American Psychoanalytic Association Research Articles

Psychoanalysis

Article AbstractFrom our regular book review column.Psychoanalysis: The Major Concepts is the culmination of the efforts of the editors in a lineage dating to 1967 with the publication of A Glossary of Psychoanalytic Terms and Concepts, a small but useful manual published in 2nd edition form in 1968 as a public information effort of the American Psychoanalytic Association and its Committees on Public Information and Indexing. The intent was to clarify for the public in plain language what was meant by psychoanalytic terms and concepts. That small book had 102 pages, and 74 contributors addressed 164 indexed terms. Embedded in the definitions were 149 other terms, separately indexed.

Pathways to self-knowledge. Private reflections and mutual supervision and other shared communications.

As part of a national survey of analysts in the American Psychoanalytic Association, analysts responding to the questionnaire reported the different ways in which they continued their self-explorations stimulated by their work with patients. Twenty-six of these analysts were interviewed about this process. Their responses clustered in four groupings; (1) analysts who revealed their self-reflections in writing; (2) analysts who used their self-discoveries in teaching; (3) analysts who communicated their self-discoveries to only a few people most often a spouse and one or two close friend-colleagues; and (4) analysts who participated in peer groups or had several friends and/or friend-colleagues with whom they were mutually self-disclosing. Subsequently, ten analysts were interviewed specifically about mutual supervision and self and other exploration in this process. This paper presents data about the frequency and methods of these reporting analysts' self-enquiry and their ideas about privacy and self-disclosure in relation to their self-reflections. The role of transference in self-revelation to peers is discussed in respect of its regressive and non-regressive aspects.

Psychoanalytic research and the IPA: history, present status and future potential.

This paper traces the chequered history of formal psychoanalytic research within the century-long development of psychoanalysis as theory and practice. It describes the official involvement of the American Psychoanalytic Association in the support of psychoanalytic research since 1970, and of the International Psychoanalytical Association since the 1980s. In the IPA, this has consisted of the introduction at the 1987 Montreal Congress of two half-day panels on formal psychoanalytic research; in the creation in 1991 of an annual IPA Research Conference held in March at University College London; and then the creation in 1996 of an annual ten-day IPA Summer School for neophyte psychoanalytic researchers, also at UCL in London. The paper then details the inauguration by the IPA, at the 1997 IPA Congress in Barcelona, of a mechanism for funding psychoanalytic research the Research Advisory Board (RAB), and the overwhelming--and totally unanticipated--worldwide response to the initial call for proposals in the autumn of 1997. Implications of this for psychoanalysis as a discipline are sketched.

The Tragic Success of European Psychoanalysis: "The Budapest School"

By the end of World War I the Hungarian Psychoanalytic movement was strong and deeply integrated into the cultural life of Budapest. The paper discusses how Budapest lost its growing eminence as a center of European psychoanalysis because of the political-social changes in Hungary in the year 1918?1920. The author examines the two waves of Hungarian emigration between the world wars, the first in the early twenties to the Weimar Republic, and then in the thirties, to the United States and Australia. These moves of important Hungarian psychoanalysts, account both for the destruction of the Budapest School and at the same time for its influence in other countries. The author highlights the outstanding role of the American Psychoanalytic Association in setting up the ?Emergency Committee on Relief and Immigration? and thereby saving the lifes of many European colleagues. America was open to European psychoanalysis and in return immigrants facilitated the development of modern psychotherapy and psychoanalysis. The influence of Vienna, Budapest and Berlin can be traced in the contemporary psychoanalytic culture in the United States.

Response to the presidential address: new challenges for proven values.

