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How to study the ‘quality of psychoanalytic treatments’ and their long‐term effects on patients' well‐being: A representative, multi‐perspective follow‐up study3
Abstract
How can we study the 'quality of psychoanalytic treatments'? The authors attempt to answer this question by discussing a naturalistic, multi-perspective and representative follow-up study of psychoanalyses and long-term psychoanalytic psychotherapies. We studied a representative sample (n = 401) of all the patients who had terminated their psychoanalytic treatments with members of the German Psychoanalytical Association (DPV) between 1990 and 1993. Between 70 and 80 per cent of the patients achieved (average 6.5 years after the end of treatment) good and stable psychic changes according to the evaluations of the patients themselves, their analysts, independent psychoanalytic and non-psychoanalytic experts, and questionnaires commonly applied in psychotherapy research. The evaluation of mental health costs showed a cost reduction through fewer days of sick leave during the seven years following the end of long-term psychoanalytic treatments. The results achieved using non-psychoanalytical instruments are complemented by the richness of the idiosyncratic findings, gained by the psychoanalytic research instruments.
... Success is measured according to simplified, uniform measures of symptoms which may bias towards pharmacological or behavioral approaches while being less suited to the mode of action of psychoanalytic approaches. The patients' own assessments and preferences hardly get attention, etc. Arguments of scientific theory were also expressed: comparative psychotherapy research in effect was promulgating a methodological myth about the uniformity of science as well as of clinical practice (Hampe, 2003;Leuzinger-Bohleber, Dreher & Canestri, 2003). It was applying research designs suitable for pharmacology to the field of psychotherapy research in a way that was not justified either theoretically, practically or scientifically. ...
... Based on the studies of Schlessinger and Robbins (1974) and Kantowitz (1986), -they developed methods of psychoanalytic expert validation, in order to assess the transformations of the inner mental world of former patients on the basis of psychoanalytic follow-up interviews. This psychoanalytic evaluation was contrasted with a number of other assessments (through self-or blind external assessment, health-economic data, etc.) in a multiperspective consideration of therapeutic outcome (Leuzinger-Bohleber, Stuhr & Beutel, 2003). ...
... These are possible reasons why we observed "structural changes" only in the majority of patients in PAT after three years of treatment not in the CBT group. We hypothesize that "structural changes" will further consolidate at our five-year measurement in the PAT group contributing to a decline of work disability, the major driver of health costs in chronic depressed patients (see Leuzinger-Bohleber et al, 2003;Taylor, 2010, Bleichmar, 2010, Leuzinger-Bohleber, 20102015;Rudolf et al., 2012, Shedler, 2015Subic-Wrana et al, 2011). ...
Worldwide, the pressure on psychoanalysis to prove the results of its treatments according to the criteria of so-called evidence-based medicine has increased. While a large number of studies on the results of psychoanalytic short-term therapies are now available, such studies are still largely lacking on psychoanalysis and psychoanalytic long-term therapies. In a large multicentre study, the results of psychoanalytical and cognitive-behavioural longterm therapies in chronically depressed patients were compared, Both psychotherapies led to statistically highly significant changes in depressive symptoms three years after the start of the treatments However, the focus of psychoanalytic treatments is not exclusively on reducing psychopathological symptoms, but on changes in the inner world of the patients that are reminiscent of the goal of psychoanalyses that Freud has characterized as developing “the ability to love, work and enjoy life.” In the German-speaking community, such transformations are called “structural changes.” This article reports results on such structural changes achieved with the help of a sophisticated measuring instrument, the Operationalized Psychodynamic Diagnostics (OPD). These so-called structural changes are compared with symptomatic changes. Three years after the start of the treatments, significantly more patients in psychoanalytical treatments show such structural changes than patients in cognitive-behavioural treatments.
... 5,6 Positive long-term effects of long-term psychoanalytic treatments in complex mental disorders have been shown in several studies. 7,8 In a recent study 8 comparing long-term psychoanalytic therapy with treatment as usual, PAT showed a delayed therapeutic effect (not before 24 months after intake) and later (up to 42 months) turned out superior to the control condition. Until now, no RCT studies have compared long-term PAT and CBT directly. ...
... One major aim of PAT is to achieve so-called "structural changes" as a presupposition for sustaining change in patients, which can be observed in long followups. 4,7,18,22,32,33 According to this rationale, structural changes need longer and more intensive treatment. Our data showed that PAT had a mean (SD) of 80.4 (27.8) sessions during the BDI, Beck Depression Inventory II; CBT, cognitive-behavioural therapy; PAT, psychoanalytic therapy; PREF, preference arm; QIDS-C, clinician-rated Quick Inventory of Depressive Symptoms; RAND, randomization arm. ...
... Sustained improvement of the depressive symptoms has great relevance for these severely ill patients who have enormously high relapse rates. 1,5,7 Preventing relapses of the chronically depressed is also significant for their families, reducing intergenerational transmission of depression and saving costs. 7,[32][33][34][35] Contrary to our expectation, being treated by the preferred psychotherapy did not result in better outcome than randomly assigned psychotherapy. ...
Objective::
For chronic depression, the effectiveness of brief psychotherapy has been limited. This study is the first comparing the effectiveness of long-term cognitive-behavioural therapy (CBT) and long-term psychoanalytic therapy (PAT) of chronically depressed patients and the effects of preferential or randomized allocation.
Methods::
A total of 252 adults met the inclusion criteria (aged 21-60 years, major depression, dysthymia, double depression for at least 24 months, Quick Inventory of Depressive Symptoms [QIDS] >9, Beck Depression Inventory II [BDI] >17, informed consent, not meeting exclusion criteria). Main outcome measures were depression self-rating (BDI) and rating (clinician-rated QIDS [QIDS-C]) by independent, treatment-blinded clinicians. Full remission rates (BDI ≤12, QIDS-C ≤5) were calculated. An independent center for data management and biostatistics analyzed the treatment effects and differences using linear mixed models (multilevel models and hierarchical models).
Results::
The average BDI declined from 32.1 points by 12.1 points over the first year and 17.2 points over 3 years. BDI overall mean effect sizes increased from d = 1.17 after 1 year to d = 1.83 after 3 years. BDI remission rates increased from 34% after 1 year to 45% after 3 years. QIDS-C overall effect sizes increased from d = 1.56 to d = 2.08, and remission rates rose from 39% after 1 year to 61% after 3 years. We found no significant differences between PAT and CBT or between preferential and randomized allocation.
Conclusions::
Psychoanalytic as well as cognitive-behavioural long-term treatments lead to significant and sustained improvements of depressive symptoms of chronically depressed patients exceeding effect sizes of other international outcome studies.
... A century ago, after more than 30 years of pioneering psychoanalytic work, Freud published his theoretical synthesis, "The Ego and the Id" (Freud, 1923), describing his metapsychological model of the mental apparatus. This model has since served as a guide for psychoanalytically-based treatments for various types of debilitating emotional disorders (Leichsenring, 2005). Prospective (Kernberg et al., 1972;Kantrowitz et al., 1987), meta-analytic (de Maat et al., 2013), and follow-up studies (Leuzinger-Bohleber et al., 2003) have clearly demonstrated the effectiveness of psychoanalytic treatments for carefully selected patients who are both healthy enough as well as sick enough to warrant such an extended, intensive, and ambitious treatment. ...
... Internally, a new and quite influential, but controversial neuropsychoanalytic model of the mind is becoming ascendant and is purported to be based on more rigorous and modern neuroscientific findings and principles (Solms, 2013;Solms, 2021a;Solms, 2021b). Externally, societal and economic forces and psychopharmacologic advances have rendered this lengthy, inconvenient, and expensive psychoanalytic treatment-which may nevertheless be uniquely effective for some (Leichsenring, 2005)unavailable to most. These internal and external threats to the Freudian metapsychological model of the mind mirror the internal (id instincts) and external (objects in reality) threats to the very survival of Freud's adaptive Ego itself. ...
In 1926, Freud famously conjectured that the human ego defense of repression against an internal instinctual threat evolved from the animal motor defense of flight from an external predatory threat. Studies over the past 50 years mainly in rodents have investigated the neurobiology of the fight-or-flight reflex to external threats, which activates the emergency alarm system in the dorsal periaqueductal gray (dPAG), the malfunction of which appears likely in panic and post-traumatic stress disorders, but perhaps also in some “non-emergent” conditions like social anxiety and “hysterical” conversion disorder. Computational neuroscience studies in mice by Reis and colleagues have revealed unprecedented insights into the dPAG-related neural mechanisms underlying these evolutionarily honed emergency vertebrate defensive functions (e.g., explore, risk assessment, escape, freeze). A psychoanalytic interpretation of the Reis studies demonstrates that Freud’s 1926 conjecture is confirmed, and that internal instinctual threats alone can also set off the dPAG emergency alarm system, which is regulated by 5-HT1A and CRF-1 receptors. Consistent with current psychoanalytic and neurobiologic theories of panic, several other of the primitive components of the dPAG alarm system may also have relevance for understanding of the unconscious determinants of impaired object relationships (e.g., avoidance distance). These dPAG findings reveal (1) a process of “evolution in situ,” whereby a more sophisticated dPAG ego defense is seen evolving out of a more primitive dPAG motor defense, (2) a dPAG location for the phylogenetically ancient kernel of Freud’s Ego and Id, and (3) a Conscious Id theory that has been conclusively invalidated.
... werden aufwändige und methodisch anspruchsvolle retrospektive Studien in der Welt der »evidenzbasierten Medizin« kaum wahrgenommen (vgl. dazu u. a. Leuzinger-Bohleber et al. 2003). Als Goldstandard gilt nach wie vor die randomisierte, kontrollierte Studie (RCT). ...
