Ciba Foundation Symposium - The Role of Learning in Psychotherapy

352 Pages·1968·14.641 MB·English

THE ROLE OF LEARNING
IN PSYCHOTHERAPY
THE ROLE OF
LEARNING IN
PSY C HO TH E RA PY
A Ciba Foundation Symposium
Edited by
RUTH PORTER
J. & A. CHURCHILL LTD.
104 GLOUCESTER PLACE, LONDON
I968
First published 1968
Containing 30 illustrations
Standard Book Number 7000 1380 6
ALL RIGHTS RESERVED
This book may not be reproduced by any means, in whole or in part, without permission.
Application with regard to reproduction should be addressed to the Publishers,
Printed in Great Britain
Contents
Ruth Porter Preface xi
N. Miller Chairman’s opening remarks I
E.
Ethology
G. P. Sackett The persistence of abnormal behaviour in monkeys
following isolation rearing 3
Discussion Bandura, Carstairs, Dalla Volta, Gelder, Hinde, Hunt,
Kaufman, Kubie, Lazarus, Lebedev, Leder, Marks, Miller,
Sackett, Sandler 25
Validation of Results of Psychotherapy
J. D. Frank Methods of assessing the results of psychotherapy 38
Discussion Bandura, Carstairs, Frank, Gelder, Kubie, Malan, Marks,
Miller 53
D. Malan Psychodynamic assessment of the outcome of psycho-
H.
E. Rayner therapy 61
H.
A. Bacal
H.
E. S. Heath
F. H. G. Balfour
Discussion Foss, Frank, Malan, Miller 66
I. M. Marks Controlled trials in behaviour therapy 68
M. G. Gelder
Discussion Gelder, Hinde, Hunt, Kubie, Lazarus, Marks, Miller,
Sandler 81
P. Sifneos Learning to solve emotional problems: a controlled study
E.
of short-term anxiety-provoking psychotherapy 87
Discussion Foss, Frank, Gelder, Hunt, Kubie, Leder, Malan, Marks,
Miller, Sifneos 97
Learning: Techniques in Education and Treatment
A. Dalla Volta Basic aspects of learning in the psychology and psycho-
J. Mansueto Zecca pathology of the child
I00
Discussion Dalla Volta, Foss, Frank, Hunt, Lazarus, Miller, Sifneos
I10
S. Leder Psychotherapy: placebo effect and/or learning I I4
Discussion Bondura, Carstairs, Foss, Frank, Hunt, Krasner, Lazarus,
Lebedev, Leder, Marks, Miller, Sandler, Sifneos I23
A. A. Lazarus Behaviour therapy and graded structure I34
Discussion Bandura, Carstairs, Foss, Freeman, Gelder, Hunt, Krosner,
Kubie, Lazarus, Leder, Malan, Marks, Miller, Sockett,
Sandler 144
L. Krasner Assessment of token economy programmes in psy-
chiatric hospitals I55
Discussion Carstairs, Foss, Freeman, Hunt, Kaufman, Kiernan,
Krasner, Kubie, Lazarus, Lebedev, Leder, Marks, Miller,
Sondler, Sifneos
I74
V
vi CONTENTS
T. Freeman The learning component in the dynamic therapeutic
situation
I86
Discussion Frank, Freeman, Gelder, Hunt, Krasner, Kubie, Lazarus,
Malan, Miller, Sackett, Sandler, Sifneos
I93
A. Bandura Modelling approaches to the modification of phobic
disorders
20 I
Discussion Bandura, Gelder, Hinde, Kubie, Lazarus, Marks, Miller
217
L. Kubie The psychotherapeutic ingredient in the learning process
S. 224
Discussion Dalla Volta, Foss, Frank, Freeman, Gelder, Hinde, Hunt,
Kaufman, Kiernan, Krasner, Kubie, Leder, Miller, Sackett,
Sandler
233
General discussion Krasner, Kubie, Lazarus, Malan, Marks, Miller
242
Prospects for the Future
H. Hunt Prospects and possibilities in the development of
F.
behaviour therapy
246
Discussion Bandura, Carstairs, Frank, Hunt, Iansson, Kaufman,
Krasner, Kubie, Lazarus, Malan, Marks, Miller, Sackett,
Sandler, Sifneos
26 I
J. Sandler Psychoanalytic psychology and learning theory
274
W. G. Joffe
Discussion Foss, Frank, Hinde, Hunt, Kaufman, Kiernan, Kubie,
Miller, Sackett, Sandler
287
N. E. Miller Visceral learning and other additional facts potentially
applicable to psychotherapy
294
Discussion Bandura, Hunt, Kiernan, Miller, Sifneos
309
Group discussion Bandura, Foss, Frank, Freeman, Gelder, Hunt, jansson,
Kiernan, Krasner, Kubie, Lazarus, Malan, Marks, Miller,
Sandler, Sifneos
312
N. E. Miller Chairman’s closing remarks
329
Author Index
334
Subject Index
335
Membersh ip
Symposium on The Role Learning in Psychotherapy held 31st
of
January-2nd February, 1968
N. E. Miller Rockefeller University, New York
(C hai r man)
A. Bandura Department of Psychology, Stanford University, California
G. M. Carstairs Department of Psychiatry, University of Edinburgh
A. Dalla Volta Institute of Psychology, Faculty of Medicine, University of
Genoa
B. M. Foss Department of Psychology, Institute of Education, Univer-
sity of London
J. D. Frank Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, Maryland
T. Freeman Holywell Hospital, Antrim, Northern Ireland
M. G. Gelder Institute of Psychiatry, The Maudsley Hospital, London
R. A. Hinde Department of Zoology, University of Cambridge
H. F. Hunt Department of Psychology, Columbia University, New York
B. Jansson Psykiatriska Kliniken, Sahlgrenska Sjukhuset, University
of Goteborg
I. C. Kaufman Department of Psychiatry, State University of New York,
Downstate Medical Center, Brooklyn, New York
C. C. Kiernan Department of Psychology, Birkbeck College, University
London
of
L. Krasner Department of Psychology, State University of New York,
Stony Brook, New York
L. Kubief Department of Psychiatry, University of Maryland School
S.