I am speaking tonight about my theme—New Challenges for Proven Values: Defending Access, Fairness, Ethics, Decency. I am proud to become your 126th President in the most exciting days in our history. To this distinguished audience of colleagues, I want to recognize with gratitude the contributions of Harold Eist, whose high energy, enthusiasm, and courage have conveyed fresh hope to members beleaguered by the swift currents swirling around us and, indeed, all of medicine. The synergy in our working relationship has advanced the resolution of extraordinary problems. Over the past 20 years I have received generous advice and counsel from Gerry Flamm, the late Jim Trench, Hugo Taussig, Dan Borenstein, Drew Clemens, and Larry Hartmann. I am especially grateful to my many colleagues on the more than 20 components on which I served, my friends in the Assembly, and my fellow Board members whose judgment and insights have deepened my understanding and truly confirmed our proven values. I salute my Yale mentors whose wisdom has shaped my personal and professional development. The late Milton J.E. Senn, Sam Ritvo, Al Solnit, Fritz Redlich, Ted Lidz, Steve Fleck, Jay Katz, and the late Wilbur Downs have been inspirational teachers and friends. I especially want to thank Dr. Albert Solnit, friend and mentor for over 40 years, whom I first met when I was a pediatric intern at Yale. Al, a former Director of the Yale Child Study Center, has been a national leader as President of the American Psychoanalytic Association, the American Academy of Child and Adolescent Psychiatry, and the International Association of Child and Adolescent Psychiatry. Currently, he is Connecticut’s Commissioner of Mental Health. Al has been a distinguished policy advisor to state and federal governments. In theory and in practice, Al has inspired legions of psychiatrists. My wife, Helen, is a consummate professional who directs a model psychiatric clinic in the New Haven Superior Court for Juvenile Matters. She has quietly supported my 20 years of activity in the national APA. Caring, yet challenging on matters of substance, she has sharpened my view of crucial issues. Of my four children, two are attorneys, and two are in the financial industry. Russell works with the Navajo nation, living on the reservation, and Kate is general counsel and senior vice president of a major hospital. Doug and Eric have taught me that even Mammon can be found to have a social conscience. My six loving grandchildren have given me a chance to look at my own childhood once more. With my own children, my grandchildren, and my young patients, I am surrounded by blocks, Corgi toys, markers, and board games. In my personal and professional life I can’t seem to get up from the carpet. Helen, Russell, Doug and Patty, and their three girls—Olivia, Lizzy, and Haley—are here tonight. Mel Sabshin is leaving APA shortly. I have known him and loved him for more than 20 years. He is a teacher at heart, and his reflections have given strong guidance to our growing and vigorous Association. On the occasion of John Nemiah’s 10th anniversary as Editor of the journal of the American Psychiatric Association, Mel cited a quatrain written by Clarence Day 75 years ago.

Informed Consent To Review

The American Psychoanalytic Association does not intend this Practice Bulletin to state or serve as a standard of practice for mental health care. It is intended as a guideline only. The ultimate judgment regarding a particular clinical decision or method of intervention or overall treatment plan will be made by the practitioner on the basis of the clinical data presented by the patient and the diagnostic and treatment options available in the particular clinical setting.

Charting Psychoanalysis

The American Psychoanalytic Association does not intend this Practice Bulletin to state or serve as a standard of practice for mental health care. It is intended as a guideline only. The ultimate judgment regarding a particular clinical decision or method of intervention or overall treatment plan will be made by the practitioner on the basis of the clinical data presented by the patient and the diagnostic and treatment options available in the particular clinical setting.

Psychoanalysis—the Major Concepts

BURNESS E. MOORE AND BERNARD D. FINE, EDS. Psychoanalysis-the Major Concepts. New Haven: Yale University Press, 1995, 577 pp., $60.00, ISBN 0-300-06329-6. This book, in painfully small print for aging eyes, essentially constitutes the Summa Psychoanalytica of the American Psychoanalytic Association. In 1990, the editors published the third edition of their Glossary of Psychoanalytic Terms and Concepts, an outstanding collection of important definitions. The book under review here is a sequel, consisting essentially of a series of essays on innumerable clinical and abstract topics. The authors are prominent members of the American Psychoanalytic Association and, although the editors claim that the book is published independently of that organization, represents a thorough coverage of the traditional United States views on the practice and theory of that would be endorsed by that organization. The essays range widely in style, from those exceptionally clearly written, as for example by Pulver, and as such with special value for beginners, to those that are exceedingly scholastic in the high medieval sense, such as the chapter on narcissism by Moore (one of the editors of the volume) or on self by Vann Spruiell. Some of the chapters, for example those by McLaughlin on resistance and by Renik and Grossman on working with are of great technical value and go into considerable detail. The book is divided into two main parts: clinical and theoretical concepts. The section on clinical contains essays on therapeutic applications, technical issues, and other clinical phenomena such as dreams, character, somatization, narcissism, and sadomasochism. The section on theoretical concepts covers factors affecting normality and pathology, instinct theory, sexuality, affects, development, self, objects, identification, conflict, defense, structural theory, metapsychology, and finishes with essays on psychoanalytic education and research. Thus all conceivable aspects of the major concepts of are covered by these essays. The authors are very conservative and seem to agree with each other on most major issues. For example, Pulver maintains that five sessions per week are desirable and four the minimum number to constitute a psychoanalysis (p. 8). His opening chapter is the only one specifically addressed to the beginner, and in he states that Eissler's concept of is now passe (p. 22). This issue of parameters seems to haunt some of the authors; for example, Seelig, in an attempt to differentiate individual psychoanalytic psychotherapy from psychoanalysis, states that it is useful to think of the psychotherapy as being the first stage of an analysis, essentially a parameter of technique that must be employed in the initial period of the work but which can be analyzed later (p. 54). Her chapter deals with one of the most controversial topics in the book, and I suspect every reader will take issue with some of the statements to be found there. Also on this conservative line, Pulver opposes the constructivists without giving details of their radical point of view in his chapter on analytic processes and mechanisms of change. …