... Doch wie schon erwähnt, liegen aus methodischen und forschungspraktischen Gründen erst wenige Studien zu psychotherapeutischen Langzeitbehandlungen vor (vgl. u. a. Sandell et al. 2001;Leuzinger-Bohleber et al. 2003;Brockmann, Schlüter & Eckert 2006;Klug, Zimmermann & Huber 2016;Knekt et al. 2011;Fonagy et al. 2015). Bisher hat keine RCT-Studie Langzeit- PAT und KVT direkt verglichen. ...
... Em saber: a ausência de qualquer diferença notável na eficácia terapêutica de todas as terapias de boa fé, independentemente de suas referências teóricas (23,24). Entre elas, a eficácia da psicanálise e das terapias psicodinâmicas está bem estabelecida (25,26). A psicanálise contemporânea não advoga a análise dos conflitos inconscientes do autista, este modelo resultante do tratamento dos neuróticos não é apropriado. ...
Alguns críticos da psicanálise, que influenciam as agências governamentais e aos quais a imprensa dá boas-vindas, relatam repetidamente inverdades sobre o cuidado psicanalítico dos autistas na França e sobre a suposta cientificidade neste domínio das terapias cognitivo-comportamentais (TCC). Parece-nos útil recordar aqui alguns dados essenciais.
... Many studies have validated psychodynamic treatments' efficacy in a wide range of psychiatric disorders in the last decade. Studies have consistently demonstrated that psychodynamic therapy benefits not only endure over time but also increase with time (Leichsenring et al., 2015;Leuzinger-Bohleber et al., 2003;Shedler, 2010;Steinert et al., 2017). ...
Despite the many efforts to integrate psychoanalysis with CBT, many loyal therapists of each school have consistently refused to ‘open their gate’ to the other's influence. We explain this resistance as a way to preserve a strong professional identity through the Us–Them distinction. Any attempt to encourage loyal therapists to be influenced by the other school must guarantee that the other will not threaten their identity. We use Derrida's notion of hospitality to facilitate mutual influence between the schools while overcoming the other's threatening encounter. According to Derrida, hospitality, in response to the law of ethics, opens the home's threshold to the foreigner; in this law, the other is always welcome. At the same time, hospitality prevents a hostile takeover – by the law of politics, which ensures the owner's ongoing control over his house. By thus keeping the tension between openness and control over who enters, hospitality makes listening and learning between the psychotherapeutic schools possible. We discuss practical ways to put the concept of hospitality to work between the two schools, offer illustrations, and argue for this model's advantages.
... Lambert (2013) referiert ähnliche Ergebnisse für systemische Therapiemethoden (Cluster 4/SPT). Nachhaltigkeit: Leichsenring und Rabung (2011) haben bezüglich Cluster 1 (PPT) gezeigt, dass Psychotherapie während und nach der Therapie langfristig wirkt, insbesondere in Hinblick auf Persönlichkeitsveränderungen über das Therapieende hinaus (siehe dazu auch Fonagy und Kächele 2009;Fonagy et al. 2015;Leuzinger-Bohleber et al. 2003, 2019Zimmermann et al. 2015). Effektstärken: Manchen Untersuchungen zufolge erweisen sich psychotherapeutische Verfahren der Cluster 1 (PPT), 2 (VT) und 3 (HPT) als ähnlich wirksam wie andere Therapien (Steinert et al. 2017). ...
Zusammenfassung
30 Jahre nach der Verabschiedung des österreichischen Psychotherapiegesetzes wird die Besonderheit der Psychotherapie im Gesundheitssystem mit Bezug auf nationale Gegebenheiten und international vorliegende Forschungsergebnisse dargestellt. Dabei werden zentrale Qualitäts- und Unterscheidungsmerkmale der Psychotherapie im Verhältnis zur Klinischen Psychologie und zu weiteren Gesundheitsberufen unter Miteinbeziehung von evidenzbasierter Forschungsliteratur vorgestellt. Es wird deutlich gemacht, dass Psychotherapie das bedeutsamste und weitreichendste Versorgungsangebot zur interaktionellen Behandlung psychischer Erkrankungen darstellt. Zu den zentralen Merkmalen der Psychotherapie zählen die umfassenden, evidenzbasierten sowie wissenschaftstheoretisch und methodisch in vier Clustern verankerten Konzepte zur Erklärung, Diagnose und individuellen, prozessorientierten Behandlung von psychischen Erkrankungen sowie die im Vergleich zu ähnlichen Berufen deutlich höhere Qualität der Ausbildung .
... This led to great tensions and also massive anxieties in many psychoanalytic societies. The DPV's outcome study of psychoanalyses and psychoanalytic long-term therapies was an attempt to limit the destructive political consequences of this attack (Leuzinger- Bohleber et al. 2003). ...
... In certain instances, the direct communication of the therapist's experience of frustration (objective hate (142) Disclosing the therapist's experience is one of the cutting edges of the relational approach to psychodynamic therapy. ...
Psychoanalysis is hardly a practical treatment alternative for the twenty-first century. The principles derived from this treatment, however, have powerfully influenced other psychotherapeutic approaches, whether long-term or short-term therapy or psychiatric care more generally, particularly in the United States. At the time of its invention, it was the unique effective psychosocial treatment method for psychiatric disorder which offered a genuine alternative to the sometimes barbaric and generally ineffective treatment methods available. Not surprisingly, its proponents adopted an almost religious zeal in defending its value against alternative approaches. While understandable, such an attitude has no place in the sophisticated evidence base underpinning multi-agency service planning. Psychoanalytic clinicians face a challenge in identifying their niche in the complex mental health care delivery systems of the twenty-first century.
... Unter ihnen waren 27 %, die als depressiv diagnostiziert worden waren, meist in Kombination mit einigen Persönlichkeitsstörungen. Als unerwartetes Ergebnis der Studie zeigte sich die enge Verbindung zwischen Trauma und schwerer psychischer Erkrankung: 62 % der Patient*innen waren schwer traumatisierte Kinder aus dem Zweiten Weltkrieg (Leuzinger-Bohleber et al., 2003). ...
Die LAC-Studie ist die wohl erste kontrollierte Psychotherapiestudie, die die Ergebnisse psychoanalytischer und kognitiv-verhaltenstherapeutischer Langzeitpsychotherapien bei chronisch Depressiven mit randomisierter und präferierter Zuweisung miteinander vergleicht. Beide Psychotherapieverfahren erwiesen sich als erfolgreich. Die Effektstärken und die vollständigen Remissionsraten waren höher als in anderen Studien. In zukünftigen Arbeiten werden nun Mediatorenund Moderatorenvariablen untersucht, um beschreiben zu können, welche therapeutischen Faktoren in welchem der beiden Verfahren zu welchen Effekten geführt haben. In diesem Artikel werden die mittlerweile auch ausführlich publizierten Erkenntnisse aus der LAC-Studie sowie das methodische Vorgehen knapp skizziert.
... A more recent large-scale study of outcome and quality of psychoanalytic treatments, using both quantitative and qualitative measures, similarly found no significant correlation between 'good enough' therapy outcomes and the particular theoretical school to which the analyst belonged. (Leuzinger-Bohleber 2003). They did however identify a number of characteristics which correlated with good outcome, in particular empathy and flexibility, where 'technique was orientated towards the patient's needs, not primarily towards their own convictions or beliefs'. ...
... Im Zentrum stehen Strukturveränderungen und deren Operationalisierung, um sie auch mit Hilfe von extraklinisch-empirischen Methoden zu untersuchen (vgl. dazu u. a. Fischmann, Russ & Leuzinger-Bohleber 2013;Fonagy 2001;Josephs & Bornstein 2011;Kantrowitz 1986;Leuzinger-Bohleber et al. 2003;Wallerstein et al. 1989). Wie im Beitrag von Leuzinger- Bohleber et al. (2019) in diesem Heft diskutiert, verstehen wir unter struktureller Veränderung anhaltende psychische Transformationen der Objekt-und Selbstrepräsentanzen, der »inneren Welt« der Patienten, die eng verbunden sind mit der Fähigkeit zu mentalisieren bzw. ...
... As is the case with other nomological studies of the effectiveness of psychoanalytic treatments-they all came to the conclusion that psychoanalytic treatments are effective, 2 psychoanalysts might be pleased by the situation and the outcome of this study. On closer scrutiny however, it becomes recognisable that the study by Huber et al. is to be subjected to the same critique we 3 put forward in discussing the study by Leuzinger-Bohleber et al. 4 Huber et al. 1 's study gives reason to recall some of our former arguments. In so doing, I will restrict myself to the authors' comparison of psychoanalysis and cognitive behavioural therapy, start with my comments and end with some general remarks regarding the nomological attempts at verifying the effectiveness of psychoanalytic treatments. ...
... Em outros estudos, follow-up refere-se à avaliação e acompanhamento do paciente logo após o encerramento da psicoterapia, no momento da alta (por exemplo, Vermote et al., 2011, Salminen et al., 2008. Há ainda outro conceito, que entende follow-up como um período de avaliação que deve acontecer um tempo depois de ser finalizado o tratamento (Leuzinger et al., 2003;Wallerstein, 2001). ...
The effectiveness of a treatment is usually measured by the clinical
improvement of the patient. However, an important factor to consider is the maintenance of the results after the end of the treatment. For this, the follow-up is a relevant tool. The objective of this study was to systematically review and analyze follow-up studies with clinical interventions in psychodynamic psychotherapy from 2006 to 2016. The searches were made in the main databases with the following descriptors: psychodynamic psychotherapy, outcome, follow-up and equivalents. Twenty-seven articles met the inclusion criteria. Studies indicate that psychotherapies are effective treatments not only during the process and results tend to remain after patient discharge. Conclusions indicate that follow-up measures should be considered to assess the long-term effectiveness of a treatment. In studies comparing models of psychotherapy effectiveness, it was seen that in most cases there were no significant differences between treatment groups, that is, patients presented improvement independently of the type of psychotherapy. However, long-term treatment models tend to have higher maintenance rates of improvement in the post-discharge period. The maintenance of long-term treatment results seems to be a relevant clinical indication to be considered when indicating treatment.
