Story of Psychology - Morton Hunt [381]
He would then teach the patient deep muscle relaxation, which involves the “letting go” of muscle groups first in the forehead, then the face, and so on down to the toes, until a fully relaxed, half-trancelike state is achieved. While the patient was becoming adept at achieving this, he or she and Wolpe would construct a “hierarchy,” or graded list of stimuli, according to their power to arouse anxiety. Wolpe would have the patient envision the feeblest of them while in the relaxed state. Once it no longer caused any discomfort, they would tackle the next one. The patient would become progressively deconditioned, until the last and worst stimulus was associated with the relaxed state and rendered innocuous.
In a typical case report, Wolpe told of Mrs. C.W., a fifty-two-year-old Johannesburg housewife, who came to him because of overpowering fears of rejection, illness, and death, along with fears of the symptoms created by these feelings. He and she assembled a hierarchy for each of her fears. That for physical symptoms comprised nine items, the mildest of which was fear of pain in the left hand (caused by an old injury); the most severe, fear of irregular heartbeats. By her eighteenth desensitization session, he had deconditioned her to all but the three most severe items on the list, and at that session worked on her third worst fear, that of pain in her left shoulder. First, he got her deeply relaxed and had her concentrate on her pleasant feelings. Then he proceeded as follows:
If by chance any scene should disturb you, you will indicate it by raising your left hand. First, we are going to have something already familiar to you at these sessions—a pain in your left shoulder. [In previous sessions she had said she was disturbed at imagining this.] You will imagine this pain very clearly and you will not be at all disturbed… Stop imagining this pain and again concentrate on your relaxing…Now again imagine that you have this pain in your left shoulder… Stop imagining this pain and again relax…[A third cycle followed.] If you felt in the least disturbed by the third presentation of this scene, I want you now to indicate it by raising your left hand. (The hand does not rise.) [The patient later reported that the first presentation of the imagined pain had slightly disturbed her, but by the third presentation it had not done so at all.]50
By this method, Wolpe claimed, he had been able to cure not only phobias but neuroses of many sorts—usually in about one-twentieth the number of therapeutic sessions required by psychoanalytic therapy. Many of his cases were more dramatic than that of Mrs. C.W.; they ranged from an extreme fear of driving to an equally extreme fear of urine (by a youth who had been a bedwetter). Even when the presenting symptoms sounded like the kind of neurosis that would require dynamic therapy, Wolpe found explanations based on simple phobias. A twenty-seven-year-old woman came to him complaining of frigidity (Wolpe’s word) and serious problems in her marriage, notably an inability to assert herself. Wolpe, rather than searching for deep psychological fears of domination, as Freudians might have, concluded after questioning that her anxiety was triggered by situations involving the sight or touch of a penis, which she found revolting.
He and she then worked up a hierarchy in which the least fearful situation, for her, was seeing a nude male statue in a park thirty feet away. After she overcame anxiety at imagining this scene, he brought her closer and closer, until she could imagine herself handling the stone penis. He then switched to a series of scenes in which she imagined herself at one end of the bedroom, seeing her husband’s penis from a distance of fifteen feet. Through desensitization, she was brought closer and closer until she could imagine herself briefly touching the penis, and then doing so for longer periods of time. By