GENERAL PRINCIPLES OF PSYCHOTHERAPY
LEO ALEXANDER M. D.1
1 Instructor in Psychiatry, Tufts College Medical School. Director, Neurobiologic Unit, Division of Psychiatric Research, Boston State Hospital, Boston, Mass.
I should like to conclude with a few do's and don'ts in the use of psychotherapy in office practice. In general you can't go wrong with a warm, supporting attitude, and in offering the patient opportunity for ventilation. If this ventilation should be associated with a marked emotional abreaction, be sure that you can maintain your objective supporting attitude in the face of this abreaction, even if it should include the expression of hostility toward you. Do not interpret unless you are really sure of your ground—much damage can be done by novices.
If the patient improves only at the price of too much dependence on you, or if he should become dependent on you without improving, refer him to a person with more skill and experience in the field of psychiatry. Remember that dependence is regression into an infantile state. While such regression may sometimes be necessary as a transitory phase during treatment, and frequently is undesirable even then, you must ultimately wean your patient and help him to mature. A physician of my acquaintance who rather prides himself on his self-taught skill in his psychotherapeutic management of neurotic patients told me once as a proof of his accomplishments that his cured neurotic patients retained so much confidence in him that for years after treatment they would make no major decision without asking his advice, even in entirely nonmedical matters. To me this sounded as if a surgeon were taking pride in the fact that his patients were letting him dress their still-draining incisions for years after each operation. We must keep our goal firmly in mind, which is to help our patients to achieve health, happiness, maturity, and independence. In every psychotherapy there comes the time when we must throw the ball of responsibility terminedly to our patient, and trust him to carry it.