... Sekundärdaten sind für unsere Fragestellungen besonders gut geeignet, weil weder Erinnerungsfehler [23] noch die Krankheitsschwere der Befragten [24] die Genauigkeit der Daten beeinflussen. Auch die Zusammensetzung der Untersuchungsgruppe ist weder von der Bereitschaft der Therapeuten [10,25,26] noch von der Bereitschaft der Befragten abhängig, an einer Studie teilzunehmen. ...
Introduction In employed populations sickness absence can be used as a good indicator of health status. In the present study, it was examined how periods of sickness absence are developing within one year before and after psychotherapy under comparison of three types of psychotherapy (behavior therapy, psychodynamic psychotherapy, and psychoanalysis), all fully covered by statutory health insurance. Methods and data The analyses were performed with pseudonymized claims data from the AOK Niedersachsen, a statutory health insurance (N=2,900,065 insured). Certified sickness absences before and after psychotherapy were examined for 9,916 patients. Parallelized controls were used to build a comparison of the length of sickness absences. Analyses were performed separately for women and for men. Results Within one year before starting psychotherapy, patients had longer sickness absences than controls on average. There was a reduction in the length of sickness absence of 20 days (median) within one year before to 12 days (median) within one year after the psychotherapy. The obtained differences between types of psychotherapy were considerable. Discussion Differences in terms of sickness absences may in part be explained by socio-demographic differences. Patients who underwent psychoanalysis were younger and had higher educational levels. However, it remains unclear why the differences of sickness absence periods were that high. It has to be discussed whether self-selection of patients with better health into psychoanalysis had occurred. Conclusions Patients undergoing psychoanalysis differ from patients who underwent other types of psychotherapy in terms of their duration of sickness absence as well as socio-demographic profile. Thus, due to differences in the composition of patients future research in psychotherapy will have to differentiate by type of psychotherapy.
© Georg Thieme Verlag KG Stuttgart · New York.
... Many clinicians are skeptical about clinical research, especially outcome research and randomized controlled trials. Some find this kind of research too constrained to capture the complexity of clinical work and thus the findings irrelevant for their clinical practice (Busch et al., 2001;Leuzinger-Bohleber, Stuhr, Rüger, & Beutel, 2003). ...
Studies have shown that many clinicians are skeptical about research and hesitant about participating in research. In the present study, we explored this issue by studying experienced therapists’ reflections on their participation in practice-based research. Data were drawn from a practice-based research study at the University of Oslo, Norway. Twelve highly experienced therapists who had contributed to the study were invited to complete an open-ended questionnaire regarding their participation, and the text material was analyzed using a thematic analytic approach. Results indicated that research participation was experienced both as beneficial and demanding, and that being observed by others and following research procedures was experienced as affecting therapists’ clinical work. We discuss these findings in relation to the distinction between “treatment as usual” versus “treatment in a research context”, and offer suggestions for steps to increase the clinical relevance and the ecological validity of psychotherapy research.
... Las unidades de observación en las entrevistas eran de transferencia y constelaciones contratransferenciales. La entrevista tiene afinidades con la forma Pfeffer (1959Pfeffer ( , 1961Pfeffer ( , 1963 y el estudio Deutschen psychoanalytischen Vereinigung (DPV) (Leuzinger-Bohleber, 2002;Leuzinger-Bohleber et al., 2003) hizo uso de la metodología de seguimiento de entrevista con énfasis en la captura de los patrones de transferencia actualizados. Sin embargo, también se decidió utilizar la contratransferencia como información sobre formas de ser como una fuente de datos para la definición de escenarios actualizados del paciente. ...
El artículo argumenta y propone que los conceptos de escenario relacional, afectos estructurados y afectos actualizados sean considerados a la hora de observar los cambios en los modos de ser relacionales que se expresan en la transferencia. Se presenta una entrevista psicoanalítica de seguimiento de un ex-paciente analítico para ilustrar cómo el cambio en los modos de ser relacional pueden ser registrados y estudiados. Triangulando la información verbal del paciente sobre el cambio con la información no verbal y las dinámicas transferencia-contratransferencia, uno puede captar cambios cualitativos en los modos de ser relacional. El caso presentado ilustra el continuo proceso de trabajo del ex-paciente para representar la agresión de una manera más directa, y cómo este proceso puede observarse con la ayuda de los conceptos propuestos para la situación de entrevista. Estos conceptos de escenario relacional, afectos estructurados y actualizados se comparan con el concepto de transferencia usado en los estudios sobre el tema central del conflicto relacional (CCRT).
... In nomological psychoanalytic efficacy research, a multitude of divergent methods were used (compare, for instance, Bachrach, 1993;Buchholz, 1996;Freedman et al., 1999;Huber et al., 2012;Kächele, 1986;Kantrowitz et al., 1990aKantrowitz et al., , 1990bLeuzinger-Bohleber et al., 2003;Sandell et al., 2000; other attempts, all applying completely different methods, have been assembled by Brandl et al., 2004). In the epistemological understanding findings are specific to the method used, and in order to acquire knowledge of the object of the study the method used must be appropriate to the particularity of that object. ...
The author summarizes the problems inherent in nomological approaches examining the efficacy of psychoanalysis as a form of treatment. He argues that nomologically oriented research operates with assumptions lacking empirical foundation and, moreover, that studies of this type merely give the impression of the effectiveness of psychoanalytic therapies while overlooking the specificity of the psychoanalytic method. He suggests that research into psychoanalytic treatments should not be subjected to a nomological conception of science, and that structural analysis of treatment courses should be examined and systematized within the frame of psychoanalytic treatment theory relative to their outcome. Given this approach, and provided that the theory of treatment is based on conceptual common ground, such studies would enable a prognostic conclusion that psychoanalytic treatments are successful, providing that the sequences generalized in the treatment theory do actually take place in treatments that take patients’ individuality into account.
... Anders als die meist sehr kurzen Behandlungen in klinischen Studien sind ambulante Psychotherapien von beträchtlich längerer Dauer (KVT bis zu 60 Sitzungen, tiefenpsychologische bis zu 80, psychoanalytische Therapien von 240 bis zu 300 Sitzungen). Trotz positiver Hinweise auf die Langzeitwirkungen von psychoanalytischen Langzeitbehandlungen v. a. bei CD und komplexen psychischen Erkrankungen (Huber et al. 2012;Leuzinger-Bohleber et al. 2003) fehlen bisher randomisierte kontrollierte Studien zur Wirksamkeit psychoanalytischer Langzeitbehandlungen in dem in Deutschland üblichen Rahmen (Leichsenring und Rabung 2011). ...
... The group I refer to as the radical ego psychologists Klein, 1969Rapaport & Gill, 1959, among others) had, by mid-century, begun to deal with these issues. Very much in the tradition of Psychology versus Metapsychology and as demonstrated in a multitude of contemporary outcome studies (e.g., Leuzinger-Bohleber, Stuhrast, Rüger, & Beutel, 2003;Leuzinger-Bohleber & Target, 2001;, the therapist's theoretical orientation seems to be startlingly irrelevant to a successful therapeutic outcome. (This observation has not seemed to trouble most psychoanalytic theoreticians overly much.) ...
Psychoanalysis and Psychotherapy have, in one way or another, focused on the amelioration of the negative. This has only done half the job; the other half being to actively bring Positive Experience into patients’ lives. Positive Psychoanalysis moves away from this traditional focus on negative experience and problems, and instead looks at what makes for a positive life experience, bringing a new clinical piece to what psychoanalysts do: Positive Psychoanalysis and the interdisciplinary theory and research behind it. The envelope of functions entailed in Positive Psychoanalysis is an area of Being described as Subjective Well-Being. This book identifies three particular areas of function encompassed by SWB: Personal Meaning, Aesthetics, and Desire. Mark Leffert looks at the importance of these factors in our positive experiences in everyday life, and how they are manifested in clinical psychoanalytic work. These domains of Being form the basis of chapters, each comprising an interdisciplinary discussion integrating many strands of research and argument. Leffert discusses how the areas interact with each other and how they come to bear on the care, healing, and cure that are the usual subjects of psychoanalytic treatment. He also explores how they can be represented in contemporary psychoanalytic theory. This novel work discusses and integrates research findings, phenomenology, and psychoanalytic thought that have not yet been considered together. It seeks to inform readers about these subjects and demonstrates, with clinical examples, how to incorporate them into their clinical work with the negative, helping patients not just to heal the negative but also move into essential positive aspects of living: a sense of personal meaning, aesthetic competence, and becoming a desiring being that experiences Subjective Well-Being. Drawing on ideas from across neuroscience, philosophy, and social and culture studies, this book sets out a new agenda for covering the positive in psychoanalysis. Positive Psychoanalysis will appeal to psychoanalysts and psychotherapists, neuroscientists and philosophers, as well as academics across these fields and in psychiatry, comparative literature, and literature and the mind.
... Anders als die meist sehr kurzen Behandlungen in klinischen Studien sind ambulante Psychotherapien von beträchtlich längerer Dauer (KVT bis zu 60 Sitzungen, tiefenpsychologische bis zu 80, psychoanalytische Therapien von 240 bis zu 300 Sitzungen). Trotz positiver Hinweise auf die Langzeitwirkungen von psychoanalytischen Langzeitbehandlungen v. a. bei CD und komplexen psychischen Erkrankungen (Huber et al. 2012;Leuzinger-Bohleber et al. 2003) fehlen bisher randomisierte kontrollierte Studien zur Wirksamkeit psychoanalytischer Langzeitbehandlungen in dem in Deutschland üblichen Rahmen (Leichsenring und Rabung 2011). ...
