The Psychoanalytic Therapy for Phobia
The success of a therapy can sometimes be relevant evidence for the theory from which the therapy is derived.
What is the psychoanalytic therapy
for phobias, and how does it fare?
The psychoanalytic therapy for phobia...
follows from the theory that phobic fear is the displacement of anxiety
generated by unacceptable intra psychic conflict onto some innocent object.
The therapist must help the patient to bring the unconscious conflict to
light, and to gain insight into the repressed traumatic incident that generated
the phobia. In addition, some analysts recommend that the patient's
attention should be focused away from the phobic object, but that as the patient
comes to recognize the unconscious conflict, he should be encouraged
to re-experience the phobic situation while learning that the fear is not intolerable.
Psychoanalysts recognize that the prognosis for phobics under this
regime is not good (Laughlin, 1967; Arieti, 1979).
One must anticipate that many, many sessions willbe required. A great deal of
time and effort is generally required on the part of both doctor and patient alike.
Further, no guarantee as to the results can be given.... It may be a strenuous
job, takinghundredsof therapeutic sessions over some years. The end results can
beworth far more than the considerable investment of time, effort and money required.
(Laughlin, 1967, p. 601)
Overall, then, the Little Hans case history provides unsatisfactory evidence
for the psychoanalytic view of phobias. The interpretations are large,
uncompelling leaps. This alone would not necessarily be fatal to the theory
if there existed experimental evidence to support the interpretation, or if
psychoanalysis cured phobias. There is no such evidence, however, and psychoanalytic
therapy is of doubtful value for overcoming phobias. Moreover,
there exists an alternate account that is consistent with case history material
and experimental evidence, and that is of considerable therapeutic value:
the behavioral account.
THE BEHAVIORAL ACCOUNT OF PHOBIAS
The behavioral analysis ofphobias begins by assuming that normal fear and
phobia are learned in the same way. According to this view, both fear and
phobia arise when a neutral signal happens to be around at the same time as
a bad event. If the bad event is mild, the neutral signal becomes mildly fear
provoking. If, however, the bad event is particularly traumatic, as when
Anna watched in horror as her father drowned a kitten, the signal becomes
terrifying, and the phobia develops. Phobic conditioning is simply an instance
of classical fear being conditioned by a particularly traumatic unconditioned
stimulus.
Classical Conditioning of Fear
Recall that classical conditioning consists of a procedure in which a conditioned
stimulus (CS)-or signal-happens to occur at the same time as an unconditioned stimulus (US)-or traumatic event in the case offear conditioning-
which evokes a strong unconditioned reaction (UR). Thereafter,
the previously neutral CS produces a conditioned response (CR) that resembles
the UR. The CR is the phobic response and the CS is the phobic object.
Hans's experience fits this description. Hans himselfasserted that his phobia
began suddenly when he saw a horse fall down in the street and violently
thrash its legs. This gave him an awful fright. The sight of a horse, once not
fearful, is a neutral CS. As he looks at the horse, it falls down and thrashes
about (US) which evokes fear (UR). Thereafter, the CS of seeing a horse
produces a CR offear. Hans has been classically conditioned to fear horses;
we need not postulate deeper fears or lusts. According to this analysis, Hans
was not afraid of castration by his father; he was afraid of horses (Wolpe and
Rachman, 1960). The precipitating trauma, when it occurs in phobic cases,
can be well described by classical fear conditioning. This details the
classical fear conditioning analysis of several ofour phobic case histories.
In addition to fitting many case histories, a substantial body of experimental
evidence supports the hypothesis that pairing a neutral object with a
frightening situation produces strong fear of the neutral object. In 1920,
John B. Watson and Rosalie Rayner performed the first experiment on this
topic. Little Albert B. was a normal, healthy eleven-month-old who, from
birth, had been reared in the hospital in which his mother worked as a wet
nurse. On the whole, he was big, stolid, and unemotional. One day, Albert
was presented with a white rat, and he eagerly began to reach for it. Just as
his hand touched the rat, the experimenters struck a metal bar suspended
above Albert's head with a hammer. This produced such a loud and startling
sound that Albert jerked violently, burying his head in the mattress, and
whimpered. This pairing of the rat and the sound was repeated several times.
When Albert was shown the rat later, he began to cry.
He fell over on his side, and began to crawl away as rapidly as he could.
A phobia had been conditioned...
This experiment was a primitive, but pioneering study. We will discuss in
the critique of the behavioral account of phobias section below some of the
flaws (Harris, 1979; Seligman, 1980). Nonetheless, since the Little Albert
experiment, literally hundreds of studies of classically conditioned fear in
animals and several in humans have been published. It is now well established
that pairing a neutral CS with a traumatic US produces strong acquired
fear to the CS. So classical conditioning of fear provides a potential
experimental model of phobias because it fits many case histories and seems
to be a sufficient condition for learning strong fear.
