RELIGION PLUS PSYCHOTHERAPY
From – Understanding and Counseling the Alcoholic
Howard J. Clinebell, Jr. (1956)
The Emmanuel Movement is of salient importance to anyone who would help alcoholics. Though it is no longer in existence as a movement, it is anything but a mere ecclesiastical museum piece. Its goals, working philosophy, understanding of man, conception of alcoholism, and even some of its methods are worth emulating today. Here was perhaps the earliest experiment in a church-sponsored psychoreligious clinic. Here was the first pioneering attempt to treat alcoholism with a combination of individual and group therapy, the first attempt to combine the resources of depth psychology and religion in a systematic therapeutic endeavor. During its course the movement attracted many alcoholics and became well known for its success in treating them.
The movement came into being on a stormy evening in November, 1906, at the Emmanuel Episcopal Church in Boston, when the first "classes" for those with functional illnesses was held. The guiding genius of the movement was a brilliant Episcopal clergyman named Elwood Worcester. His associate throughout most of its course was the Rev. Samuel McComb. Both men had had extensive graduate study in psychology and philosophy. Worcester had a Ph.D. from Leipzig where he studied under Wilheim Wundt, founder of the first psychological laboratory, and physicist-psychologist-philosopher Gustav Fechner.
For a long time before 1906, Worcester had had a growing conviction that the church had an important mission to the sick, and that the physician and clergyman should work together in the treatment of functional ills. As a preliminary step he consulted several leading neurologists to ascertain whether such a project as he had in mind, undertaken with proper safeguards, would have their approval and cooperation. A favorable response was received, and the plan was launched.
The Emmanuel program of therapy consisted of three elements: group therapy administered through its classes, individual therapy administered by the ministers and staff at the daily clinic, and a system of social work and personal attention carried on by "friendly visitors." The growth of the movement was phenomenal. Three years after its inception, a California disciple could write:
The work, begun as a parish movement, has grown so that the local demands have overtaxed a large corps of workers while importunate calls from many cities in this and other lands for knowledge of the work, and pitiful calls for help from sick ones everywhere have to be put aside... .Meanwhile, in two years the work has been taken up by ministers of many faiths who see in the new movement a return to the faith and practice of the Apostolic Church. These. . .are finding new power in their work.
This disciple also described the manner in which plans were being put into operation for training ministers who wanted to use the Emmanuel technique in their parishes, and for setting up the movement in large centers. By 1909 the movement had spread abroad and was represented in Great Britain by a committee under the title "Church and Medical Union." The Emmanuel clinic in Boston was deluged by patients. During one six-month period nearly five thousand applications were received by mail alone. Of these only 125 could be accepted. Hundreds of clergymen and many physicians were visiting Boston to study the methods. Influential physicians like Richard C. Cabot gave their support to the movement.
The first definite book on the movement was Religion and Medicine, The Moral Control of Nervous Disorders, which appeared in 1908. Demand for this book was so great that it went through nine printings in the year of publication. For twenty-three years Worcester continued as rector at Emmanuel. The movement continued to flourish there and in other parts of the country. The need for help was so great that often a line of patients cued outside the church. In 1929 Worcester resigned from his parish in order to give full time to the movement. A considerable sum of money had been received to carry on the work, so the movement was incorporated as the Craigie Foundation. In addition to the patients which he saw at his home, Worcester accepted many invitations to conduct week long clinics and lecture series in prominent eastern churches. In 1931 Worcester and McComb produced Body, Mind and Spirit, a book which showed clearly the development of their thought following the earlier books of the movement. For all practical purposes the Emmanuel Movement as such came to a close with Worcester’s death in 1940.
It is noteworthy that three outstanding lay therapists for alcoholics in this country, Courtenay Baylor (who carried on the work at the Emmanuel Church for a time after Worcester’s death), Richard Peabody, and Samuel Crocker, were products of the movement. A lay therapist is a nonmedical practitioner who specializes in helping alcoholics professionally. For a description of the method of treatment used by Courtenay Baylor, see Dwight Anderson’s "The Place of the Lay Therapist in the Treatment of Alcoholics," Q.J.S.A., September, 1944.
