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T H E DYNAMICS O F CHANGE IN P S Y C H O T H E R A P Y *
W . H . COONS, Ph.D. 1
The primary concern of this paper equating the acquisition of insight with
will be with the conditions under which changes in his patients' adjustment.
change occurs during psychotherapy; a Freud's system of psychoanalysis was
concern which stems from the difficulty designed to provide an experience which
encountered by all major schools of psy would foster insight. T o him, insight
chotherapy in explaining bow and why meant an awareness and understanding
therapeutic changes come about. of the relationship between contempor
Since Freud's development of psycho ary behaviour and repressed infantile
analysis, the primary stress in all syste sexuality (6). Initially, he placed pri
matic psychotherapies has been on mary emphasis on the intellectual aspects
insight as the core of adjustment. of the process. The assumption was that
However, no unequivocal relationship when the patient was made aware of the
between degree of insight and level of forgotten incidents in his life, the im
adjustment has yet been demonstrated. pact of the new knowledge would re
When insight is considered to be a cog sult in immediate amelioration of the
nitive act by which we grasp the signi maladjustment. However, this expecta
ficance of some pattern of relations tion was not confirmed. In Freud's
(13), clinical experience does not wholly words:
support its use as an explanatory con
"We accounted it specially fortunate if it
cept. Improved adjustment occurs in were possible to obtain information of the
persons who have not shown evidence forgotten traumas of childhood from external
of increased insight; other persons who sources, from parents or nurses, for instance,
are thought to 'have gained insight re or from the seducer himself, as occurred
occasionally, and we hastened to convey the
main seriously maladjusted.
information and proofs of its correctness to
Attempts to explain this discrepancy the patient, in the expectation of bringing
between theoretical expectation and the neurosis and the treatment to a rapid
clinical experience have resulted in the end by this means. It was a bitter disappoint
ment when the expected success was not
postulation of two types of insight: forthcoming" (<5, p. 362).
intellectual and emotional. However,
specifying the difference between them Freud attributed to 'resistance' the
has been difficult. In practice, differen reluctance of patients to accept as fact,
tiation is usually based on the presence incidents from their past. Resistance was
or absence of improvement in adjust assumed to be due to the repression from
ment; if the patient with insight im consciousness, as a result of unconscious
proves, he has emotional insight; if he psychic activity, of incidents which were
does not improve, he has intellectual in painful, disagreeable, frightful, or ob
sight only. This is essentially a circular noxious, to the ego of the patient. The
definition and suggests that some more belief was and is, that resistance to the
basic factor is at work. recall of ego-deflating incidents mani
fests itself in psychoanalysis in the form
Assumptions of Psychotherapists of transference; the patient transfers to
Freud the analyst those feelings and attitudes
Early in his experience in psychother which he holds toward important figures
apy, Freud encountered difficulty in in his past experience — usually parents.
^Manuscript received August, 1965. Successful analysis requires that the pa-
Department of Psychology, York University, Toronto.
3
tient recognize the existence of the contents of the mind as have hitherto
transference before progress is possible. remained unconscious. Insight is the pri
However, Freud was forced to re mary objective which can be best
cognize that 'uncovering' the transfer achieved within a warm, personal rela
ence is only the beginning of the tionship between the patient and the
analysis; a process which he called authoritarian therapist.
'working through' must follow if the
analyst's efforts are to be successful. Rankian Psychotherapy
Here is how he described it: The work of another of Freud's re
"One must allow the patient to get to know calcitrant students, Otto Rank (12),
this resistance of which he is ignorant, to merits special consideration. In my view,
'work through it', to overcome it, by con his contribution to the evolution of psy
tinuing to work according to the analytic
chotherapy has not received the recog
rule in defiance of it. Only when it has come
to its height can one, with the patient's co nition it deserves. Perhaps it is because
operation, discover the repressed instinctual of the difficulty in formulating a defini
trends which are feeding the resistance; and tive statement of the actual technique
only by living them through in this way of therapy employed by Rank. Theore
will the patient be convinced of their pow
er." "This 'working through' of the resis
tically at least, he introduced a new
tance may in practice amount to an arduous emphasis to the conduct of psychothera
task for the patient and a trial of patience peutic interviews.
