‘Peace and happiness await us’: Psychotherapy in Yugoslavia,1945–85

Psychotherapeutic practice in Yugoslavia in the early post-WWII period

Prior to WWII, talk therapy enjoyed some limited success in entrenching itself as a mental health intervention in what was then the Kingdom of Yugoslavia. A handful of practitioners in Belgrade and Zagreb, most of whom had undergone training in the major psychoanalytic centres of Central Europe, helped to bring psychological theories of mental illness to the profession and the public. Both the Yugoslav Society for Mental Hygiene (founded in 1932) and the Belgrade-based Psychoanalytic Society (founded in 1938) represented practitioners interested in utilizing talk therapy with patients. These groups were small, numbering less than a dozen members in the case of the Psychoanalytic Society, and served an important function by providing training opportunities as well as potential patients through their public education initiatives. The broadly left-wing agenda of these groups sometimes clashed with that of the authorities; the Psychoanalytic Society, for instance, was forced to move its meetings underground after being banned from meeting at the University of Belgrade. Fellow psychiatric practitioners, most of whom hewed closely to neurological interpretations of mental illness, were also not always enthusiastic in their dealings with these psychoanalytically oriented groups. As Ana Antić’s exceptional research reveals, leading psychiatrists in interwar Yugoslavia largely repudiated non-organic approaches, eschewing those methods that ‘purport to analyze all secret mechanisms hidden in individuals’ (Stanojevic, 1929, quoted in Antić, 2012: 34).

The war and subsequent upheaval devastated the small community dedicated to establishing psychologically focused psychiatry. The German occupation and concurrent rise of the fascist Independent State of Croatia severely weakened the movement, especially since its membership was disproportionately comprised of Jews. For instance, Nikola Sugar, Belgrade’s leading psychoanalytic advocate, was deported and killed at Theresienstadt, and several others perished in what was a particularly brutal conflict within the Yugoslav lands. Neither the Psychoanalytic Society nor the Society for Mental Hygiene survived the war. The few remaining psychoanalysts then had to deal with a post-war political climate in which Freud’s ‘bourgeois’ theories were sometimes framed as inimical to Marxism (Savelli, 2013). Although psychoanalysis was never completely banned, some medical authorities linked to the newly established Communist government aped efforts elsewhere to ‘Stalinize’ medicine, including attempts to disqualify psychodynamic treatment on ideological grounds. ⁴ Although the situation would change after Yugoslavia’s break from the Soviet sphere in 1948, psychoanalysis was generally shunned during the early post-WWII period, carrying the connotations of being a bourgeois pastime unfit to meet the newly socialist country’s pressing health needs.

Thus, in the immediate post-WWII period, psychotherapeutic psychiatry seemed to be facing a grim future in Yugoslavia, with few practitioners, virtually no remaining professional structure, and important figures in the ruling Communist Party taking a relatively hostile view towards it. To make matters worse, many of the most influential psychiatrists of the time, including Belgrade’s Vladimir Vujic (vice-dean of the country’s largest medical school) and Sarajevo’s Nedo Zec (who doubled as Bosnia’s new Minister of Health) heavily favoured biological interpretations of mental disorder. A number of other high-ranking practitioners had trained abroad under organically focused luminaries such as Richard von Krafft Ebing and Julius Wagner-Jauregg, and the tendency to approach mental illness as a material problem of the brain, rather the mind, culminated in the conjoining of neurology and psychiatry into a single discipline – neuropsychiatry – in 1948. Vujic, whose own research focused on larval encephalitis, was tasked with drawing up plans for how the country’s medical schools were to train neuropsychiatric specialists. As critics of the plan would point out, it skewed heavily towards organic, neurological approaches, with psychological and behavioural conceptions receiving short shrift. ⁵ Although the conjoining of neurology and psychiatry would stay in place until the 1980s, practitioners ultimately tended to drift towards specialization in one area over another. Among those that favoured psychiatry, as the next section will demonstrate, many would eventually align themselves with psychological approaches to psychiatric treatment, despite these early hindrances.