The Method of Treating Alcoholics
The Emmanuel classes were held once a week. In this group experience, alcoholics were lumped together with patients suffering from other functional illnesses treated by the clinic. A disciple of the movement, Lyman P. Powell, who had tried the technique in his own church, describes the procedure:
Any Wednesday evening from October until May you will find, if you drop in at Emmanuel Church, one of the most beautiful church interiors in the land filled with worshipers.. .A restful prelude on the organ allures the soul to worship. Without the aid of any choir several familiar hymns are sung by everyone who can sing and many who cannot. A bible lesson is read. The Apostles’ Creed is said in unison. Requests for prayer in special cases are gathered up into one prayerful effort made without the help of any book. One Wednesday evening Dr. Worcester gives the address, another Dr. McComb, still another some expert in neurology or psychology. The theme is usually one of practical significance, like hurry, worry, fear, or grief, and the healing Christ is made real in consequence to many an unhappy heart.
Other subjects discussed at the classes included: habit, anger, suggestion, insomnia, nervousness, what the will can do, and what prayer can do. The class was always followed by a social hour in the parish house. Reporting on the results of these group experiences, Powell says: "Though the mass effect of the service is prophylactic, it is not uncommon for insomnia, neuralgia and kindred ills to disappear in the self-forgetfulness of such evenings."
The heart of the Emmanuel therapy was the clinic. Before a patient was accepted for treatment, he was required to have a careful diagnostic examination by a physician and in some cases, a psychiatrist. If psychosis or organic pathology was disclosed, the individual was not accepted. If the disease appeared to be simply functional, the applicant was registered for treatment and directed to the rector’s study. In the case of alcoholics, it was felt by Worcester that they should be seen every day, especially in the early phases of their treatment. The new, nonalcoholic habits which the "psychotherapy" was implanting were to be treated as tender shoots until they took firm root. The patient was felt to need the daily support of the therapist until these new habits were firmly rooted, after which the therapist met the patient once or twice a week. Just how long the average alcoholic treatment took is not clear from the literature. No cases of alcoholism were listed among the quick cures - i.e., those effected in one or two sessions. A treatment period of at least several months seemed to have been involved in most of the cases cited.
The treatment itself included "full self—revelation" in which the patient poured out all the facts - physical, mental, social, moral, and spiritual — which might have any bearing on the sickness. This catharsis was felt to have a curative effect in itself often serving to "unlock the hidden wholesomeness" of the patient’s inner life. The second phase of the treatment consisted of "prayer and godly counsel." This apparently was aimed chiefly at teaching the patient the techniques of prayer and helping him strengthen his spiritual life, rather than praying for the individual. The third phase was the use of relaxation and "therapeutic suggestion," the latter administered in some cases while the patient was under mild or deep hypnosis. It is noteworthy that although Worcester began by using hypnosis in many different types of difficulties, he eventually limited it to use with some alcoholics. Apparently he felt that the alcoholic needed the more powerful effect of hypnotic suggestion.
"The patient is next invited to be seated in a reclining chair, taught to relax all his muscles, calmed by soothing words, and in a state of physical relaxation and mental quiet the unwholesome thoughts and untoward symptoms are dislodged from his consciousness, and in their place are sown the seeds of more health-giving thoughts and better habits."
During the course of the movement there occurred a highly significant transition in the thought and methodology used. The change consisted of the gradual incorporation of psychoanalytic techniques, as Worcester began to learn of the dynamic psychology of Freud. This was accompanied by diminishing dependence on suggestion, the therapeutic device in vogue in the early days of the movement due to the influence of Worcester’s European training with the physiological psychologists. Worcester stoutly defended the method of psychoanalysis. In 1932 he wrote: "I cannot agree with Stekel who advises that analysis be attempted in alcoholic cases only after other means have failed. I have found it helpful to begin my treatment with an analysis of childhood and youth." Worcester used standard psychoanalytic techniques such as dream analysis and the probing of early memories as a part of his therapy.
Like others who have attempted to use such techniques with alcoholics, Worcester had encountered the problem of breaking the addictive cycle long enough to allow the therapy to have some effect. He developed his own unique solution which he felt was responsible for his success in keeping the patient sober while therapy got a foothold. The solution consisted of two parts: (a) making the analysis relatively brief; (b) combining analysis with his earlier method, therapeutic suggestion.
