Course Of Psychoanalytic Treatment Research Articles

The Hero Transformed: The Dialectics of Heroism and Psychoanalytic Process in Working with Israeli Men

ABSTRACT This article examines the meaning of the heroic in the Israeli context. I will describe the meaning of the heroic as it appears in my psychoanalytic work with Israeli men. The heroic in this context looms large, it becomes a passion and a mission celebrated at the level of the individual and the social. Myths of heroism sustain hope and agency, as they also help sustain the dissociation from suffering. Heroism appears as an intrapsychic dialectic that may enhance and express vitality and personal agency, as it may also enhance grandiose and persecutory ideals. The heroic is at the same time a powerful social construction intertwined with the idiosyncratic history of the individual. Clinical examples are used to demonstrate the dialectics of heroism in the Israeli context, and the process of transformation of idolization of military heroism in the course of psychoanalytic treatment.

Assessment of Change in Psychoanalysis: Another Way of Using the Change After Psychotherapy Scales.

A systematic method is presented whereby material from a full course of psychoanalytic treatment is analyzed to assess changes and identify patterns of change. Through an analysis of session notes, changes were assessed using the CHange After Psychotherapy scales (CHAP; Sandell 1987a), which evaluate changes in five rating variables (symptoms, adaptive capacity, insight, basic conflicts, and extratherapeutic factors). Change incidents were identified in nearly every session. Early in the analysis, relatively more change incidents related to insight were found than were found for the other types of change. By contrast, in the third year and part of the fourth year, relatively more change incidents related to basic conflicts and adaptive capacity were found. While changes related to symptoms occurred throughout the course of treatment, such changes were never more frequent than other types of change. A content analysis of the change incidents allowed a determination of when in the treatment the patient's main conflicts (identified clinically) were overcome. A crossing of quantitative data with clinical and qualitative data allowed a better understanding of the patterns of change.

Faith and the Couch: A Psychoanalytic Perspective on Transformation

Transformation requires the capacity to leave behind presently held positions in favor of different or new ones, in order to accommodate impingements of new complexity, on a higher level of psychological organization. The object relations course of this developmental capacity is embedded in transitional progression from the early monadic mode of relatedness in the newborn to the dyadic intersubjective experience of the second and the third year, and finally to the triadic narrative mode of relatedness of the oedipal period (years 4–6) and beyond. Transformation in the course of psychoanalytic treatment involves conflict resolution, removal of fixation points, and repair of deficits in self-regulation. Faith as a transformative force claims miracles and is the central core of a Moslem believer's integrity and sense of self. Islam, like other major religions, praises self knowledge, values morality and transcendence, and teaches primacy of meaning. Psychoanalysis similarly seeks deepening of self-knowledge through introspection, searching for value, and the personal meaning of one's experience. To the theological perspective of Islam, psychoanalysis can bring the scientific dimensions of the dynamic unconscious, the developmental view and conflict theory, object relations, transitional experience, and mentalization.

Choice

Understanding how and why analysands make the choices they do is central to both the clinical and the theoretical projects of psychoanalysis. And yet we know very little about the process of choice or about the relationship between choices and motives. A striking parallel is to be found between the ways choice is narrated in ancient Greek texts and the experience of analysts as they observe patients making choices in everyday clinical work. Pursuing this convergence of classical and contemporary sensibilities will illuminate crucial elements of the various meanings of choice, and of the way that these meanings change over the course of psychoanalytic treatment.

Veränderungen des Emotionserlebens im Verlauf psychoanalytischer Langzeitbehandlungen/ Changes in emotional experience during the course of psychoanalytic therapy

Does the subjective emotional experience of patients change in the course of psychoanalytic treatment? Ten patients were interviewed four times during their first two years in psychoanalytic therapy. Interviews were coded with regard to the patients' subjective emotional experience. Changes in individual emotion profiles were then tested for associations with therapy outcome using a hierarchical linear model. Better therapy outcome was associated with an increase in emotional variability and a decrease in the proportion of negative emotions. In contrast, neither the number of emotions verbalized by the patients nor the frequencies of specific emotion categories were associated with therapy outcome. Remarkable changes of emotional experience during the course of psychoanalytic treatment could be demonstrated. Particularly, a more variable emotional experience proved to be closely associated with improvement in mental health.

Interpretation as Shaped by Projective Identification

How to make interpretations during the course of psychoanalytic treatment is a recurring clinical question. Certain aspects of the analysis serve as helpful signposts along the way. Patients have particular interpersonal ways of presenting themselves. The unique intrapsychic manner the patient has of relating to us (transference) and our feelings (countertransference) to these matters give us clues to study. Our understanding of these situations may lead to the development of a hypothesis we may or may not choose to share with the patient. Projective identification is a complex mental mechanism that can often shape the content and manner of an interpretation.

The analytic therapist in the group 1980: Continuities and discontinuities with Sigmund Freud

Freud's clinical concepts, formulated in the course of psychoanalytic treatment of individual patients, remain viable today in the practice of analytic group therapy. The context has changed. The transition into the group modality adds dimensions and intensifies the existing ones. Crucial, too, is the increased awareness we have of the therapeutic relationship with its power and complexity, as the context for these clinical concepts. The knowledge that each individual is unique and human applies to the therapist as well as to the patient. Comprehension of this permits better understanding of transference and resistance.

Inability to open the mouth: An unusual psychosomatic symptom

In applying field theory to psychosomatic disorders, in addition to the many familiar elements in the field, one must be attentive to the possible sequence of chronically disturbed function becoming causal in altering structure, sometimes irreversibly. This is a clinical report of two symptoms involving essentially the same anatomical area; one was reversible in the course of psychoanalytic treatment and one was not. The patient suffered from a severe stammer and a severe limitation in his ability to open his mouth. In the course of psychoanalytic treatment, the stammer was relieved, however the inability to open the mouth remained unchanged. The latter symptom was ultimately corrected surgically, after it was diagnosed as due to a mechanical obstruction of the passage of the coronoid processes of the mandibles under the zygomatic arches due to hypertrophy of the coronoid processes bilaterally. This paper makes an effort to understand this latter rare pathology as a psychosomatic entity and an extension of the same psychopathology as the stammer. The relationship between the patient's severe castration anxiety and the belated mechanical obstruction diagnosis and surgical treatment is also considered.