ROLE OF FANTASIES IN PSYCHOTHERAPY AND PSYCHOPATHOLOGY

Abstract

Despite the central role of induced fantasies in systematic desensitization, the theoretical formulations by the behavior therapists have excluded consideration of the psychological matrix of these complex intrapsychic phenomena. Furthermore, Wolpe and many of his followers appear to have jettisoned most of the older approaches (such as insight-oriented or supportive psychotherapy) from their therapeutic armamentarium. This institutionalization of the technical procedures and theoretical underpinnings of behavior therapy may unnecessarily restrict the potential range of fantasy utilization and shut out other effective approaches. The present paper reports some observations of the utilization of fantasies in broad spectrum psychotherapy with 40 patients. After being instructed to observe and report their visual fantasies, each of the patients reported spontaneous fantasies that occurred either between therapy sessions or during the sessions. For example, it was found in 10 cases of “free floating anxiety” that a fantasy of some imminent danger was present and appeared to generate the anxiety. When the patient was trained to control these autonomous fantasies, he showed a dramatic reduction in his anxiety level. The contents of the spontaneous fantasies were used in a number of cases to clarify the individual's psychological problems and to pinpoint the precise nature of these problems. Induced fantasies were also found useful in a much broader clinical context than the relatively narrow band demarcated by Wolpe. Induced fantasies were used to help pinpoint the specific nature of a current problem; to reduce unpleasant affect through repetition of the fantasy; and to modify the patient's overt behavior by stimulating structured or “guided” fantasies. The significance of visual fantasies in promoting therapeutic change is discussed in terms of modifying the cognitive processes. There appears to be a very close bond between the visual fantasies and the patient's affect. By modifying the patient's fantasies, or the underlying ideational systems, it is possible to damp down unpleasant affect, such as anxiety, depression, or hostility. Furthermore, by recognizing the obvious distortions of reality in the content of the fantasies, the patient can interpret his experiences in a more realistic way.

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