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July 20, 1963

Prognostic Factors in Psychotherapy-Reply

JAMA. 1963;185(3):219. doi:10.1001/jama.1963.03060030077039

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To the Editor:—  Dr. Chutkow is correct in stating that patients' motivation for psychotherapy is quite varied. Some patients who apply for treatment at a psychiatric clinic do so with unrealistic expectations of an immediate magical kind of help. When this is not forthcoming, they disappear with their conviction that "no one will help them" reinforced and the feeling of abuse and abandonment more deeply ingrained. Other patients who are clearly severely ill emotionally will not even take the first step toward seeking help and seem to prefer to maintain a martyr-like, masochistic position of suffering. These patients, while secretly yearning for help, may refuse it or frustrate it when it is offered.These patients are quite different from those who somehow convey the impression that they are expecting to get well and that they are willing to cooperate with the doctor in his efforts to help them. Doctors generally

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