Carving out space for psychotherapy

The shift towards widespread use of psychotherapy in Yugoslav psychiatry occurred slowly and relied heavily upon the efforts of a few dedicated practitioners, most of whom built and maintained ties to the psychotherapeutic movement abroad. In Serbia, Vojin Matic was an early leader in this regard. Like other practitioners of his generation, he received a post-war World Health Organisation stipend for international study, using it to train in Paris under the tutelage of giants of the French psychotherapeutic world, notably Georges Heuyer, Rene Diatkine and Serge Lebovici. These connections would have far-reaching consequences for Yugoslav psychotherapy as a number of Matic’s students, including Nevenka Tadic and Svetomir Bojanin, were also sent to train under Diatkine and Lebovici (Bojanin, 2008; Stajner-Popovic and Vuco, 2000; Tadic, 2010). The Parisian experience of these individuals would shape their decision to specialize in child psychiatry and, in time, psychodynamic approaches to children’s mental health would become a Yugoslav specialty. On his return from Paris, Matic combined clinical work with a teaching position at Belgrade’s Medical Faculty although he did not last long, being removed from that post either due to interpersonal quarrels or because of his inability (both personally and professionally) to fit into the new social system of post-war Yugoslavia (Bojanin, 2008; Tadic, 2010;Vuco, 2008).

In 1953, Matic founded the Medical Pedagogical Counseling Center, a psychodynamically oriented therapeutic service for children that utilized a team-based approach to care. The institution proved very successful, being the only one of its type in Eastern Europe, and attracted patients from across Yugoslavia (Klajn, 1989: 62). Matic spent the next decade training members of his staff along psychodynamic lines, many of whom would go on to transmit psychotherapeutic knowledge to other practitioners across the country. In 1963, however, local governmental authorities forcibly closed the institution. Again, the circumstances around this closure are somewhat opaque. Apparently Matic was simply informed that ‘our society has no need for this type of institution’, although the exact meaning of that statement was unclear (Stajner-Popovic and Vuco, 2000). According to Petar Klajn, a psychoanalyst who completed an insider’s retrospective examination of psychoanalysis in Serbia, jealous rivals had attacked Matic’s ‘decadent, bourgeois’ approach to treatment (Klajn, 1989: 62). After the closure of his institution, Matic continued to train students secretly at his apartment, taking token payments of cash or coffee in return for access to the world of psychodynamics. Although this practice never completely abated, Matic eventually found legitimate employment at the newly established Institute for Mental Health, which opened in 1963, effectively replacing Matic’s former Medical Pedagogical Counseling Center. The institute’s new director, a respected Communist party member named Slavka Moric-Petrovic, brought most of Matic’s old staff directly to the new institute. At the request of his former staff members, she also agreed to bring Matic on to the institute’s payroll (Bojanin, 2008). Thus, despite Moric-Petrovic’s personal inclination for studying the genetics of psychiatric illness, the new Institute for Mental Health – which would become one of the country’s leading research institutions and treatment centres – now had a strong contingent of psychotherapeutically oriented practitioners.