What is the psychoanalytic therapy
for phobias, and how does it fare?
The psychoanalytic therapy for phobia...
follows from the theory that phobic fear is the displacement of anxiety
generated by unacceptable intra psychic conflict onto some innocent object.
The therapist must help the patient to bring the unconscious conflict to
light, and to gain insight into the repressed traumatic incident that generated
the phobia. In addition, some analysts recommend that the patient's
attention should be focused away from the phobic object, but that as the patient
comes to recognize the unconscious conflict, he should be encouraged
to re-experience the phobic situation while learning that the fear is not intolerable.
Psychoanalysts recognize that the prognosis for phobics under this
regime is not good (Laughlin, 1967; Arieti, 1979).
One must anticipate that many, many sessions willbe required. A great deal of
time and effort is generally required on the part of both doctor and patient alike.
Further, no guarantee as to the results can be given.... It may be a strenuous
job, takinghundredsof therapeutic sessions over some years. The end results can
beworth far more than the considerable investment of time, effort and money required.
(Laughlin, 1967, p. 601)
Overall, then, the Little Hans case history provides unsatisfactory evidence
for the psychoanalytic view of phobias. The interpretations are large,
uncompelling leaps. This alone would not necessarily be fatal to the theory
if there existed experimental evidence to support the interpretation, or if
psychoanalysis cured phobias. There is no such evidence, however, and psychoanalytic
therapy is of doubtful value for overcoming phobias. Moreover,
there exists an alternate account that is consistent with case history material
and experimental evidence, and that is of considerable therapeutic value:
the behavioral account.
THE BEHAVIORAL ACCOUNT OF PHOBIAS
The behavioral analysis ofphobias begins by assuming that normal fear and
phobia are learned in the same way. According to this view, both fear and
phobia arise when a neutral signal happens to be around at the same time as
a bad event. If the bad event is mild, the neutral signal becomes mildly fear
provoking. If, however, the bad event is particularly traumatic, as when
Anna watched in horror as her father drowned a kitten, the signal becomes
terrifying, and the phobia develops. Phobic conditioning is simply an instance
of classical fear being conditioned by a particularly traumatic unconditioned
stimulus.
Classical Conditioning of Fear
Recall that classical conditioning consists of a procedure in which a conditioned
stimulus (CS)-or signal-happens to occur at the same time as an unconditioned stimulus (US)-or traumatic event in the case offear conditioning-
which evokes a strong unconditioned reaction (UR). Thereafter,
the previously neutral CS produces a conditioned response (CR) that resembles
the UR. The CR is the phobic response and the CS is the phobic object.
Hans's experience fits this description. Hans himselfasserted that his phobia
began suddenly when he saw a horse fall down in the street and violently
thrash its legs. This gave him an awful fright. The sight of a horse, once not
fearful, is a neutral CS. As he looks at the horse, it falls down and thrashes
about (US) which evokes fear (UR). Thereafter, the CS of seeing a horse
produces a CR offear. Hans has been classically conditioned to fear horses;
we need not postulate deeper fears or lusts. According to this analysis, Hans
was not afraid of castration by his father; he was afraid of horses (Wolpe and
Rachman, 1960). The precipitating trauma, when it occurs in phobic cases,
can be well described by classical fear conditioning. This details the
classical fear conditioning analysis of several ofour phobic case histories.
In addition to fitting many case histories, a substantial body of experimental
evidence supports the hypothesis that pairing a neutral object with a
frightening situation produces strong fear of the neutral object. In 1920,
John B. Watson and Rosalie Rayner performed the first experiment on this
topic. Little Albert B. was a normal, healthy eleven-month-old who, from
birth, had been reared in the hospital in which his mother worked as a wet
nurse. On the whole, he was big, stolid, and unemotional. One day, Albert
was presented with a white rat, and he eagerly began to reach for it. Just as
his hand touched the rat, the experimenters struck a metal bar suspended
above Albert's head with a hammer. This produced such a loud and startling
sound that Albert jerked violently, burying his head in the mattress, and
whimpered. This pairing of the rat and the sound was repeated several times.
When Albert was shown the rat later, he began to cry.
He fell over on his side, and began to crawl away as rapidly as he could.
A phobia had been conditioned...
This experiment was a primitive, but pioneering study. We will discuss in
the critique of the behavioral account of phobias section below some of the
flaws (Harris, 1979; Seligman, 1980). Nonetheless, since the Little Albert
experiment, literally hundreds of studies of classically conditioned fear in
animals and several in humans have been published. It is now well established
that pairing a neutral CS with a traumatic US produces strong acquired
fear to the CS. So classical conditioning of fear provides a potential
experimental model of phobias because it fits many case histories and seems
to be a sufficient condition for learning strong fear.
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