The Changing Concept of Goals in Therapy

Many years ago, when I was what is presently known as a “generalist,” but was then called a “general practitioner,” I had an experience which taught me something about the therapeutic goal of symptom removal. A neighbor and patient was a woman of about 30 years of age, married and childless, and quite unsophisticated. One day she came into my office and indicated that she was completely unable to utter a word. Apparently this state of affairs had gone on for several hours. I tried to visualize her vocal cords with the laryngeal mirror; failing to do so, I referred her to an otolaryngologist. A few hours later she returned to my office, speaking normally. I was delighted at this “cure.” I called the consultant, who told me that he had examined her vocal cords, and found them entirely normal. He had persuaded her to make a few squeaking sounds, then a few sounds lower in pitch, then a word or two, and soon she was talking. An excellent result! Twenty-fours hours later she returned to my office, unable to urinate. This condition had been going on for several hours, and she was distended and beginning to have lower abdominal pain. I had no difficulty catheterizing her and drawing off a considerable amount of urine. Her abdominal discomfort disappeared promptly, and all was well again. The next day she had a generalized convulsion. Her husband called me to the house, where I found her unconscious on a couch. She promptly regained consciousness, and within a few minutes was restored to her usual condition. Shortly thereafter I went into army, and I never saw her again.

This experience taught me what practitioners of psychoanalysis learned early in the growth of this therapeutic method; that is, that symptom removal is not a satisfactory goal in itself. Symptoms are, after all, an indication that something is psychologically and emotionally wrong with the patient, and unless the underlying pathology is corrected, the removal of symptoms will provide only temporary relief. I