Beyond the Institute of Mental Health, the psychotherapeutic department of the Dragica Misovic Hospital formed Belgrade’s other major bastion of talk therapy. It was founded in 1956 under Vladimir Klajn, a high-ranking member of the Communist party and military establishment, who had been a participant in pre-war psychoanalytic circles. Patients on the ward participated in four psychotherapy sessions per week, in addition to two group sessions. Relationships on the ward were imagined through the lens of psychoanalytic transference (Klajn and Petrovic, 1957: 37). ⁶ Although psychopharmaceuticals were utilized, they were prescribed mainly as aids to enable the psychotherapeutic process (Klajn and Petrovic, 1957). Klajn’s department became well known within the capital and many members of the intelligentsia apparently sought out treatment at Dragisa Misovic (Brzev-Curcic, 2010). In addition to taking patients, Misovic was a training hospital; the psychotherapeutic ward hosted dozens of classes and seminars that attracted large numbers of mental healthcare workers from across Yugoslavia (Klajn, 1979). The staff offered trainees a broad grounding in psychotherapeutic concepts and many practitioners favourable to psychodynamic concepts learned their craft there (Brzev-Curcic, 2010). ⁷ Like those in Matic’s children’s centre, the staff of the Misovic psychotherapeutic ward helped to embed psychotherapeutic techniques into the mainstream of Yugoslav psychiatry.

In Croatia, meanwhile, Stjepan Betlheim worked tirelessly to promote psychotherapy. Prior to WWII, Betlheim had spent time in Vienna with a list of mentors that reads like a roll-call of Freud’s inner circle. Paul Schilder was his primary analyst, but he also worked with Sandor Rado, Helene Deustch and Karen Horney. Schilder introduced him to Freud himself, and Betlheim became a member of both the Viennese Psychoanalytic Society and the International Psychoanalytic Association. When WWII arrived, he joined Tito’s partisans, devoting much of his attention to the problem of war neurosis. After the war, Betlheim helped usher in a new generation of psychotherapists, using his reputation and credibility with the authorities to give psychodynamic ideas more credence. He took the first steps in this direction when he arrived at Zagreb’s Medical Faculty in 1948 and introduced psychodynamic theory into the student curriculum. In addition to spreading the psychoanalytic gospel to other medical practitioners, he began publishing work that demonstrated a wide breadth of psychodynamic concepts and techniques in his therapy, ultimately producing dozens of articles and book chapters on psychotherapy. During the 1950s, he commenced work with his first generation of students, most notably Duska Blazevic, Eugenija Cividini-Stranic, Eduard Klain and Neda Bucan.

Although, as outlined previously, other practitioners initially frowned on his proclivity for talk therapy and psychological interpretations of mental illness, Betlheim managed to convert a section of the neuropsychiatric clinic at Rebro into a full-blown department for psychotherapy in 1953. Alongside his closest students, Betlheim began to work with individuals and groups, primarily along psychoanalytic lines. These students, who would take on the psychoanalytic mantle on Betlheim’s death in 1970, described this early, difficult period:

It was a pivotal moment for Yugoslav psychotherapy. In a very difficult and unfavourable work climate, he [Betlheim] assembled a group of enthusiasts with whom he discussed and worked, people that he taught, with whom he investigated and analyzed such dilemmas…He taught us to prize humility and perseverance in work…This department became a model for psychiatry across the country, which was in the first case inspired by his soul…a spirit that says that psychoanalysis and psychotherapy are medicine and treatment, not simply literature. (Suradnici, 1970: 121)

Among psychotherapists, discussions about some sort of formal structure to delineate themselves from ‘normal’ psychiatrists began in the 1960s, with Betlheim acting as a central actor in this regard. At the profession’s annual Neuropsychiatric Congress held at Ohrid in 1964, the first large-scale discussions towards this end took place. Consequently, many republics formed their own domestic psychotherapeutic groups within larger medical societies (such as the Zbora Lijecnika Hrvatske and the Srpskog Lekarskog Drustva). Finally, in 1968, the various component societies joined to form the Association of Psychotherapists of Yugoslavia (Udruzenja Psihoterapeuta Jugoslavije). With this link firmly established, the size and frequency of educational meetings, training seminars, and academic conferences steadily increased – all of which had the effect of further cementing the importance of talk therapy to Yugoslav psychiatry (Popovic and Rakic, 1979). Perhaps the ultimate consequence of this display of unity, in the reckoning of Vladislav Klajn, was that psychotherapy in Yugoslavia was finally reconciled with mainstream medicine, signalling a defeat of strictly organic approaches to understanding the human psyche (Klajn, 1979).

