Recent Contributions of Neuropsychiatric Research to the Theory and Practice of Psychotherapy

It is a pleasure to express my appreciation for the privilege and honor implied by this opportunity to give the Karen Horney Lecture of 1960, particularly as the material I wish to discuss has been obtained by the basic methods of clinical investigation of psychiatric problems in which Dr. Horney was so able a pioneer. Further, the clinical studies we will briefly review here independently confirm Dr. Horney's conclusions on the importance for mental health and mental illness of current events and social factors. They thus contribute to the concept of “the whole patient” as the concern of therapy.

Clinical research is a difficult and taxing field. The investigator necessarily explores unknown areas which affect the health, welfare and happiness of other human beings. He has a pre-determined, or at least a clearly anticipated goal: change from abnormality toward normality. He uses all available information, methods, and tools to promote this change, utilizing all the cues and all the factors which are available to him in the total situation. The criteria of validity are those of the direction of the course of the process with respect to the desired result. This is quite different from the application of the experimental or scientific method to a problem. In the latter case the objective is to differentiate a complex phenomenon into two or more simpler parts (concepts) by operations which can be communicated (or defined) in generally understood terms. The criteria are those of economy, consistency, and accuracy of operational definition. It is quite clear that the rigorous scientific method cannot be applied in exploration. It is necessary that the area of investigation be defined and that—especially in therapy—the course of the interaction be brought under sufficient control to permit measurements and comparison. It is thus only after exploratory clinical investigations have provided a stable situation that more or less clearly defined operations (measurements) can be