for the analyst." "Nevertheless", Freud goes
on, "it is the part of the work that effects
T o him, relationship and will are the
the greatest changes in the patient and dis primary components, and, if we accept
tinguishes analytic treatment from every kind his statements literally, the patient
of suggestive treatment" (6, p. 375-376). rather than the therapist is the central
figure in the therapeutic process. He
The 'working through', Freud held
believes that the patient has within him
must always occur in an understanding,
self the 'forces of self-creation' as well
non-moralizing atmosphere. He emphas
as of 'self-destruction'. The former
ized that the analyst must carefully re
forces, those of self-creation, can be
frain, even in the later stages of analysis,
brought into play if the therapist will
from making interpretations to the pa
play the non-authoritarian role of 'ego-
tient "until the patient is already close
helper' or 'assistant ego'. The goals of
upon it, so that he has only a short step
therapy are achieved by the patient
to take in order to grasp the explana
through the experiencing of the present
tion himself" (6, p. 361).
rather than through an explanation of
Adler and Jung the past. In the close relationship with
the therapist the patient reacts in terms
The conditions which are basic to
of all his earlier reaction-patterns, plus
Freud's psychoanalysis are characteristic
those of the present. This experience,
also of the techniques of others who do
Rank believes, is the most direct means
not subscribe to his theory of personal
of bringing the patient to feel the will
ity. Thus, Adler (1927) rejects Freud's
conflict present in his total life situation
emphasis on repressed infantile sexuality.
and his denial of the will for indepen
He favours a concern for the patient's
dence and self-reliance.
neurotic life-plan which is determined
by compensation for feelings of infer The dynamic of change is inferred to
iority. T o Jung (16), individuation is be the experiencing, through the thera
the goal of analysis, individuation being peutic relationship, of the present mal
denned as the utmost widening and adaptive modes of adjustment. There
deepening of consciousness. But, while appears to be no place for interpretation
the content of 'insight' differs they both, (which would imply, of course, an
like Freud, seek to make conscious such authoritarian relationship), nor is insight
June, 1967 PSYCHOTHERAPY 241
experience between two human beings. concern itself with rationalizing post-mor
tems and fitting into some cognitive struc
He says: ture in which the person can have faith,
"One of the arguments for this point of view what actually did happen, or what is wished
is that in play therapy, particularly, many for, or anticipated in interpersonal inter
of the processes we have discussed either do course."
not occur, or occur only in unverbalized
form, and yet constructive changes take Here, Bach is quite obviously exclud
place. What are we to regard as essential to ing, or at least minimizing, the role of
psychotherapy if success occurs in dealing
the conscious, cognitive 'insightful',
with a child, when there have been no ver
balized insights, little expression of attitudes control of social behaviour. In essence,
toward the self, no certain expression of he is saying that we behave without
denied experiences, and only a fresh and thinking. After we have acted, we try
vital experiencing of self?" (14, p. 158). to rationalize what we have done; we
It seems that, while Rogers' client- try to make our behaviour appear 'logi
centered technique of therapy is designed cal'. But elsewhere (2, p. 235) he says:
to facilitate the development of insight, "Then gradually through identification with
he has reservations about according it the group, the patient can accept with rela
the primary role in the production of tively little resistance, the meaning of his
behavioural improvement. patterns of set-up operations, and this spells
the beginning for deep therapeutic effects.
Now with the recognition of his inner
Group Psychotherapy
enemy, of his neurotic patterns, the immense
The practice of group psychotherapy motivation of the human organism for prob
has depended primarily upon the modi lem-solving begins to shift and applies itself
fication of theories and techniques of to the relevant aspects of his life: his in
effectual contact operations and his patholo
individual psychotherapy for use with
gical need structure" (Italics mine).
groups of patients. Generally, the same
assumptions are used with one exception: Bach then, experiences the same dif
most group psychotherapists believe ficulty in reconciling his biases regard
that, at least with some patients, the ing the necessity of cognitive under
group provides a more effective medium standing with his clearly expressed
for the 'working through' required for belief in the practical efficacy of a par
the development of insight. Generally ticular type of interpersonal experience.
too, group psychotherapists share with The self is inconsequential in the volun
individual psychotherapists the dilemma tary direction of social behaviour, but
resulting from discrepancy between motivation for problem solving is im
practice and theory. portant in therapy.
