Fifty years after Freud: Dora, the rat man, and the wolf-man

Article Abstract:

Freud's case histories are still of great interest to psychiatrists; three such case histories are reviewed. The patient, known as Dora from Freud's writings, was a teenager he diagnosed with hysteria and a condition now known as depression. Freud published her case to explain the causes of hysteria and show how his dream theory could be used in psychotherapy. The second case study was of a young lawyer who suffered from obsessional neurosis. He was known to readers as the Rat Man because he described a cruel torture he had observed in which rats attacked a man. The Rat Man had repeated fears that the woman he loved and his father would be tortured in this way or killed; Freud then discovered his father was already dead. Freud's efforts to treat this patient were highly successful, and their therapeutic relationship is still studied. Finally, the case of the Wolf-Man was the most significant and complex of Freud's clinical histories. The patient, a young Russian aristocrat, was disabled by multiple anxieties and phobias. Freud focused on his childhood neurosis; the patient was afraid of wolves and suffered from a recurrent anxiety dream about them. Freud believed the dream symbolized an incident in which, as a child, he witnessed his parents having sexual intercourse. In each case history, Freud was a participant in the clinical drama. Since Freud's time, psychodynamic theory has recognized that the clinical setting involves the psychology of two people interacting, rather than the psychology of an isolated patient. Freud's writings exhibit great intellectual creativity and have an important value in that they stimulate the professional reader to discover and investigate new psychodynamic phenomena.

Therapist-patient relations, Psychology, Pathological, Psychopathology, Freud, Sigmund, Freudian theory, Psychotherapist and patient

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Audiotape playback as a technique in the treatment of schizophrenic patients

Article Abstract:

One characteristic of schizophrenia is a serious communication disorder, the cause of which is not well understood. To examine possible ways of alleviating the problem, in hopes that this would lead to better social skills and improved psychotherapeutic results, two schizophrenic patients were tape recorded during a psychotherapy session and their voices were later played back to them in an attempt to facilitate verbal communication between patient and therapist. Through this process the patient becomes more aware of language and thought organization and can perceive himself more objectively. Results indicated that the audiotape replay technique was useful in helping these two patients to organize their thoughts and verbal communications, and that this technique encouraged participation of the patient in the process of psychotherapy. It was noted that this approach is particularly helpful for patients who have a sustained language disturbance, who are not in an active psychotic state, and who are motivated to resolve discrepancies between verbal communications and their inner thoughts. It is not clear whether the tape playback actually promoted progress or merely accelerated changes that would have occurred anyway. Clinical evidence indicates this technique improved psychotherapy but it is premature to make any generalizations prior to further investigation.

Care and treatment, Schizophrenia, Schizophrenics, Tape recordings, Audio tapes in psychotherapy

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Patterns of psychotherapy utilization

Article Abstract:

Past studies have shown that most people who receive outpatient psychotherapy do so on a limited, short-term basis. Contrary to this, most psychotherapy training and practice is based on a long-term model, and most research has shown that long-term therapy is more effective. This study followed 405 subjects undergoing outpatient psychotherapy, most of whom were self-referred, from the beginning to the end of their treatment. The majority were diagnosed as mildly to moderately disturbed, and the psychoanalysis they received was broadly representative of the general psychotherapy prevalent in the United States today. Twenty-four percent attended fewer than five sessions, and 32 percent attended more than 26 sessions. Therapists generally spend most of their time with long-term patients and may not be sensitive to the beginning phase of treatment. The median number of sessions increased as the number of visits increased, which illustrated the importance of the initial phase of therapy in determining duration and possibly the outcome of treatment. Cost and insurance coverage seemed to have a limited impact on duration of treatment. Patients of staff therapists tended to stay in therapy longer than trainee therapists, who tended to leave within the first four weeks. (Consumer Summary produced by Reliance Medical Information, Inc.)

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