ACTIVE PSYCHOTHERAPY

A treatment procedure in which the patient is directed to make a graduated series of changes in his behavior. Active psychotherapy was developed by Alexander Herzberg (1945) as a means of breaking a neurotic behavior pattern and thereby speeding up the therapeutic process. The therapist assigns a progressive series of therapeutic tasks, first aimed at altering the more superficial expressions of the patient’s neurosis, and later directed at his deeper problems. As White (1964) points out, the assigned behavior must not awaken too much anxiety and resistance, and “the strategy can succeed only when the proposed task is so nearly within the patient’s present capacity that he needs only a little added impetus to carry it out ... It is strong medicine, and the doses must be selected with the utmost skill.” In applying this treatment, the therapist takes a calculated risk, for the patient may not be able to carry out his first assignments, or may feel so anxious in carrying them out that he will break off treatment and perhaps be worse off than before. If he is able to get over the first hurdles, however, he will probably feel he can overcome his problems, and will “win at least a local victory over neurosis.” To make the most of this local victory, the thera pist must go on to attack the patient’s deeper problems—otherwise the behavioral changes will leave the basic neurosis untouched, and new symptoms may arise to replace the ones eliminated. Illustrative Case: active psychotherapy The following summary of one of Herz- berg’s cases, quoted from White, represents a successful application of active therapy: “A wife felt strongly hostile toward her husband because of his lack of initiative and failure to earn well. At the same time she liked him for his kindness and consideration. For the sake of their children she wanted the marriage to continue, and her own hostility therefore filled her with self- reproach. Her aggressive feelings were thus constantly turned back on herself in the form of blame, and this finally resulted in depression with insomnia and various bodily symptoms. By concentrating fiercely on her symptoms she could now forget her aggression toward her husband. This neurotic solution of the main conflict, however, soon became exploited for secondary gain. By constant complaining about her illness she obtained increased attention from her husband, who took her out every day in order to make her feel better and who allowed her to keep a maid. Before long she was receiving presents and financial aid from her parents. Because of her condition she refused sexual intercourse, thus in effect punishing her husband. How can therapeutic tasks be used in treating this neurosis? Obviously it would be futile to direct them straight at the main emotional problem, telling her to stop hating her husband or punishing herself. Tasks were assigned instead which had the effect of removing the secondary gain. Progressively she was required to stop speaking of her symptoms at home, to discharge her maid and do her own housework, to resume sexual relations and discontinue her daily requests to be taken out, and to refuse all assistance from her parents. As these steps were successfully accomplished it became possible to go on to more nuclear problems.” (White, 1964)