Die Studie Langzeittherapie bei chronischen Depressionen (LAC-Depressionsstudie) vergleicht als eine der ersten Studien psychoanalytische mit kognitiv-behavioralen Langzeittherapien prospektiv miteinander, und sie untersucht den Einfluss von Zuweisung nach Randomisierung und Präferenz der Teilnehmer. Es handelt sich um eine umfangreiche, multizentrische Studie, die einen naturalistischen und einen randomisierten kontrollierten Zugang kombiniert. Mit der langfristigen Anlage der Studie sowie einem breiten Spektrum von quantitativen und qualitativen Forschungsmethoden sollen Beiträge zur Weiterentwicklung psychotherapeutischer Behandlungsmethoden bei dieser Patientengruppe und zur Wirksamkeitsforschung von Langzeittherapien geleistet werden. Hintergrund der Studie, Design und aktueller Stand der Durchführung werden dargelegt. Insgesamt wurden 402 Patienten mit chronischer Depression in die Studie aufgenommen; zurzeit werden die Ein- und Zweijahresnacherhebungen ausgewertet.
... Jenseits der messenden Psychotherapiewirksamkeitsforschung spielt das subjektive Erleben von Patienten innerhalb der Psychoanalyse eine große Rolle -auch in Bezug auf die Betrachtung von Behandlungsergebnissen. Mittlerweile liegen bereits einige qualita-tive Metaanalysen vor, die ausdrücklich betonen, dass "the patients' voice" durch qualitative Methoden deutlicher gehört werde (Timulak 2007(Timulak , 2009; Levitt et al. 2016). Ein bekanntes Beispiel für die systematische Erfassung von "Behandlungsrückblicken" ist die "Katamnesestudie" (Leuzinger-Bohleber et al. 2003). Es wurden ehemalige Psychoanalysepatienten und deren Psychoanalytiker einige Jahre nach Beendigung der Behandlung befragt. ...
Background
Psychoanalytic psychotherapy represents a small fraction of psychotherapies within the German healthcare system. Additionally, they are often of shorter duration and take place less frequently than recommended by the rules of German psychotherapy guidelines. Apart from research on psychotherapy efficacy via questionnaires, special interest is shown for patients’ subjective experiences in psychoanalytic contexts.
Objective
The investigation was carried out to find out how therapists specify the setting in psychoanalytic psychotherapy as well as what patients report about the therapy.
Material and methods
Data of completed psychoanalytic psychotherapies of the German Psychoanalytical Society (DPG) practice study (a prospective naturalistic long-term study that examines the effectiveness of psychodynamic psychotherapy) were used. Therapists’ information (n = 108) was collated via questionnaires and for the patients’ perspective, free texts from patients (n = 37) were categorized via qualitative content analysis.
Results
The long-term therapies examined in the DPG study often used the full contingency of sessions stipulated by the German psychotherapy guidelines. They were often carried out in a classical (couch) setting and at a frequency of 2–3 h per week. Patients often described the therapy as challenging but all in all they seemed satisfied with the treatment.
Conclusion
Psychoanalytical psychotherapy is often carried out in accordance with the rules of German psychotherapy guidelines, at least in this study. Patient reports gave an insight which is close to the reality of patient experiences and, therefore, promises to be an interesting research perspective for the future.
... As entrevistadas também relataram diversas áreas específicas em que houve ganhos psicoterapêuticos (subcategoria G.2). Melhoras nas relações interpessoais, na qualidade de vida, na saúde geral e na vida profissional foram apontadas como resultado da psicoterapia. Esses ganhos estendidos também foram encontrados em outros estudos 31,34 . Observamos que nos comentários do grupo C havia mais referências a ganhos efetivos e gerais com a PP (por exemplo, "Fui curada…", C6; "Resolvi toda minha vida… mudei meu comportamento…", C7), enquanto os do grupo D enfatizavam ganhos parciais ("a palavra 'submissão' sempre combina comigo, mas sinto que estou chegando lá… a ter mais minha própria opinião", D1). ...
This paper compares beginning and end of treatment of patients who were classified by their therapists either as dropouts (D) or completers (C) in psychoanalytic therapy (PT). The study aims to understand factors associated with unilateral termination and completion of therapy in a community PT clinic related to a post-graduation PT course. This is a qualitative study that examined the content of initial and post-treatment interviews of 10 PT cases, five dropouts and five completers. The analyzed corpus comprised 236 pages and generated 672 record units, grouped into 8 categories, 5 from initial and 3 from after-treatment interviews. In comparison to C, at the beginning of therapy, D patients showed less broad objectives, less willingness to change and less insight, more negative perception of previous treatments, more negative transference and more resistance. Post treatment interviews indicated that during therapy completers were less resistant than dropouts. Also, after therapy C were more satisfied with results and exhibited more effective benefits, like the ability to continue working thought psychological issues by their own. Taking together, results offer hypotheses for the complex phenomena of the dropout and completion in PT. These hypotheses may be considered taking into account the methodological limitations of the study. Others studies are needed to better understand reasons for interruption or completion of psychoanalytic therapy.
Structural changes in chronically depressed patients in psychoanalyses compared to cognitive-behavioral longterm psychotherapy
The Melbourne Study of Psychoanalytic Psychotherapy examined the implementation, lived experience, and perceived therapeutic gains of psychoanalytic psychotherapy in a low‐cost, private‐sector community clinic. A first in Australia, this 8‐year demonstration project allowed naturalistic study of the impact and process of intensive, long‐term, time‐limited psychoanalytic psychotherapy delivered to self‐referred adults by clinicians with a common theoretical frame of practice. Presented in three papers, the research employed the RE‐AIM planning and evaluation framework, using complementary quantitative and qualitative methods, to study the psychotherapy service in terms of Reach, Effectiveness, Adoption, Implementation and Maintenance . This first paper reports the Reach of the program to be 67% for those presenting for assessment for psychoanalytic psychotherapy, with Adoption of the full 2‐year treatment program being 60%. Improvements in mental health and life functioning provided quantitative evidence of Effectiveness for those completing the 2‐year treatment program, with Maintenance at 8‐month follow‐up. Patient age, gender and personality characteristics did not modify these improvements. In‐depth qualitative exploration of patient and psychotherapist perspectives regarding the psychotherapy is reported in the second paper highlighting expectations, experience and benefits of the psychotherapy. The third companion paper presents the qualitative findings concerning factors experienced as facilitating or challenging therapeutic progress. Each of the three related papers amplifies understandings of how low‐cost, long‐term but time‐limited psychoanalytic psychotherapy can be implemented in the community with adults otherwise unable to afford such treatment, and discusses lessons learned.
Die vorliegende Arbeit erschließt zwei Psychotherapien mit dem Ziel, darin enthaltene Orientierungen am Modell (OaM) (Dausendschön-Gay et al., 2007) über den Therapieverlauf zu untersuchen. OaM stellen individuelle Formulierungsroutinen dar, die von PatientInnen und TherapeutInnen eingesetzt werden können, um rekurrente Formulierungsaufgaben zu lösen. Die longitudinale konversationsanalytische Aufarbeitung der OaM zweier Psychotherapien zeigt, wie eine als hilfreich erkannte Formulierung bzw. multimodale Gestalt von den Teilnehmern wiederholt flexibel verwendet wird, um gleich- oder neuartige Formulierungsprobleme zu lösen. Im Rahmen dieser Arbeit wird dargestellt, wie individueller Sprachwandel in therapeutischer Interaktion über mehrere Jahre hinweg stattfindet. Dabei wird eine OaM durch wahrnehmbare Ähnlichkeiten (Palacios & Pfänder, 2014) zu einem bekannten Idiom bei gleichzeitiger kreativer Ausformung durch die TeilnehmerInnen und expliziter Markierung salient. Die Ähnlichkeit der rekurrenten OaM zeigt sich auf formaler (morphosyntaktischer), funktionaler (semantischer) und phonetischer (rhythmischer) Ebene. Das longitudinale Design der Untersuchung ermöglicht es, die Einführung, die Veränderung und die therapeutische Relevanz mentaler Modelle aus Teilnehmerperspektive darzustellen. Die Arbeit zeichnet nach, wie PatientInnen und TherapeutInnen gemeinsam nach einem adäquaten Modell suchen, es in Interaktion und damit in Beziehung weiterentwickeln und eine mental repräsentierte Interaktionserfahrung schaffen, die auch Jahre nach der Therapie noch als hilfreich beschrieben wird.
Dans le monde entier, la pression exercée sur la psychanalyse pour qu’elle prouve les résultats de ses traitements à l’aune des critères dits « fondés sur des preuves » ( evidence based medecine ) a augmenté. Tandis qu’un grand nombre d’études sur les résultats des thérapies psychanalytiques brèves est maintenant disponible, de telles études font grandement défaut pour la psychanalyse et les thérapies analytiques de longue durée. Cet article compare au moyen d’une grande étude multicentrique, les résultats de thérapies cognitivo-comportementales et psychanalytiques chez des patients chroniquement déprimés. Les deux types de thérapies ont permis des changements hautement significatifs quant aux symptômes dépressifs trois années après le début des traitements. Cependant la visée des traitements psychanalytiques n’est pas exclusivement de réduire les symptômes pathologiques mais aussi celle de provoquer des changements dans le monde intérieur des patients, changements qui nous rappellent le but des psychanalyses tel que Freud l’avait spécifié : développer la capacité d’aimer, de travailler et de jouir de la vie. Dans la communauté germanophone, de telles transformations sont dites « changements structurels ». Cet article rapporte donc des résultats en termes de tels changements structurels, obtenus à l’aide d’un instrument de mesure sophistiqué : l’OPD ( Operationalized Psychodynamic Diagnostics : Diagnostics Psychodynamiques Opérationnalisés ). Lesdits changements structurels sont comparés avec les changements symptomatiques. Trois ans après le début du traitement, significativement plus de patients sous traitement psychanalytique ont présenté de tels changements structurels par rapport aux patients sous traitement cognitivo-comportemental (TCC).
