You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
In a unique clinical experiment, the same staff was used in two psychiatric clinics in areas of only forty minutes' drive apart—one upper-class, and the other lower-middle-class. The lower-middle-class patients had more acute problems combined with greater reluctance to enter and remain in therapy. There were more overt psychosomatic and behavioral disturbances in the lower-middle-class patients, whereas in the upper-stratum outpatient clinic the symptomatology was mixed with over-all personality disorganization superimposed on, and confusing, the neurotic constellation in what is called 'sociopathologization'. The upperstratum patients were sophisticated about therapy and often asked for classical psychoanalysis. Only half who requested analysis were considered suitable and tended to stay in therapy. The number of 'good' psychoanalytic cases that came from the lower-middle-class group as well as the success of the technique was unexpected.
As a result of this experiment the authors question conventional preferences for any approach to therapy. Rather, they see mental health as complex, even including resistances that are, at times, effectively and permanently adaptive. They argue that cultural circumstances not only influence therapy but enter initially and fundamentally into the structure of treatment. Any attempt to impose on the intellectual and economic setting must result in failure. They seek to expand it without abandoning basic essentials of psychotherapy—individual improvement with realization of human dignity.