TENSION CHANGES IN PATIENTS UNDERGOING PSYCHOTHERAPY

180 Pages·014.712 MB·English

by  LIGHT, BERNARD H

COPYRIGHTED
BY
BERNARD H. LIGHT
1952
TENSION CHANGES IN PATIENTS
UNDERGOING PSYCHOTHERAPY
BY
BERNARD H. LIGHT
B.S., University of Illinois, 1947
A.M., University of Illinois, 1948
THESIS
SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OP DOCTOR OP PHILOSOPHY IN PSYCHOLOGY
IN THE GRADUATE COLLEGE OP THE
UNIVERSITY OF ILLINOIS. 1951
URBANA. ILLINOIS
UNIVERSITY OF ILLINOIS
THE GRADUATE COLLEGE
AUGUST 2 1, 1951
I HEREBY RECOMMEND THAT THE THESIS PREPARED UNDER MY
SUPERVISION RV BERNARD H. LIGHT
ENTITLED TENSION CHANGES IN PATIENTS UNDERGOING
PSYCHOTHERAPY
BE ACCEPTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR
THE DEGREE OT? DOCTOR OF PHILOSOPHY IN PSYCHOLOGY
t Required for doctor's degree but not for master's.
M440
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TABLE OF, CONTENTS
Chapter Page
INTRODUCTION AND PROBLEM , 1
I. INTRODUCTION TO THE CONCEPTS OF RESISTANCE AND
SYMPTOMATOLOGY 7
II. SYNOPSIS OF TECHNIQUES EMPLOYED 13
A. SYNOPSIS OF PROCEDURE 14
1. SUBJB3TS 14
2. CONTROLS 14
S. SYNOPSIS OF RESULTS 15
III. THE FUNCTION OF PALMAR SWEAT 22
A. COLORIMBIRIC METHODS OF MEASURING
PERSPIRATION 24
B. OBJECTIVE MEASUREMENTS OF PALMAR SWEAT
THROUGH REFLB3TANCE 31
C. TEST ADMINISTRATION 35
IV. RESULTS • 38
A. SUBJECTIVE 38
B. OBJECTIVE 64
C. COMPARISON OF OBJECTIVE AND SUBJECTIVE RESULTS 106
D. CONTROL RESULTS. 120
V. DISCUSSION AND INTERPRETATION OF RESULTS 136
VI. SUMMARY 159
APPENDIX 161
A. REPRODUCTION OF PRINTS 161
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ACKNOWLEDGMENT
The writer wishes to express his sincere gratitude to Dr. 0. H. Mowrer for
mafcing this study possible. Ee contributed a major part of the data and provided
the writer with valuable guidance, kind advice, and constant encouragement
throughout the course of this study. This problem was also formulated as the
result of many stimulating personal and class discussions with him.
Further acknowledgment is made to Dr. Rex Collier, Dr. Leonard O'Kelly,
Dr. Joaef Cohen, Dr. Frederick Smith, Dr. Leo Hellmer, Dr. I. E. Horvath,
Dr. Alice Jonietz, and professor J. 0. Kraehenbuehl for their assistance and
keen interest in this research; and to Dr. Lyle Lanier, Dr. Donald Pomeroy, and
Dr. Leota Jaenke for the use of the University of Illinois Psychological Clinio
facilities.
Grateful acknowledgment is also made to Walter Fisher, John Stern, and
Marjorle Richey, and all the others who served as controls and sub jects'in this
study.
Last but not least he owes a debt to his wife for her faith in him through
out the course of his graduate studies.
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FIGURES PAGES
1. Curves showing the response of palmar sweating to rise
in temperature 23
2. Diagram of the refleotometer used for measuring
reflectance 33
3-4. Diagrams showing subjective cumulative changes in
tension and happiness 45-46
5-12 48-55
13-18. 57-62
19-42. • 65-88
43. Curves indicating the absolute changes in palmar sweating
before and after therapy 93
44-45 95-96
46-49 98-101
50-52 103-105
53. Curves comparing the cumulative subjective tension
rating and the cumulative palmar sweating index 107
54-55 109-110
56-59 112-115
60-62 117-119
63-66. Curves showing the result of tests of palmar sweating
administered before and after therapy and neutral
activity on different occasions 123-126
67-68. Curves showing the result of tests of palmar sweating
administered before and after therapy and neutral
activity within an interval of 4 to 5 hours 128-129
69-71. Curves showing the result of tests of palmar sweating
administered under neutral conditions only 130-132
72. Curves comparing changes in the palmar sweating index
for patient and therapist 135
TABLES
Table page
1. Number and percentage of patients experiencing subjective
increments or decrements in tension and happiness 16
2. Number and percentage of patients experiencing objective
increments or decrements in tension. 17
3. Results of the palmar sweating test administered to 1360
pat ients in an Army Gene ral Hospital 27
4. Number and percentage of therapy sessions in whioh
patients experienced subjective tension and happiness
increments, decrements, or no change..... 39
5. Number and percentage of therapy sessions in which
patients experienced tension increments and decrements
only 41
6. Number and percentage of therapy sessions in which
patients experienced objeotive increments or decrements
in tension. 89
7. Mean values for refleotometer measurements which have
been derived from dividing successive interviews of a
protracted therapy into 1st half before and after values
and 2nd half before and after values. 91
8. Mean refleotometer differences between therapy and neutral
activity for 7 controls 121
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INTRODUCTION
Although moat present day researchers and clinicians working in payohothera
py are more sophisticated in their knowledge of payohotherapy than were their
predecessors of a half century ago. many of the problems which confronted previ
ous maatera at ill remain unanswered today. This doea not derogate the laat fifty
yeara of progress; it shows rather that there is still much to be learned about
psychotherapy and that a part of the inability to answer age-old problems ia due
to the fact that research in psychotherapy often involves venturing into a veri
table no-man's land.
