A similar paper was well received at the APA'a annual meeting in San Diego, in May 2007.
The paper discusses results of 1,172 patients treated with Lifetrack method over the last 20 years, with 48% of the patients exceeding their previous maximum level of adjustment according to their own daily subjective self-rating scores on 41 parameters.
Of those who exceeded their previous maximum level, 31 % reached a level more than twice, 24% reached more than three times, 20 % reached more than four times, 16 % reached more than five times, and 7.6 % reached more than ten times, their previous maximum level of adjustment, according to their own daily subjective self-rating.
Of those who failed to reach their previous maximum level of adjustment (51%), 75% showed improvement in their overall adjustment, and 77% showed reduction of symptoms when they prematurely terminated therapy. However, 24% showed reduction of overall adjustment level, and 22% showed increased symptoms when they prematurely terminated therapy.
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25 years ago, a brilliant scientist Dr. Y became my patient. He was hospitalized on an emergency basis for severe depression with suicidal impulse and paranoid thoughts. His diagnosis was; 1. Depression with psychotic features, and 2. Severe borderline personality disorder.
He was treated with daily Lifetrack couple therapy with his wife participating in each session in the hospital, lasting 2-3 hours for 45 days. Therapy was exclusively focused on bringing the couple far closer than ever before, taking advantage of his distress.
He was encouraged to learn to ‘accept’ and ‘depend’ on his wife more than ever before, and his wife was encouraged to unconditionally ‘accept’ and care for her husband in the most unacceptable and worst condition ever. Specifically, he was encouraged to get closer to his wife in depression, as he was better able to ‘accept’ and ‘depend’ on his wife thanks to depression.
It was explained to them that by getting close enough to his wife while he is in distress, he could learn to accept himself in his ‘worst shape’ vicariously through his partner's unconditional acceptance of him, making his depression unnecessary.
He made rapid progress through therapy, emerging from his crisis transformed into a caring and stable person through 45 days in the hospital. On the day he left the hospital, he scored his previous maximum of 10 for all positive parameters, declaring that he ‘had never felt as good’ in his life.’
However, when he returned to a post discharge follow-up session, he surprised me by saying, ‘I have a problem with this daily self-rating. I scored 10 all across on the day I left the hospital, as I felt better than ever before. However, now I am feeling even better and am having difficulty to keep scoring 10, while I know I am doing better. I think I scored too high when I left the hospital. Should I revise my previous scores downward, since now is truly my previous best, deserving 10?’
I was taken aback, and did not know what to tell him. I thought out loud, ‘It would be very cumbersome for you to revise all previous scores. Besides, you may have to do this every time you felt better.’
Then, he surprised me by asking, ‘Can I score above 10 when I feel better than before then?’
Dr. Y, a scientist who used super computers in his work, was conscientious in his self-assessment and inadvertently taught me how clinical improvement can and should be recorded with ‘incremental scale’, which can measure condition that is better than ever before.
Through our upbringing and years of surviving through academic competition, we acquire ‘decremental’ thinking in which perfection is unattainable and potential for mistakes, humiliation and punishment is ever present. While such attitude is necessary and even desirable to survive in adversity and competition, it interferes with one's ability to experience ‘happiness’ (self sphere), ‘closeness’ (intimacy sphere), and ‘satisfaction’ (achievement sphere) beyond our previous maximum levels.
In psychiatric practice, we are working with individuals who are ‘unhappy’ and ‘unsuccessful’ in their coping with life experiences. Thus, it is clear that their ‘previous best’ adjustment, or score 10, has proven insufficient.
The purpose of Lifetrack Total Adjustment Sheet is to acquire ‘incremental’ thought process first in one's intimacy sphere, in which it is always possible to get closer to one's partner today than yesterday, and tomorrow than today.
Once ‘Breakthrough Intimacy’ (closeness far greater than previous maximum level) is experienced, self and achievement spheres benefit from ‘incremental’ thinking, making transformation of existing personality (reintegration of self, intimacy, and achievement spheres at a much higher level) possible through Lifetrack therapy.
| Case Report | |
|---|---|
| (As of 6/23/07) | |
| Emily (39) | First Seen: 5/02/07 |
| Dr. Yukio Ishizuka | Last Report: 5/26/07 |
During the month of June, Emily and Norman had four sessions (6/1, 6/8, 6/15, 6/23). Emily's graph 2 below tracks her symptoms from the last report on 5/26 to 6/23. During the month of June (second month of therapy), she had four surges of symptom spikes.
By 6/2, She reported worsening – almost daily – panic attacks. She felt Norman's guerrillas (defense against closeness) had appeared in force. She said she used to have once monthly attacks, this last week she has had daily panic attacks, as he seemed cool and indifferent, complaining of her distressed condition rather than comforting her. He remained distant and non-cooperative and not even asking her how she was feeling. She thought he was obstructive and demanding instead of being giving as he used to be, just as she has been trying hard to change, and need his help the most.
