Psychoanalytic Treatment Research Articles

The development of the psychoanalytic psychotherapy process with a depressed adolescent: an empirical case study

ABSTRACT This paper explores the psychotherapy process in a short-term psychoanalytic treatment (STPP) with a depressed adolescent. The empirical case study draws on both quantitative and qualitative data to examine the development of the psychotherapy process over time. 15 of the 29 audio recorded therapy sessions with a 16-year-old boy were sampled at intervals across the treatment. Session transcripts were coded using the Adolescent Psychotherapy Q-Set (APQ) and data analysed descriptively to compare characteristics of the process across the three treatment phases – beginning, middle, and ending. Descriptive statistics are supported with session extracts. Analysis of the APQ data suggests change in the patient’s presentation across the therapy. In the early stages, he appeared withdrawn and made minimal responses to the therapist’s attempts to work together; in the middle phase, he became more engaged, more able to talk about feelings, and more active in the sessions; and this was reflected in a less depressed presentation in the final phase. The therapist maintained a consistent therapeutic approach across all phases: supportive, non-judgemental, and working to make sense of the young person’s experiences, looking for patterns and inviting curiosity about how things might be understood differently. Despite increased engagement in the therapy, depressive symptoms remained in the clinical range.

Fostering trust - a qualitative outcome study of psychodynamic group and individual psychotherapy for refugees with PTSD.

Background: Refugees and asylum-seekers have an elevated risk of mental health issues, such as depression and posttraumatic stress. Qualitative outcome studies can contribute by offering insight into patients' experiences of what they find beneficial and how they undergo the process of recovery. This study aligns with the small body of qualitative research focusing on refugees' perspectives of psychotherapeutic treatment for PTSD.Objective: This study investigates and compares the treatment experiences of refugees with posttraumatic stress disorder (PTSD) in psychoanalytic group therapy (PAGT) and individual psychodynamic therapy (PDT) within an outpatient context in Sweden.Method: 10 former patients were interviewed using a semi-structured interview schedule. Data were analysed and interpreted according to the principles of grounded theory.Results: The findings reveal distinct categories for each treatment modality, being reborn for PDT and building a home for PAGT. Being reborn involved persistent intrapersonal change and lasting improvement in posttraumatic symptoms. Building a home involved a sense of belonging, support and temporary relief from posttraumatic symptoms. Participants from both treatment modalities underscored the significance of cultivating trust in therapeutic relationships.Conclusions: The study emphasises the necessity for tailored therapeutic approaches, contributing valuable insights to the limited research on effective mental health interventions for this population.

Beginning the Treatment on a Personal Note: Creating Emotional Connection

Psychoanalysis reflects the minds of its creators and is an ethical practice in the sense that the theories with which we psychoanalysts identify are those that reflect what is most important in life to each of us. I present autobiographical material that points to the personal sources, even earlier than my psychoanalytic training, of my conviction that the creation of emotional connection between two actual persons lies at the heart of psychoanalysis and is the key element in the beginning of psychoanalytic treatment. I argue that the beginning of an interpersonal/relational treatment has more continuity with the beginning of non-psychoanalytic relationships than does the beginning of treatment carried out by analysts from other schools. I present what I believe are the reasons for this difference and offer comparisons and contrasts of these ways of establishing a psychoanalytic situation. The article ends with a brief clinical illustration.

Turning towards voyeurism: Discussion of Schreiber’s the hidden and the seen: Art as an intersubjective medium

ABSTRACT This paper discusses the manuscript “The Hidden and the Seen: Art as an Intersubjective Medium.” The author used artwork in psychoanalytic treatment to explore exhibitionism. Additionally, this paper will explore the use of artwork to analyze the conversion of trauma into voyeurism. It highlights various ways to incorporate art, focusing on how a patient’s fixation can be harmful, reparative, and pleasurable.

