A Study of Psychodynamic Changes in Untreated Neurotic Patients

Abstract

up 49 out of 76 patients who had been on the waiting list for psychotherapy for three to seven years but had not received treatment. (Seven patients who had found treatment elsewhere in the meantime were excluded.) 65 per cent. were found to be â€oe¿ recovered― or â€oe¿ improved―. Criteria were: â€oe¿ Recovered: these were symptom free and in full employment, and had suffered no loss in socioeconomic status. Improved: these were troubled only by residual symptoms, were in full employment, and had suffered no loss in socioeconomic status.― (c) Saslow and Peters (5956) followed up 87 out of ioo consecutive patients who had been diagnosed as â€oe¿ behaviour disorder― andâ€"for any reasonâ€"had not had more than two interviews. Follow-up was one to seven years. Criteria used were those of Miles, Barrabee and Finesinger (595 i). @ per cent. were â€oe¿ apparently recovered― to â€oe¿ improved―. This study is rendered less valuable by the statement that 53 per cent. of the patients had had â€oe¿ continuous care of some kind― (nature not stated) since their original interview. 2. The second type of study is that in which untreated controls are compared with treated patients, or in which â€oe¿ less treated― or â€oe¿ less specifi cally treated― patients are compared with those who were â€oe¿ more treated―. The evidence from this type of study is equivocal. Studies in which little significant difference could be found between the two series are: (a) Barron and Leary (i@@@; criteria: changes in the M.M.P.I.; follow-up 7â€"8 months); (b) Brill (1966; criteria: M.M.P.I., clinical evaluation; follow-up about two years). This study contained a series of patients who were put on a waiting list but in fact never received treatment. (c) Endicott and Endicott (1963, and in press; criteria: many psychological tests, including M.M.P.I., and many clinical rating scales; follow-up 6 months for the waiting list controls). Studies in which significantly more improve ment was found in the treated patients were: (a) Rogers and Dymond (sg@; criteria: self * This includes Case i i, whose original complaint (vocational problems) had disappeared, though the word â€oe¿ symptom― is perhaps not entirely appropriate.

Conjoint marital therapy: a controlled outcome study

“…But were the outcome measures appropriate to the treatments used ? The measures used related mainly to complaints stated at the beginning of treatment and to adjustment in various life situations: they did not relate to 'dynamic' factors (Malan, 1963;Malan et al 1968), and this was largely due to the difficulty of rating such factors. On the Semantic Differential Scale, however, which is perhaps the nearest to a dynamically relevant scale, no important differences between treatments emerged.…”

Prognostic Factors in the Neurotic Illness

“…Although 55 % of the subjects showed adequate functional capacity during the period of observation, this does not indicate absence of neurotic tendencies. An assessment of psychodynamically suspect subjects (Malan et al (1968)) has not been undertaken. Neither have we ventured an evaluation of the importance of therapy or the effect of later conflicts and special life situations in the course of illness.…”

Bion and Foulkes: The Group-as-a-Whole

“…They are supposed to feel extra frustration at being reduced to a part of the greater thing the group. They regress and reject the group (Brown, 1985;Malan et al, 1968). Tavistock groups are often felt as a call to investigate social pathology, when people are all the time suffering their own neurosis.…”