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It will be of great value to psychoanalysts, psychotherapists, and students of psychoanalysis. Contributors include: Jorge L. Grossman, Gail S. It is edited by Peter Fonagy and Mary Target. Other books in this series.
Psychoanalytic Theories Peter Fonagy. Add to basket.
Horwitz, L. Add to Wishlist. Helmchen, H. When a defensive blocking of those associations occurs within the analysand, this blocking is called repression. Psychoanalytic Review, 97 6 , — Molino eds. Eagle, , Fonagy, , Stern, and on the neuroscientific bases of psychological functioning e.
A Language for Psychosis Paul Williams. The Perversion of Loss Susan Levy. Psychoanalysis Jorge Canestri. Organisations, Anxiety and Defence R. Psychoanalysis, Science and Masculinity Karl Figlio. Back cover copy With contributions from leading European and American psychoanalysts, this innovative text systematically investigates and analyses the relationship between clinical practice and psychoanalytic theories. Psychoanalysis: From Practice to Theory makes a significant contribution to the debate about the most important problems that psychoanalysis presents. Contributors: Jorge L.
Our study is of the largest collection of fully recorded psychoanalyses, numbering only 27 cases conducted by 7 psychoanalysts, in the collection of the Psychoanalytic Research Consortium, a not-for-profit organization whose purpose is to collect and make available to qualified researchers and teachers confidentialized samples from the collection www.
A previous report details the substantial benefits occurring in the course of most of these analyses Waldron et al. In order to assess such dimensions, many efforts were made to use clinical judgment to evaluate psychoanalytic sessions. But it turned out that systematic efforts to assess what was going on between patient and analyst showed that analyst-evaluators tended to have divergent views of cases they studied e.
Seitz, This divergence resulted in low reliability of measures and hence scant findings. Being aware of these problems, Waldron started a research group in to study recorded psychoanalyses in order to develop measures that improve reliability in psychoanalyst-researcher judgments about the processes of psychoanalysis.
Our approach was to formulate clearly definitions of various psychoanalytic processes, and to develop a coding manual that would provide descriptions of these processes at different levels, using a 5-point Likert scale, rated from zero to four, with examples at the zero-point, two-point and four-point levels of the aspect being evaluated. We named our research group the Analytic Process Scales or AP S Group, and spent several years rating recorded clinical material, which was divided into relevant segments, on the various patient and therapist scales, while continually refining our definitions and case illustrations .
Indeed, it turned out that we could rate reliably the presence and strength of what we call core analytic activities, including clarifying, interpreting, addressing transference, defenses and conflicts. At first, we replicated the earlier findings of unreliability: when raters only studied one session, each brought their own prejudices to bear, and so findings were unreliable from one rater to the next.
But when the raters familiarized themselves more with the cases by studying some sessions from just prior to the material to be rated, their ratings converged, as long as they regularly referred to the descriptions given in the coding manual, to minimize rater drift Waldron, Scharf, Hurst et al. What were the results of these evaluations?
Does skillful technique have a positive impact upon the patient? The study described in this article relied on ratings by experienced psychoanalysts using the Analytic Process Scales APS , a research instrument for assessing recorded psychoanalyses, in order to examine analytic interventions and patient productivity greater understanding, affective engagement in the analytic process, and so on.
In the three analytic cases studied, the authors found significant correlations between core analytic activities e. Such enhanced productivity included a variety of ways of greater participation, conveying experiences both within the analytic setting and in the rest of life, increased self-reflection, and making meaningful connections between past and present. Addressing the question of outcome meant that our research group stumbled over what then turned out to be our next major problem. We discovered that evaluation of outcomes left almost as much to be desired as that of processes.
Similarly, there are many clinician rated symptom scales, with the Hamilton Rating Scale for Depression Hamilton, being a good early example. We realized that our Analytic Process Scales did not explore sufficiently the interpersonal aspects of the treatments being evaluated, which our experienced clinician raters were responding to in listening as they read the transcripts of the confidentialized recorded sessions.
These more interpersonal dimensions were expressed in a new instrument called the Dynamic Interaction Scales Waldron et al. These variables were assessed for whole sessions with good reliability. Several years ago our New York group made a liaison with a group of psychoanalytic researchers at Sapienza University in Rome, Italy, under the leadership of Francesco Gazzillo, with the support of Vittorio Lingiardi.
The Roman group proposed to study sessions from early, middle and late in the 27 fully audio recorded psychoanalyses in the PRC collection. Evidence derived from this study supported strongly that most of these treatments were substantially beneficial by the end of treatment. Our group has succeeded via factor analysis of the rated sessions to identify six factors which emerge from the two psychodynamic process scales that we have developed and that characterize the analytic process we have observed in the 27 recorded analyses Gazzillo et al.