He acknowledged that his ‘guerrillas’ had appeared to have taken over. She complained that he watches TV while she wants to talk with him and suddenly reaches out for sex after turning the light off. She has been hurt, upset and withdrawn.
She complained that he does not accommodate her needs, maintaining his daily routine regardless of her condition and needs. She said, ‘I try to accommodate others, while he put himself ahead of everything else.’ She said she hates herself for being so frustrated over his unresponsiveness. ‘I always restrain myself, while he is straightforward in self-assertion.’ He would repeatedly ask for permission to go to a baseball game, in the middle of her distress.
On 6/8, after the session, the couple had a major crisis over his wanting to take his son to a baseball game, while the child was having running nose. She became ‘psychotic’ in rage after an hour of argument over when her husband should return from the baseball game. She had severe attack of anxiety, apathy, and stiff shoulders following the argument. On 6/19-6/20, he was dismissive when her ‘guerrillas’ raised their heads. Instead of being understanding and supportive of her, she found him to be unusually cold and distant, making her feel anxious about future and pessimistic about outcome of therapy.
Her graph 2 below showed continued high spikes of symptoms, with her physical symptoms becoming more prominent.
Her graph 26 below showed her intimacy struggling against formidable waves of defense. Her intimacy seemed to lose ground during the month of June to repeated waves of defense that pulled down her intimacy each time it advanced. However, her intimacy remained dominant over her self and achievement spheres, maintaining stage I pattern of personality transformation.
His graph 2 below showed a particularly high spike of anger on 6/9, when his 6-year old daughter repeatedly struck at him with Karate technique (more than ten times despite his effort to restrain her) imitating he mother of last week. He finally lost his temper and yelled at his daughter, frightening her. After the incident on 6/9, his graph showed escalating physical symptoms, which finally seemed to peak on 6/21.
Emily complained that he had been exceptionally cool and indifferent while she was in distress.
His graph 26 below showed his intimacy struggled below his self and achievement spheres, finally breaking out on 6/22, emerging above his self and achievement spheres, as his persistent physical symptoms finally peaked and diminished rapidly.
The couple was reassured that the new waves of defense had been provoked by the very advance their intimacy was making, and that each time defense mobilizes, it becomes weakened by exhaustion, as long as they keep recovering from crises, reaching yet higher peaks in their intimacy.
Emily's graph 2 below tracks her symptoms over the entire two months of therapy, showing steady escalation of her symptoms.
Her graph 26 below showed her intimacy struggling after reaching its highest peak of 18.9 on 5/31, as her defense mobilized provoked by Norman's resistance, just as she was breaking through her defense in seesaw-like sequence of defense.
The couple was reassured that the very advance she had made on 5/31, had provoked defense on both sides, resulting in escalating defense (spikes of symptoms) on both sides. However, such mobilization will inevitably cause defense on both sides to weaken by exhaustion, as long as the couple do not give up their effort to keep thinking, feeling, and acting in such ways that their closeness would increase through conscious and unnatural efforts.
Norman's graph 2 below tracks his symptoms over the entire two months of therapy, showing steady escalation of his defense, particularly physical symptoms – severe stiff shoulders – as his ‘unprocessed’ stress is pushed out of consciousness manifesting through physical symptoms. If and when he becomes more successful in taking the ‘4 key steps of problem solving,’ processing his stress more effectively, physical symptom should disappear as it becomes unnecessary.
Norman's graph 26 below showed his intimacy finally emerging above his self and achievement spheres as his escalating defense has finally peaked on 6/19, as his intimacy broke through.
Her graph 1 below showed her ‘positive peak average’ advancing through sharp ups and downs, while her defense continued to spike.
Norman's graph 1 below showed his ‘positive peak average’ steadily advancing through ups and downs, while his ‘negative peak average (symptoms) persisted.
Emily's graph 3 below showed her ‘overall adjustment’ score struggling against repeated waves of defense, challenging the invisible ceiling of defense at 12.
His graph 3 below track his progress over the two months, with is ‘overall adjustment’ (average of 27 scores covering self, intimacy, and achievement spheres) finally advancing clear above previous maximum of 10, after recovering from two particularly deep setbacks.
Comments: While their defense is still active and formidable throughout the second month of therapy, the couple is making steady advance in their intimacy, provoking and overcoming waves of defense.
(6/23/07) Yukio Ishizuka M.D.
Your questions and comments are welcome;
Progress report on Emily and Norman during the month of July will
follow.
Yukio Ishizuka M.D.
dri@lifetrack.com