A study of psychodynamic changes in untreated neurotic patients. I. Improvements that are questionable on dynamic criteria.

Abstract

A review of the available evidence suggests strongly that symptomatic improvement is the rule rather than the exception in untreated neurotic patients. The present study is an attempt to evaluate these symptomatic improvements from a psychodynamic point of view. A method of psychodynamic assessment is described, depending for each patient on criteria laid down from the diagnostic interview before the patient is seen for follow-up. In a two- to eight-year follow-up study of 45 untreated Tavistock Clinic patients, 23 (51 per cent.) were found to be at least symptomatically improved, of whom 9 (20 per cent.) were symptomatically recovered. On the other hand, out of these improvements at least 7 (16 per cent. of the 45) and possibly 13 (29 per cent.) were psychodynamically suspect; and only 1 patient (2 per cent.) could be regarded as dynamically recovered. Expressed in round figures in another way; between one-third and one-half of the symptomatic improvements were psychodynamically suspect. The evidence on the thirteen symptomatically improved but dynamically suspect patients is presented in detail. Although there are reservations derived from the method of selection of these 45 patients, this result casts some doubt on the statement that roughly two-thirds of neurotic patients get better without treatment.