What Is Psychotherapy? Proc. 9th Int. Congr. Psychother., Oslo 1973 Psychother. Psychosom. 25: 239-242 (1975)
Psychotherapy and the Life History Charles A. Dailey1
In the United States, psychotherapy has become too esoteric and expensive for the average person. As a character of Malraux's puts it: ‘What good to me are all those thoughts of yours if you can’t give my tragedy a thought? What you do, all of you, is much more to the point than what you say. You guys are all too intellectual.’
1 I am profoundly indebted to Drs. Peter Sifneos and Richard Boyatzis for their encouragement regarding this paper.
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Putting therapy out of reach, both economically and intellectually, seems dubious policy. This is especially so since neither its price nor abstractness appear warranted by results. In this paper, I will offer a redefinition of psycho therapy, to bring it closer to the average person. Aside from our desire to make therapy more understandable, this redefinition seeks to make therapy more measurable as to outcome. In the ordinary man’s view, his life is composed of concrete events - mar riage, death, taxes. Imagine a vast scale of value, from disastrous events at the one end to events worth celebrating, at the other. In the plain man’s view, therapy should make his life better —make events worth celebrating more likely while minimizing disasters. I propose that this is also the way we should and can measure the value of therapy. Our first premise is that psychotherapy is effective if the events in a person’s life following it are more constructive than those preceding it. This premise is not exciting and original. What is important is that in recent years, research has produced ways of measuring such life change. The measurement is so simple that any clinician can use it without special training. Our second premise is that psychotherapy is effective if the patient comes to perceive his life history in a different way - specifically, he comes to identify
Dailey
(552) 240
new events as significant and in brief reorganizes the concept of his life. A person’s concept of his life can also, using a technique I shall describe, be measured in a simple way. In accord with these premises, psychotherapy seems to change the course of a life by changing the patient’s concept of what his life is. By ‘course of life’, I mean the pattern in time of common events such as marriage, raising children, birth, retirement. Quite simply, psychotherapy has impact only if the events of life are different from what they could have been without it. This implies that we take an inventory of the life events preceding therapy and compare them with those following it, using such as the very simple inventory (the Schedule of Recent Experience or SRE) designed by Rahe (1972) and his colleagues. Changing the patient’s concept of his life means the events he considers significant in his life history. These events differ from those collected in the SRE in that to learn the patient’s concept, we have him choose the events he con siders important and elaborate them. In this paper, I will briefly describe these two methods and some results from their use. They are to be understood as two among a long series of stand ardized life history methods which have been increasingly employed in American clinical investigations in recent years: R o ffa n d Ricks (1970); R o ffe t al. (1972).
What Is Measured?
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/3/2018 8:25:58 PM
The SRE inventory was designed to test the stress theory of Ham Selye, which postulated that mortality and morbidity are influenced by accumulated life stress. The SRE assumes that life stress is the sum of change-inducing events, where each event is weighted by the intensity and duration of life change likely to follow it. That sum is called LCU (for Life Change Units). For example, the death of one’s spouse receives 100 units, but of one’s pet, perhaps only a few. Holmes and Masuda (1967) showed that these weights are quite similar for different cultures. The higher the LCU score, the more recent stress is being reported. The SRE inventory can be administered in only 15 min and is easily scored. I suggest that psychotherapy should bring the rate of change in a person’s life within manageable limits. According to the findings of Rahe et al. (1967), physical illness incidence is predicted by the LCU index. Perhaps it can be demonstrated that therapy reduces the incidence of physical illness by reducing the level of stress. Other investigators, Dohrenwend and Dohrenwend (1972), working with similar procedures have developed two other scores from the data, based on the assumption that some such events are desirable and some, undesir able. The former are called Gains (such as getting a promotion) and the latter,
Psychotherapy and the Life History
(553) 241
Losses (such as getting fired). Gains and losses in life history have been shown, not surprisingly, to be related to affluence and socioeconomic level of one’s parents. The second procedure for determining therapeutic change is a simple method we developed at Dartmouth College to study the development of stu dents as they faced various identity formation problems. Each student kept a journal for a year, in which he recorded each week the ‘high’ or ‘low’ point for that week. These events were coded on a scale from Very Disorganized (or Loss) experiences to Very Self-Confirming (or Gain) experiences. Students differed quite radically in the proportions of each that they reported (Dailey, 1971). With patients and other adult populations, this procedure has been adapted in the following way in order to make studies of the entire life cycle. The person is asked to reconstruct his life history by recalling a high and low point for each year of life. These events are then coded on some of the scales we have been discussing. It is possible from the results to determine what his concept of his own life is like, including such questions as: —In what situations does he recall his most positive experiences (or Gains)? When and where do such Gains occur? —In what situations does he recall his most negative experiences (or Los ses)? When and where do such Losses occur? A generalized trend for the entire life cycle can be plotted for both Gains and Losses showing the concept the patient has. I expect this measure to show that in effective therapy, the patient’s memories change.
