精神療法における「劇的な」治癒機転―長期予後調査によるその検証

Dramatic Curative Dynamics in Psychotherapy-Verification by investigation of long-term prognosis

抄録

　精神療法がなぜ効果があるかを究明するには，精神療法における治癒機転が解明されねばならない。筆者は精神療法過程で生起した顕著な治療的展開に注目した。それには重要な治癒機転，言わば「劇的な」治癒機転(以下，DCDと略す)が内在しているが，以前それが生起する前提条件的要因と，４つの治療状況を分明にした。それが生起した症例で，治療終結後30年以上経過した５症例の長期予後を調査した結果，治療前とは別人のような確かな生き方を続けていた。この結果から，DCDが内在していた顕著な治療的展開が生起した意義が実証されたと考えた。そこでDCDを構成する5つの治療的変化を明確にすることにより，DCDとは何かを明示した。

Summary

　To investigate why psychotherapy is effective, it is necessary to elucidate curative dynamics in psychotherapy. The author noticed marked therapeutic change in the process of psychotherapy. Dramatic curative dynamics (DCD) can be detected within marked therapeutic change. Formerly the following were clarified：Preconditional elements of marked therapeutic change and four therapeutic situations where marked therapeutic change was brought about. Long-term prognosis of five cases in which marked therapeutic change was brought about were investigated. Over thirty years have passed since the termination of the treatment, and all are living well. Three persons are still working, two persons have retired. They seem to be different persons, compared with their life-styles before the treatment. As a result, the significance of marked therapeutic change, with DCD immanent, seemed to be verified. The following therapeutic changes are the ingredients of DCD：(3)coincidence of the patient's recognition of the problem with that of the therapist (1)emotional arousal (2)empathy with the therapist (4)self-examination caused by empathy (5)change in the way the thrapist is perceived by the patient.