Talk therapy, despite the early threats against its continued existence, was simply not going away. And as new threats appeared, as was the case with growing interest in the chemical imbalance theory of mental illness, psychotherapists were in a good position to head off the challenge. For example, Vladimir Hudolin (one of the country’s leading experts on alcoholism) used his position as chair to open up the 13th International Congress of Psychotherapy by restating the case for psychotherapy:

Is psychotherapy still relevant amid this obsession with neurotransmitters? Something tells me that simply getting our neurotransmitters in check is not going to solve the threat of nuclear war, nor can it solve our difficulties in family life or how we cope with our surroundings. This focus on neurotransmitters is dehumanising, threatens to take away the ‘spice of life’ and turn us into robots instead of distinct personalities. Peace and happiness await us somewhere in the distant future and at that level psychotherapy can act. (Hudolin, 1985)

Theoretical and practical currents of Yugoslav psychotherapy: Brief psychotherapy and group treatment

In some regards, the constraints placed upon Yugoslav practitioners did not look any more onerous than those facing psychiatrists across much of Europe. Aside from those first few post-war years, Yugoslavs could study psychoanalysis without substantial fear of repression. They had the ability to travel and live abroad for the purposes of training, and the intellectual climate was generally free enough to permit widespread debate and prevent the development of any dominant ‘line’ in psychiatric thinking. Nothing like the infamous Pavlov session ever occurred within Yugoslav psychiatry. At the same time, however, certain factors also conditioned its development in ways that differed greatly from most of Western Europe. For one, private practice was typically outside the boundaries of legal and professional acceptability, so the upper-middle-class segment of the population that tended to provide psychotherapeutic clients elsewhere was severely diminished. Moreover, psychiatric resources (both material and personnel) were scarce and, although permitted, psychoanalysis was still somewhat tainted by suspicions about its bourgeois foundations. These local specificities would play important roles in shaping both the theoretical and practical application of psychotherapy in Yugoslavia.

The academic structure of Yugoslav psychiatry in the early post-war decades guided the discipline in the direction of psychotherapy. Practitioners with psychodynamic leanings occupied important training posts across the country, especially in Zagreb and Belgrade. People like Milan Popovic, Stjepan Betlheim, Vojin Matic, and Vladislav Klajn all held high-ranking positions in research institutions and medical faculties, enabling them to cast influence over medical students and young practitioners. Their psychoanalytic sympathies may not have transferred entirely to their students but the climate they engendered exposed people to the principles of the talking cure. The most widely used psychiatry and psychology textbooks included substantive sections devoted to psychotherapy. For instance, in his overview of forensic psychopathology published in 1960, Jevtic gave considerable space to the theories of Freud, Adler and Jung; in his view, learning Freud was fundamental to any aspiring forensic psychiatrist (Jevtic, 1960). In another example, large sections of the seminal psychiatric textbook Psihijatrija (first published by Medicinska Knjiga in 1963) were written by avowed psychoanalysts: Betlheim (a co-editor) tackled the sections on mental hygiene, neuroses, psychotherapy, psychopathy and sexual perversions whereas his closest student, Duska Blazevic, wrote the chapter on schizophrenia (Lopasic, Bethlheim and Dogan, 1963). Over time, the key precepts, concepts and ideas that lay at the heart of psychological models of mental illness elsewhere became common within mainstream Yugoslav psychiatry, with interest in psychotherapy going well beyond psychodynamics. Textbooks and professional journals provided practitioners with the theoretical and practical know-how to implement a variety of talk therapy interventions, including cognitive therapies associated with Beck and Ellis, Gestalt therapy, Frankl’s logotherapy, and Rogers’ client-centred approach to treatment, among others. In short, both the curriculum and training available to aspiring practitioners drew heavily from across the world of psychotherapy, offering a plethora of possibilities for how to use talk-based treatment to alleviate patients’ suffering.

