The psychodynamic therapy of Bruno Bettelheim...

THE PSYCHODYNAMIC THERAPY OF BRUNO BETTELHEIM AND ITS THEORETICAL INTERPRETATION

Abstract

Budimir Rogovoy, Ph.D. (Russia)

The world-famous children`s psychotherapist Bruno Bettelheim has described in much detail the treatment processes of his psychotherapy, which is extremely effective and is able to heal completely schizophrenic and autistic  patients formerly considered incurable, without using any psychotropic drugs.
Nevertheless, the main therapeutic principles lying at the root of these treatment processes remain up to now insufficiently elucidated, which puts obstacles not only to a further spreading of this difficult-to-carry-out psychotherapy but also to its theoretical elaboration.
It was from this position that the author has endeavored to begin  a theoretical re-interpretation of Bruno Bettelheim`s psychotherapy, which re-interpretation is mainly guided by the descriptions and formulations of B.Bettelheim`s himself but taken in its entirety rests on the responsibility of the author.
Using the words of B.Bettelheim`s from another context, his psychotherapy is “favoring the development of ego strength directly”, mainly by means of “playing id against superego”, which helps the weak ego to neutralize their opposite energies and gain control over these frequently irrational forces.
In this therapeutic orientation B.Bettelheim leans possibly upon the psychoenergetic tenets of S.Freud who reasoned that the id can provide the ego with the energy necessary to mold unconscious tendencies and use them constructively.
In accordance with this general psychotherapeutic line the so called “negative” symptoms of the patients are fought against only in extreme cases, and the principle of reality is reminded to them only very mildly.
The indispensable condition and the main way of ego strengthening seems to be activity. As B.Bettelheim says about his patients:
“They returned to life only when we could create conditions or be a catalyzing force which induced them to act on their own behalf”.
The aim of the activization of his patients is reached by B.Bettelheim by creating for them a special environment ( the so called Orthogenic School), which makes his work rather an environmental therapy.
One of the main tasks of this environment is to completely free the patients from all “pressure to be active”, which is dialectically the first step for them to become spontaneously active without any pressure. That makes the psychotherapy of B.Bettelheim rather a “dialectical:” therapy.
Another indispensable condition needed for ego strengthening according to B.Bettelheim  is “a wide gratification of all, or almost all needs of the patients”.It sounds absolute and makes the psychotherapy of B.Bettelheim prima facie a therapy of gratification. But in practice this principle is applied with some  limitations.
It is especially noteworthy that the main concern in helping for the gratification of the patients is not the positive reinforcement of some desirable kinds of activity, as is customary in the traditional behavior therapy, but the building up of the general gratificatory background for the life of the patients.
We should like to point out the intrepidity of B.Bettelheim in immersing his patients into the depths of  continuously intensifying gratification, without deviating from this line even when the results seem to be unsatisfactory for some time and the state of the patient worsens, sometimes very seriously.
 “Spontaneous personal relations geared to the specific problem at hand” are a privileged source of gratification in the psychotherapy of B.Bettelheim. Indiscriminate reliance upon other sources of gratification without this human factor would not be sufficient. Such personal relations are an indispensable source of “social energy” ( the term of G.Ammon), they help for operant conditioning in the difficult art of gratification and spontaneous activity, they give models of behavior, mildly implement the principle of reality and provide the patients with ego ideals as the replacement of the rigid superego.
It is a characteristic feature of the treatmenr processes in the psychotherapy of B.Bettelheim that a final improvement is often preceded by some worsening caused by the reactivation of the formerly repressed drives of id.
“…Our work,-says B.Bettelheim,-is made up from a long series of ups and downs, but … by and large each low is less deep, and each new high that follows is both higher and better than the one that preceded it”.
The problem of these regressive worsenings was considered in detail in our article “Regressive exacerbations in the Psychotherapy of Bruno Bettelheim” (unpublished).
B.Bettelheim first tried to find a theoretical foundation to his psychotherapy in the traditional Freudian theory of the structure of human personality but later grew dissatisfied with it: “the theory, he admitted, did not fit the case”.We believe that in order to get a fuller explanation of the immense practical results of B.Bettelheim a new psychological theory is needed, which may or not be called psychoanalytic but must take into account the achievements of contemporary psychology and philosophy in such fields as activity, self-realization, human relations, existential freedom and gratification.
Such a theory if correctly built up could find a wide range of applications incl. beyond the scope of the psychotherapy of child schizophrenia.
A more detailed analysis of the psychotherapy of B.Bettelheim was given in our English-language article “Gratification and activity in schizophrenia” published in the German journal Dynamische Psychiatrie, Muenchen, 1994, #146/147, S. 206-219.
(The article is written in English, some in 2000., reprinted by the author on the computer in January 2013)


An earlier version of the article (about 2000):

