197
oral
contraceptives (sequential
combined) the incidence of chromosomal anomalies in-
or
spontaneous abortions due creases and that this is caused by to
a
hormonal
imbalance,
as
in
the "after oill effect".
University Department of Obstetrics
DAVID B. WEISS* YESHAIA ABOULAFIA ARIEL MILEWIDSKY
and Gynæcology, Shaare Zedek Hospital, Jerusalem 91000, Israel ’Present address:
Upton Hospital, Slough, Berks SL1 2BJ.
PSYCHOTHERAPY VERSUS BEHAVIOUR THERAPY your fine editorial’ and the excel(July 3, p. 45) I would like further to examine certain important issues. Those unfamiliar with the practice of psychotherapy but entrusted with the task of making provision for psychotherapy within the N.H.S. may be unduly biased by the good results in symptomatic improvement reported in the control group in the trial you cited :2 the controls "had no formal treatment other than the initial ’in-depth’ assessment interview common to all three groups and a monthly phone-call assuring them they had not been forgotten." It has been suggested that improvements in the control group occur due to such immeasurable factors as the therapist’s personality, enthusiasm, and involvement. These may very well be contributory. In my view, the initial psychiatric interview may be of farreaching consequence if well performed, because it helps to structure psychic material in a new way for the patient, and, in a sense, to pose problems that have been obscure, in a more "scientific" manner, so that the mind may come to grips with them better. Further, the provision of expectation of cure, improvement, or growth are in themselves most material to an increase in well-being. I might even say that just this provision, without further treatment, may in itself be an enormous gain, because the patient is not then immediately brought face to face with his problem, which would have a regressive "making-more-ill" effect. This should be taken more seriously in assessing the so-called supportive or "no treatment" effect, because patients are then stimulated to relive the hopeful periods of their lives which, as often as not, have kept them going in the face of internal and external stresses. Those patients who fail in treatment and become the chronic neurotics or reactive depressives may date their failure in therapy to the actual loss of hope or expectation, which previously sustained. them or which was enhanced initially by meeting with the
SIR,-With reference
to
lent letter from Dr Weissman
therapist. I find no significant contribution in your editorial to any understanding of the psychological processes underlying improvement in either therapy. This is perhaps understandable where the issues are statistical rather than qualitative. The points made concerning the provision of psychotherapy for a national at this centre are model for specialty psychotherapy centres at a regional or area level in England. For practical as well as research reasons, the Tavistock or Cassell or Maudsley models of psychotherapy departments would be inappropriate. On the other hand the provision of single appointments of consultant psychotherapists isolated in district general hospitals or psychiatric departments, makes for a watered down effect. Such a specialty centre should contain a sufficient nucleus of trained staff of many disciplines to make an impact on a whole community by training professional nonmedical workers as well as general practitioners and so on and by coping with in-service specialty training in psychotherapy.
population
are
very
important. We
concerned with the creation of
Paddington Centre 217-221 Harrow London W2 5EH
for
a
Psychotherapy,
Road,
ISMOND ROSEN
1 Lancet, 1976, i, 1225. 2. Sloane, H. B., Staples, F. R., Cristol, A. H., Yorkston, N. Psychotherapy versus Behavior Therapy Boston, 1975.
J., Whipple, K.
CHRONIC ASTHMA AND GROWTH FAILURE IN CHILDREN
SIR,-We were surprised to learn that Lacey and Parkin,’ in their community study of children in Newcastle upon Tyne, had not encountered asthma as a cause of short stature. We had the impression that children with chronic asthma are often short, which has been the experience of others.23 Wetherefore measured the height of 183 consecutive children with asthma in an allergy practice. To see whether we could identify the cause of the stunting, when it occurred, we inquired about corticosteroid therapy, age of onset of wheezing, frequency of wheezing, appetite, milk intake, birth-weight, and frequency of respiratory infections and of fevers. Arteriolised P02 measurements were made on all who were wheezing audibly or had obvious air trapping. Po2 was also measured on all with a long history of asthma and with rhonchi heard on auscultation. Details of the methods used are given elsewhere.4 There were 90 boys and 93 girls (age range 7-20 y, mean 10 y). Their mean height was significantly below the standard mean for ages (p
oral
contraceptives (sequential
combined) the incidence of chromosomal anomalies in-
or
spontaneous abortions due creases and that this is caused by to
a
hormonal
imbalance,
as
in
the "after oill effect".
