Reassurance in Therapy

To reassure means “to free from fear, anxiety, and terror.” This definition has a special relevance for modern psychiatry because in recent years anxiety has become a most important focus of psychotherapy. Before we can reassure intelligently, we should have some idea of what constitutes anxiety. Its most characteristic quality, to which I wish to give particular attention, is its unamenability to reassurance—that is, reassurance as one ordinarily understands it.

Subjectively, anxiety is a state of apprehension, a fear that something indefinite and terrible is imminent, and no amount of ordinary reassurance can in any way convince the anxious individual to the contrary. Subjectively comparable to anxiety but dynamically different are those emotional states of fear, terror, and phobia related to something definite and specific. The individual may feel these states to be rational or may accept them as irrational; but here again the common quality is their unamenability to reassurance. Where there is apprehension, feelings of impending disaster and similar expressions of anxiety, we say the fear has not been objectified or externalized. In the phobias, we say there has been objectification or externalization of the fear. There is good reason to think that the process of objectification which occurs unconsciously is always preceded by a brief or prolonged phase of anxiety, is a protection against that anxiety, and is an attempt therefore at what we could call internal reassurance. That is, the individual, through natural, unconscious processes within him, attempts to relieve his own anxiety. The phobia, or objectified fear, is more tolerable than the non-objectified anxiety.

One doctor, when referring a panicky apprehensive patient, told me that in response to his age-worn reassuring cliché, “My dear, there is really nothing to be afraid of,” the patient quickly said, “Oh doctor, that's what's the matter—if I only had something to be afraid of.”

We should in therapy consid