Psychotherapy

“ There is no pretence that by psychotherapy or any appeal to mental powers anything can be done for the underlying pathological process. And it may be frankly said that no remedy of any kind, physical or mental, will avail much, while some of those that have been suggested are just as likely to do harm as good. ”

“ As a matter of fact, the science of psychotherapy or mental treatment is simply the science of re-education,—a process designed to break up old unhealthy complexes which disrupt the forces of the individual, and to build up healthy complexes which adjust him to the social world and enable him to use his energy in useful ways. ”

“ Psychotherapy has now become for us the effort to repair the disturbed equilibrium of human functions by influencing the mental life. It is acknowledged on all sides that the most powerful of these influences is that of suggestion. ”

“ Every neurosis is a deliberate choice by a part of the personality. Self-discovery is helpful only when it leads to better ways of self-expression. The final aim of psychotherapy is the happy adjustment of the individual to the demands of society and the establishment of useful outlets for his energy. ”

“ Much can be done for the relief by psychotherapy, that is, by making the patient see the realities of his condition, suggesting to him that succeeding crises are less painful and that if his general condition is as good as it should be he becomes better able to stand the pain of his crises and the shock of them is not so disturbing to his system. ”

“ This phase of psychotherapy in the olden time is not only interesting in itself, but furnishes a valuable commentary on corresponding modern institutions, since it shows that it is not so much the physical influences, which have differed markedly at different periods, as the mental attitude so constantly influenced at these institutions which was the real therapeutic factor. ”

“ The patient literally "worrys themselves sick" over trivial symptoms and makes serious cases worse than necessary. Most of his use of psychotherapy consists of informing, diverting and cheering the patient so that worry and its consequences are not piled on top of real or imagined disease. ”

“ Behavioral approaches to therapy must be tailored to the individuality of each client; whatever goals are established have to be in accord with the client's own desires. Behavioral psychotherapy presupposes that clients will practice instructions and new behaviors between sessions and that they can maintain an adequate level of motivation, both while in treatment and after treatment ends, so that new habits of behaving or thinking can become effective and reliable parts of their own personalities. ”

“ The removal of many false notions that are thus working harm will reward the medical practitioner who gets at his patient's ideas. The old rule in therapeutics is non nocere—to be sure to do no harm. The special rule in psychotherapy is to be sure to remove all the ideas that are doing harm to the patient and making his symptoms mean more to him than they really signify. ”

“ Just in the same way, our psychotherapy must be dosed out according to the special need of each individual, the form of the affection and the particular kind of mind that is to be dealt with. To learn the place of mental influence in healing, so that we shall not be attributing to other therapeutic factors what is really due to the mind, will be a great advance in therapeutics. ”

“ The curative place of psychotherapy is in the obtaining, as far as possible, of placid easy lives for these patients. This does not mean that they are to give up their occupations, for very often the internal emotional life, which develops when they have nothing to do but think about themselves, will be more serious in its effect upon the heart than the ordinary vocation. ”

“ Every large city has one or another specialist who applies suggestive therapy, one or another nerve specialist who hypnotizes, but the average physician moves on without any serious effort to utilize psychotherapy. It is as if the prescription of the modern chemical drugs were confined to some leading scholars in the country, while the thousands abstained from it in their office work and in their family practice. In reality psychotherapy ought to be used by every physician, as it fits perfectly the needs of the whole suffering community. ”

“ Such things seem trivial by contrast with serious disease and may seem safely negligible. Trivial they are, but little things count both in themselves and as to the attitude of mind which they occasion. It is the attitude of mind that we try to modify by psychotherapy, and even the removal of little sources of annoyance help a patient materially to get through life more happily and through work more efficiently and without any more discomfort than is absolutely unavoidable. ”

“ There is probably nothing more valuable in the ordinary application of psychotherapy than these various auxiliaries, with their power to remove disturbing factors, while, on the other hand, nothing aids more in bringing relief for many conditions than the removal of certain disturbing factors. ”

“ In substituting healthful complexes for unhealthful ones, psychotherapy not only changes ideas and emotions, but alters the feelings of pleasure or pain that are bound up with the ideas. Dr. Tom A. Williams writes: "The essence of psychotherapy and education is to associate useful activities with agreeable feeling-tones and to dissociate from injurious acts the agreeable feeling-tones that may have been acquired." Right character consists not so much in enjoying things as in enjoying the right things. ”

“ THE AIM OF PSYCHOLOGYContents
The only safe basis of psychotherapy is a thorough psychological knowledge of the human personality. Yet such a claim has no value until it is entirely clear what is meant by psychological knowledge. We can know man in many ways. Not every study of man's inner life is psychology and the careless mixing of different ways of dealing with man's inner life is largely responsible for the vagueness which characterizes the popular literature of psychotherapy. It is not enough to say that a statement is true or not true. ”

“ The physician finds them under the most unexpected circumstances at times and in patients apparently above all suspicion of their self-infliction. They can only be prevented by changing the patient's state of mind, though this is scarcely what is ordinarily thought of in psychotherapy. ”

“ Basically, this is why studies of the effectiveness of psychotherapy have generally led to discouraging results. Most psychological conditions (there are exceptions, as we will see) are not, at least at present, treatable in the medical sense. To combat them requires of the client a great deal of his or her own effort and even exertion. They require self-discipline, moral courage, faith in oneself—all the things emotional distress tends to undermine. No approach to psychotherapy can itself be medically effective in treating conditions like these. ”