From insight gained through analysis of alcoholics, Worcester arrived at a profound understanding of alcoholism: "The analysis, as a rule, brings to light certain experiences, conflicts, a sense of inferiority, maladjustment to life, and psychic tension, which are frequently the predisposing causes of excessive drinking. Without these few men becoming habitual drunkards. In reality drunkenness is a result of failure to integrate personality in a majority of cases. Patients, however darkly, appear to divine this of themselves, and I have heard some fifty men make this remark independently: "I see now that drinking was only a detail. The real trouble with me was that my whole life and my thoughts were wrong. This is why I drank."
He went on to say:
"It is this consciousness of crippling dissociation of powers, of inhibition and repression which predisposes men to drink. In alcoholism in its early stages they find release of their faculties, the dissociation of their fears and inhibitions, as so many have said, "A short cut to the ideal."
The aim of Emmanuel therapy was the reconstruction of the inner self so that the alcoholic could remain abstinent -Worcester had no illusions about alcoholics becoming social drinkers. There was a conviction that this reconstruction of personality must utilize the resources inherent in the person. Psychoanalysis was an important technique for releasing these resources.
While Worcester came to regard analysis as essential, he also observed that "few drunkards have been cured by analysis alone." He recognized that their are two levels to the alcoholics problem - the underlying psychic conflicts and what he called the "habit itself," the effect on the nervous system of continued inebriety and the craving resulting therefrom. Analysis, he had found, had little effect on the latter, whereas suggestion often "supplied immediate help and permanent immunity from the return of the habit." His working hypothesis was that analysis relieved the psychic problems, "reducing the problem presented by the drunkard largely to a physical habit." Suggestion effected a strengthening of the will and a distaste for liquor so that the physical habit could be controlled.
Fortunately Worcester gives a sample of how he administered therapeutic suggestion to alcoholics: "Most alcoholics are highly suggestible and I have found a few who failed to respond to the technique intended to induce mental repose and abstraction and physical relaxation. When the patient had obtained this condition, I should address him in low monotones and offer him repeated suggestions, positive and negative, somewhat as follows: "You have determined to break this habit, and you have already gone days without a drink. The desire is fading out of your mind, the habit is losing its power over you. You need not be afraid that you will suffer at all. In a short time liquor in any form will have no attraction for you. It will be associated in your mind with weakness and sorrow and sickness and failure. These thoughts are very disagreeable to you and you turn away from them. You wish to be free, you desire to lead a useful, happy life. Liquor is your enemy, but you are overpowering it and in a short time it will have no power over you at all." Then as a person accustomed to depend on alcohol for sleep, when deprived of it, are apt to suffer from insomnia, I should add suggestions as to sleep and rest."
In addition to the suggestions given by the therapist, the patients were taught autosuggestion so that their treatment could continue between sessions.
The third phase of the Emmanuel program consisted of the "friendly visitors," whose purpose was "to give the environment of the patients care similar to that provided for their bodies by the physicians, and for their minds by the clergymen."
"Very often patients... .need more than anything else a friend to show personal sympathy and interest, to encourage them, and to make sure they are following the prescribed directions. Victims of alcohol especially need this assistance to prevent relapse after the conclusions of treatment before they have acquired full self—reliance."
Worcester and McComb reported that the system was very successful. They pointed out that alcoholics profited from becoming friendly visitors to other alcoholics who were beginning their treatment and that they made very effective visitors. One thinks immediately of the A.A. system of sponsorship and the principle of Twelfth Step work in this connection.
"Our patients... .need occupation to keep them from being self-centered. Clerical work has been found useful, but the best results have come from sending them as friendly visitors to others less fortunate. Not only does this have a good effect on the visitor, but new converts are proverbially enthusiastic, and the alcoholic who finds himself released from his bondage is a most valuable assistant in encouraging and keeping up to the mark patients who have just begun."
The friendly visitor system was administered by a committee which included several trained social workers. Through this system the alcoholic was aided in finding employment and, if necessary, given a financial loan for a limited time while he adjusted his life. The friendly visitors often helped the patient readjust in the area of his family life.
Philosophically the Emmanuel Movement stands in contrast to the approaches studied previously. All of Worcester’s writings reflect the conception that all life is permeated by the divine spirit, a belief which had its roots in the panpsychism of his teacher, Fechner. In discussing "Mabn’s Life in God," Worcester wrote:
"The secret of all spiritual religion is the union of the human soul with the divine soul, the belief that man’s spirit and God’s spirit are in their essence one. Without this belief man’s relations with God become formal and external. The world, robbed of the haunting presence of the indwelling deity, becomes irreligious and profane."