This chapter sketches a psychoanalytical understanding of depression unconsciously determined by the individual life and trauma histories of the patients and by specific social and cultural factors. In the second section of the paper, some basic lines of a psychoanalytic understanding of depression are summarized: (a) depression as a reaction to loss, guilt, and reparation; (b) narcissistic and psychotic depression; and (c) integrative models of depression. In the third section, some interdisciplinary findings on depression and trauma are outlined. An unexpected result of the LAC depression study had been that more than 80% of the chronically depressed patients who were in long-term psychoanalytic or cognitive-behavioral therapy in this study had experienced severe trauma in their childhood. Therefore, in Sect. 5.3, concepts and empirical findings from embodied cognitive science on how to understand the effects of early trauma are discussed. The second interdisciplinary point of reference is the neuroscientific memory research, particularly the concept of memory reconsolidation, which offers interesting explanations for the relationship between early trauma and depression. It is thus illustrated that contemporary psychodynamic therapies of depression are strongly influenced by interdisciplinary knowledge. The chapter ends with a plea for a differential indication for psychotherapies of chronically depressed patients.
Background:
A recent meta-analysis has confirmed that the effects of psychotherapy on patients with borderline personality disorders (BPD) are still insufficiently understood. Evidence of differences between different types of therapies has been questioned.
Aim:
To study repetitive interaction patterns in patients with BPD undergoing either psychoanalysis or psychodynamic therapy.
Methods:
Psychoanalysis (PSA) or psychodynamic psychotherapy (PDT) was administered to 10 patients each, the two groups were matched. Therapy regimens were applied according to care as usual/manualized including quality control and supervision as usual. Randomization to one of the groups was done after baseline assessment. During classical PSA (n = 10) and PDT (n = 10), semiannually, recordings (audio or video) of five consecutive therapy sessions were taken over three years for an ex-post analysis. The patients' characteristics, such as affect parameters [Affect regulation and experience Q-sort (AREQ)], quality of object relations (quality of object relations scale) and personality traits [Shedler-Westen Assessment Procedure (SWAP-200)] were analyzed retrospectively by independent raters. Therapeutic action (psychotherapy process Q-sort) and affective (re)actions of the patients (AREQ) were then analyzed in relation to changes found in the patients' characteristics.
Results:
During the first year of therapy (PSA: n = 10; PDT: n = 9), the therapeutic method PSA was associated with significant improvements in the variable "SWAP Borderline", while in PDT change was not significantly different to baseline (PSA: P = 0.04; PDT: P = 0.33). Long-term results and follow up was available for seven participants in PSA and for five in PDT after three years; change in SWAP borderline for the whole sample was not significant at this time point when confronting to baseline (P = 0.545). However, differences between PSA and PDT were significant when analyzing the "mean change" in the SWAP Borderline variable after one year of therapy (P = 0.024): PSA led to slightly increased BPD symptoms, while PDT to a decrease; for the long run, variance of observed change was higher in PSA than in PDT (SDPSA ± 9.29 vs SDPDT ± 7.94). Our assumption that transference interpretations, closely followed by affective changes in the patient, could be useful modes of interaction was reproducible in our findings, especially when looking at the descriptive findings in the long-term data. The analysis of repetitive interaction structures demonstrated a very specific "time-lag" between therapeutic intervention and a corresponding increase in positive affect in successful therapy cases.
Conclusion:
Exploring the change processes in the patients' characteristics and linking these changes to specific treatment strategies is of clinical importance when starting treatment and for its long-term progress.
In the multicenter LAC study, 554 chronic depressive patients were interviewed in four treatment centers, 252 of whom were enrolled in the study. The self-assessments of the patients (BDI) showed large and stable changes. The complete remission rate was 34% after 1 year and increased to 45% after 3 years. The effect sizes were d = 1.17 after 1 year and increased to 1.83 after 3 years. Analogous results were shown in the assessments of the independent, blinded raters (QIDS: remission rates after 1 year, 39%; after 3 years, 61%; effect strengths d = 1.56 after 1 year; d = 2.08 after 3 years). Contrary to their hypotheses, however, the authors found no statistically significant difference between the procedures with regard to symptom reduction and no effect differences between randomized treatment allocation and treatment. However, there were differences in the structure of the personality (measured with Operationalized Psychodynamic Diagnostics, OPD). Three years after the start of treatment, more patients in psychoanalytic treatments showed more changes in the structure of their personality than in cognitive-behavioral treatments. In addition, these structural changes in psychoanalytic therapy had a stronger influence on symptom change than in cognitive-behavioral therapy. These results—3 years after the start of treatment—were published in 2019. Currently, the results are evaluated 5 years after the start of treatment as well as other secondary measures of outcome—the book chapter summarizes these latest results and the study and combines them with considerations on the psychoanalytic treatment technique of this patient group. A detailed case study serves as illustration.
Parcourant l’enseignement de Lacan, l’auteur tente de cerner le désir-de-l’analyste que celui-ci pense être le « pivot » le plus opérant de la cure analytique. Ce désir averti, assoupli, marqué par la castration symbolique et restructuré par sa cure personnelle est le résultat d’une confrontation de l’allant-devenant analyste à l’ Hilflosigkeit originaire et à son être pour la mort. Il suppose la guérison de sa névrose de transfert, le dépassement du plan des identifications aliénantes, des croyances dans un souverain Bien valable pour tous, dans des relations sexuelles pleinement satisfaisantes et dans l’existence d’un Maître qui saurait ce qui serait bon pour lui. Il s’agit d’un désir plus fort que les autres désirs qui peuvent habiter l’analyste en tant que personne, un désir qui accepte d’incarner dans le semblant l’objet qui cause le désir de son analysant et qui renonce à faire de celui-ci l’objet de satisfaction de sa jouissance. Il est le résultat d’une analyse personnelle menée suffisamment loin, complétée par une expérience clinique élaborée à l’occasion de contrôles ou de supervisions et d’autres rencontres cliniques avec ses pairs.
Im einführenden Beitrag zu diesem Band wurde schon auf die vielschichtigen Veränderungen hingewiesen, die sich in den letzten 50 Jahren in der Welt der Wissenschaften vollzogen und auch die psychoanalytische Forschungslandschaft umgepflügt haben. Sie findet heute in weltweiten, interdisziplinären und
intergenerationellen Netzwerken statt, wie wir nun anhand einiger der laufenden großen Forschungsprojekte im Grundlagen und Klinischen Bereich am SFI illustrieren möchten. Zudem versuchen wir in all diesen Forschungsprojekten eine Verbindung zwischen klinischer und extraklinischer Forschung, die einer wissenschaftstheoretischen Position entspricht, die die verantwortliche Leiterin des Schwerpunkts >Klinische Forschung< und
>Grundlagenforschung< (M. Leuzinger-Bohleber) in verschiedenen Publikationen vertreten und der Konzeptualisierung aller laufenden Projekte in diesem Bereich am SFI zugrunde gelegt hat. Daher wird diese wissenschaftstheoretische Position zuerst kurz anhand einer Grafik skizziert und daraufhin anhand der verschiedenen Projekte illustriert.
After the foundation of psychoanalytic institutes in Berlin (1920), Vienna (1922), and London (1925), the Frankfurt Psychoanalytic Institute (1929–1933) was among the first European institutes. Its closure in 1933 at the hands of the National Socialists, along with the transformation of the Berlin Institute into a state-governed psychotherapeutic institute, obliterated for a long time all memory of psychoanalysis in Germany. In West Germany, Alexander Mitscherlich was able to found a new “Institute and Training Centre for Psychoanalysis and Psychosomatic Medicine” in Frankfurt in 1960, which was renamed the “Sigmund-Freud-Institute” (SFI) in 1964. The German Federal State of Hessen financed this foundation as an act of reparation for psychoanalysis. From 1995 onwards, the institute mainly focused on research and the training branch was given to the newly founded Frankfurt Psychoanalytic Institute (FPI). The SFI was now defined as a purely psychoanalytic research institute and remains the only state-supported institute devoted solely to psychoanalytic research up to the present. Due to the changes in the scientific world, it had to be structured in new ways over the last 15 years. The SFI is now an internationally and interdisciplinary well-known and productive psychoanalytic research institute.
Se presenta un estudio de caso para evaluar la eficacia del psicoanálisis y la persistencia de sus beneficios 20 años mas tarde en una mujer joven con depresión severa, inhibición profesional y dificultades en la selección de pareja debido a mandato transgeneracional (TGM, por sus siglas en ingles). La investigación se llevo a cabo mediante entrevistas psicoanalíticas con la paciente y el analista, quienes fueron evaluados por jurados psicoanalíticos y no psicoanalíticos, siguiendo una metodología derivada de aquella ya puesta a prueba por Leuzinger-Bohleber et al. (2003), en Alemania. El tratamiento psicoanalítico comenzó a principios de los años 80 en Monterrey, Mexico. El estudio concluye que el psicoanálisis fue eficaz en relación al trastorno del caracter y la selección de pareja de la paciente debido, sobre todo, a la alianza terapéutica, al análisis de la transferencia y del caracter, como también al incremento de capacidad de mentalización como resultado de la interpretación del TGM.