Dopamine reuptake site densities in patients with social phobia.

It has been suggested that social phobia is associated with dysfunction of the noradrenergic and dopaminergic systems, but there are no published anatomic data on the monoaminergic abnormalities found in the brains of phobic patients. The authors studied the density of dopamine reuptake sites in patients with social phobia. The study included 11 patients with social phobia and 28 healthy comparison subjects, 11 of whom were age- and gender-matched to the patients for the analyses. Measurement of the density of dopamine reuptake sites was performed by using a 123I-labeled cocaine analogue, [123I]beta-CIT, with single photon emission computed tomography (SPECT). Blind quantitative analysis revealed that striatal dopamine reuptake site densities were markedly lower in the patients with social phobia than in the age- and gender-matched comparison subjects. The results indicate that social phobia may be associated with a dysfunction of the striatal dopaminergic system.

Joost A.M. Meerloo, M.D.: “Some Psychological Processes in Supervision of Therapists”

THEODORE SHAPIRO M.D.* Meerloo's 1952 commentary on the psychological processes in supervision provides a practical working frame for teaching dynamic psychotherapy. The brief paper alerts us to the pitfalls of controlling our supervisees versus teaching them while offering homey recommendations that include catch-phrases such as guidance. He notes that his approach revives old way of learning and teaching medicine, i.e., learning by precept. Curiously, the piece is both modern and dated as evidenced by the didactic tone and recommendations about empathy as well as the assumption that teaching psychotherapy is a feature of medical education. The former seems modern, the latter an unlikely assumption for our next generation, as physicians are being taught other forms of therapy in most areas of the U.S. The contrast Meerloo makes between the technical present in 1952 and the humane personal aspects of meeting with a patient remain current concerns. Indeed, in usual psychiatric curriculum planning we contrast knowledge and skill learning. At the same time we contrast blind spots to dumb spots, a distinction that has been attributed to so many that I dare not use a citation because it is bound to offend someone. At any rate, the blind spot must be analyzed for its unconscious dimensions; the dumb spot, by contrast, may be removed by education. Since Meerloo's paper, using the psychoanalytic frame, there have been multiple commentaries and one book, Becoming a Psychoanalyst: A Study of Psychoanalytic Supervision by Robert Wallerstein,1 in 1981 and more recently, in 1993, a paper by Szecsody, Kachele and Dreyer,2 among others, that address the supervisory process. Szecsody described four ambiguities in supervision: 1. The candidate must be good enough in his openness to learn. 2. The supervised candidate must now consider his/her role as real as well as fantasied transference object. 3. Parallel process between patient and analyst and analyst and supervisor must be considered. 4. The triangular situation established is central in any dialogue between two of the parties. In addition, the COPE Study Group of the American Psychoanalytic Association described three styles of supervision: (1) didactic, (2) collegial, and (3) Socratic. Each has its pitfalls. Turning to formal empirical research on psychotherapy, we find that supervision now takes the shape of formal training. The therapist is taught to adhere to a specific procedure, for there is no possibility of studying any therapy without reviewing and judging the therapist's reliability and adherence to a manual designed to deliver a specific treatment. …

Journal reviews

Böuhle, Alexander. Die Ratio des Mythos: Ein Versuch über die Apriori psychoanaly‐tischer ErkenntnisGrotstein, James S. ‘Projective identification reappraised’, Parts I & II. Contemporary PsychoanalysisHart, David L. ‘Toni Wolff and the first Jung Institute’. Psychological PerspectivesHaule, John. ‘Erotic analysis and the shape of eros’. SpringHillman, James‘Pink madness, or Why does Aphrodite drive men crazy with pornography?’SpringReggiori, Joan. ‘The other side of fifty’. Journal of the British Association of PsychotherapistsOrbach, Ann. ‘Psychotherapy in the third age’. British Journal of PsychotherapyLimentani, Adam. ‘Creativity and the third age’. International Journal of PsychotherapySchafer, Roy. ‘Aloneness in the countertransference’. Psychoanalytic QuarterlyTyson, Phyllis. ‘Bedrock and beyond: an examination of the clinical utility of contemporary theories of female psychology’. Journal of the American Psychoanalytic Association

A classic revisited: Loewald on the therapeutic action of psychoanalysis.