 
THE PSYCHODYNAMIC THERAPY OF BRUNO BETTELHEIM AND ITS THEORETICAL INTERPRETATION

Abstract

Budimir Rogovoy, Ph.D. (Russia)

The world-famous children`s psychotherapist Bruno Bettelheim has described in much detail the treatment processes of his psychotherapy, which is extremely effective and is able to heal completely schizophrenic and autistic  patients formerly considered incurable, without using any psychotropic drugs.
Nevertheless, the main therapeutic principles lying at the root of these treatment processes remain up to now insufficiently elucidated, which puts obstacles not only to a further spreading of this difficult-to-carry-out psychotherapy but also to its theoretical elaboration.
It was from this position that the author has endeavored to begin a theoretical re-interpretation of Bruno Bettelheim`s psychotherapy, which re-interpretation is mainly guided by the descriptions and formulations of B.Bettelheim`s himself but taken in its entirety rests on the responsibility of the author.
Using the words of B.Bettelheim`s from another context, his psychotherapy is “favoring the development of ego strength directly”, mainly by means of “playing id against superego”, which helps the weak ego to neutralize their opposite energies and gain control over these frequently irrational forces.
In this therapeutic orientation B.Bettelheim leans possibly upon the psychoenergetic tenets of S.Freud who reasoned that the id can provide the ego with the energy necessary to mold unconscious tendencies and use them constructively.
In accordance with this general psychotherapeutic line the so called “negative” symptoms of the patients are fought against only in extreme cases, and the principle of reality is reminded to them only very mildly.
The indispensable condition and the main way of ego strengthening seems to be activity. As B.Bettelheim says about his patients:
“They returned to life only when we could create conditions or be a catalyzing force which induced them to act on their own behalf”.
The aim of the activization of his patients is reached by B.Bettelheim by creating for them a special environment ( the so called Orthogenic School), which is dialectically the first step for their becoming spontaneously active without  any pressure.
Another indispensable condition of ego strengthening in the psychotherapy of B.Bettelheim  is “a wide gratification of all, or almost all needs of the patients”. We believe that gratification of need-fulfilling activities helps to  interiorize pleasure “in functioning” and thereby provides sufficient psychological support necessary for a “basic trust” to reality.
It is especially noteworthy that in B.Bettelheim,s psychotherapy gratification is used primarily not for the positive reinforcement of some desirable kinds of activity (as is done in the traditional behavior therapy) but for creating their gratificatory background (pleasures of eating, touching, playing etc.), often with significant regressive elements (e.g., sucking from a baby bottle).
We should like also to stress the intrepidity of B.Bettelheim in immersing his patients into the depths of  all-sided and ever so intensifying gratification, without deviating from this line even when the results seem to be unsatisfactory for some time and the state of the patient worsens, sometimes very significantly.
“Spontaneous personal relations geared to the specific problem at hand” are a privileged source of gratification in the psychotherapy of B.Bettelheim. Indiscriminate reliance upon other sources of gratification without this human factor would no more than using mechanical devices, which is always  undesirable. Such personal relations are an indispensable source of “social energy” ( the term of G.Ammon), they help for operant conditioning in the difficult art of gratification and spontaneous activity, they give models of behavior, mildly implement the principle of reality and provide the patients with ego ideals as the replacement of the rigid superego.
   It is a characteristic feature of the treatment processes in the psychotherapy of B.Bettelheim that a final improvement is often preceded by some worsening caused by the reactivation of the formerly repressed drives of id.
   In case of such a crisis the course for more gratification usually remains unchanged or even intensifies with more personal nearness to patient. Nurses show extreme tolerance to aggression and other psychopathological manifestations in the behavior of the patients.  The child in crisis becomes an object of special attention for every member of the therapeutic staff dealing with him.
   In these as in many other situations therapeutic influence is also exerted on the individual by the group of the patients to which the child in crisis belongs.
   The result of such a therapeutic attitude is a final “unfreezing” of the patient with the changing of the pathological transference reactions into true honest-to-goodness ones.

B.Bettelheim first tried to find a theoretical foundation to his psychotherapy in the traditional Freudian theory of the structure of human personality but later grew dissatisfied with it: “the theory, he admitted, did not fit the case”. We believe that in order to get a fuller explanation of the immense practical results of B.Bettelheim a new psychological theory is needed, which may or not be called psychoanalytic but must take into account the achievements of contemporary psychology and philosophy in such fields as activity, self-realization, human relations, existential freedom and gratification.
   Such a theory if correctly built up could find a wide range of applications incl. beyond the scope of the psychotherapy of child schizophrenia.
    A more detailed analysis of the psychotherapy of B.Bettelheim was given in our English-language article “Gratification and activity in schizophrenia” published in the German journal Dynamische Psychiatrie, Muenchen, 1994, #146/147, S. 206-219 and  “Regressive Exacerbations in the Psychotherapy of Bruno Bettelheim” (sent to the British Journal of Psychotherapy in 1998)