Psychoanalysis and psychedelics: The censored story in Argentina

This essay examines the combination of psychoanalytic therapy and psychedelic substances in mid-20th century Argentina. Through document analysis, it examines the intersection of psychedelics and psychoanalysis, drawing from historical texts and writings by local psychoanalysts to develop a comprehensive understanding of the distinctive clinical practices and therapeutic approaches in the Argentine context. It details the experimental use of these substances, the clinical practices developed, and the professional and societal challenges encountered. Notably, psychoanalysts Luisa de Álvarez de Toledo, Alberto Tallaferro, and Alberto Fontana conducted pioneering research, exploring the therapeutic potential of these substances and publishing their findings in academic papers and books. According to these psychoanalysts, the use of psychedelic drugs in therapy could enhance transference, catalyze catharsis, and circumvent unconscious defenses, allowing for a vivid exploration of the patient's psyche that necessitated interpretation. Despite the innovative nature of this work, resistance from within the Argentine Psychoanalytic Association led to the eventual cessation of psychedelic research in this country. The essay calls for a reconsideration of the psychoanalytic community's relationship with psychedelics, emphasizing the potential for renewed dialogue and incorporation of these substances in contemporary therapeutic practices. In conclusion, this article sheds light on an overlooked chapter of psychoanalysis in a local setting and serves as a call for future explorations in broader scenarios. The resurgence of interest in psychedelics for mental health treatment presents an opportunity for psychoanalysts to engage with emerging research, enriching both theory and practice.

Asthma and allergic rhinitis connections with psychotherapy

There is a close relationship between emotional tensions and respiratory function, which makes it likely that many diseases of this apparatus have aetiology or are compromised by psychogenic factors, which occurs, for example, in allergic diseases such as rhinitis and asthma, as well as in certain inflammatory diseases. Asthma is diagnosed by the sensation of oppression in the chest, dyspnea that can evolve to cyanosis, discrepancy between the combined action of the diaphragm and the levator muscles of the ribs, which remove air through the narrowed bronchioles, and the weak exhalation force, which depends on the elasticity of the lungs, making breathing difficult and leading to emphysema during paroxysm. In the initial stages there may be simple cough; later, the expectoration of a thick, foamy phlegm begins. The temperature is normal and the pulse is tachycardic. Auscultation reveals crackling rales and wheezing. Asthmatics can improve with the various types of psychotherapy: supportive, cognitive behavioral techniques, counseling, relaxation techniques and mainly psychoanalytic therapy, either individual or in group. In conclusion, the treatment of asthma and allergic rhinitis, should be done by two specialists, the allergist and the psychotherapist.

“A Woman Who Found She Needed a Session of Indefinite Length”: A Look at Chapter Four of Winnicott’s Playing and Reality Through the Prism of its Modalities of Temporality

ABSTRACT This paper offers a reflection and an open, experiential reading of one of Winnicott’s most fascinating case studies. I try to show how the question of time in the psychoanalytical context emerges not only in relation to a deviation from the traditional setting but also concerns an axis inherent to some key therapeutic issues, such as the meaning of time and the temporal as a quality of holding in regression to dependency; or as a component in the transference experience or in the therapist’s holding in mind of the patient’s potential, through holding the future. The high frequency of meetings in psychoanalysis facilitates qualitative change, allowing patients and therapists to be in touch with deep, primitive strata of the psyche. Extending time in psychoanalytic treatment, therefore, whether as an ad hoc response to the patient’s needs or as an extension of the setting, is tantamount to enabling a multi-layered experience of time across the spectrum of its manifestations. Attention to the temporal component in therapy and the experience of time in the transference is a valuable resource in our work. This paper contributes to the attempt to elaborate this dimension of psychoanalytic listening.

Therapists' defense use impacts their patients' defensive functioning: a systematic case study.