Versions of the following papers were presented at the panel "Psychoanalytic Classics Revisited: Hans Loewald's "On the Therapeutic Action of Psychoanalysis' " (Gerald I. Fogel, chair) at the meetings of the American Psychoanalytic Association, December 1993. As a tribute to Loewald's lifetime of achievement, and in belated recognition of his preeminent position in the field of psychoanalysis, the exchange appears here almost in its entirety, rather than as a conventional panel report.

Psychoanalysis: Waning or Waxing?

To the Editor. —In the December 14, 1994, issue ofThe JOURNAL, Drs Clemens and Mosher 1 argued that psychoanalysis is not on the wane and provided some statistical data regarding membership in various organizations to support this opinion. First, they argued that the membership of the American Psychoanalytic Association has increased in the past two decades. Secondly, they reported that the membership of Division 39 of the American Psychological Association (the section of the American Psychological Association concerned with psychoanalysis) has increased in the past decades. Finally, they provided information regarding the increase of membership in such organizations outside the United States. Although these numbers are correct, they are somewhat misleading because the authors used raw numbers rather than proportions to examine their hypothesis. While the number of members in the American Psychiatric Association has increased almost twofold from 20 000 to 29 000 to 38 000 during the

Psychoanalysis: waning or waxing?

To the Editor. —Dr Somerfeld-Ziskind 1 begins a recent review of a book on biological with the gratuitous sentence: Now that psychoanalysis is on the wane, inevitably earlier opinions in psychiatry will resurface. While it may be comforting to some to repeat the myth that psychoanalysis is in some sort of decline, the facts about psychoanalysis support exactly the opposite conclusion. In the United States, the membership of the American Psychoanalytic Association has gone from 1880 in 1974, to 2828 in 1984 to 3050 in 1994 (oral communication, American Psychoanalytic Association, August 1994). Most of these members are physicians. In addition, the membership of Division 39 of the American Psychological Association, the section concerned with clinical psychoanalysis, has risen from 1950 in 1984 to 3801 in 1994 (oral communication, American Psychological Association, August 1994). While surveys over these years have shown a slight decline in the number of psychoanalytic

Frontal-subcortical circuits and neuropsychiatric disorders.

Five parallel anatomic circuits link regions of the frontal cortex to the striatum, globus pallidus/substantia nigra, and thalamus. The circuits originate in the supplementary motor area, frontal eye fields, dorsolateral prefrontal region, lateral orbito-frontal area, and anterior cingulate cortex. Open loop structures that provide input to or receive output from specific circuits share functions, cytoarchitectural features, and phylogenetic histories with the relevant circuits. The circuits mediate motor and oculomotor function as well as executive functions, socially responsive behavior, and motivation. Neuropsychiatric disorders of frontal-subcortical circuits include impaired executive function, disinhibition, and apathy; indicative mood disorders include depression, mania, and lability. Transmitters, modulators, receptor subtypes, and second messengers within the circuits provide a chemoarchitecture that can inform pharmacotherapy.

Predictors of posttraumatic stress symptoms among survivors of the Oakland/Berkeley, Calif., firestorm