We have not used the LCU or other variable to measure change in psycho therapy, preferring first to build up norms on the general, non-psychiatric popu lation. First I will report the result of a recent Boston study, in which we interrogated 300 adults from various socioeconomic backgrounds and age groups from 20 to 50. These were ‘street-corner subjects’ - persons recruited by Harvard University graduate student interviewers in places such as the bus sta tion, beauty parlors, and supermarkets. Among the findings were: (1) Stress lasted longer for females than for males. (2) Rate of life change was greater for persons under 30 than over 30, but the events involved in the change differed systematically. A typical young per son’s stressors included finances, marriage, unemployment and drinking. A typi cal over-30 person’s stressors included losing a frier.d by death. (3) Stress was correlated with drinking, aggressive, and antisocial behavior. The High/Low Point procedure has been used to reconstruct the life cycles of several occupational groups and college students. Sample findings concern the differences between small businesses and large corporation managers:
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/3/2018 8:25:58 PM
Sample Findings
Dailey
(554) 242
(1) Corporation managers reported fewer Losses at every point in life than did the small-business men; specifically, the small-business men reported considerable family travail in early life and fewer Gains involving family matters in later life. (2) The more tranquil the life cycle, the more the events reported as signifi cant concerned family life; and the more stressful the life, the more the events concerned materialistic and financial affairs.
References
Request reprints from: Dr. Charles A. Dailey, 77 Old Coach Road, Sudbury, MA 01776 (USA)
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/3/2018 8:25:58 PM
Dailey, C.A.: Assessment of lives (Jossey-Bass, San Lrancisco 1971). Dohrenwend, B. and Dohrenwend, B.: Social class and the relation of remote to recent stressors; in R o ff Robins and Pollack Life history research in psychopathology. II. (University of Minnesota Press. Minneapolis 1971). Holmes, T.H. and Masuda, M.: The social readjustment rating scale. A cross-cultural study of Japanese and Americans. J. psychosom. Res. 10: 227-237 (1967). Malraux, A.: Man’s hope, p. 391 (Random House, New York 1938). Rahe, R.H.; McKean, J.D., and Arthur, R.J.: A longitudinal study of life change and illness patterns. J. psychosom. Res. 10: 355-366 (1967). Rahe, R.H.: Subjects’ recent life changes and their near-future illness susceptibility. Adv. psychosom. Med. 8: 2 -1 9 (1972). Roff, M. and Ricks, D. (eds.): Life history research in psychopathology. I. (University of Minnesota Press, Minneapolis 1970). Roff, M.: Robins, I,., and Pollack, M. (eds.); Life history research in psychopathology. II. (University of Minnesota Press, Minneapolis 1972).
Psychotherapy and the Life History Charles A. Dailey1
In the United States, psychotherapy has become too esoteric and expensive for the average person. As a character of Malraux's puts it: ‘What good to me are all those thoughts of yours if you can’t give my tragedy a thought? What you do, all of you, is much more to the point than what you say. You guys are all too intellectual.’
1 I am profoundly indebted to Drs. Peter Sifneos and Richard Boyatzis for their encouragement regarding this paper.
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/3/2018 8:25:58 PM
Putting therapy out of reach, both economically and intellectually, seems dubious policy. This is especially so since neither its price nor abstractness appear warranted by results. In this paper, I will offer a redefinition of psycho therapy, to bring it closer to the average person. Aside from our desire to make therapy more understandable, this redefinition seeks to make therapy more measurable as to outcome. In the ordinary man’s view, his life is composed of concrete events - mar riage, death, taxes. Imagine a vast scale of value, from disastrous events at the one end to events worth celebrating, at the other. In the plain man’s view, therapy should make his life better —make events worth celebrating more likely while minimizing disasters. I propose that this is also the way we should and can measure the value of therapy. Our first premise is that psychotherapy is effective if the events in a person’s life following it are more constructive than those preceding it. This premise is not exciting and original. What is important is that in recent years, research has produced ways of measuring such life change. The measurement is so simple that any clinician can use it without special training. Our second premise is that psychotherapy is effective if the patient comes to perceive his life history in a different way - specifically, he comes to identify
Dailey
(552) 240
new events as significant and in brief reorganizes the concept of his life. A person’s concept of his life can also, using a technique I shall describe, be measured in a simple way. In accord with these premises, psychotherapy seems to change the course of a life by changing the patient’s concept of what his life is. By ‘course of life’, I mean the pattern in time of common events such as marriage, raising children, birth, retirement. Quite simply, psychotherapy has impact only if the events of life are different from what they could have been without it. This implies that we take an inventory of the life events preceding therapy and compare them with those following it, using such as the very simple inventory (the Schedule of Recent Experience or SRE) designed by Rahe (1972) and his colleagues. Changing the patient’s concept of his life means the events he considers significant in his life history. These events differ from those collected in the SRE in that to learn the patient’s concept, we have him choose the events he con siders important and elaborate them. In this paper, I will briefly describe these two methods and some results from their use. They are to be understood as two among a long series of stand ardized life history methods which have been increasingly employed in American clinical investigations in recent years: R o ffa n d Ricks (1970); R o ffe t al. (1972).