A good therapeutic alliance has been found to be the best predictor of outcome in psychotherapy, but psychotherapists also need to develop an understanding of the mechanisms by which that alliance is created and the factors that may damage that alliance and contribute to harmful effects of psychotherapy. I explore these factors in three contexts: the nature of the therapy itself, the characteristics of the therapist, and the dynamics of the patient–therapist relationship. I discuss the research that suggests that potentially harmful processes can be avoided by a dynamic‐agentive systems model, which views psychotherapy as a conversation, in which turn‐taking, rupture and repair, and perspective‐taking are the intersubjective tools that help to build the therapeutic alliance and that can be the focus for further study into the mechanisms by which psychotherapy is helpful or harmful. The neuroscience research that supports this model is summarized.
En el trabajo se realiza un repaso de las pruebas a favor de la efi cacia, efi ciencia, efectividad y demás componentes que miden la calidad de la psicoterapia como terapia.
Para desbrozar el terreno, el autor propone refl exionar sobre una serie de elementos epistemológicos, teóricos, técnicos y pragmáticos que subyacen hoy a la polémica acerca de la efectividad y efi ciencia de la psicoterapia en salud mental y de la utilidad mayor o menor de sus diversas formas y variantes.
En tal sentido, se revisan conceptos elementales, como los utilizados para “medir” la utilidad de las investigaciones en ciencias de la salud: modelos, teorías, cualidades y metodologías (con especial atención al concepto de estudio controlado y aleatorizado, a los metanálisis y a las revisiones). También se discute el valor y fundamentos de algunas técnicas bibliométricas, tales como el FI o Factor de Impacto bibliométrico.
Se propone una revisión a fondo en esos cuatro ámbitos, revisión orientada por modelos epistemológicos, teóricos y técnicos actualizados, así como la necesidad de una “irrupción de la democracia social” en las organizaciones científi cas y de reparto de fondos para la investigación y la asistencia, al menos en los campos de la salud mental y la psiquiatría actuales
Psychoanalysis has a long tradition where different concepts have been developed. The beginnings of psychoanalysis focused on psychic mechanisms of various disorders ranging from melancholia to the various forms of neuroses.
The present article explores ways in which psychoanalytic theory and technique can help clinical social workers and psychoanalytic clinicians face some of the challenges of working with difficult-to-access populations. It addresses how to bridge gaps in mental health services by doing culturally sensitive mental health outreach to specific vulnerable communities. The article addresses clinical competencies, and how we can strengthen them with psychoanalytic theory to reach out to marginalized populations considered “difficult to reach.” Specifically, this article examines the experience of providing mental health counseling in male bathhouses, using psychoanalytic theory to support a single-session counseling model geared to decreasing the risk of HIV transmissions among gay, bisexual, and other men who have sex with men (MSM).
Sorprendentemente a menudo en los psicoanálisis de pacientes con depresión crónica, la depresión representa un intento inconciente de hacer frente psíquicamente al dolor psíquico insoportable tras un trauma severo: estados disociativos, un estado psíquico cronificado de shock, una desaparición de las emociones, un vaciamiento del yo y las relaciones de objeto, así como una desaparición de la psique en el cuerpo se encuentran entre las posibles consecuencias. El tratamiento de estos grupos difíciles de analizandos también puede llevar a los analistas a los límites de lo tolerable. A menudo relacionado con esto está el peligro repetido de negar el trauma, y una retraumatización del analizando en la situación analítica. El trabajo analiza el hecho de que, en comparación con otros enfoques terapéuticos, el psicoanálisis cuenta con una conceptualización muy diferenciada de los determinantes psíquicos y el tratamiento de la depresión crónica. No obstante, a fin de conservar su creatividad y la innovación como disciplina científica, debe desarrollar constantemente su conceptualización a través de la investigación sistemática y extra-clínica - como se observa en la insuficiente explicación conceptual de la traumatización severa durante la génesis de la depresión crónica. En este sentido, se expondrán varios ejemplos ejemplares de estudios extra-clínicos en el ámbito de la investigación psicoterapéutica, la neurobiología, la epigenética y la ciencia cognitiva corporizada. Como se tratará en la parte final de este trabajo, no menos importante son las conceptualizaciones en la investigación clínica en psicoanálisis, que se basan en el análisis meticuloso, cuidadoso de la reactivación del trauma en la transferencia, y la comprensión y el trabajo a través de ellos en la relación analítica.
Las controversias actuales sobre investigación clínica, conceptual y empírica arrojan luz sobre cómo el psicoanálisis enfrenta su naturaleza y su futuro. Se examinan algunos debates relevantes con respecto a las características de sus argumentos, en los que han participado Wallerstein, Green, Hoffman, Eagle y Wolitzky; Safran, Stern, Blass y Carmeli y Panksepp. Se exploran acuerdos y desacuerdos para encontrar caminos que podrían haber permitido que continuara el debate. Se destacan dos puntos centrales en estos debates: a) si existe un fundamento común en psicoanálisis y qué tipo de procedimiento podría contribuir a aclararlo más; b) complementación de las pruebas intraclínicas y extra-clínicas. Se examinan ambos aspectos: la posibilidad de complementar diversas metodologías y la naturaleza de la evidencia clínica compartida analizada en grupos de discusión clínica, como los promocionados por el Comité de Observación Clínica de la IPA. Se acentúa la importancia de la triangulación y de la consiliencia en lo concerniente a su contribución a la solidez del psicoanálisis. Para fortalecer una perspectiva crítica que amplíe el campo argumentativo de la disciplina, el psicoanálisis debe tomar en cuenta argumentos provenientes de diferentes fuentes, de acuerdo con sus méritos específicos. Al hacerlo, el psicoanálisis aumenta su importancia dentro del diálogo interdisciplinario actual.
This paper provides a first theoretical and empirical analysis of the effects of psychotherapy on individual productivity. We build a simple model in which a deterioration of mental health endogenously causes a decrease in productivity, which is counterbalanced by psychotherapy. We test our hypotheses on the British Household Panel Survey data. We find that individuals suffering from mental health problems benefit economically from consulting a psychotherapist. Moreover, we find that the returns are higher for men than for women, even though women are more likely to seek help.
A case study is presented to evaluate the effectiveness of psychoanalysis and the persistence of its benefits 20 years later in a young woman with severe depression, professional inhibition, and difficulties in partner selection due to transgenerational mandate (TGM). The investigation was carried out with psychoanalytic interviews with the patient and analyst, which were evaluated by both psychoanalytic and non-psychoanalytic judges following a methodology based on one tested in Germany by Leuzinger-Bohleber et al. (2003). The psychoanalytic treatment began in the early 1980s in Monterrey, Mexico. The study concludes that the psychoanalysis was effective in assisting with the patient's character disorder and partner selection, mainly because of the therapeutic alliance, the analysis of transference and character, and the patient's increased capacity for mentalization as a result of the interpretation of the TGMs.
The outcomes of psychoanalysis, as with other psychotherapies, vary considerably. Psychoanalytic Treatment in Adults examines the results of a longitudinal study of change during psychoanalysis, illuminating the characteristics of patients, analysts and analyses which can help to predict outcomes of treatment. Written by experienced psychologists and psychoanalysts, chapters in the book draw upon sixty case studies to consider how patients with very different analytic outcomes respond at both the beginning and end of their analysis. Psychoanalysts used a clinician report measure, the Shedler-Westen Assessment Procedure, to describe a patient at the beginning of psychoanalysis and every six months until the analysis ended. This allowed the authors to learn about changes over analysis and, in turn, improved treatment planning and practice for the well-being of other patients. Chapters explore five outcomes: a negative therapeutic reaction; attrition when the patient drops out; attrition due to external events; mutual agreement between patient and analyst without maximum benefits; and mutual agreement between patient and analyst with maximum benefits. The findings from these chapters will be of interest to researchers and academics in the fields of psychoanalysis, psychotherapy, psychodynamic therapy, psychoanalytic education, psychiatry and psychology. The results should also help clinicians recognize potential problems early in analytic treatments so that they can work more effectively with patients. © 2016 Rosemary Cogan and John H. Porcerelli. All rights reserved.
Psychoanalysis really should not exist today. Until a few years ago, most of the evidence suggested that its time was drawing to a close, and yet psychoanalysis demonstrated remarkable resilience in the face of criticism, alongside significant resurgence over the course of the last years. In "Conservative and Radical Perspectives on Psychoanalytic Knowledge: The Fascinated and the Disenchanted" psychoanalyst and philosopher Aner Govrin describes the mechanisms of sociology within the psychoanalytic community which have enabled it to withstand the hostility levelled at it and to flourish as an intellectual and pragmatic endeavour. He defends the most criticized aspect of psychoanalysis: the fascination of analysts with their theories. Govrin demonstrates that fascination is a common phenomenon in science and shows its role in the evolution of psychoanalysis. Govrin argues that throughout its history, psychoanalysis has successfully embraced an amalgam of what he has defined and termed "fascinated" and "troubled communities." A "fascinated community" is a group that embraces a psychoanalytic theory (such as Bion's, Klein's, Winnicott s) as one embraces truth. A "troubled community" is one that is not satisfied with the state of psychoanalytic knowledge and seeks to generate a fundamental change that does not square with existing traditions (such as new psychoanalytic schools, scientifically troubled communities and the relational approach). It is this amalgam and the continuous tension between these two groups that are responsible for psychoanalysis' rich and varied development and for its ability to adapt to a changing world. Clinical vignettes from the work of Robert Stolorow, Betty Joseph, Antonino Ferro and Michael Eigen illustrate the dynamic by which psychoanalytic knowledge is formed. "Conservative and Radical Perspectives on Psychoanalytic Knowledge" will be of interest to psychoanalysts, psychotherapists and philosophers alike.