Research into defensive functioning in psychotherapy has thus far focused on patients' defense use. However, also the defensive functioning of therapists might be significant because of its potential in promoting changes in the patient's overall defensive functioning by sharing their higher-level understanding of a given situation and letting the patient have the opportunity to learn how to cope more successfully. This exploratory case study is the first to examine therapist's defense mechanisms and their relationship to changes in the patient's defensive functioning evaluated at different times throughout psychoanalytic treatment. We assessed the use of defense mechanisms with the Defense Mechanisms Rating Scales in 20 sessions collected at three phases (early, middle and late) of the psychoanalytic treatment. For each session, we identified therapist's and patient's defenses, defense levels and overall defensive functioning, with particular attention to the sequence of consecutively activated defenses within the therapeutic dyad. Results showed that the patient's defensive functioning tended to gradually improve over the course of the treatment, with a slight decrease at the end. Therapists' overall defensive functioning remained stable throughout the treatment with values in the range of high-neurotic and mature defenses. Assessment of the dyadic interaction between therapist and patient's use of defenses showed that within-session, the patient tended to use the same individual defenses that the therapist used, which was especially pronounced in the initial phases of the treatment. Towards the end of the treatment, once there was a stable shared knowledge, the patient started to explore using new, higher-level defenses on her own, independent from what defenses the therapist used. Our findings emphasized the analyst's role in encouraging the development of more effective ways of coping in the patient, confirming previous theoretical and empirical research regarding the improvement of patient's defensive functioning in psychotherapy. The alterations in these coping strategies, also called high-adaptive defenses, as part of the therapist-patient interaction demonstrate the importance of studying defenses as an excellent process-based outcome measure. The measurement of the degree to which the analyst models and illustrates these superior coping methods to the patient is a prime vehicle for supporting internalization of these skills by the patient.

Artificial Intelligence and Psychoanalysis: A New Concept of Research Methodology

The recent high performance of ChatGPT on several standardized academic tests has thrust the topic of artificial intelligence (AI) into the mainstream conversation about the future of education. As deep learning is poised to shift the teaching paradigm, it is essential to have a clear understanding of its effects on the current education system to ensure sustainable development and deployment of AI-driven technologies at schools and universities. Hence, AI behavior cannot be fully understood without human and social sciences. After the imaginary and symbolic registers, AI is the third register of identification. Therefore, AI extends the movement that is at work in the Lacanian interpretation of the mirror stage and Oedipus complex and which Latour’s reading helps us to clarify. From this point of view, I describe an AI system as a set of three contrasting forces: the human desire for identification, logic, and machinery. In the “Miscomputation and information” section, I show how this interpretative model improves our understanding of AI. Systematic research on psychoanalytic treatments has been limited by several factors, including a belief that clinical experience can demonstrate the effectiveness of psychoanalysis, rendering systematic research unnecessary, the view that psychoanalytic research would be difficult or impossible to accomplish, and a concern that research would distort the treatment being delivered.

The heart of healing: Echoes of Sándor Ferenczi's legacy in Jeremy Safran's relational commitments.

In this duet of two voices honoring Jeremy Safran's legacy, the authors celebrate some points of resonance between Sándor Ferenczi's groundbreaking relational interventions and Safran's approach to the therapeutic relationship as the heart of healing. Karen Starr first highlights Ferenczi's now well-knowncreative experimentation with technique and his emphasis on and care for the relational dimension of psychoanalytic treatment. Jill Bresler then links Safran's career-long dedication to the therapeutic alliance to Starr's introductory remarks, honoring Safran and Ferenczi's shared dedication to expanding options in clinical practice through focus on the relationship. Recalling Safran's naming Ferenczi as a key figure in psychotherapy integration's origin story, Bresler reflects on her own learning from Safran's groundbreaking transtheoretical research into the mutative aspects of psychotherapy and his translating apsychoanalytic focus on the therapeutic relationship to CBT researchers and practitioners.

Childhood trauma and differential response to long-term psychoanalytic versus cognitive-behavioural therapy for chronic depression in adults.