Because he held that the spirits of God and man are in their essence one, Worcester did not think of man as depraved or lost in sin. Man’s spirit is a part of God; his realization and healing consist not in surrender to an external Power, but in the redirecting, releasing, and reeducating of the inherent powers—the hidden wholesomeness—of the spirit within. This positive conception of man contrasts vividly with mission and Salvation Army doctrines of the impotent, sinful man who can be saved only by surrender to an external Power. Rather than seeing man’s beatitude in the abnegation of self, Worcester felt that the purpose of therapy was to help the person "find freedom and to discover a better way of life for himself." Prayer was considered an important means of releasing the divine energies within the soul trapped by one’s neurosis.
Worcester felt that many religious workers in the field of healing had made the mistake of supposing that God can cure in only one way. God cures by many means. An act of healing, whatever the means used, is religious, since the divine spirit permeates all of life. The healing of bodies and spirits by medicine, rest, kindness, and self—understanding is just as much an act of God as healing which depends on prayer and suggestion. Further, healing of the mind and spirit is not some sort of divine magic but is the divine spirit working through the orderly forces of nature. This general orientation provided the basis for a thoroughly cooperative relationship between the various healing disciplines involved in Emmanuel therapy.
In his view of man Worcester (in contrast to previous approaches) held to a thoroughly unrepressive attitude toward man’s desires and feelings. He recognized that the tendency, especially among Christian thinkers of the past, has been to deny these factors in human life. Concerning the conflict between reason and conscience on the one hand, and emotion and desires on the other, he writes:
"The first step toward a possible solution of this fundamental problem of human life... .is to recognize the legitimacy of both these elements of our being. In our disposition to do this lies whatever superiority we possess over former generations and our chief hope for the future."
This handling of the problem reflects Worcester’s psychoanalytic orientation.
The problem of responsibility, a key problem whenever religion and psychology meet, was handled in a realistic manner by this approach. Worcester could not have fallen into freewill moralism concerning alcoholism. For one thing, from the beginning of the movement, he recognized alcoholism as an illness. Further his training in psychology had acquainted him with the role played by the subconscious mind in all behavior, including alcoholism. In 1908, long before the idea had become generally accepted, Worcester wrote:
"We believe that there is a subconscious element in the mind and that this element enters into every mental process. Our daily life is influenced far more than the shrewdest of us suspect by the subconscious activity which is at work, exercising a selective power even in apparently accidental choices. Hence the real cause of our acts are often hidden from us."
Worcester was convinced that "it is the subconscious that rules in the mental and moral region where habit has the seat of its strength." Further, he believed that therapeutic suggestion was able to unfluence and guide the subconscious mind into paths of health. As the influence of Freud grew in his thinking, the importance of subconscious factors was further enhanced.
There was another reason why Worcester avoided a moralistic conception of alcoholism and human ills in general. As early as 1908 he had recognized that the first six years of a child’s life are the most important and determinative of his life. It was therefore relatively easy for him to accept the findings of the psychoanalysts in this area. In his last book he wrote: "The great psychological thinkers and workers, Freud, Jung, Adler, and others, were quick to perceive the significance of childhood as the chief determinant of life."
An Evaluation of This Approach
How effective was the Emmanuel therapy in breaking the addictive cycle and providing initial sobriety? And how successful was it in providing long-term sobriety? It is impossible to answer these questions with certainty, since the movement no longer exists and apparently there are no quantitative records. For several reasons, however, it seems probable that the Emmanuel movement enjoyed a relatively high degree of success in providing at least temporary sobriety. We know that the Emmanuel workers accepted for treatment only those who wanted to stop drinking and who came on their own volition. A.A. experience has shown that these mental attitudes on the part of the alcoholic are essential prerequisites for successful therapy. These Emmanuel requirements meant that only patients who were "at bottom" and who would accept responsibility in asking for help would be treated. Second, we know that the Emmanuel therapists had the advantage over "straight religious" approaches of having medical assistance - a valuable aid in effecting initial sobriety. Third, we know that suggestion administered as in this therapy by a person with status, exercises a powerful control over behavior. This is especially true in the case of insecure and dependent people, such as alcoholics frequently are. Fourth, we know from various reports that suggestive therapy has produced impressive results with alcoholics. Prior to the Emmanuel movement, Charcot treated 600 cases over a twenty—year period and reported 400 "cures." Tokarsky of Moscow reported that 80 percent of the 700 alcoholics he had treated were cured, and Wiamsky of Saratow claimed about the same percentage of cures out of the 319 cases he treated. Unfortunately, no definition of "cure" was given in these reports.
