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This is the third report on the Psychotherapy Research Project at the Menninger Foundation. Environmental factors contributing to the patient's total 'life space' are divided into six categories of data to help evaluate the degree and quality of internal change in the patient. The categories are: 1, 'conflict triggers', the environmental factors which activate and resonate with the nuclear conflicts; 2, 'stress', any noxious external event 'which an average adult in our culture would classify as stressful'; 3, 'supporting' factors tending to maintain ego integrity (e.g., concerned mother, loyal spouse, etc.); 4, 'opportunities for growth' which might be realistically possible in the particular environment; 5, 'need-congruence', the presence of situations which 'resonate favorably or unfavorably with individual values, interests, and characterological styles'; 6, the possibilities for change ('mutability') in the patient's environment.
Two cases demonstrate the use and pertinence of this kind of data. A woman who was free of symptoms and living with satisfaction and happiness at the time of follow-up two years after the termination of treatment, changed not as a result of internal resolution of the presumed nuclear conflicts but rather through some radical changes in her life situation, including divorce and marriage to an entirely different type of man. In the second case what appeared to be a successful resolution of the nuclear conflicts turned out in the follow-up to be the patient's realization that he had to 'establish a new way of life which would be less conflict-triggering and more supportive'. If all the forty-two cases in this series are studied with the thoroughness hinted at in this report, the final publication should be useful to all analysts and psychiatrists.