This we accomplish by measuring changes in the analytic process from one session to the next one in our sample, using sets of scales we and others have developed to measure presumably important aspects of psychoanalytic process. In contrast to the second order factor analysis referred to above, which linked the variables to the distal outcome of psychological health as determined by the SWAP, this analysis compares interventions with the psychological functioning of the patient in the subsequent session.
Since we are interested in the immediate impact of the previous session, we studied only those sessions that were close together in time, mostly one to three days apart. There were pairs of our rated sessions which met this criterion. As described above, we decided to explore what factors would adequately describe the 42 process variables we included in our analysis Gazzillo et al. What emerged was the previously described set of analyst factors, patient factors and one interaction factor, perhaps best characterized by a graphic Figure 1.
The six ellipses contain the factors which emerged: on the left the therapist factors, on the right the patient factors, and in the middle the interaction factor. Our study permitted us to make an examination, promised at the beginning of the chapter, of what kinds of analyst activity and relatedness led to apparent benefit for our 27 patients. First, we found that the average early score across the 27 patients for every one of the items in the APS and DIS scales which would be expected to have higher scores in cases proceeding well was higher in the eighteen patients who had substantial benefit from early to late in their analyses than the nine patients who showed little or no benefit.
With such a small number of patients, the differences on any one item between the groups were not statistically significant, but the overall significance of 31 comparisons all coming up in one direction only is, of course, very high. There were pairs of sessions that occurred within one day or a few days of each other. This provided us with the opportunity to test whether the higher scores on each of the six factors in one session impacted any of the other factors in the next session. We will also call a factor whose score in session A, when higher, was correlated with a higher score on a different factor in session B the causative factor , and the resultant session B factor the resultant factor .
Figure 2 shows which factors whose scores in session A correlated significantly with which other factors in session B.
The starting point of each arrow is the score in session A, and the tip of the arrow is the score in session B. As shown in Figure 2, there are seven different ways that a given factor in Session A had a statistically significant impact on a factor in session B .
Barber, Muran, McCarthy. In order to make these findings more meaningful to the reader, the following diagrams Figures 3 through 7 list those items in each factor that were individually significantly contributing to the relationship found between Session A and Session B factor scores adjusting for the Session A level of the resultant factor score . The relationship between each individual variable from a factor in Session A and the individual variables of the resultant factor in Session B were also calculated. Other individual items are also mentioned, which are part of the factor, but which did not attain the level of statistical significance in relation to items in the other factor.
When evaluating the impact of Therapist Relational Competence on Interaction Quality Figure 3 we discovered that therapists who permit themselves to respond in a more subjective way, with more feeling, straightforwardly in session A appear to contribute to the interaction quality. Three Therapist Relational Competence variables were not significantly related to improved interaction quality — the therapist being warm, amicable, and supportive. Therapist dynamic competence is so named because the component items are central to psychodynamic theory about the active agents that a psychoanalyst or psychodynamic therapist employ with a patient.
These include: addressing transference, encouraging elaboration, addressing conflicts, clarifying, and overall good communication all of which, when they were rated highly in session A contributed to higher interaction quality in session B. Two items were not significant predictors of improved interaction quality: interpretation and addressing defenses.
The Patient Dynamic Competence Factor is the most important factor related to outcome we have found. As we have discussed above, we see that Interaction Quality in Session A which is influenced by therapist relational and dynamic competence contributes to Patient Dynamic Competence in Session B, as we would expect.
First, some of the modifications in therapeutic techniques and practices implied by these findings, based as they are on only 20 sessions per analysis, the work of 7 different analysts, and only 27 patients, may be desirable. On the other hand, since two-thirds of these analyses occurred several decades ago, and there have been modifications in technique widely adopted by practitioners, it might be erroneous and harmful to conclude that, in general among therapists, the more subjective the therapist, or the more warm, or the more the analyst promotes greater engagement with the patient, the better the treatment outcome!
In other words, we cannot tell from these findings how broadly these findings may apply across a range of patients, or across a range of clinicians. This approach changed the statistical significance of our results somewhat: while the overall patterning of relationships among the variables remained, the results did not consistently reach statistical significance when controlling for between-dyad effects. One central finding — therapist dynamic competence contributes to subsequent interaction quality — was confirmed as statistically significant using the more sophisticated procedures.
Indeed, we will need to consider whether the between-group variance, itself, has clinical significance in that different subgroups of dyads show different patterning among the variables. These considerations epitomize the nature of psychoanalytic process research — as we deepen our exploration of patient-analyst interaction, our data comes closer to capturing the differing patterns of psychoanalytic processes for different patient-analyst pairs. We expect that this will lead to a more refined understanding of when and how psychoanalysis and long-term therapy works.
Psychoanalysis and psychodynamic psychotherapy are processes that involve empathically connecting with the subjectivity of a patient and then finding ways to communicate through a variety of theoretically driven and empirically derived considerations, with the intent of helping the patient toward healthier functioning.