It seems probable that many of those who gained temporary sobriety through Emmanuel therapy stayed sober for an extended period. The fact that Worcester and McComb over the years acquired a reputation for success in treating alcoholics indicates that many of their patients must have stayed abstinent. In 1932 they were able to report: "It is well known that we have obtained as good and as permanent results in these fields as any other workers." If most of their cures had been short—lived, they would not have enjoyed this reputation.
Several cases are presented in Emmanuel literature which show that sobriety extended over long periods. Worcester tells, for instance, of treating a very difficult alcoholic with homicidal tendencies who had been given up as hopeless by the doctors. At the time of writing the man had enjoyed seven years of sobriety. Worcester reported having little success in treating "dypsomaniacs" - apparently the equivalent of periodic alcoholics as contrasted with "ordinary alcoholics" (steadies). In spite of this, he tells of successfully treating a woman "dypsomanic," who had been judged hopeless by two psychiatrists. Worcester writes:
"As I have kept in contact with this woman, I can say that she was cured in the sense that for twenty—two years there has been no return of the fatal cycle, not a drop of liquor has passed her lips." That a good deal of success was enjoyed by the movement, even in cases where relapses occurred, is shown by Samuel McComb’s statement: "There are other cases of alcoholism where a relapse has occurred, but it has only been temporary; and fathers and sons have been restored to their families with what a joy only those who have felt the curse of intemperance can realize."
Writing in 1931, the Emmanuel leaders could report, "On the whole our successes have been far more frequent than our failures." This statement was made with the perspective of twenty-five years of experience in the movement.
There are many points at which the Emmanuel approach was superior in theory and practice to the evangelistic approaches. While recognizing the importance of group experience, the Emmanuel approach also supplied individual psychotherapy. This combination of individual and group therapy represents an obvious advance over the mass evangelistic approaches. As the Emmanuel approach came to incorporate psychoanalytic procedure in its therapy, it dealt to some degree with the underlying causes of inebriety, rather than simply relieving or changing symptoms. Worcester’s observation that alcoholics respond best to relatively brief therapy concurs with modern findings.
The Emmamuel approach achieved an integration of the healing resources of medicine, psychology, social work, and religion. In the Salvation Army we saw a certain eclecticism in which the resources of other professions were drawn on as supplements to the basic religious approach. In contrast, the Emmanuel workers saw medicine, psychology, and social work as integral parts of a total "religious" approach to healing. The medical and psychiatric screening of patients not only protected the church clinic but also improved the possibility of a favorable outcome.
The goal of Emmanuel therapy - to promote the freedom and growth of the individual by releasing inner resources, in contrast to authority-centered approaches,- is in keeping with the healthy needs of the alcoholic. We have seen that alcoholics often have neurotic needs which encourage the formation of immature dependency relationships. Their healthy needs are for increased self—esteem and constructive autonomy. In contrast to previously studied approaches, which encouraged dependency and surrender to authority, Emmanuel thought encouraged independence and growth in responsibility. Worcester shunned the use of exhortation and persuasion as being "wholly out of place in treatment." They may provoke opposition on the patient’s part, or, they may even be dangerous, because they impose the teacher’s personality and philosophy on the patient instead of allowing him to find freedom and to discover a better way of life for himself."
Instead of depending on religious thrill and a sudden, dramatic conversion, Emmanuel therapy relied on the gradual type of religious change. It seems clear that Emmanuel’s psychotherapy offered greater possibility of lasting change than was true of the evangelistic approaches. The Emmanuel workers recognized that evangelistic approaches have value for some alcoholics; they also saw that many alcoholics cannot be reached by those approaches. Powell, an Emmanuelite, wrote: "While men like Gerry McAuley and the Salvation Army leaders have done something, the emotional motive which they use does not avail in every case."
The Emmanuel approach recognized fully that the alcoholic needs individual and group support during his recovery. The "friendly visitor" system combined the principle of A.A. sponsorship with the resources of a social caseworker. Undoubtedly this friendly, individual attention and help were major factors in the success of the approach.