Of course, more practical requirements also conditioned the development of psychotherapy. One of the hallmarks of Yugoslav mental healthcare was a reliance on ‘brief psychotherapy’, a modality built chiefly upon psychodynamic principles but lacking the depth of classical analysis. For economic reasons, applying brief psychotherapy made perfect sense. Although it is difficult to determine the exact number of patients who made use of psychotherapeutic service, it is clear the number of patients far outweighed available practitioners (a complaint frequently made by psychotherapists). Moreover, the amount of time required for true psychoanalysis was simply unavailable. Although there was no consensus in terms of exactly what ‘brief psychotherapy’ meant, it generally involved meeting patients less frequently, less intensively and for fewer total sessions than ‘proper psychoanalysis’, which might usually have required years of weekly (or even daily) meetings. In light of the relative shortage of psychotherapists, there was some hope that the tools of short-term psychotherapy could be utilized by other types of medical practitioners. Betlheim, for instance, pushed for general practitioners (GPs) to learn to apply this method, but cautioned that any practitioner had to possess a sound knowledge of key Freudian concepts to properly conduct such treatment (Betlheim, 1967: 7–18). As other commentators were keen to point out, however, physicians had leeway in choosing how to apply brief psychotherapy and it was not necessarily psychoanalytic in its implementation; some therapists, echoing trends elsewhere in the world, tended to focus on the ‘here and now’ rather than the world of childhood conflicts (Kobal and Bregent, 1979).

In time, brief psychotherapy established itself as a widely used intervention. Despite this fact, those who used it felt the need to defend it from (imagined) detractors, although it was never clear who the doubters were – perhaps members of the older organic establishment or more practitioners of classic analysis. For example, one physician detailed the history of a patient who, after 25 sessions of short-term psychotherapy, was largely cured of her depression and conversion neurosis. His stated aim in writing the article was simply to demonstrate the efficacy of less intensive forms of psychotherapy (Markovic, 1969: 93–8). From Slovenia, meanwhile, Milos Kobal and Leopold Bregent vociferously defended the usage of brief psychotherapy by invoking Freud. They argued that even the great master himself had essentially used short-term psychotherapy for all of his patients after Anna O (Kobal and Bregent, 1979). As therapy occurred primarily in state-funded institutions, the decision about whether to permit practitioners to utilize this abbreviated form of talk therapy rested primarily with the hospital or institute director (Tadic, 2010), and it is clear that few of them had any sort of reservations about brief psychotherapy, as it was widely established by the late 1960s.

The other defining characteristic of Yugoslav psychotherapeutic practice was a proclivity for group psychodynamic therapy. The economic advantage of such a practice was obvious, because groups of multiple patients could be treated in the same amount of time it would take to work with a single patient. For a system burdened by a high patient to practitioner ratio, group psychotherapy was thus a near-perfect match. Beyond this economic logic, philosophical justifications were equally important. Yet whereas Christine Leuenberger (2001) has demonstrated that, in the case of the GDR, group therapy was seen as more ideologically sound than some alternatives, its appeal to Yugoslav practitioners instead reflected the strength of Yugoslav psychiatry’s links to the international community of researchers dedicated to exploring social psychiatry and social psychology.