One should not, moreover, be discouraged by this lack of acientlfio knowl
edge. For, aa in any type of pioneer undertaking, one must first explore his
territory before staking out hia claime. Research in psychotherapy must there
fore begin with preliminary investigations, expand the results of these investi
gations through deductive reasoning and further research, and then attempt to
lay a foundation of knowledge which will finally enable researchers to construct
a science of psychotherapy through the experimental method. It is only through
suoh a prooesa that the myateriea of payohotherapy will eventually be removed and
the seemingly mysterious aspects of therapy be made lucid and dear. It will
probably be a long time before empirical research ia going to tell practloners
much. Ultimately, however, research should make for sounder practices and more
adequate theory. It waa with this view in mind that this research began. And
although thia experiment does not purport to be anything more than an exploratory
study, it is hoped that it will provide sufficient stimulation and incentive for
reaearchers to continue studies of this nature.
The problem to be considered here revolves around the realisation that only
60$ to 80% of the persons who seek psychotherapeutic help remain in therapy to
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"work through'* their emotional problems. Although this ia common knowledge
clinically, no one has to date found a way of empirically predicting which pa
tients will remain in therapy and which will terminate their Interviews prema
turely. Researchers have, however, succeeded theoretically in explaining this
therapeutic ''mortality rate." Some have claimed that therapy aggravates the
emotional conflict instead of alleviating it. As Dollard and Miller (1950) would
say, "Therapy may create more misery than the neurotic conflict" (p.253). Others
might take another, although not completely antithetical view, and say that many
patients seek only symptom relief from therapy and that when the patient's expec
tations in this respect have been fulfilled, he shrinks from the necessity for
further personality change or therapeutic work. A final group might surmise that
therapy generates fear and that this fear forces the individual to discontinue
the performance of those responses which arouse fear.
Now these are all plausible conjectures, but in order to expand the scope
of our psychotherapeutic knowledge, we must also attack the problem through the
experimental approach. This study will therefore attempt to discover a way of
predicting, on the basis of completely objeotive evidence, whether a patient la
going to remain In psychotherapy or terminate prematurely. And from the results
the consistency of theory may be tested.
Aa was intimated, the theoretical explanations contain a substantial degree
of logic. Psychotherapy, for example, which is designed to uncover deep-seated
conflicts, which is not oonoerned with arousing repressed material that has lain
dormant, and which is not exclusively oonoerned with emotional comfort but rather
with the patient's eventual integration, can, through this uncompromising tech
nique, be temporarily aggravating to the problem. But in order for the patient
finally to achieve personality integration, some of the temporary pain and dis
comfort must be endured, so that repressed material can become conscious and
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dissociated feelings and emotions can become assooiated. If, however, therapy
beoomes too dlsoomfortlng or too disconcerting, the possibility of the patient's
remaining in therapy beoomes remote.
There are patients, on the other hand, who experience almost immediate re
ward from the interpretations and reflections in therapy in the form of symptom
relief. The patient may then say to himself, or even to his therapist, "I feel
fine. I don't find anything else to talk about. I guess I've got everything out
of therapy that I need." The motivation for suoh commonly called "flights into
health" is frequently the anticipation of produoing new, uncomfortable, tension-
arousing material. Self-deception, so characteristic of persons with personality
problems, thus enables the patient to figment a "legitimate" excuse for termi
nating therapy at the point of symptom alleviation.
Fear is an extremely Important oonoept for psychotherapy. The fear of
"losing one's mind," the fear of impending disaster, the fear of responsibility,
the fear of failure, the fear of poverty, the fear of sex, without knowledge of
fear causation, are just a few of the feara which may drive a person into psycho
therapy, but the fear that is experienced in exploring past experiences, past
events, past feelings and past oonfllots, may cause the patient to question the
feasibility of produoing those responses of reminiscence which are almost always
potentially fear producing. This type of fear may be called a fear of the re
pressed, or It may be a fear of again experiencing the punishment of oonaoienoe
that has been so neatly neutralized and dissociated. (This latter premise ia
baaed on the hypothesis that a neurotic is not, according to the traditional
Freudian view, an individual with an over-developed superego, but rather one
whose superego is not fully functional or not completely assimilated.) Uncover
ing, or making unconsolous material conscious thus beoomes painful, and the fear
of pain may cause the patient to withdraw from therapy prematurely.