The approach was well equipped to help the alcoholic find real self—acceptance and release from guilt. Its superiority lay in its splendid conception of alcoholism and its understanding of the psychodynamics’ of human behavior. Twenty—seven years before A.A. began, this approach was regarding alcoholism as a disease to be treated like other functional diseases. In this early period there was a degree of moralism connected with the conception of all functional illnesses. The influence of psychoanalytic concepts gradually removed this moralism, revealing the manner in which behavior is conditioned by early experiences and by unconscious forces which are not subject to the will.
The therapy sought to reduce the alcoholics’ guilt rather than to enhance it as in the previous approaches. It achieved this by its disease conception of alcoholism and its positive conception of man, allowing the therapist to establish a nonjudgmental relationship with the patient. By means of his acceptance of the patient, the therapist was able to help the patient achieve self-acceptance. Self-acceptance, it is well to remember, implies a sense of being accepted by life. This the Emmanuel therapist was well equipped to convey because of the positive, life-affirming philosophy and theology of the movement. There is a sense of course, in which the experience of "accepting oneself as being accepted," to use Paul Tillich’s description of salvation, results from any psychotherapy which is successful. Emmanuel therapy apparently was frequently able to convey this experience. When guilt is reduced, the energies previously employed in the guilt and self-punishment process are freed and made available for therapeutic ends.
Forgiveness was achieved in Emmanuel therapy not by petitioning an authoritarian Deity, but by modifying the unmerciful superego of the patient. McComb wrote as follows concerning what he called the "New England or Quaker conscience":
"The great need here is for a new conception of God. The mind must be taught to rest in his fatherly love, in his tenderness and grace. . . .By the constant presentation to the mind of these ideas the conscience is gradually lightened of its morbidity and the will is set free to act."
Rather than concerning itself with specific "sins," the Emmanuel approach focused attention on the underlying causes of these symptoms - namely, the sick personality. This also aided in reducing the alcoholic’s guilt load. In addition, the psychoanalytic concept that alcoholic behavior is determined in large measure by subconscious factors (beyond the realm of willpower) had a tremendous guilt-reducing effect. The positive conception of man and the recognition that his drives and feelings are not inherently evil both contribute to healthy self-acceptance on the part of the patient. Likewise the conception of the healing process as resulting from the release of inner resources (as contrasted with external divine intervention) tends to enhance self—esteem by enabling the patient to feel a sense of achievement in his improved condition. It also serves to keep the responsibility for healing with the patient. The alcoholic’s inferiority is reduced not by identifying with a powerful authority-figure, but by becoming aware of his "higher and diviner self" which is his most real self.
The Emmanuel workers recognized clearly that religious symbols can be employed in ways that promote maturity and health. They threw their influence behind the latter. As a result we do not find the emphasis on fear and guilt which was present in the previous approaches.
With only minor changes, the mature Emmanuel concept of alcoholism would be acceptable in the most enlightened circles today. In one way it was superior even to the A.A. conception. Because of its orientation in depth psychology, it recognized that the selfishness and egocentricity of the alcoholic are actually symptoms of deeper problems and conflicts. This is in contrast to the A.A. position which does not seem to recognize the symptomatic nature of selfishness. (It should be added that many individual A.A.’s, particularly those who have had psychotherapy, do recognize the nature of selfishness.) Because of deeper understanding of personality, the Emmanuel therapy was beamed more accurately at the roots of alcoholism than is the A.A. therapy. Its use of psychoanalytic techniques in its therapy provided it with the practical means of getting at these underlying causes. Such techniques are not present to any great degree in A.A. The Emmanuel approach was superior to A.A. in that it made individual as well as group therapy available to the alcoholic. Further, because of its psychoanalytic grounding, it was less repressive than A.A. in its attitude toward the self.
In spite of its areas of theoretical superiority, it seems probable that from a practical standpoint, Emmanuel was less effective than A.A. Its therapy was less adequate than A.A. in that it lacked an all-alcoholic support group. Further, it did not capitalize fully on the recognition that helping other alcoholics help the alcoholic patient to stay sober himself. Nor did it capitalize on its recognition that one alcoholic has a natural entree to another. Even though its goal was nonauthoritarian, its therapy was dispensed by an authority figure. It lacked the advantage of A.A.’s self-help orientation, particularly the feeling on the part of the A.A. member - "We’re licking this thing ourselves" and "This is our fellowship." Since the Emmanuel approach was dependent on professionals, the number of alcoholics who could be helped was quite limited as compared to A.A.
