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Rapid population growth, particularly evident in Southern California, is significantly related to the equally rapid expansion of psychotherapy, encompassing ever larger potential patient groups and dealing with ever more complex problems.
Modern society abounds in the creation of new social settings in which the basic approaches of psychotherapy and the original models of individual treatment can be demonstrated to be valid and useful, on condition that they are qualified and modified according to the new requirements and new standards. The specific social and cultural settings co-determine the therapeutic strategy and approach, in interaction with the individual's psychology, and decide about success or failure of the ultimate outcome. Specifically, this means that what is designated as desirable motivation in one setting may well be escape and rationalization in another. The ideological bias of one frame of reference may be the health goal of another; reality may be experienced as resistance and vice versa, from different vantage points.
During the past eight years, our clinical staff has had a unique opportunity to observe psychiatric patients and processes in two vastly different cultural settings. Since 1944, we have operated a psychotherapeutic outpatient clinic in an upper-stratum, residential area of Beverly Hills (an area now both famous and notorious for its inordinate number of psychoanalysts). Some years later, in 1956, we opened a similar clinic in a strikingly different area—the lower middle-class industrial suburb of Lynwood, approximately a 40