PATIENTS' EXPECTANCIES AND RELEARNING AS FACTORS DETERMINING IMPROVEMENT IN PSYCHOTHERAPY
JEROME D. FRANK M.D.,
LESTER H. GLIEDMAN M.D.,
STANLEY D. IMBER PHD.,
ANTHONY R. STONE M.S.S.W., , and
EARL H. NASH M.S.1
1 The Henry Phipps Psychiatric Clinic of the Johns Hopkins Hospital.
A group of psychiatric outpatients received either individual psychotherapy, group psychotherapy or minimal therapy for about 6 months. After 6 months the treatment experiences of the patients became increasingly varied. Patients were rated with respect to change in subjective discomfort and social ineffectiveness at 6 months and at regular follow-up intervals up to 2 years. It was found that at 6 months the average discomfort had markedly decreased, and that the decrease was the same regardless of kind or amount of treatment. Symptoms of anxiety and depression tended to be scored higher initially and to decline more than somatic complaints. Subsequent studies with these and similar patients showed that a similar drop in discomfort could be found within one week, or even in the course of a single interview.
A significant improvement in social ineffectiveness also was found at 6 months. It was significantly greater for patients who had received group or individual therapy than for those in minimal therapy or those who dropped out within 4 sessions.
After 6 months, improvement in discomfort was maintained but did not increase, whereas social ineffectiveness continued to improve throughout the observational period.
These results are consistent with the view that improvement in psychotherapy may be produced by at least 2 factors: 1. Non-specific expectancy of relief; 2. Relearning, which is related to the amount and kind of treatment contact.
