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Subjective Change With Medical Student Therapists: I. Course of Relief in Psychoneurotic Outpatients

Subjective Change With Medical Student Therapists: I. Course of Relief in Psychoneurotic Outpatients Abstract MOST PSYCHONEUROTIC patients coming for treatment are especially concerned about the distressing quality of their subjective experience in living. What counts most for the patient is the way he feels about himself and his situation, and the initiation, maintenance, and interruption of the treatment situation itself follows mainly from these feelings. Novey1 has emphasized that, with such patients, the psychiatrist, too, sets goals and evaluates progress largely in terms of the patient's inner experience, and quite properly so. Psychoneurotic patients from the lower socioeconomic classes increasingly seek relief of distress through outpatient clinics associated with medical schools. Here they are usually assigned to trainees for their psychiatric care2(p273) which must be integrated with the requirements of the training program. The medical student's first attempts at psychotherapy perhaps offer the greatest potential for conflict with the patient's welfare.3(p153) What relief can patients ac References 1. Novey, S.: Behavior and Inner Experience: Parallels and Contradictions in the Appraisal of Treatment, read before the Sheppard and Enoch Pratt Hospital 75th Anniversary Program, Towson, Md, June 1966. 2. Hollingshead, A.B., and Redlich, F.C.: Social Class and Mental Illness: A Community Study , New York: John Wiley & Sons, Inc., 1958. 3. Heine, R.W. (ed.): The Student Physician as Psychotherapist , Chicago: University of Chicago Press, 1962. 4. Wallerstein, R.S., and Robbins, L.L.: The Psychotherapy Research Project of the Menninger Foundation: Second Report: I. Further Notes on Design and Concepts , Bull Menninger Clin 22:117-125, 1958. 5. Parloff, M.B.; Kelman, H.C.; and Frank, J.D.: Comfort, Effectiveness and Self-Awareness as Criteria of Improvement in Psychotherapy , Amer J Psychiat 111:343-351, 1954. 6. Mattsson, N.B., et al: Dimensions of Symptom Distress in Anxious Neurotic Outpatients , Psychopharmacol Bull , to be published. 7. Bendig, A.W.: The Development of a Short Form of the Manifest Anxiety Scale , J Consult Psychol 20:384, 1956.Crossref 8. Barron, F.: An Ego-Strength Scale Which Predicts Response to Psychotherapy , J Consult Psychol 17:327-333, 1953.Crossref 9. Lasky, J.J.: The Problem of Sample Attrition in Controlled Treatment Trials , J Nerv Ment Dis 135:332-337, 1962.Crossref 10. Uhlenhuth, E.H., et al: Dosage Deviation and Drug Effects in Drug Trials , J Nerv Ment Dis 141:95-99, 1965.Crossref 11. Lorr, M.; Katz, M.M.; and Rubinstein, E.A.: The Prediction of Length of Stay in Psychotherapy , J Consult Psychol 22:321-327, 1958.Crossref 12. Rosenthal, D., and Frank, J.D.: The Fate of Psychiatric Clinic Outpatients Assigned to Psychotherapy , J Nerv Ment Dis 127:330-343, 1958.Crossref 13. Cattell, R.B., and Scheier, I.H.: The Meaning and Measurement of Neuroticism and Anxiety , New York: The Ronald Press Co., 1961. 14. Greenfield, N.S.; Alexander, A.A.; and Roessler, R.: Ego Strength and Physiological Responsivity: II. The Relationship of the Barron Ego Strength Scale to the Temporal and Recovery Characteristics of Skin Resistance, Finger Blood Volume, Heart Rate, and Muscle Potential Responses to Sound , Arch Gen Psychiat 9:129-141, 1963.Crossref 15. Frank, J.D., et al: Immediate and Long-Term Symptomatic Course of Psychiatric Outpatients , Amer J Psychiat 120:429-439, 1963. 16. Stone, A.R., et al: An Intensive Five-Year Follow-Up Study of Treated Psychiatric Outpatients , J Nerv Ment Dis 133:410-422, 1961.Crossref 17. Schachter, S., and Singer, J.E.: Cognitive, Social and Physiological Determinants of Emotional State , Psychol Rev 69:379-399, 1962.Crossref 18. Uhlenhuth, E.H.: "Some Suggestions for Further Exploration of the Placebo Response," in Transactions of the 5th Research Conference on Cooperative Chemotherapy Studies in Psychiatry and Research Approaches to Mental Illness, Veterans Administration 1960, vol 5, pp 209-212. 19. Wilder, J.: Modern Psychophysiology and the Law of Initial Value , Amer J Psychother 12:199-221, 1958. 20. Steinbook, R.M.; Jones, M.B.; and Ainslie, J.D.: Suggestibility and the Placebo Response , J Nerv Ment Dis 140:87-91, 1965.Crossref 21. Uhlenhuth, E.H., et al: Drug, Doctor's Verbal Attitude and Clinic Setting in the Symptomatic Response to Pharmacotherapy , Psychopharmacologia 9:392-418, 1966.Crossref 22. Frank, J.D.: Persuasion and Healing: A Comparative Study , Baltimore: Johns Hopkins Press, 1961. 23. Truax, C.B., and Carkhuff, R.R.: Toward Effective Counseling and Psychotherapy: Training and Practice , Chicago: Aldine Publishing Co., 1967. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Subjective Change With Medical Student Therapists: I. Course of Relief in Psychoneurotic Outpatients

