On the Value of One or Two Interviews

A woman of thirty suffered from severe hypochondriacal ideas for as long as she could remember. She had all sorts of fears that she had some dire illness, usually a belief that she had cancer; and the slightest symptom or injury was always a life-threatening condition. She was terrified of dying. In part she could not help being fully convinced that she was suffering from the hopeless condition, but part of her ego always realized that it was not fully true.

She consulted a psychiatrist only when she was offered a good position in a remote area, believing this was her last opportunity. She was seen twice with an interval of three weeks between the visits.

During the first interview the main dynamics could be clearly discerned. She was raised in a family of such excessively high ideals that, though scarcely ever mentioned explicitly, they permeated the entire manner and atmosphere of the household, exceeding any standards with which a child could comply. Failure nevertheless produced shame, and the rebellion was entirely repressed and produced guilt. The guilt and the hostility repressed and turned upon herself were the main sources which activated her symptoms. Her death wishes against her parents were turned into death impulses against herself.

The patient was tremendously relieved in this one interview. She was made to realize that the family standards were too high for anyone to live up to; hence the guilt and shame for her common human shortcomings were unnecessary. She realized, in fact, that she was a very superior person as to character and ideals. She was also relieved to learn that her rebellion was not unjustified; moreover, she could now understand the rational emotional basis for her wanting to leave the family and go to distant parts. These insights undermined her sense of the reality of her symptoms and made her see much more clearly how her beliefs in the afflictions she diagnosed in herself were only the resultants of other forces.

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