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May 1968

Subjective Change With Medical Student Therapists: II.Some Determinants of Change in Psychoneurotic Outpatients

Author Affiliations

From the departments of psychiatry and behavioral sciences (Dr.Uhlenhuth) and statistics and biostatistics (Dr.Duncan), Johns Hopkins University, Baltimore.

Arch Gen Psychiatry. 1968;18(5):532-540. doi:10.1001/archpsyc.1968.01740050020004

PSYCHOTHERAPY is a powerful procedure which can be either helpful or harmful.1,2(p21) In a study3 of subjective distress reported by a group of 128 primarily psychoneurotic outpatients over some six weekly psychotherapeutic interviews with senior medical students, the group's mean symptomatic distress decreased by 22%. Individual patients within the group, however, varied markedly in their responses: 72% felt improved and 26% actually felt worse at termination. This paper explores some sources of the individual variation observed in symptomatic response.

The present approach to this problem assumes that manifest psychological events are determined jointly by multiple factors. Further assumptions include the following: (1) Many of these factors may be related to one another, and to this extent their individual effects are confounded. (2) The effects of some factors may be contingent upon the effects of others (interaction4,5).

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