Am J Psychiatry 1996; 153:11-23
Copyright © 1996 by American Psychiatric Association
Onset conditions for psychological and psychosomatic symptoms during psychotherapy: a new theory based on a unique data set
L Luborsky
Department of Psychiatry, University of Pennsylvania Health System, Philadelphia, USA.
OBJECTIVE: The author's goal was to evaluate theories of the conditions
that exist before onset of psychological and somatic symptoms by assessing
these preconditions clinically and quantitatively. METHOD: He assembled a
set of texts from the cases of seven patients who had recurrent
psychological or somatic symptoms and examined the segments of texts that
came before the symptoms occurred; he then compared these segments with
segments of text that occurred before control points in the same case. The
recurrent psychological symptoms were momentary forgetting, shifts in level
of depression, and phobic behavior; the recurrent somatic symptoms were
stomach ulcer pains, migraine headaches, absence epilepsy (petit mal)
episodes, and premature ventricular contractions of the heart. RESULTS:
1)Independent ratings of presymptom segments compared with precontrol
segments revealed some significant differences in all seven cases. 2) Some
variables that distinguished the presymptom from the precontrol segments
occurred in all of the cases. In rank order of their effect size across
cases, these variables were hopelessness, lack of control, anxiety, feeling
blocked, helplessness, concern about "supplies," depression, and hostility
toward the therapist. For example, hopelessness was significant in seven of
the seven cases. CONCLUSIONS: For the first time, segments of texts of
psychotherapy sessions that occurred before recurrent symptoms have been
assembled and analyzed. These brief segments before recurrent symptoms
showed more of certain qualities than did segments before control points
where no symptoms appeared. On the basis of these results the author
constructed a new symptom-context theory of symptom formation and compared
this new theory with five classical theories of symptom formation, drawing
implications for research and for treatment techniques.
