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Our first thoughts on what is effective in the therapy of neurosis are concerned with a clarification of the changes we are attempting to bring about in our patients.
Many psychiatrists work with different theories of human motivation and of neurosis. Their goals in therapy will depend on the theories they work with.1 As a result, there is considerable variance among therapists as to what is effective in therapy and why it is effective.
My concept of neurosis is similar to that of Horney in all essentials. Briefly, neurosis is determined by the culture.2 Its origin is the anxiety germinated in the child as a result of living in an environment unsuited to spontaneous self-satisfying growth.
Neurosis is early characterized by behavior aimed at safety, and modified to appease the varied surroundings. In time these different maneuvers become the compulsive driving forces (neurotic trends) of the individual's life.3 They gradually encroach on the individual's natural incentives and growth toward self-fulfillment. Ever-increasing conflicts ensue between one and another of the neurotic trends; and between the various neurotic trends and the individual's innate constructive incentives. These conflicts are the core of neuroses. Their very nature fosters their increase. They are a continual threat to the patient's inner unity. The consequent anxiety invokes multiple efforts to keep the conflicts out of awareness. These efforts (neurotic solutions) distinguish the neurotic patient. They include such mental mechanisms as externalization, cynicism and compartmentalization. Their results are devastating to the patient. They increasingly alienate him from his inner resources. They produce anxiety, hostility and hopelessness.4
On the basis of this theory of neurosis, therapy will have two objectives. One will be toward strengthening the patient's constructive incentives for fulfillment. The other will be a gradual resolution of the whole neurotic structure. Among the evidences of effec