Training abroad was a rite of passage for most high-profile psychiatrists in Tito’s Yugoslavia, with scores of practitioners heading to the UK, France, West Germany, and the USA to study. Although the aforementioned group of child-focused psychotherapists gathered around Vojin Matic orbited Paris, a much larger nexus made London their base. From the late 1950s until Yugoslavia’s collapse in the early 1990s, at least two dozen practitioners spent time at important centres of British psychiatric thought, including the Tavistock Institute and the Maudsley Hospital, among others. Among those UK-based theorists who left the deepest impression on the visiting Yugoslavs were those interested in their patients not only as individuals but as products of, and participants in, their social context. These practitioners – Maxwell Jones, Joshua Bierer, SH Foulkes, Wilfred Bion, among others – dedicated themselves to trying to understand and treat individuals as constituent components of the broader social environment. ⁸ Collectively, they were part of a vanguard of theorists determined to place social groups and society itself under the psychiatric lens. For instance, Jones helped pioneer the concept of the therapeutic community, whereby treatment spaces saw the traditional hierarchies that undergirded mental healthcare subverted by the democratic process, so that patients played a more active role in shaping hospital life and their own treatment. Bierer, on the other hand, was among the first to experiment with open-door psychiatric facilities and to organize post-treatment social clubs for former patients, later acting as a sort of figurehead in the international social psychiatry movement. Bion and Foulkes, meanwhile, were both associated with the famous Northfield Experiments that yielded important theoretical and practical discoveries about the practices of analytically oriented group psychotherapy. Foulkes, in particular, galvanized interest in group psychotherapy by co-founding the Group Analytic Society and the Institute of Group Analysis in London, as well as the newsletter-cum-journal, Group Analysis – International Panel on Correspondence. Although they may have disagreed on its exact meaning, these men helped bring the concept of social psychiatry to the profession’s attention, even if only temporarily.

In Yugoslavia, however, their theories were no mere flashes in the pan. Through personal and professional relationships, they left lasting impressions on a number of influential Yugoslav psychiatrists and affected many more through their texts, which were widely read. ⁹ Among the most important consequences of these connections was a shift towards group psychotherapy, which would ultimately be entrenched as a major specialty of the field in Yugoslavia. From the perspective of these Yugoslav practitioners, grounded in both social psychiatry and the precepts of group analysis, mainstream psychiatry did itself a disservice by overemphasizing the individual as the locus of study and treatment. Human beings were, in their view, inherently interconnected in systems ranging from the family to the workplace to society more broadly (Savelli, 2011). If the raison d’être for mental health treatment was to equip a person for a return to society, group therapy was surely better preparation than a single spot on a therapist’s couch.

The first publicized discussions of group psychotherapy in Yugoslavia appeared in the early 1950s. In an early issue of Neuropsihijatrija (the first post-war journal devoted entirely to psychiatry), Betlheim and his prize student, Duska Blazevic, introduced the practice by describing their own experiences with group psychotherapy. They had taken 15 patients who had not responded to somatic treatments for their problems with impotency and used group talk therapy over a period of seven months. In their view, having a male and female therapist present for the sessions provided an ‘intimate setting’ for group discussion, something that prompted patients to respond much better than they had in individual treatment (Betlheim and Blazevic, 1953). For one, patients in the group offered substantially less resistance to the idea that their illness was psychogenic in origin. Moreover, the group setting made it easier to treat the patients’ transference issues. Such a practice was not without problems, however, and some of the patients, particularly those who were less well educated, had trouble comprehending the key theoretical concepts despite efforts on the therapists’ part to avoid introducing psychodynamic jargon. On the whole, they recommended further experimentation with group analysis, but urged that highly neurotic individuals still be seen individually (Betlheim and Blazevic, 1953).

Although the dynamics of group therapy differed from individual treatment, these early practitioners found that many of the same tools and processes could be harnessed in its practice. To take one example, Betlheim utilized dream interpretation heavily in his work with groups (Betlheim, 1957). Despite his status as the expert authority, he found that patients often agreed more with the interpretation of fellow group members than that of the therapists, leading to new insights. The group setting also demonstrated its value by offering extra encouragement for reluctant members to come forth with dreams, even if resultant interpretations were sometimes superficial (Betlheim, 1957). Leaning heavily upon the analytically oriented group treatment practiced by both Foulkes and Bion, Betlheim’s approach substantially widened the indications about who was an appropriate candidate for group psychotherapy, ultimately paving the way for its expansion in Yugoslavia.