The purpose of this study was to examine factors predicting the development of posttraumatic stress symptoms after a traumatic event, the 1991 Oakland/Berkeley firestorm. The major predictive factors of interest were dissociative, anxiety, and loss of personal autonomy symptoms reported in the immediate aftermath of the fire; contact with the fire; and life stressors before and after the fire. Subjects were recruited from several sources so that they would vary in their extent of contact with the fire. Of 187 participants who completed self-report measures about their experiences in the aftermath of the firestorm, 154 completed a follow-up assessment. Of these 154 subjects, 97% completed the follow-up questionnaires 7-9 months after the fire. The questionnaires included measures of posttraumatic stress and life events since the fire. Dissociative and loss of personal autonomy symptoms experienced in the fire's immediate aftermath, as well as stressful life experiences occurring later, significantly predicted posttraumatic stress symptoms measured 7-9 months after the firestorm by a civilian version of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder and the Impact of Event Scale. Dissociative symptoms more strongly predicted posttraumatic symptoms than did anxiety and loss of personal autonomy symptoms. Intrusive thinking differs from other kinds of posttraumatic symptoms in being related directly to the trauma and previous stressful life events. These findings suggest that dissociative symptoms experienced in the immediate aftermath of a traumatic experience and subsequent stressful experiences are indicative of risk for the later development of posttraumatic stress symptoms. Such measures may be useful as screening procedures for identifying those most likely to need clinical care to help them work through their reactions to the traumatic event and to subsequent stressful experiences.

A psychodynamic model of panic disorder

Current psychiatric research on panic disorder and its treatment are heavily influenced by neurobiological and cognitive-behavioral models rather than psychodynamic propositions, and psychodynamic treatment is generally considered to be of little benefit in amelioration of symptoms. However, because neither of the current models fully explains the clinical psychopathology, etiology, or pathogenesis of panic disorder, there is a need for further model building. The authors suggest that a psychodynamic approach may add to the understanding of patients with panic disorder. They base their psychodynamic formulation on pilot interviews with nine patients with panic disorder, published reports of psychological characteristics of patients with panic disorder, and data from infant and animal research on temperament. Interview results included the following: 1) all of the patients described themselves as fearful, nervous, or shy as children, 2) they remembered their parents as angry, frightening, critical, or controlling, 3) they frequently indicated discomfort with aggression, 4) most described chronic feelings of low self-esteem, 5) their spouses were characterized as passive, kind, and nonaggressive, and 6) stressors associated with frustration and resentment preceded the onset of panic. The authors propose a model in which inborn neurophysiological irritability predisposes to early fearfulness. Exposure to parental behaviors that augment fearfulness results in disturbances in object relations and persistence of conflicts between dependence and independence, which predispose to fears of feeling trapped, suffocated, and unable to escape and/or feeling alone and unable to get help. Catastrophic fears of helplessness in the face of suffocation or abandonment are easily accessible.(ABSTRACT TRUNCATED AT 250 WORDS)

The concept of boundaries in clinical practice: theoretical and risk- management dimensions

The authors systematically examine the concept of boundaries and boundary violations in clinical practice, particularly as they relate to recent sexual misconduct litigation. They selectively review the literature on the subject and identify critical areas that require explication in terms of harmful versus nonharmful boundary issues short of sexual misconduct. These areas include role; time; place and space; money; gifts, services, and related matters; clothing; language; self-disclosure and related matters; and physical contact. While broad guidelines are helpful, the specific impact of a particular boundary crossing can only be assessed by careful attention to the clinical context. Heightened awareness of the concepts of boundaries, boundary crossings, and boundary violations will both improve patient care and contribute to effective risk management.

Psychoanalytic training today.

Psychoanalytic education in the United States faces multiple challenges as we enter the last decade of this century. (1) Changing interest and career path patterns for psychiatrists have resulted in fewer medical applications for psychoanalytic training. (2) Increased opportunities for full psychoanalytic training of nonphysicians have resulted in increased applications from highly skilled clinicians who often have more clinical experience than their medical colleagues. (3) Increased enrollment of women candidates has required rethinking of progression requirements, in light of their combined careers as professionals and mothers. (4) Independent institutes not accredited by the American Psychoanalytic Association compete for applicants while maintaining training standards that require less time and immersion in psychoanalytic theory and practice. (5) Economic factors increasingly influence the desirability of prolonged psychoanalytic training and the availability of suitable analysands for control analyses. (6) Evolution of theory and practice and the emergence of "new schools" of psychoanalytic thought have rendered the previous psychoanalytic landscape dominated by drive theory and ego psychology more multifaceted and less uniform. The American Psychoanalytic Association and its institutes attempt to understand these changing patterns and take them into consideration in the design and implementation of psychoanalytic training programs. Only one aspect of this complex situation will be described in this work, the current state of psychoanalytic training in the 28 institutes accredited by the American Psychoanalytic Association. Although the data available at this time leave unanswered many important questions about the philosophies that organize the content and emphases of the curriculum in different institutes, much has been learned about the overall structure of psychoanalytic training programs.

Bulletin of the American Psychoanalytic Association

Bulletin of the American Psychoanalytic Association