of Medicine, Baltimore
A. A. Lazarus Department of Behavioral Science, Temple University
School of Medicine, Philadelphia, Pennsylvania
B. A. Lebedev Mental Health Unit,World Health Organization, Geneva
Leder Psychoneurological Institute,Warsaw
S.
D. H. Malan Tavistock Clinic, London
* Present address: Wheeler Lane, Sparks, Maryland
vii
viii MEMBERSHIP
I. M. Marks Institute Psychiatry, The Maudsley Hospital, London
of
G. P. Sackett Department Psychology, Primate Laboratory, University
of
Wisconsin, Madison
of
J. Sandler Academic Department Psychiatry, Middlesex Hospital
of
Medical School, and Index Project, Hampstead Child-
Therapy Clinic, London
P. Sifneos* Department Psychiatry, Massachusetts General Hospital,
E. of
and Department Psychiatry, Harvard Medical School
of
*
Present address : Department of Psychiatry, Harvard Medical School, Beth Israel Hospital,
Boston, Massachusetts
The Ciba Foundation
The Ciba Foundation was opened in 1949 to promote
international cooperation in medical and chemical re-
search. It owes its existence to the generosity of CIBA
Ltd., Bade, who, recognizing the obstacles to scientific communi-
cation created by war, man’s natural secretiveness, disciplinary
divisions, academic prejudices, and separation by distance and dif-
ferences in language, decided to set up a philanthropic institution
whose aim would be to overcome such barriers. London was
chosen as its site for reasons dictated by the special advantages of
English charitable trust law (ensuring the independence of its
actions), as well as those oflanguage and geography.
The Foundation’s house at 41 Portland Place, London, has
become well known to workers in many fields of science. Every
year the Foundation organizes six to ten three-day symposia
and three or four shorter study groups, all of which are published
in book form. Many other scientific meetings are held, organized
either by the Foundation or by other groups in need of a meeting
place. Accommodation is also provided for scientists visiting
London, whether or not they are attending a meeting in the
house.
The Foundation’s many activities are controlled by a small
group of distinguished trustees. Within the general framework
of biological science, interpreted in its broadest sense, these
activities are well summed up by the motto of the Ciba Founda-
tion: Consocient Gentes-let the peoples come together.
I* ix
Preface
THISs ymposium grew from discussions, in with Dr. Isaac Marks
1964,
about the paucity of objective, and particularly of controlled, studies
assessing the results of psychotherapy, and also about the lack of informa-
tion about the factors that affect these results. The unlearning of
maladaptive habits and the learning of new, more appropriate behaviours
would seem to be two important factors that influence the outcome of
psychotherapy. At that time it seemed that a meeting in which psycho-
therapists of different schools discussed their underlying theories, tech-
niques and results was now possible and could be a useful approach to
these problems.
Drs. Michael Gelder and David Malan were soon drawn into these dis-
cussions. Isaac Marks and Michael Gelder, using behavioural techniques,
and David Malan, using brief dynamic psychotherapy, had already started
some comparative studies on the results of their treatments of patients with
phobias and other neuroses. With Professor Morris Carstairs’ help we
finally settled for a symposium whose subject would be the role oflearning
in psychotherapy. At this symposium ethologists, experimental psycholo-
gists and psychiatrists, and psychotherapists of all schools could meet.
Professor Neal Miller agreed to take the chair at this meeting and
provided tremendously helpful advice about its form and membership, at
first in letters from New York and later in personal talks with me, in
Geneva, wMe he was there (very briefly), in connexion with his work for
W.H.O. I would like to thank all these people, and also Dr. Joe Sandler,
for their help in planning this symposium. I would also like to thank
Dr. W. G. Joffe for his help in the editing of parts of this book.
In a meeting in which such varied and at times emotional and hotly
disputed views might have inhibited constructive discussion, the open-
mindedness of the participants and their capacity for accepting each other’s
points of view were noteworthy. The extent of agreement between the
protagonists of the different schools was sometimes surprising. At one
stage it even looked as if this might mask areas of disagreement, and thus
useful material and constructive criticism be lost. Fortunately, Professor
Neal Miller’s chairmanship avoided this pitfall, and his sincere search for
objective truth and acceptance of unorthodoxy were somehow transferred
to all the participants.
xi
xii PREFACE
The members of this symposium examined together their various
techniques in a liberal way. They also looked, with scientific objectivity
and with humanity, for new ways of assessing their results. It is hoped that
this book may play some part in encouraging those who read it in the same
sorts of ways.
RUTHP ORTER