Thus, Bach (2) questions the effec Bach's position epitomizes that of
tiveness in behaviour of conscious, cog individual and group therapists alike:
nitive, control. He argues that behaviour practice has impressed upon them the
occurs spontaneously in the absence of
inadequacy of techniques which • aim at
voluntary direction. In discussing the
relationship of the self to social behav imparting insight in the absence of
iour be says (p. 227-228): interaction, but for some reason they
"The self concept is not a central integrative cannot quite accept the evidence which
or even selective organ in the sense of con points to interpersonal interaction with
trolling or directing contact. The ego inter in the therapeutic situation as the origin
prets dead issues only, past experiences, and/ of the change which results.
or lapses in fantasies about the future. It
This has been a veiy brief survey of
does not direct the contemporary spon
taneous life. Upon contact, the social instinct
some of the psychotherapists who have
life (mutuality), rather than the self, governs most profoundly influenced the thera
unconsciously and spontaneously what a per peutic assumptions and techniques most
son will do with, to, or for another. The commonly used today. There are gross
'self has little to say about it. It can only differences in many aspects of their ap-
June, 1967 PSYCHOTHERAPY 243
him by those with whom he is inter of distortion and yet be unable to mod
acting. The nature of his behaviour is a ify his behaviour in terms of that under
product of his perception of the role standing. Apparently we act in strict
assigned to him, and of his system of accord with our perceptions even though
need-dispositions. Non-conformity we recognize that the results of our
(which includes maladaptive behaviour) behaviour are ineffective or unsatisfying.
may result from inaccuracy of his per Intellectually understanding the trouble
ception of the role expected of him does not help. In the distorted room
(presumably because of discrepancies experiment it is reported (15), that what
between his perception of past exper did belp to modify the subjects' percep
ience and the reality of the present situa tions and subsequent behaviour, was
tion), or from needs which predispose continued practice in hitting the rat or
him to antagonistic behaviour. striking the marked spots on the wall.
Parsons and Shils appear to feel that The continued striking in this experi
most individuals are aware, most of the ment appears to be analagous to the
time, of the forces which determine their continuous interaction characteristic of
behaviour. However, they do acknowl psychotherapy. T o make the analogy
edge that some indeterminate proportion complete it is necessary to assume that
of behaviour springs from factors about the therapist (and possibly the physical
which the behaving individual is un attributes of the therapeutic setting) is
aware. Numerous other authors (Mc- consistent in his reactions to the pa
Ginnies ( 7 ) , Postman and Brunei- (10), tient, just as the oblique room is always
Postman, Brunei- and McGinnies (11), oblique.
Bruner (3), Miller ( 8 ) , Cameron (4)
This is not easily accomplished. Dif
describe the manner in which the be
ficulties of the type encountered by the
haviour of both 'adjusted' and 'malad
subjects in Ames' experiment must be
justed' persons is influenced by these
magnified tremendously in interpersonal
'unconscious' factors.
situations in which reality (in the form
An experiment by Ames (one of the of the persons with whom interaction
Hanover experiments), demonstrates occurs) can manifest itself in such com
quite explicitly how these unconscious plex and nebulous form. However, a
factors may result in maladaptive be study by Coons (5) suggests that the
haviour. The experimental setting was a analogy is basically valid. Groups of
miniature distorted room of oblique patients who were involved in a form of
shape which, when viewed monocularly, group psychotherapy which facilitated
seemed to 'have the shape of an ordinary social interaction in the absence of the
rectangular room. The behaviour of usual insight-producing techniques pro
subjects asked to react to phenomena duced significantly more change than did
occurring within the room, was maladap insight group psychotherapy with mini
tive even though they understood the mal social interactions. In fact, the latter
nature of the subterfuge; the subjects groups did not differ significantly from
behaved as if the room were normally control groups which received no psy
shaped. Because they were using un chotherapy.
realistic cues, based on their previous It seems then, that there is substantial
experience with rooms, they were un basis in both research and theory for
able to perform simple tasks like hitting the assumption that social behaviour is
a rat, or striking marked spots on a wall determined by the expectancies or anti
(15). Their performances give striking cipations which the behaving individual
testimony to the manner in which a has built up on the basis of prior exper
person may understand intellectually the ience. A4aladaptive social behaviour may
nature and the perceptual consequences be assumed to result from the develop-
June, 1967 PSYCHOTHERAPY 245