A STUDY OF PSYCHOTHERAPEUTIC RELATIONSHIPS BETWEEN PHYSICIANS AND SCHIZOPHRENIC PATIENTS
JOHN C. WHITEHORN M.D., and
BARBARA J. BETZ M.D.1
1 The Henry Phipps Psychiatric Clinic of the Johns Hopkins Hospital.
In a study of the therapeutic successes and failures of 35 physicians, members of the resident staff of the Henry Phipps Psychiatric Clinic between 1944 and 1952, it has been found that success with one type of patient does not correlate very highly with success with a different type of patient. To get a wide range of empirical facts, regarding factors significant for the improvement of schizophrenic patients, we selected for comparison 2 groups of patients, the A group 48 in number and the B group 52 in number, the A group having been treated by the 7 physicians who were most successful with schizophrenic patients and the B group by the 7 physicians who were least successful. [see Table 7 in source PDF.]
In the A group 75%, of the patients were improved at discharge; whereas only 27% of the B group were improved.
So wide a difference can not be attributed simply to inherent differences between the A and B groups, because a detailed clinical comparison indicates only slight differences not statistically significant.
From analysis of nurses' notes, charts, conference notes, and other portions of our case records which served to supplement and check the physicians' notes, comparisons have been made as to differences in the way the physicians worked with these patients, and the way the patients responded. The comparisons and contrasts of these empirical facts, presented in Tables 4, 5, 6, and 7, indicate that improvement in the schizophrenic patient is most likely to occur:
(1) when the physician indicates in his personal diagnostic formulation some grasp of the personal meaning and motivation of the patient's behavior, going beyond mere clinical description and narrative biography;
(2) when the physician, in his formulation of strategic goals in the treatment of a particular patient, selects personality-oriented goals rather than psychopathology-oriented goals, i.e., aims at assisting the patient in definite modifications of personal adjustment patterns and toward more constructive use of assets rather than mere decrease of symptoms or vague "better socialization";
(3) when the physician, in his day-by-day tactics makes use of "active personal participation," rather than the patterns "passive permissive," "interpretation and instruction," or " practical care."
These findings have been tested by statistical methods and are statistically significant beyond the .001 level of mere chance.
There is a similarly high association between improved condition at the time of a patient's discharge and the development by the patient, while in treatment, of a trusting, confidential relationship to the physician.
We interpret these empirical findings to mean that in the psychotherapy of schizophrenic patients success is to a large extent determined by the differences found among physicians in the extent to which they are able to approach their patients' problems in a personal way, gain a trusted, confidential relationship and participate in an active, personal way in the patient's reorientation to personal relationships. Techniques of passive permissiveness, or efforts to develop insight by interpretation appear to have much less therapeutic value.