62 hospitalized female patients (aged 18–43 yrs) with a clinical diagnosis of borderline personality disorder (BPD) were assessed for Axis II disorders by the SCID-II and for personality traits with the NEO-Personality Inventory (NEO-PI). The predominant personality trait profile for these patients involved a very high Neuroticism score and low Agreeableness score. Five of the 8 BPD criteria had significant correlations with NEO-PI scales. The combination of BPD severity and personality traits as measured on the NEO-PI had a significant relationship to the patients' social adjustment. The utility of gathering information on both borderline personality pathology and personality traits is discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Psychoanalytic therapy research can be divided into 4 generations, marked by increasing conceptual sophistication and technological enhancement. The 1st generation (1917–1968) comprised simple retrospective counts of improved outcomes by unspecified criteria. The 2nd generation (1959–1985) consisted of 2 kinds: (1) prospective group-aggregated studies of psychoanalytic treatments, with specified definitions, operationalized criteria, and predictions to expected outcomes, and (2) individually studied outcomes in a sequence of patients. The 3rd generation (1954–1986) combined both kinds of 2nd-generation studies with the added feature of separating outcomes at termination from the more enduring effects at subsequent follow-up. The 4th, current generation (1970s–) adds in microanalytic process studies made possible by recent technological advances-audiotapes, combined with computer searches. Programs are currently being fashioned to combine these ongoing process studies with the best outcome measures in order to realize the principle of Patient-Treatment-Outcome Congruence, the representation of the patient's illness, the treatment process, and assessed outcome in comparable terms. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In this study we critically review the formal research literature pertinent to the outcomes of psychoanalysis and the factors influencing these outcomes. Our inquiry was conducted from a psychoanalytic perspective. We found the research yield consistent with the accumulated body of clinically derived psychoanalytic knowledge, e.g., patients suitable for psychoanalysis derive substantial therapeutic benefit; analyzability and therapeutic benefit are relatively separate dimensions and their extent is relatively unpredictable from the perspective of initial evaluation among seemingly suitable cases. The studies all contain clinical and methodological limitations which are no more substantial than in other forms of psychotherapy research, but they have not substantially advanced psychoanalytic knowledge. This raises challenges for the further development of formal research strategies native to psychoanalysis.
Dieses Buch stellt den ersten Band einer interdisziplinären Zusammenarbeit von Psychoanalytikern, Neurowissenschaftlern, Kognitionspsychologen, Emotionsforschern, nCognitive Science Forschern über Theorien des Gedächtnisses dar. Die verschiedenen Beiträge zeigen auf, was die Psychoanalyse gewinnen kann, wenn sie sich auf diesen Dialog einlässt. Sie zeigen aber auch, dass die Neuro- und Kognitionswissenschaften umgekehrt gut beraten sind, den spezifischen Beitrag der Psychoanalyse zur Erkenntnis unbewusster Prozesse ernst zu nehmen.
Edelman, einer der bedeutendsten heutigen Hirnforscher, charakterisiert eine Fragestellung, die bekanntlich auch für die Psychotherapieforschung von besonderer Relevanz ist, aber nach dem Angriff von Grawe, Donati & Bernauer (1994) auf differenzierte Einzelfallstudien in der Öffentlichkeit erneut diskutiert werden muß. In allen ernsthaften Psychotherapien, allen voran in psychoanalytischen Behandlungen, geht es um das Verstehen eines individuellen Leidens, einer unverwechselbaren Lebenssituation eines einzigartigen Menschen und seiner idiosynkratischen Geschichte. Wie kann eine wissenschaftliche Erforschung der Persönlichkeit erweitert werden, ohne die subjektive Einmaligkeit des Individuums aus dem Auge zu verlieren? Diese Fragestellung ist fast so alt wie die Psychoanalyse selbst und prägte die wissenschaftstheoretischen, methodologischen und metatheoretischen Diskurse der letzten Jahrzehnte. Doch auch in der empirischen Psychotherapieforschung hat sich die Erkenntnis durchgesetzt, daß in einer ernsthaften empirisch-psychoanalytischen Forschung die „subjektive Einmaligkeit des Individuums“ Berücksichtigung Emden muß. Darauf verweist u. a. Fischer (1994) bezugnehmend auf die von Kächele (1992) vorgeschlagene historische Gliederung der empirischen Psychotherapieforschung. Er unterscheidet a) die ergebnisorientierte Forschung (1930–1970), b) kombinierte Prozeß- und Ergebnisstudien (1960–1980) und c) Untersuchungen der Mikrodynamik des Prozeßgeschehens (seit 1980).
2 In der 3. Forschungsperiode rückt die systematische und detaillierte Einzelfallstudie vermehrt in den Fokus der Aufmerksamkeit, verbunden mit einem hermeneutischen Vorgehen (vgl. unten). In einigen Studien, auf die ich exemplarisch noch eingehen werde, werden qualitative und quantitative Methoden zur Erforschung des Einzelfalls kombiniert (vgl. dazu auch Faller & Frommer 1994).
This paper addresses the question of why psychoanalysts in general view their identity as more closely related to the literary world than to that of science. The affective and imagelike quality of the processes which precede verbal communication in analysis give rise to an “analytic opus”. An extraction process is described which results in models at different levels of abstraction and generalization. These models are instantiated in three forms: (1) in therapeutic practice, (2) in experiments, and (3) in computer simulations. This new view of the relationship between therapeutic practice and psychoanalytic theories makes discussions of metapsychology superfluous. Instead, the development of psychoanalytic theories of affective and imagelike processes should be given priority.
Freud (1895, S. 227) erörtert in der Epikrise von Elisabeth von R., daß es ihn eigentümlich berühre, daß seine Krankengeschichten „wie Novellen zu lesen sind“, da er nicht immer Psychotherapeut, sondern ein Neuro-Pathologe gewesen sei. Er weiß sich aber zu trösten, wenn er „die Natur des Gegenstandes“ für die Notwendigkeit der Novellenform seiner Krankengeschichten verantwortlich macht, die es zu ermöglichen scheint, in seelische Vorgänge, wie bei einem Dichter aber „bei Anwendung einiger psychologischer Formeln“, Einsicht zu gewinnen.
The practice of psychotherapy is cut off from the findings of psychotherapy research. As a psychotherapist, I do not look to those fmdings for help in doing psychotherapy, or for answers to questions that come to my mind as I do psychotherapy. I do not look to those findings to settle disagreements I have with psychotherapists who apparently do psychotherapy differently from the way I do it, or to decide which of two ideas I have about what is going on in my patient’s mind here and now is the better or more accurate idea.
Studies on the long-term cost-effectiveness of psychotherapies are still rare. In the context of a retrospective long-term follow-up study, the authors assessed work loss and hospitalization days before, during, and after psychoanalytic treatments based on patients' self-reports and health insurance records. They also determined the correlation between patients' ratings and health insurance data. Health insurance records showed evidence of a lasting and remarkably stable reduction in work absenteeism and a low level of inpatient treatments. These trends contrasted favorably with the age-related increase in sick leave among the general population. Patients' self-reports reflected the general trend of the health insurance data but were not accurate enough to estimate costs and savings. Even disregarding other illness-related costs, based on health insurance records, considerable savings accrued over the 7-year follow-up period in terms of reduced absenteeism from work. Advantages (e.g., long follow-up periods) and limitations (e.g., selection) of collecting health insurance data are discussed.
One purpose of our research was to determine the pretreatment predictive factors in the patient and therapist (Project A of this book). . . . Our other purpose was to determine the predictive factors within the treatment, especially in the early sessions (Project B of the book).
The first part of the book, known as "Project A," is largely devoted to the Penn Psychotherapy Project as it was first conceived.
The second part of the book reports on "Project B," which is aimed at locating predictive factors within the early sessions of the treatment. . . . Project B, therefore, offers a set of measures of the key concepts of psychoanalytic psychotherapy. The book winds up with a massive chapter summarizing all the findings in the Penn study and comparing them with the findings of most other predictive studies of the outcomes of psychotherapy.
This book will interest three types of readers: those who are practitioners of psychotherapy, those with a research interest in the topic, and those with both clinical and research interests. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Psychoanalysis and psychoanalytical psychotherapy remain unparalleled sources of insight into the unconscious determinants and dimensions of psychological suffering. However, there is a worldwide debate as to the most appropriate ways in which to carry out research into psychopathology and treatment that remains true to the essence of the discipline. This volume presents the rationales, methods and findings of some of the main empirical studies. The methodological and scientific problems, as well as some sophisticated solutions, are illustrated with concrete research examples. The distinguished authors of this volume share the common aim to bridge the gap between practicing therapists and researchers. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In this first of a series of monographs dealing with different aspects of psychoanalysis, the authors use an intensive follow-up (FU) process to identify key variables in the psychoanalytic process and assess their implications for theory and technique. FU data were organized in terms of the nature of the therapeutic alliance, the special configuration of the oedipus complex, the defense transference, and dreams. Case studies of 5 25–30 yr old females illustrate the FU process, the fate of the transference neurosis, the fate of the analytic alliance, a defense transference, and tension regulation. The FU method is used to review the FU literature; it is suggested that it could be applied in reformulating the clinical experiences of reported studies. Theoretical implications of this approach involve the analytic alliance and symptom formation and defense transference in a developmental context. It is concluded that early developmental vicissitudes in character formation and neurotic conflict are significant. (4 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Traducción de: From Anxiety to Method in the Behavioral Sciences
This paper reports in detail the phenomena associated with the study of one of five subjects who were examined two or more years following completion of an analysis deemed satisfactory by analyst and analysand. This subject's protocol was selected because of its typical character and because of the subject's ability to portray the subjective side of the research experience, thus increasing the amount of information available for examination. The subjects experienced the follow up studies as though they were analyses. The interviews seemed to produce recapitulations of their analyses, i.e., transferences: their associated defenses and characteristics appeared, intensified and resolved. The studies suggest that following completion of analysis, the transference neurosis remains as a latent structure which may, under certain conditions, be revived, repeated, and rapidly mastered. This capacity reflects growth resulting from the analytic experience. The observations confirm those made by Pfeffer (1963), who emphasized 'the idea that in analysis repetition is not eliminated, but rather the content or substance of what is repeatable is changed. That is to say, the neurotic repeats the conflicts of the infantile past, whereas the satisfactorily analyzed patient in new situations that require mastery is capable, in addition, of repeating the solutions of these same conflicts as achieved in the analysis.'