Childhood trauma is a major risk factor for chronic depression. It has been suggested that adults with chronic depression who have experienced childhood trauma may require long-term treatment owing to a breakdown of basic trust and related difficulties in developing a productive therapeutic relationship. As empirical studies have been preliminary and scarce, we studied the effects of psychoanalytic therapy (PAT) versus cognitive-behavioural therapy (CBT) for chronic depression in adults with a history of childhood trauma. In this subgroup, we expected a greater symptom reduction in PAT compared with CBT. In a large trial of long-term psychotherapies for chronic depression (LAC-Study; Clinical Trial Register ISRCTN91956346), 210 adults received open-ended CBT or PAT in an out-patient setting and were examined yearly over 5 years on the Beck Depression Inventory - II (BDI-II). Based on a linear mixed model approach, we tested participant-reported childhood trauma based on the Childhood Trauma Questionnaire (CTQ) as a predictor and moderator of treatment outcome. CTQ subscales were examined exploratively. Depressive symptoms decreased over time (b = -4.55, s.e. = 0.90, 95% CI -6.32 to -2.81, T = -5.08; P < 0.001). A significant three-way interaction between childhood trauma, time and therapy group (b = -0.05, s.e. = 0.02, 95% CI -0.09 to -0.01, T = -2.42; P = 0.016) indicated that participants with childhood trauma profited especially well from PATs. Our results indicate differential benefits from PAT compared with CBT among adults with chronic depression and a history of childhood trauma. The results have important implications for differential indication and policy.

Effect of personality traits among teenagers for depression on the psychoanalytic therapy

Teenagers with Major Depressive Disorder (MDD) are much more inclined into have co-occurring Personality Disorder (PD). Teenagers with MDD benefit in short-term psychoanalytic psychotherapy (STPP). The FEST-IT research was an initial experimental study of transference among adolescents, which showed that STPP with MDD-affected adolescents was effective. Investigating potential moderators could improve the value of STPP. Following the diagnosis of 69 depressed teenagers (ages 16 to 18) using a systematic assessment for DSM-IV PDs; the teens were randomized to a 28-week STPP course, either with or without transference treatment. The operationalized model was a mixed linear model. Time, treatment group, and several PD criteria were used in a three-way exchange to assess the moderator impact. The findings for cluster B personality disorder indicate a small but significant moderating influence. When encouraged to examine their current patient-therapist contact, patients who started therapy with a higher percentage of group B PD symptoms fared better. Adolescents with signs of cluster B PD receiving psychoanalytic treatment for MDD appear to benefit more with relationship work than those without this disease.

Traumatic experience and loss: A brief therapy with a traumatized refugee boy and his parents in exile.

In this paper, the author portrays the psychoanalytic therapy with a twelve-year-old refugee boy and his parents, prior to which the boy had been traumatised by the deaths of both his brothers in the civil war. In 2015 he had travelled with his father to Austria, where he was warmly received in a small community. The author examines how this child reacted to the traumatising experiences, as well as which resilience factors played a role in overcoming them. The psychoanalytic process is illuminated in a detailed analysis of the therapy sessions, which created a space for overcoming the helplessness, mourning the loss and furthering the integration process of the identity, disturbed after the traumatic experiences.

University Students: Preferences for Counseling Methods

The mental health of university students has become an important concern escalated by pandemic-related stresses and insights into effective therapy for this population is needed. Participants (n 389) completed a survey indicating preferences regarding seeing a therapist employing methods reflecting one of three established schools of thought: psychoanalytic, person-centered, or cognitive-behavioral therapy (CBT). Analysis of results indicated that the CBT approach was the most popular method. However, when participants reacted to hypothetical dilemmas, there was evidence of some departure from the method students selected as their original preference. The CBT approach was more persistently chosen by participants who indicated an initial preference for that method. Demographic differences are reported. Commentary is offered on why college-aged participants might vary in their preferences for treatment styles and why so many maintain a propensity for CBT.

Empty Heart Disease: Teaching and Learning in China.

Drawing on 15 years of experience teaching psychoanalytic theory and therapy primarily from an object relations perspective to Chinese psychotherapists onsite and online, the authors present their learning about Chinese culture, social history, and philosophy, and the Chinese way of communicating about emotional experience. Their essay is imbued with the Chinese use of metaphor and psychosomatic symbolization, particularly involving the heart. They elaborate on the Chinese concept of Empty Heart Disease, comparing and contrasting it to Western concepts from literature, sociology and psychoanalysis, namely spleen, anomie, dead mother, and schizoid, empty, false, and narcissistic self-states. They expand upon and extend the empty heart concept to various age groups and symptom presentations in China, illustrated by a vignette from individual psychoanalysis with a woman and three vignettes from applied psychoanalysis of a couple with no intimacy, a child with an obsessive psychosomatic symptom, and an adolescent school dropout who was self-harming and suicidal in response to academic pressure. Having emphasized the connection between symptom presentations and social life and times, they discuss the impact of trauma, its transgenerational transmission in China, and the impact of unprecedented economic growth and social change on individuals, couples and families.

