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This paper will compare contrasting explanations for therapeutic change offered by two psychoanalytic theories, namely the traditional psychoanalytic theory of Freud (1911-1915) evolved before he developed his ego psychology, and the control mastery theory of Weiss (Weiss, et al., 1976, 1977), which is a variant of ego psychology. It will compare their explanations for the improvement in this type of patient when his demands for help were not met, and why he became worse when the therapist gave in to them. It will also compare their explanations for why the patient, unaided by interpretation, both recovered warded-off traumatic memories and improved clinically.
The patient, a 20-year-old college student, came to the psychiatric clinic at Langley Porter for treatment of severe symptoms of depression. The patient was seen twice a week. He immediately demanded that the therapist prescribe antidepressants and give him advice in order to relieve his symptoms. The therapist, a second-year resident in psychiatry, who presented this patient at the author's continuous case conference, at first felt extremely worried about the patient when the patient, appearing very upset, harangued him with such complaints as, “You're doing nothing while my life is falling apart.” “Nothing is happening that helps.” Or, “Why don't you do something when you see my intense pain?” When the therapist, as a result of his worry, gave in to the patient's demands for both medication and advice, the patient's symptoms became more severe. Conversely, when the therapist followed my recommendation not to comply with the demands, the patient's symptoms eased markedly.
During a I 1/2 year period, when the patient was 9-10 1/2, his father, on several occasions, was close to death from renal disease. The