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References (22)

Publisher
American Medical Association
Copyright
Copyright © 1968 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1968.01740040044006
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Abstract

Abstract MOST PSYCHONEUROTIC patients coming for treatment are especially concerned about the distressing quality of their subjective experience in living. What counts most for the patient is the way he feels about himself and his situation, and the initiation, maintenance, and interruption of the treatment situation itself follows mainly from these feelings. Novey1 has emphasized that, with such patients, the psychiatrist, too, sets goals and evaluates progress largely in terms of the patient's inner experience, and quite properly so. Psychoneurotic patients from the lower socioeconomic classes increasingly seek relief of distress through outpatient clinics associated with medical schools. Here they are usually assigned to trainees for their psychiatric care2(p273) which must be integrated with the requirements of the training program. The medical student's first attempts at psychotherapy perhaps offer the greatest potential for conflict with the patient's welfare.3(p153) What relief can patients ac References 1. Novey, S.: Behavior and Inner Experience: Parallels and Contradictions in the Appraisal of Treatment, read before the Sheppard and Enoch Pratt Hospital 75th Anniversary Program, Towson, Md, June 1966. 2. Hollingshead, A.B., and Redlich, F.C.: Social Class and Mental Illness: A Community Study , New York: John Wiley & Sons, Inc., 1958. 3. Heine, R.W. (ed.): The Student Physician as Psychotherapist , Chicago: University of Chicago Press, 1962. 4. Wallerstein, R.S., and Robbins, L.L.: The Psychotherapy Research Project of the Menninger Foundation: Second Report: I. Further Notes on Design and Concepts , Bull Menninger Clin 22:117-125, 1958. 5. Parloff, M.B.; Kelman, H.C.; and Frank, J.D.: Comfort, Effectiveness and Self-Awareness as Criteria of Improvement in Psychotherapy , Amer J Psychiat 111:343-351, 1954. 6. Mattsson, N.B., et al: Dimensions of Symptom Distress in Anxious Neurotic Outpatients , Psychopharmacol Bull , to be published. 7. Bendig, A.W.: The Development of a Short Form of the Manifest Anxiety Scale , J Consult Psychol 20:384, 1956.Crossref 8. Barron, F.: An Ego-Strength Scale Which Predicts Response to Psychotherapy , J Consult Psychol 17:327-333, 1953.Crossref 9. Lasky, J.J.: The Problem of Sample Attrition in Controlled Treatment Trials , J Nerv Ment Dis 135:332-337, 1962.Crossref 10. Uhlenhuth, E.H., et al: Dosage Deviation and Drug Effects in Drug Trials , J Nerv Ment Dis 141:95-99, 1965.Crossref 11. Lorr, M.; Katz, M.M.; and Rubinstein, E.A.: The Prediction of Length of Stay in Psychotherapy , J Consult Psychol 22:321-327, 1958.Crossref 12. Rosenthal, D., and Frank, J.D.: The Fate of Psychiatric Clinic Outpatients Assigned to Psychotherapy , J Nerv Ment Dis 127:330-343, 1958.Crossref 13. Cattell, R.B., and Scheier, I.H.: The Meaning and Measurement of Neuroticism and Anxiety , New York: The Ronald Press Co., 1961. 14. Greenfield, N.S.; Alexander, A.A.; and Roessler, R.: Ego Strength and Physiological Responsivity: II. The Relationship of the Barron Ego Strength Scale to the Temporal and Recovery Characteristics of Skin Resistance, Finger Blood Volume, Heart Rate, and Muscle Potential Responses to Sound , Arch Gen Psychiat 9:129-141, 1963.Crossref 15. Frank, J.D., et al: Immediate and Long-Term Symptomatic Course of Psychiatric Outpatients , Amer J Psychiat 120:429-439, 1963. 16. Stone, A.R., et al: An Intensive Five-Year Follow-Up Study of Treated Psychiatric Outpatients , J Nerv Ment Dis 133:410-422, 1961.Crossref 17. Schachter, S., and Singer, J.E.: Cognitive, Social and Physiological Determinants of Emotional State , Psychol Rev 69:379-399, 1962.Crossref 18. Uhlenhuth, E.H.: "Some Suggestions for Further Exploration of the Placebo Response," in Transactions of the 5th Research Conference on Cooperative Chemotherapy Studies in Psychiatry and Research Approaches to Mental Illness, Veterans Administration 1960, vol 5, pp 209-212. 19. Wilder, J.: Modern Psychophysiology and the Law of Initial Value , Amer J Psychother 12:199-221, 1958. 20. Steinbook, R.M.; Jones, M.B.; and Ainslie, J.D.: Suggestibility and the Placebo Response , J Nerv Ment Dis 140:87-91, 1965.Crossref 21. Uhlenhuth, E.H., et al: Drug, Doctor's Verbal Attitude and Clinic Setting in the Symptomatic Response to Pharmacotherapy , Psychopharmacologia 9:392-418, 1966.Crossref 22. Frank, J.D.: Persuasion and Healing: A Comparative Study , Baltimore: Johns Hopkins Press, 1961. 23. Truax, C.B., and Carkhuff, R.R.: Toward Effective Counseling and Psychotherapy: Training and Practice , Chicago: Aldine Publishing Co., 1967.

Journal

Archives of General Psychiatry – American Medical Association

Published: Apr 1, 1968

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