Not everything proceeded smoothly, of course, and among the early conundrums faced by Betlheim and Blazevic was the question of how to determine the characteristics of a workable group. Early experience demonstrated that considerable thought and caution had to be put into the formation of therapeutic groups, since one individual had the potential to threaten the success of treatment for the entire group (Blazevic, 1956: 99–116). To this end, they settled on the idea that groups should be modelled on the family, with therapists acting as ‘parents’ and patients as the ‘children’. Betlheim had found that the use of ‘co-therapists’ changed the transference dynamic because, rather than occupying both roles as was common in individual therapy, the male therapist came to represent the paternal image whereas the female therapist occupied the maternal role (Betlheim, 1957). In terms of patients, difficulties arose when one exhibited behaviour reminiscent of an only child, demanding the therapists all to themselves (Betlheim, 1968). For Blazevic, meanwhile, the family was the most important group in terms of personality development, so it simply made sense to try and replicate it in the hospital (Blazevic, 1968). In later work, two of Betlheim’s other students, Eugenija Cividini-Stranic and Eduard Klain, encouraged their fellow psychotherapists to think outside the family dynamic, suggesting that the use of mixed-sex co-therapist pairs could be formulated to serve as different types of people from the patient’s past and not merely parental figures (Cividini and Klain, 1968).

The other major preoccupation of this early period was the issue of how to manage and interpret transference within a group setting. This psychoanalytic concept, describing how participants ‘transfer’ their unconscious feelings about one person (e.g. a parent) onto another – in this case the therapist or a fellow group member – became a central thread of discussion as Yugoslav therapists tried to work out the secret to successful group psychotherapy. By the 1960s, roughly a decade after Blazevic and Betlheim had introduced group practice, practitioners from across the country flooded journals and conferences with research articles about the experience of group therapy. ¹⁰ For instance, the 1968 meeting that brought the country’s psychotherapists together focused specifically on the issue of group therapy, with transference representing the most discussed topic of the meeting. After some strained debate, the conference came to the unanimous conclusion that transference and counter-transference represented the single most important issue for developing group psychotherapy within Yugoslavia (Muacevic, 1968), although no resolution to this issue was ever achieved.

As the meeting demonstrated, group psychotherapy was firmly entrenched by the late 1960s. Betlheim had been able to use his personal relationships with individuals such as SH Foulkes and Henry Ezriel (both at the Tavistock), as well as his own training analyst Paul Schilder (who helped bring group psychotherapy to the USA), to ensure that his students (Blazevic, Cividini-Stranic, Klain and others) had access to training opportunities and literature from abroad, with institutions in Zagreb, Ljubljana and Belgrade holding subscriptions to the major periodicals, including the International Journal of Group Psychotherapy and Group Analysis. Yugoslavs eager to study group psychotherapy continued to make trips to the Institute of Group Analysis in London, reporting back on the latest developments (Cividini-Stranic, 1976; Kulenovic, 1985), and members of the group analytic movement also arrived from abroad. In 1977, for instance, the Centre for Mental Health (which had grown out of the psychotherapeutic unit opened by Betlheim at Rebro Hospital) hosted a workshop for more than fifty psychiatrists, psychologists, and social workers. They arranged for Jim Home, a founding member of the Group Analytic Society, to come to Yugoslavia and lead training groups for the attendees. ¹¹ Over subsequent years, the links between the Yugoslav cadre and the wider group analytic movement would deepen, as Group Analysis began publishing research from Yugoslavia, including pieces from Cividini-Stranic and Klain, as well as Ljiljana Moro, Petar Opalic, Dubravka Trampuz and others. Yugoslavia’s status as a leading centre of group treatment was eventually recognized when the 9th International Conference on Group Psychotherapy was held in Zagreb in 1986, just a few years before the country’s destruction.