In the course of studying various aspects of patients' responses to and experiences following analysis, two cases who had had 'successful' analyses, when called back two years following termination for follow up interviews, provided unusually clear information about incompleteness. In one case, an aspect of reality joined a transference resistance as a specific kind of 'reality resistance'. In the other case, the continuing partially analyzed quest to live out the transference fantasy was described by the patient as it was experienced during the analysis and 'maintained' postanalytically. At termination, the postanalytic course, the subsequent self analytic attempts, and the eventual manner in which each presented himself for further treatment are evaluated in terms of the specific kind of incompleteness.
As part of a long-term followup study of the outcome of psychoanalysis, we examined the relation between the extent of resolution of the transference at termination and the characteristics of the patient-analyst match. For twelve of the seventeen patients interviewed five to ten years after termination of psychoanalysis, the researchers found that the patient-analyst match played a role in the outcome of the analysis. Illustrations of the influence of the match in cases where the transference was resolved and those where it was not are presented.
Thirteen of seventeen patients in followup interviews five to ten years after the termination of analysis reported the development or refinement of a self-analytic capacity. According to the accounts of these patients, there did not appear to be a direct relation between the attainment of a self-analytic function and the extent of resolution of the transference neurosis or the maintenance of therapeutic gains after treatment.
Seven out of 17 patients interviewed in a long-term followup of psychoanalysis showed either improvement in psychological functioning or a retention of psychological gains they had made during the course of psychoanalysis. Six patients deteriorated in their psychological functioning, but their gains were restored with subsequent treatment. Four patients deteriorated in psychological functioning without restoration, whether or not treatment was reentered. Neither analysts' assessments at the time of termination nor patients' assessments of themselves or assessments based on psychological tests one year after termination predicted which patients would improve or retain psychological change. No causal generalizations about factors related to psychological change can be made from these data. Different factors in interaction are suggested to account for the stability and instability of psychological change.
Psychoanalysis has never developed a tradition of systematic followup study to evaluate outcome and to improve technique and theory for a variety of reasons, partly theoretical, stemming from the conception of the unfolding transference neurosis and its analytic resolution as the precondition for cure, and partly historical, having to do with the happenstance of its development as a private practice-based discipline and training outside of the academic setting. Freud, however, was never bound by such strictures and published whatever post-treatment data he acquired on all his best-known case histories. But following Freud most analysts, with some notable exceptions, eschewed followup activity as unanalytic. It is this tradition that more recent studies like those of Pfeffer in New York and the Psychotherapy Research Project of The Menninger Foundation in Topeka have squarely challenged. Data are presented from the Menninger project dealing specifically with the impact of routine planned followup on issues of treatment termination and resolution and on the nature of the post-treatment period. The degree and kind of patient cooperation with the followup inquiry, the impact of followup on treatment termination and resolution (both impeding and facilitating), and the role of followup intervention in relation to return to formal post-treatment therapy (or consolidating against it), are all discussed.
Attempts to define the central factors contributing to psychological change from psychoanalytic treatment have occurred throughout the history of psychoanalysis. Insight from interpretations and clarifications and the affective relationship to the analyst are agreed to be the crucial elements in analytic work as they play out in the transference and resistance. Each patient and analyst pair, however, has its own unique interaction. Even though patients potentially may have successful analyses with many different analysts, the experience of each patient-analyst dyad has its own non-replicable characteristics. The interdigitation of the particular characteristics of the analyst and the patient may be therapeutically beneficial and may determine the depth and range of work in any specific area. An illustration is offered where the positive impact of an interaction came from subtle, often non-verbal aspects of a particular patient-analyst pair. The author's thesis is that, in addition to the analyst's technical and empathic skill, the subtle aspects of character and conflict of both patient and analyst and their interplay constitutes a central therapeutic factor in analytic work.
1994 saw the publication of the volume Psychotherapie im Wandel. Von der Konfession zur Profession ("Psychotherapy in Transition. From Confession to Profession") by K. Grawe et al. This book did much to fuel the professional policy debate on the purpose and efficiency of long-term and high-frequency analytic psychotherapies. The author examines Grawe's book, comparing its methodological approach with other (largely US-American) studies on psychotherapeutic research, and concludes that the studies analysed by Grawe do not do justice to the realities of psychoanalytic therapy. He advocates more naturalist designs reflecting the change from controlled therapies in institutions to clinical treatment in private practices. Finally he criticises psychoanalysts for having failed to provide evaluation of long-term and high-frequency analysis.
The attacks mounted by Grawe, Donati and Bernauer on the individual case study as an instrument of research in psychoanalytic studies has had major political repercussions, not least with regard to professional corporate identity. The author takes the opportunity of inquiring into the quality and the advantages of scientific inquiry into the individual case. She proceeds in this from a discussion of the familiar quandary posed by the fact that the necessarily idiosyncratic nature of the individual case will by definition resist generalization. The very definition of inquiry that qualifies for the term "scientific" is, however, precisely that it should be able to make statements with a claim to general validity. The line taken by Leuzinger-Bohleber is that the internal (narrative) coherence of psychoanalytic interpretations should be supplemented by an external form of coherence in such a way as to ensure that genuinely psychoanalytic interpretations and concepts do not stand at odds with accepted knowledge in other scientific disciplines. With special reference to Moser's arguments, she demonstrates that a trial-and-error research approach with an inbuilt suspicion of and resistance to orthodox tenets, professions of faith and ultimate truths is quite definitely in a position to proceed from individual cases to subsequent generalizations, from data to metaphors, concepts and finally theories susceptible of validation by further new data. By referring theoretical models back to new practical situations (the therapeutic situation, the experimental situation, computer simulation) the author feels that it is entirely possible to at least sustain, if not resolve, the tension between individual case study and scientific claims of general validity. This is entirely in line with the view of psychoanalysis as a "science between the sciences", an approach reconciling "understanding" and "explanation", hermeneutics and hardcore science.
Previous work of the author presents a salutogenic theoretical model designed to explain maintenance or improvement of location on a health ease/dis-ease continuum. The model's core construct, the Sense of Coherence (SOC), was consciously formulated in terms which are thought to be applicable crossculturally. The SOC scale which operationalizes the construct is a 29-item semantic differential questionnaire, its design guided by Guttman's facet theory. A 13-item version of the scale has also been used. The purpose of the present paper is to present the extant evidence from studies conducted in 20 countries for the feasibility, reliability and validity of the scale, as well as normative data. In 26 studies using SOC-29 the Cronbach alpha measure of internal consistency has ranged from 0.82 to 0.95. The alphas of 16 studies using SOC-13 range from 0.74 to 0.91. The relatively few test-retest correlations show considerable stability, e.g. 0.54 over a 2-year period among retirees. The systematic procedure used in scale construction and examination of the final product by many colleagues points to a high level of content, face and consensual validity. The few data sets available point to a high level of construct validity. Criterion validity is examined by presenting correlational data between the SOC and measures in four domains: a global orientation to oneself and one's environment (19 r's); stressors (11 r's); health, illness and wellbeing (32 r's); attitudes and behavior (5 r's). The great majority of correlations are statistically significant. All available published normative data on SOC-29 and SOC-13 are presented, data which bear upon validity using the known groups technique.(ABSTRACT TRUNCATED AT 250 WORDS)
Psychoanalysis has insecure foundations. Many of its core theories and therapeutic principles are contested from both within and without the discipline. While it often has little difficulty embracing new ideas it has terrible trouble rejecting old ones. Typically those within the discipline have dealt with this situation by destructive rationalisation, denial, splitting and idealization. Foremost is the tendency to multiply schools and paradigms and to rely on rhetoric and argument by authority. It is argued that to counter such inevitably destructive processes we need to find a way of improving constructive engagement with each other and to achieve a discipline that can grow on the secure foundations of gradually accumulating knowledge. Giving examples, the author describes the ongoing development of a methodology for evaluating psychoanalytic papers according to a common standard. It is proposed that it is possible to conduct reasoned international and cross-cultural peer review. This means that we can in principle evaluate and reach agreement as to the merit of psychoanalytic papers even though their authors may have backgrounds in profoundly different local style and local traditions of argument. Moreover, it is suggested, this can be done without creating the monster of an internationally homogenised style that would numb creativity and original thought.
The authors point out that psychoanalytic research papers are cited with less frequency than clinical papers, and, presumably, are read with less frequency. Results from two sets of questionnaires from psychoanalysts indicate that a majority of analysts report high levels of conviction in the rationales and techniques in their clinical work. However, analysts with higher degrees of conviction read fewer research papers than analysts with lower degrees of conviction. The authors speculate that analysts with higher degrees of conviction may have an underlying sense of uncertainty about their analytic work. Their uncertainty may generate concerns that research may raise questions and doubts about their rationales and techniques, and, consequently, they have little interest in empirical psychoanalytic research. Such an attitude would be understandable because analysts sense or explicitly believe that confidence in their work is an important, perhaps essential, element in the mutative effects of treatment, and must be maintained and protected. The authors believe that clinical and research approaches have each contributed to the development of psychoanalysis and that both need to be used.
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