University Department of Obstetrics
DAVID B. WEISS* YESHAIA ABOULAFIA ARIEL MILEWIDSKY
and Gynæcology, Shaare Zedek Hospital, Jerusalem 91000, Israel ’Present address:
Upton Hospital, Slough, Berks SL1 2BJ.
PSYCHOTHERAPY VERSUS BEHAVIOUR THERAPY your fine editorial’ and the excel(July 3, p. 45) I would like further to examine certain important issues. Those unfamiliar with the practice of psychotherapy but entrusted with the task of making provision for psychotherapy within the N.H.S. may be unduly biased by the good results in symptomatic improvement reported in the control group in the trial you cited :2 the controls "had no formal treatment other than the initial ’in-depth’ assessment interview common to all three groups and a monthly phone-call assuring them they had not been forgotten." It has been suggested that improvements in the control group occur due to such immeasurable factors as the therapist’s personality, enthusiasm, and involvement. These may very well be contributory. In my view, the initial psychiatric interview may be of farreaching consequence if well performed, because it helps to structure psychic material in a new way for the patient, and, in a sense, to pose problems that have been obscure, in a more "scientific" manner, so that the mind may come to grips with them better. Further, the provision of expectation of cure, improvement, or growth are in themselves most material to an increase in well-being. I might even say that just this provision, without further treatment, may in itself be an enormous gain, because the patient is not then immediately brought face to face with his problem, which would have a regressive "making-more-ill" effect. This should be taken more seriously in assessing the so-called supportive or "no treatment" effect, because patients are then stimulated to relive the hopeful periods of their lives which, as often as not, have kept them going in the face of internal and external stresses. Those patients who fail in treatment and become the chronic neurotics or reactive depressives may date their failure in therapy to the actual loss of hope or expectation, which previously sustained. them or which was enhanced initially by meeting with the
SIR,-With reference
to
lent letter from Dr Weissman
therapist. I find no significant contribution in your editorial to any understanding of the psychological processes underlying improvement in either therapy. This is perhaps understandable where the issues are statistical rather than qualitative. The points made concerning the provision of psychotherapy for a national at this centre are model for specialty psychotherapy centres at a regional or area level in England. For practical as well as research reasons, the Tavistock or Cassell or Maudsley models of psychotherapy departments would be inappropriate. On the other hand the provision of single appointments of consultant psychotherapists isolated in district general hospitals or psychiatric departments, makes for a watered down effect. Such a specialty centre should contain a sufficient nucleus of trained staff of many disciplines to make an impact on a whole community by training professional nonmedical workers as well as general practitioners and so on and by coping with in-service specialty training in psychotherapy.
population
are
very
important. We
concerned with the creation of
Paddington Centre 217-221 Harrow London W2 5EH
for
a
Psychotherapy,
Road,
ISMOND ROSEN
1 Lancet, 1976, i, 1225. 2. Sloane, H. B., Staples, F. R., Cristol, A. H., Yorkston, N. Psychotherapy versus Behavior Therapy Boston, 1975.
J., Whipple, K.
CHRONIC ASTHMA AND GROWTH FAILURE IN CHILDREN
SIR,-We were surprised to learn that Lacey and Parkin,’ in their community study of children in Newcastle upon Tyne, had not encountered asthma as a cause of short stature. We had the impression that children with chronic asthma are often short, which has been the experience of others.23 Wetherefore measured the height of 183 consecutive children with asthma in an allergy practice. To see whether we could identify the cause of the stunting, when it occurred, we inquired about corticosteroid therapy, age of onset of wheezing, frequency of wheezing, appetite, milk intake, birth-weight, and frequency of respiratory infections and of fevers. Arteriolised P02 measurements were made on all who were wheezing audibly or had obvious air trapping. Po2 was also measured on all with a long history of asthma and with rhonchi heard on auscultation. Details of the methods used are given elsewhere.4 There were 90 boys and 93 girls (age range 7-20 y, mean 10 y). Their mean height was significantly below the standard mean for ages (p
