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Psychotherapy in the twenty-first century.

I am pleased to be part of this series, taking stock of the past and looking into the future of psychotherapy at a time that many have imbued with great significance. As with many historical demarcations, the beginning of a century or a millennium is a somewhat arbitrary point of punctuation. A case can be made that the twentieth century, in a coherent and meaningful rather than numerical sense, began in August 1914 rather than in January 1900; that the nineteenth century (at least for Europe) began with the defeat of Napoleon and ended with the collapse of the century-long relative peace that World War I so terribly shattered; or that "the sixties," that decade so meaningful in our recent history, began around 1964 and ended about 10 years later. In similar fashion, the "new millennium" in psychotherapy may have begun around twenty or twenty-five years ago or may not yet have arrived. As in the process of psychotherapy itself, these meanings and boundaries must be constructed; they are not given. FROM PSYCHOANALYTIC HEGEMONY TO VITAL MULTIPOLARITY I suggest that the "new millennium" may have already begun for several reasons. There are a number of ways in which, for the past two or three decades, the progress of psychotherapy has departed in important and interesting ways from its earlier roots. To begin with, for most of the twentieth century, the story of psychotherapy was very largely the story of psychoanalysis. In recent decades, this is decidedly no longer the case. For some time now, psychoanalysis has been in decline in terms of its pull or special status with both practicing therapists and the public at large. This is by no means to imply that psychoanalysis is no longer important or influential-or even that its vitality as a source of new ideas has declined; indeed, psychoanalysis has been more vital in certain ways in the last two decades than it was during its period of hegemony in the middle decades of the century. However, family therapy and cognitive-behavioral therapy, movements that essentially began early in the second half of the century, had matured by its last quarter to the point where they were clearly equal partners in the therapeutic enterprise (or, to offer a metaphorical parallel with international affairs, where they were clearly "superpowers" in their own right). The "new" millennium or century, thus, may be seen as the period that began with the establishment of a multipolar rather than hegemonic structure to the psychotherapeutic world, a structure in which strong "regional powers" (e.g., the humanistic-existential-experiential approaches) also exerted considerable influence. Further demarcating the "new millennium" as beginning well before the year 2000 was the emergence of pharmacological therapies as a powerful competitor for all the psychotherapeutic approaches. Much like family therapy and cognitive-behavioral therapy, the systematic, medicalized use of pharmacological agents for purposes of addressing psychological distress arose in the middle of the century and reached a position of great importance in the last quarter. (The unsystematic or nonmedical use of chemical agents to relieve psychological distress or alter people's psychological state, of course, stretches back before recorded history, and was an important part of almost every society long before the modern profession of psychotherapy cut its first teeth.) THE EMERGENCE AND IMPORTANCE OF AN INTEGRATIVE POINT OF VIEW Finally, the trend, also emerging in the last quarter of the century, that I most wish to highlight as demarcating a "new millennium" in psychotherapy is one that I nominate both with conviction and with clear awareness that my nomination is self-serving. I refer here to the movement toward integration of these disparate theories and methods, and I acknowledge the potentially self-serving nature of this selection because it is a movement with which I have been very closely associated. …