What Is Measured?
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/3/2018 8:25:58 PM
The SRE inventory was designed to test the stress theory of Ham Selye, which postulated that mortality and morbidity are influenced by accumulated life stress. The SRE assumes that life stress is the sum of change-inducing events, where each event is weighted by the intensity and duration of life change likely to follow it. That sum is called LCU (for Life Change Units). For example, the death of one’s spouse receives 100 units, but of one’s pet, perhaps only a few. Holmes and Masuda (1967) showed that these weights are quite similar for different cultures. The higher the LCU score, the more recent stress is being reported. The SRE inventory can be administered in only 15 min and is easily scored. I suggest that psychotherapy should bring the rate of change in a person’s life within manageable limits. According to the findings of Rahe et al. (1967), physical illness incidence is predicted by the LCU index. Perhaps it can be demonstrated that therapy reduces the incidence of physical illness by reducing the level of stress. Other investigators, Dohrenwend and Dohrenwend (1972), working with similar procedures have developed two other scores from the data, based on the assumption that some such events are desirable and some, undesir able. The former are called Gains (such as getting a promotion) and the latter,
Psychotherapy and the Life History
(553) 241
Losses (such as getting fired). Gains and losses in life history have been shown, not surprisingly, to be related to affluence and socioeconomic level of one’s parents. The second procedure for determining therapeutic change is a simple method we developed at Dartmouth College to study the development of stu dents as they faced various identity formation problems. Each student kept a journal for a year, in which he recorded each week the ‘high’ or ‘low’ point for that week. These events were coded on a scale from Very Disorganized (or Loss) experiences to Very Self-Confirming (or Gain) experiences. Students differed quite radically in the proportions of each that they reported (Dailey, 1971). With patients and other adult populations, this procedure has been adapted in the following way in order to make studies of the entire life cycle. The person is asked to reconstruct his life history by recalling a high and low point for each year of life. These events are then coded on some of the scales we have been discussing. It is possible from the results to determine what his concept of his own life is like, including such questions as: —In what situations does he recall his most positive experiences (or Gains)? When and where do such Gains occur? —In what situations does he recall his most negative experiences (or Los ses)? When and where do such Losses occur? A generalized trend for the entire life cycle can be plotted for both Gains and Losses showing the concept the patient has. I expect this measure to show that in effective therapy, the patient’s memories change.
We have not used the LCU or other variable to measure change in psycho therapy, preferring first to build up norms on the general, non-psychiatric popu lation. First I will report the result of a recent Boston study, in which we interrogated 300 adults from various socioeconomic backgrounds and age groups from 20 to 50. These were ‘street-corner subjects’ - persons recruited by Harvard University graduate student interviewers in places such as the bus sta tion, beauty parlors, and supermarkets. Among the findings were: (1) Stress lasted longer for females than for males. (2) Rate of life change was greater for persons under 30 than over 30, but the events involved in the change differed systematically. A typical young per son’s stressors included finances, marriage, unemployment and drinking. A typi cal over-30 person’s stressors included losing a frier.d by death. (3) Stress was correlated with drinking, aggressive, and antisocial behavior. The High/Low Point procedure has been used to reconstruct the life cycles of several occupational groups and college students. Sample findings concern the differences between small businesses and large corporation managers:
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/3/2018 8:25:58 PM
Sample Findings
Dailey
(554) 242
(1) Corporation managers reported fewer Losses at every point in life than did the small-business men; specifically, the small-business men reported considerable family travail in early life and fewer Gains involving family matters in later life. (2) The more tranquil the life cycle, the more the events reported as signifi cant concerned family life; and the more stressful the life, the more the events concerned materialistic and financial affairs.
References
Request reprints from: Dr. Charles A. Dailey, 77 Old Coach Road, Sudbury, MA 01776 (USA)
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/3/2018 8:25:58 PM
Dailey, C.A.: Assessment of lives (Jossey-Bass, San Lrancisco 1971). Dohrenwend, B. and Dohrenwend, B.: Social class and the relation of remote to recent stressors; in R o ff Robins and Pollack Life history research in psychopathology. II. (University of Minnesota Press. Minneapolis 1971). Holmes, T.H. and Masuda, M.: The social readjustment rating scale. A cross-cultural study of Japanese and Americans. J. psychosom. Res. 10: 227-237 (1967). Malraux, A.: Man’s hope, p. 391 (Random House, New York 1938). Rahe, R.H.; McKean, J.D., and Arthur, R.J.: A longitudinal study of life change and illness patterns. J. psychosom. Res. 10: 355-366 (1967). Rahe, R.H.: Subjects’ recent life changes and their near-future illness susceptibility. Adv. psychosom. Med. 8: 2 -1 9 (1972). Roff, M. and Ricks, D. (eds.): Life history research in psychopathology. I. (University of Minnesota Press, Minneapolis 1970). Roff, M.: Robins, I,., and Pollack, M. (eds.); Life history research in psychopathology. II. (University of Minnesota Press, Minneapolis 1972).
