relate the social milieu of the rise and fall of certain practices in psychotherapy...in describing the widespread use of marijuana and other psychoactive drugs, it's integrally important to discuss the role of the counterculture and dysfunction of the United States in the 1960s, and 2) the author has a Ph.D. in the history of science and medicine. He definitely portrays his dislike, and lack of understanding, of the importance of the Rorschach to this day (despite its overriding controversy) and also his sympathy with the claims of psychiatrists in basically portraying psychologists as substandard practitioners who are taking their overpaid jobs away from them. Never once does he claim that psychotherapy alone works for clients, instead highlighting medication as primary, with ongoing psychotherapy as secondary, to client treatment plans. I most definitely don't agree with this perspective. However, if one is looking for a relatively comprehensive overview of the rise and fall of psychoanalysis, the incorporation of CBT and biological/medical models, and integration of social work and substance abuse treatment, then this book would fit the bill just fine, keeping in mind the biased nature of the author.
October 15, 2011
mostly ok overview of the history of psychotherapy in the US by a historian of science. Clear, concise writing, good mix of research reviews and quotes from prominent individuals. My quibbles were:
1. The organizational structure is odd -- randomly mixes chapters on specific problems (e.g., alcohol abuse) with chapters on treatment approaches (rise and fall of psychoanalysis, rise of biological psychiatry) with professional/social trends (struggle for legitimacy as an independent profession for social work, ph.d. vs. psy.d. training in clinical psychology, onset of managed care). Could have done it strictly chronologically and mixed these topics, or picked one vs. another organizing theme, but the seemingly random interspersing of sample chapters from each way of carving the pie was a bit jarring.
2. Subject is too large for comprehensive review, but some of the choices for topical emphasis were questionable -- lots of material on AA, which isn't psychotherapy and isn't led by therapists, very little on behavior therapy other than some cursory material on early experiments in this vein.
3. Sloppy library research for a historian -- e.g., says on p. 226 that rush et al. (1977) found combining antidepressant meds with cognitive therapy to be superior in the treatment of depression -- in fact, there was no combination condition included in that study. Calls Hans Strupp "Krupp" a couple times on p. 234. Says on p. 255 that people with OCD "improve little with psychotherapy" without ever mentioning or reviewing research on the Tx of choice for OCD, exposure with response prevention.
1. The organizational structure is odd -- randomly mixes chapters on specific problems (e.g., alcohol abuse) with chapters on treatment approaches (rise and fall of psychoanalysis, rise of biological psychiatry) with professional/social trends (struggle for legitimacy as an independent profession for social work, ph.d. vs. psy.d. training in clinical psychology, onset of managed care). Could have done it strictly chronologically and mixed these topics, or picked one vs. another organizing theme, but the seemingly random interspersing of sample chapters from each way of carving the pie was a bit jarring.
2. Subject is too large for comprehensive review, but some of the choices for topical emphasis were questionable -- lots of material on AA, which isn't psychotherapy and isn't led by therapists, very little on behavior therapy other than some cursory material on early experiments in this vein.
3. Sloppy library research for a historian -- e.g., says on p. 226 that rush et al. (1977) found combining antidepressant meds with cognitive therapy to be superior in the treatment of depression -- in fact, there was no combination condition included in that study. Calls Hans Strupp "Krupp" a couple times on p. 234. Says on p. 255 that people with OCD "improve little with psychotherapy" without ever mentioning or reviewing research on the Tx of choice for OCD, exposure with response prevention.
December 23, 2012
Good overview of the history of psychotherapy and other forms of therapy in the United States. The author has a sense of humor and this makes the book a lot more interesting than it could have been. I found the organization to be a little strange and I wish he'd had more examples for some things but overall it was a good read for anyone interested in a brief overview of therapy in the United States.
April 5, 2009
This book's title gives it away. I found it interesting, as I studied psychotherapy in college, and it was a well connected narrative about how the different schools of therapy evolved initially from Freud and then from one another. It was a bit dry at times, though; I would only recommend it as pleasure reading to someone who had a genuine interest in the subject.
January 15, 2009
A nice, very readable review of the history of therapy dating back to WWII. Especially interesting was the information presented on the fields of psychiatry vs social work vs psychology.
February 24, 2009
i feel like this was just an overview. i wanted more! but then, i am a nerd. a nerd who is now looking to read more on melanie klein because she's bonkers.
Want to Read
June 9, 2009On NY Times book review Dec 2008
March 20, 2014
so far, it's fascinating.
July 10, 2010
An excellent overview of psychotherapy as it is practiced in general but especially in the United States.
Read
January 23, 2012Interesting history of psychoanalysis; however, the grammatical incorrectness towards the end became distracting.
Read
January 3, 2014couldn't get past the firsr chapter. this book was incredibly too dry and boring for me.
June 9, 2016
Great over view of the development of psychological practice in the US. A little slow at times, but easy to read and packed with info !
Displaying 1 - 17 of 17 reviews