The only clinical and quantitative study since Freud of the preconditions for recurrent symptoms during psychotherapy and psychoanalysis.

In this paper the author aims to evaluate theories of onset conditions both before psychological and before somatic symptoms by the first ever clinical-quantitative assessment of their preconditions, and then to compare these preconditions with Freud (1926) and with other theories of symptom formation. The seven cases in the sample were the only cases of recorded psychotherapy or psychoanalysis, each with recurrent symptoms in segments of sessions before symptoms versus segments of sessions before controls (with no symptoms) that were suitable for 'the symptom-context method'. The recurrent psychological symptom cases were: momentary forgettings, depressive shifts, and phobic feelings and behaviours; the recurrent somatic symptoms were stomach ulcer pains, migraine headaches, absence (petit mal) episodes and premature ventricular contractions (PVC) of the heart. Independent ratings of pre-symptom segments versus pre-control segments showed significant differences in all seven cases. Many emotional state qualities differentiating the pre-symptom from the pre-control segments were similar across cases. These were, in rank order, hopelessness, lack of control, anxiety, feeling blocked, helplessness, concern about 'supplies', depression, hostility to therapist, guilt, involvement with therapist, separation concern and hostility to others. For example, hopelessness significantly differentiated pre-symptom versus pre-control for all seven cases. For the first time, samples of segments of sessions before recurrent symptoms have been both clinically and quantitatively compared with segments without symptoms. Brief segments before recurrent symptoms showed significantly more of certain qualities than brief segments before controls where no symptoms appeared. These qualities led to the author's revised symptom-context theory of symptom formation and then to a comparison with five classical theories of symptom formation.