RE-EDUCATION

A form or stage of psychologial treatment in which the patient is taught—or, better, given an opportunity to learn for himself—more effective ways of dealing with problems and relationships.The term is a broad one that arises out of the fact that the goal of therapy is not merely to eliminate disturbing reactions or faulty modes of adjustment, but to replace them with more successful behavior. Most therapists view this process as “emotional re-education,” or “corrective emotional experience,” and not as a simple learning process. The reason for the emphasis on emotion is that psychotherapy is rarely viewed as an intellectual procedure. It can be effective only through modification of the patient’s feelings and reactions.There are many ways to approach re-education, and many levels of achievement. Probably the deepest and most difficult level is the one on which psychoanalysts operate. Their aim is to effect a fundamental change in the structure of the patient’s personality, so that changes in attitude and outward behavior will stem from inner sources. In the course of treatment, the patient gradually learns how to handle emotional situations, such as marital, social, or occupational problems, that have caused great anxiety in the past. If he finds his new patterns of adjustment rewarding and satisfying, he will become more capable of navigating on his own, without support from a therapist.Re-education is an essential aspect of treatment in most modem mental institutions. Patients are encouraged to adopt new attitudes toward themselves and new patterns of adjustment toward other people through such techniques as group therapy and occupational, social, and recreational activities. In the “total push,” milieu, and therapeutic community aproaches, the entire institutional life is viewed as a re-educational force. As institutionalized patients improve and approach discharge, they generally participate in classes and discussion groups which are designed to prepare them to find suitable jobs and meet the demands of everyday life in the community.Today a number of therapists are focusing directly on re-educational methods designed to bring about behavioral changes in neurotic patients. They believe it is possible to foreshorten or sweep away entirely the groundwork which psychoanalysts find so necessary —that is, the lengthy process of interpreting dreams and free associations, breaking through resistances, and analyzing the transference. Instead, they get down to the business of re-education at once, using whatever technique of behavior change they believe to be most effective. In persuasion treatment, the therapist first explores the patient’s difficulties, points out faulty reactions, such as a pattern of evading issues, and then encourages him to try different ways of meeting his problems. In directive psychotherapy, the therapist charges the patient with the responsibility of making definite changes in his behavior—for example, by asking a hypochondriac patient to refrain entirely from referring to his illnesses. In conditioned response treatment (behavior therapy), rewards may be used to reinforce new reaction patterns; or distasteful stimuli, such as electric shocks or nauseating drugs, may be used to eliminate undesirable behavior. Some therapists use hypnotic suggestion in combating insomnia, smoking, and overeating; a combination of hypnosis and relaxation techniques is occasionally applied to reduce anxiety and prepare an expectant mother to go through the birth process with a minimum of stress.All these methods have proved valuable in removing symptoms or bringing about desirable behavior changes. Their effectiveness, however, seems to be limited largely to the milder and less fixed conditions, such as habit disturbances, traumatic neuroses, phobias, and hysterical reactions of recent origin. The therapist must always be prepared for the possibility of relapse, which usually indicates that the patient’s problem is on a deeper level than behavior techniques can touch. Moreover, these techniques are not so simple and mechanical as they are sometimes pictured. Theywork best when the therapist establishes rapport with his patient, shows interest in his problems and concern for his welfare, and gains his confidence and trust. R. W. White (1964) sums up the case for and against the more rapid methods of re-education in these words: “We must accept the long-accumulating evidence that symptomatic treatment can be successful, but must not overlook the equally long-accumulating evidence that symptoms are in many cases the surface phenomena of more complex emotional difficulties.” See PERSUASION THERAPY, BEHAVIOR THERAPY, DIRECTIVE PSYCHOTHERAPY, HYPNOTHERAPY, RELAXATION THERAPY, MILIEU THERAPY, SOCIOTHERAPY, TOTAL PUSH THERAPY