“ There are many ways and means of psychotherapy. All methods are good which produce the aim of the therapy. Our usual consolation, "You will soon be well again," with which we are so generous to our patients, corresponds to one of the psychotherapeutic methods, only that on gaining a profounder insight into the neuroses we are not forced to limit ourselves to this consolation alone. We have developed the technique of hypnotic suggestion, of psychotherapy through diversion, through practice, and through the evocation of serviceable affects. ”

“ Men and women do not change, their ills are about the same, and except for certain definite scientific remedies it is only the superficial mode of treatment that differs very much. Psychotherapy has always been an important element in most of the therapeutics of history. ”

“ Place of Psychotherapy in Treatment.—The role of psychotherapy, then, in heart cases consists in the recognition of the part that the mind, the will and the emotions play in their influence over this important organ. These psychic factors may produce disturbed conditions of various kinds. The more experience the physician has with cardiac cases of all kinds, organic as well as functional, the more powerful does he recognize the influence of the mind over the heart to be. The expression that a man is living on his will is no mere figure of speech. ”

“ Rôle of Psychotherapy.—While it is important that someone closely connected with the patient should know the doctor's suspicions, he should be bound to absolute secrecy as regards the patient himself and especially as regards women friends and relatives. The attitude of mind assumed by women relatives, and especially those nearest and dearest, is sure to be communicated to the patient, if not directly at least indirectly and inadvertently, and makes for anything but relief from the depression that is sure to be his if he has any gleam of understanding of his condition. ”

“ Motives of Consolation.—The main resource of the physician who would employ psychotherapy for the treatment of those who are grieving beyond the limit of what is normal, is to supply motives by which they can understand the real significance of their loss. Very often, especially in young folks, there is no proper estimation of values in life and no recognition of the fact that human life was evidently not meant for happiness since that comes to but few, while suffering and partings are inevitable. ”

“ He uses much psychotherapy himself but it is nearly always applied unconsciously and indirectly through some form of physical or chemical therapy that he believes will cure. He is usually quite devoid of insight into the effect of his own expressed beliefs and bodily attitudes upon the adjusting mechanisms of his patients. Conscious and direct psychotherapy is left by the average practitioner to New Thoughters, Christian Scientists, quacks, and charlatans. ”

“ Psychotherapy confers its benefits mainly by securing the most complete rapport between the mind of patient and physician. Good advice is often more important than any medicine. The correction of wrong notions will do more to relieve the patient, and make whatever symptoms he has bearable, than most of the anodyne drugs. The stimulation of hope means more than almost anything else in arousing the latent forces of nature and predisposing to recovery. The removal of unfavorable suggestions is but little less efficient. ”

“ Many psychiatrists today will list their special focus there—for example, psychoanalysis, psychoanalytic psychotherapy (brief analysis) , marriage and family therapy, hypnosis, chemical dependency treatment, child and adolescent therapy. If you want to see a psychiatrist and do not find one who indicates the specialized approach you want to try, then you will need to make some calls. ”

“ Irregular Phases of Psychotherapy.—The quack has always been a psycho-therapeutist par excellence. His main stock in trade has been his knowledge of men and his power to convince them that he was able to do them good, so that he could tap all the sources of energy that were in the patient, some of them quite latent, yet of great efficiency. ”

“ To be sure, the importance of suggestion for psychotherapy is not confined to these suggestive processes of daily life. They play a rôle there, as we shall see, and we shall claim that even the mere presence of the physician may have its suggestive power and so may every remedy which he applies. But no doubt many of his suggestive effects depend on a power which far transcends the suggestions of our daily life. ”

“ In fact, existential therapists are inclined to resist the formulation and application of specific techniques of therapy, believing that psychotherapy is essentially a human endeavor and that the drive to formulate techniques is basically a dehumanizing, objectifying interest. ”

“ Our attention belongs now to the doctor's dealing with man; for him cause and effect are the only vehicles of connection. Thus he has to exclude the purposive interpretation of inner life and has to understand every factor involved from a psychological point of view: his psychotherapy must be thoroughly applied psychology. ”

“ The great physicians employed psychotherapy very commonly, and on that account many of their disciples were inclined to think that they were neglectful of medication and other remedial measures. At all times physicians have had to be large-minded and have had to recognize the limitations of medicine in {3} their own time, to turn to other agents and to appreciate how much their own influence on the patient and that of the patient on himself meant for the relief of symptoms and the increase of resistive vitality. ”

“ The relations to the impressions are usually the less neglected: and we must the more emphasize the fact that the psychology needed for psychotherapy knows no mental fact which does not start an action and that every change in the system of actions involves a change in the central experience. Wherever this equilibrium of adjusted functions is disturbed, some therapy of the physician has to set in: whether psychotherapy is in order depends upon the special conditions. ”

“ This is what must be done with regard to psychotherapy also. Just now its importance is being exaggerated by ardent advocates. In every department of therapy this has always been done by enthusiasts. The business of the practicing physician must be to select what is best, and above all what is sure and harmless, from the many suggestions offered, so as to build up a practical body of applied truth. ”

“ I do not think it at all impossible that with the proper changes in the procedure it will be possible to disregard this contraindication, and thus claim a psychotherapy for the psychoses.
3. The age of the patient also plays a part in the selection for the psychoanalytic treatment. Persons near or over the age of fifty lack, on the one hand, the plasticity of the psychic processes upon which the therapy depends—old people are no longer educable—and on the other hand, the material which has to be elaborated, and the duration of the treatment is immensely increased. ”