Conclusion

By the time of the Third Congress of Psychotherapists of Yugoslavia, held in 1979, one of the most respected figures in Yugoslav psychotherapeutic practice could afford to take stock and speak with pride about their accomplishments. Despite the initial resistance of ‘vulgar materialists’, Vladislav Klajn noted that those dedicated to psychotherapy had smashed the mind-body dichotomy associated with organic psychiatry, finding a more holistic way to understand human beings within their environmental context (Klajn, 1979). In addition to its strengths in psychodynamics, psychotherapy in Yugoslavia was moving in new directions, absorbing the knowledge and techniques generated by those practicing new behavioural and gestalt treatments. Psychiatrists and psychologists seeking to use talking cures could choose from a few highly regarded training centres (at Rebro hospital and the Centre for Mental Health in Zagreb and Misovic hospital and the Institute of Mental Health in Belgrade, among others) as well as regular seminars on a host of psychotherapeutic techniques held elsewhere. Moreover, it was possible to obtain 17 distinct master’s degrees in psychotherapy from the country’s institutions of higher education (Popovic, 1979). The country’s practitioners had organized into a formal body – the Association of Psychotherapists of Yugoslavia (with a special subsection dedicated to group psychotherapy) – and psychotherapists established their own sections within larger republican medical bodies, such as the psychotherapeutic wing of the Serbian Doctors’ Union. One of the country’s few specialist psychiatric journals, Psihoterapija, provided a forum for publishing the latest research and novel techniques related to psychotherapy, and articles dedicated to talk therapy regularly appeared in other journals like Psihijtarija Danas and Socijalna Psihijatrija, as well as in international journals dedicated to psychotherapy, group treatment and social psychiatry. Hundreds attended bi-annual meetings held at Mokrice and, every four years witnessed a Congress of Psychotherapists of Yugoslavia, where dozens of papers were presented on a bewildering variety of topics. In short, the expansion of psychotherapy across Titoist Yugoslavia appears remarkable. By the time of the country’s collapse in the early 1990s, psychotherapy had been established as perhaps the most widely used intervention in Yugoslav mental healthcare, being applied not only by psychiatrists but also addiction specialists, GPs, nurses and social workers. In short, psychotherapy did not merely survive at the fringes of Yugoslav mental healthcare, but rather it helped to define it.

Returning to the question of ideology, it appears that the evolution of psychotherapy within Yugoslavia was not significantly or directly shaped by the climate of state-sponsored socialism. Although the early post-war period was marked by a certain distrust of ‘bourgeois psychoanalysis’ among some party officials, that resistance soon gave way. Thus, rather than drawing upon Marxism for inspiration, the contours of Yugoslavia’s psychotherapeutic development owed more to emerging international connections to researchers in France and Britain, especially those connected to social psychiatry and group analysis. And although Yugoslav psychotherapists leaned heavily upon their work, knowledge did not simply flow from West to East, as Yugoslavs took part in broader psychotherapeutic and social psychiatric discussion. For instance, Stjepan Betlheim, and later his students, remained closely involved in evolving research on analytic-oriented psychotherapy, making contributions to debates on both sides of the Atlantic. Vladimir Hudolin, meanwhile, served a four-year term as the President of the World Association of Social Psychiatry and became one world’s foremost authorities on alcoholism. His famous ‘Hudolin Clubs’, themselves significantly influenced by Bierer, brought group treatment and therapeutic communities to dozens of countries across the globe.

Ultimately, the story of Yugoslav psychotherapy would end when the country itself was ripped apart in the early 1990s. As it happens, this process was greatly accelerated by a practitioner of group psychotherapy, as Jovan Raskovic, a psychiatrist from the Dalmatian town of Sibenik (who had once published an article in Group Analysis) rose to become a leader of the Serbian nationalist movement in Croatia. Perhaps ironically, however, Yugoslavia’s many psychotherapists would soon find new use for their expertise, when group therapy for post-traumatic stress disorder became ubiquitous across the region.