A treatment procedure carried out in writing in order to reduce the subjectivity involved in a personal relationship between patient and therapist. The technique was developed by Benjamin Karp- man primarily for use with institutionalized patients and patients with mild to moderate emotional disturbances.The first step in the procedure is a series of face-to-face interviews in which the therapist explains the importance of emotions in life, discusses neurosis as an emotional illness which can be cured only by understanding and not by will power. He also assures the patient that everything possible will be done for him and that he will benefit from the treatment. After this initial orientation, the therapist meets with the patient for brief periods several times a week, not for therapeutic interviews, but only to explain instructions and give and receive written material. During the first of these contacts, he gives the patient a set of about twenty questions designed to elicit general autobiographical material, including his relationships with his mother, father, siblings, friends; his early sexual interests; and his social environment. The patient is instructed to give explicit answers, but with emphasis on the emotional aspects of his experiences. At the next meeting the therapist hands the patient a memorandum which notes the highlights and explains the significance of his answers in common-sense terms. Karpman finds that this memorandum not only holds the patient’s interest but often gives him a first glimpse of insight into himself.In the next phase of the treatment the patient is asked to submit written accounts of his dreams. When he receives this material, the therapist briefly.explains the processes involved in dreams, such as symbolism, and then makes interpretations. These are again on a common-sense level, but based on the autobiographical material already supplied. The interpretations are given to the patient in writing, and he is then asked to elaborate on his dream and make his own comments in written form. Karpman finds this technique particularly useful not only in providing insight but in showing the patient that many of his thoughts are under conscious control. During this phase of the treatment the patient is also assigned readings on psychopathology and psychotherapy from such authors as Freud, Menninger, Janet, McDougall, Prince, and Stekel. The books are chosen with the patient’s level of intelligence and emotional needs in mind. The object is twofold: to educate without indoctrination, and to stimulate the recall of forgotten experiences.Next, the therapist prepares a second set of written questions based on the patient’s comments on his dreams, his reactions to the reading material, and his type of disorder. These questions are designed to reach deeper into his personality and “are likely to bring forth rather definitely some of the underlying psychogenetic mechanisms” (Karpman, 1949). They are handled in the same way as the first set, that is, the patient submits his answers in writing. A third and usually final set of questions is then given the patient, using the same ground rules as the other two. When the entire question and answer interchange has been completed, the therapist presents a “memorandum as a whole” to the patient, summarizing all the insights obtained in the process.Karpman maintains that each neurosis is unique and that the therapeutic tools must be adjusted to the individual needs of the patient as well as the personality of the therapist. He there fore does not present objective psychotherapy as the only valid approach, although he believes it has proven effective in many cases of moderate disorder, including institutionalized criminals. If he finds that his initial questionnaire does not yield enough information, he switches to a more traditional psychoanalytic approach, but he also suggests that the therapist may in some cases switch from the traditional procedure to the shorter method of objective psychotherapy, using the material gathered in free association as a basis for written questions. The therapist must therefore remain flexible and alert to the situation that will be most effective with a particular patient.