Review of From breakdown to breakthrough: Psychoanalytic treatment of psychosis.

Review of From breakdown to breakthrough: Psychoanalytic treatment of psychosis.

Precipitating Factors and Receptivity of Psychoanalytic Treatments among Chinese Americans

ABSTRACT Chinese Americans have been known for underutilization of mental health services and premature termination. This study explores these phenomena through Chinese cultural and psychoanalytical perspectives. Specifically, two sets of factors were identified: precipitating and receptivity factors. The precipitating factors include childrearing practices and pursuit of education by studying abroad at an early age. The receptivity factors include the lack of familiarity with psychoanalysis, the emphasis of efficiency in Chinese culture, shame and stigma associated with mental illness, and the seeming reluctance of this ethnic group to opening up to professional strangers. A brief review of studies on Asian American mental health was conducted. Early termination was further discussed through psychoanalytic concepts and theories including Bion’s maternal reverie, attacks on linking, and container and contained; Winnicott’s primary maternal preoccupation; and Meltzer’s apprehension of beauty and aesthetic conflict.

Transference Work and the Repair of Ruptures in Psychoanalytic Psychotherapy with Depressed Adolescents

ABSTRACT This study examines how transference work (TW) impacts alliance ruptures in short-term psychoanalytic treatment (STPP) for adolescents with depression. Using a mixed-methods approach, this study analyzed 16 STPP sessions with 4 adolescents. Observer-based measures were employed to assess both alliance ruptures-resolutions and TW, while qualitative analysis provided insight into TW’s role in repairing ruptures. The findings demonstrate that TW was commonly employed in STPP sessions and also in response to ruptures. The most frequently utilized forms of TW centered on interpretations addressing immediate issues within the therapeutic relationship, rather than drawing connections to relationships outside of therapy (genetic interpretation). Overall, this type of TW contributed positively, albeit modestly, to repairing alliance ruptures. Key factors enhancing TW efficacy included the therapist’s ability to maintain a focus on transference dynamics in the present moment and their capacity to be validating and flexible in applying TW techniques. Conversely, rigidity in the use of TW and promoting dependency between the adolescent and therapist/therapy hindered the resolution of ruptures.

The Classical Jungian Sandplay Therapy: it’s Possibilities and Application Practice in Reality of Existential Crises

The purpose of the article is to introduce the reader to the method of Sandplay therapy, to give an idea of the historical context of the creation of the method, its place in the development of child psychoanalytic therapy, about the author of the method – Dora Kalff. It contains a concise description of the main theoretical concepts and concepts underlying the method, which make it possible to understand the essence and dynamics of the therapeutic sandplay process. The categories necessary for the analysis of the sand-tray are considered. The directions of Sandplay research as a therapeutic technique and development prospects are outlined.

Development of a new observer-rated measure to assess the real relationship in psychotherapy sessions

Objectives Real relationship (RR) refers to a genuine human relationship between client and therapist, that has been found to be positively related to treatment outcome, and to predict unique variance in outcome over and above the working alliance. However, thus far, the measurement of RR has been limited to self-report. We aimed to develop an observer-rated version of the RR measure (RR-O) to assess RR in therapy sessions. Methods We adapted items from the self-report measures to an observer rated measure, which was reviewed by RR experts. The final 24-item RR-O was rated in 540 session transcripts from 27 psychoanalytic treatments that already had existing process and outcome scores. Results The RR-O showed good internal consistency and good interrater reliability. In hierarchical EFA, items clustered into a general RR factor, and client realism, client genuineness, therapist genuineness, and therapist realism group factors. In addition, the RR-O was positively related to another RR measure and to the therapeutic alliance. Conclusion The RR-O shows initial reliability and validity as an observer-rated measure of the RR to be used in post-hoc psychotherapy research. Future research should clarify the relation between RR-O and treatment outcome.