The central weakness of the Emmanuel approach to alcoholism would seem to be the use of suggestion. Although Worcester’s therapeutic aim — increasing the freedom of the patient - was psychologically sound, his method actually defeated his aim. The thing that was not recognized was that suggestion is an essentially authoritarian tool, that it substitutes the authority of the "suggester" for the autonomy of the individual, thus establishing an unconstructive dependence on the therapist. The Emmanuel workers did not realize that the "strengthening of the will" which they observed in alcoholic patients was actually the result of the projection of their authority on the patient. Carl R. Rogers includes suggestion under "Methods in Disrepute" in his discussion of counseling. He writes:
"The client is told in a variety of ways, "you’re getting better," "You’re doing well," "you’re improving," all in the hope that it will strengthen his motivation in these directions. Shaffer has well pointed out that such suggestion is essentially repressive. It denies the problem which exists, and it denies the feeling which the individual has about the problem."
It should be noted that suggestion was generally accepted as a therapeutic device during the early period of the Emmanuel movement. In fact, medical schools were teaching the technique as a healing tool. As we have seen, the Emmanuel workers put decreasing emphasis on suggestion as their knowledge of psychoanalysis increased. Though their methodology became relatively less repressive, it would seem probable that the effectiveness of their psychoanalytic procedures must have been vitiated in part by the continued use of suggestion.
Worcester was insightfully accurate in recognizing the two levels of alcoholism and in his belief that something had to be done to hold the addiction in check while psychotherapy sought to deal with the underlying causes. Unfortunately, the device he employed (suggestion) impeded the effectiveness of the psychotherapy.
Why did this movement not survive? First, it was centered around two strong and unusual personalities. There were few clergymen with the kind of training and general qualifications possessed by Worcester and McComb. Apparently the movement was not successful in training younger men to carry on the tradition. Second, the fundamental methodological weakness of the movement may have contributed to its demise. The continued use of a repressive device like suggestion over a long period of time may have resulted in diminishing enthusiasm and decreasing therapeutic return. Of course there is a sense in which the movement continues in its influence on the clergymen whose interest in psychotherapy and healing was stimulated by their contacts with the movement, its literature, or others who had felt its influence.
What We Can Learn from the Emmanuel Approach
The Emmanuel Movement was the first organized attempt to apply the joint resources of psychology and religion to the problem of alcoholism. Its degree of success suggests the
possibilities that lie in this direction. It was the first approach to understand and seek to treat the underlying causes of alcoholism. In spite of its methodological error, its general orientation was positive and life-affirming, so much so that its critics labeled it "hedonistic." The practical values as well as the psychological validity of this outlook have been discussed in our evaluation.
This approach provides an impressive demonstration of the importance in dealing with alcoholics of one’s conception of alcoholism and the human situation in general. In its understanding of the psychodynamics’ of alcoholism and its incorporation of psychoanalytic insights and methods, this approach was decades ahead of its time. In these regards, as in the handling of the problem of guilt and responsibility, the Emmanuel Movement has a great deal to teach many religious leaders today. Among other things it provides an example of the way in which a psychoanalytic orientation can mediate the acceptance of God, thus enhancing self—acceptance. As we have seen, it did this, not by encouraging surrender to an external deity, but by resolving inner conflict, thus releasing God-given resources within the personality. The resolving of inner conflict was achieved through psychoanalytic techniques which were based on a recognition of the dynamic significance of the unconscious and by an actual accepting relationship with one of God’s children, the therapist.
The Emmanuel Movement pioneered in the field of church-sponsored psychotherapeutic clinics. Its story should cause organized religion to reflect on its general role in a society plagued by widespread neurosis and inadequate facilities for treatment. Startled by the overwhelming influx of patients, the Emmanuel leaders wrote:
"The mere fact that disinterested clergymen and physicians were willing to be consulted.. . .has brought persons to us in such numbers that, although we have a good-sized staff, it is impossible for us to see one person in five for a single conversation. This one fact should cause the Church to reflect. Why should there not be adequate assistance for men and women who desire and need personal, moral and spiritual help?"
Although this was written many years ago, the question is still relevant and pressing in our day. A partial answer is emerging in the pastoral counseling movement and the two hundred or so church-related counseling services which have been established in recent years.
Reproduced in whole from the book Understanding and Counseling the Alcoholic by Howard J. Clinebell, Jr. (1956)