Psychoanalytic Treatment Research Articles

An empirical exploration of psychoanalytic processes and outcomes in 27 long-term psychoanalytic treatments

An empirical exploration of psychoanalytic processes and outcomes in 27 long-term psychoanalytic treatments

Doing-together with words: the sequential unfolding of a moment of meeting in a psychoanalytic therapy session.

Changes in psychoanalytic therapy have been traditionally attributed to self-knowledge (insight) in the client, provided by the therapist's interpretations. In recent years there has been growing realization that such changes can also be the consequence of the development of new forms of relatedness through client-therapist interaction, particularly through special intersubjective moments called moments of meeting. Drawing on the methods and findings of Conversation Analysis about the sequential organization of psychotherapeutic interaction, this single-case study examines the unfolding of a moment of meeting in the final session of a brief psychoanalytic therapy in Peru (in Spanish) with a female client victim of domestic violence. Our analysis shows that the moment of meeting, which resolves a challenge to the intersubjective relationship posed by a now moment, comes about interactionally through a sequentially accomplished shared practice of co-animation. In this sequence the client, who had previously assumed a passive role, exercises her own agency to assume an active role, which the therapist ratifies through his response. In this way, a momentary but significant transformation in the here-and-now relationship between client and therapist occurs. Thus, our analysis contributes to the understanding of how a transformation of relation-the transitory emergence of a new form of relatedness-can take place in and through sequentially organized talk and action in psychotherapy. Our study also sheds light on the role of language in moments of meeting, as the moment of meeting in our segment does not occur in parallel with the exchange of linguistic utterances between client and therapist, but through the exchange of such linguistic utterances and through the sequence of actions carried out by that exchange. In this way, the sequential doing-together with words leads to a moment of meeting, bringing about change, at least momentarily, in the implicit ways-of-being-with-others of the client.

Interpretation: Voice of the Field.

To patients, the most memorable moments in psychoanalytic treatment are seldom the contents of the analyst's interpretations, but the feeling of being understood. Interpretations are most meaningful not because of what they say but because each one is evidence that the analyst, who generally becomes someone of great significance to the patient, knows the patient more than before the interpretation was made. As a result of this process of "witnessing" patients not only know and feel-they also "know and feel that they know and feel." They can feel their roles in authoring their own experience. Therapeutic action results: patients "come into possession of themselves." Interpretations are the outcome of shifts in the interpersonal field, which reveal this new freedom to think and feel. This new freedom allows the creation of the analyst's interpretations, which therefore serve as a sign of a new way of being in one another's presence that has now become possible between analyst and patient. Field shifts are jointly created, without conscious intention, and interpretations arise from these shifts. Thus, interpretations are not really created independently by the mind of the analyst, but are instead the voice of the field. A clinical vignette illustrates these ideas.

Interpreting Interpretation.

Interpretation of the latent meaning of manifest content is the core of the traditional approach to psychoanalytic treatment. The main purpose of such interpretation is to enhance the patient's self-knowledge, in particular his or her awareness of unconscious wishes and their embeddedness in inner conflicts. An assumption of classical psychoanalysis is that veridical interpretations-as Freud put it, interpretations that tally with what is real in the patient-will be especially effective therapeutically. These basic assumptions have been called into question, as reflected in such concepts as "narrative truth" and the overriding importance of the patient's "assured conviction" regarding interpretations. Also called into question is the therapeutic value of "deep" interpretations intended to uncover repressed impulses. To an important extent, these have been replaced by interpretations of defensive processes just below the surface of consciousness, and interpretations that make connections among different experiences, both of which are intended to help the patient understand how his or her mind works. There is also an increased emphasis on nonsemantic aspects of interpretation, as well as some degree of skepticism toward the therapeutic value of interpretation itself, along with an increased emphasis on the implicit interpretive aspects of the therapeutic relationship. Finally, representative research is presented on the relation between transference interpretation and therapeutic outcome.

Treatment Of Depressive Disorders-from A Perspective Of Humanistic And Psychoanalytic

With the rapid economic growth, people's satisfaction with material life is growing by the day. Under the premise of satisfying physical needs such as food and clothing, people's attention to mental health is also growing. Depression disorder is the most common mental illness, and the number of deaths caused by depression is increasing. Therefore, in the so-called battle against depression, the more comprehensive the treatment, the better the prognosis. Among all kinds of treatment methods, psychoanalytic therapy of the psychoanalytic school and human-centered therapy of the humanistic school have their unique advantages, but there are also some disadvantages. In this paper, the advantages and limitations of the two therapies are analyzed in terms of the treatment concept and the basic view of human nature, respectively. Of course, the treatment of depression is in essence a tedious and lengthy undertaking, but it also needs the blessing of all aspects of resources.

A virtual frame – how does forensic psychotherapy work remotely?

Psychotherapy has been practised via remote technology since the mid-1990s and has grown in mainstream popularity; yet, it remains controversial, particularly for psychoanalytically informed treatment, and limited research in this area has been published. However, COVID-19 provoked a necessary transition to online working across the psychotherapy profession, including clinicians providing psychoanalytic treatment to a unique forensic outpatient group remotely for the first time. This qualitative research study sought insights from this sample via grounded theory interviews and analysis to inform hypothetical future practice of remote psychotherapy via videoconferencing to forensic populations with limited access to treatment. This generated a substantive theory about how forensic psychotherapy works remotely: In the context of a forced transition to remote working, forensic psychotherapists make attempts to substitute for real by establishing an alternative frame; noticing how differently contact is mediated; adapting technique; and evaluating suitability for remote treatment. An implication of these findings may be that developing a new Virtual Frame for forensic psychotherapy, supported by specialist training and supervision, could increase its reach within settings that provide sufficient containment for the work. Further research is encouraged to support this undertaking and consider which patients, and/or clinicians, might work effectively this way.

X, analyst

ABSTRACT This essay situates X González’s oratory and activism for gun legislation within Jacques Lacan’s Discourse of the Analyst to argue for the affirmative role of analytic silence in a body politic riddled with gun death, gridlock, thoughts, and prayers. Psychoanalytic treatment aims at intervention into a patient’s recurring patterns of behavior and speech that uphold their status quo of suffering. My essay argues for the practical and conceptual utility of Lacan’s discourse theory for rhetorical studies by advancing X as analyst against the cultural logic of the Firearm, a logic of domination I model via the Discourse of the Master.

Blank pain and pathological mourning in the analytic situation

ABSTRACT This paper presents an account of the psychoanalytic treatment of pathological mourning in the context of early psychic trauma. I introduce the concept of blank pain, understood as a negative of early trauma, to describe a distinct type of unthinkable anxiety. And I treat pathological mourning as a defence against the unbearable pain of the latter. Clinical observations reveal the extent to which, in a situation where the patient reacts to environmental failure by maintaining a façade (an insincere self), the construction of meaning depends on the use the patient makes of the analytic process and the setting. Considering these observations, I explore the relationship between the structural phenomenon of blank pain and defensive pathological mourning through the therapeutically mutative action of processive interventions and co-enacted scenarios.

The Bad Seed: Mystical Experience and Time Travel in the Treatment of Psychopathy

ABSTRACT Psychopathy has long been considered untreatable. The purpose of this paper is to provide a report from the field on therapeutic gains made in the case of a psychopathic personality and to outline what appear to be the most effective aspects of the treatment, as well as to help integrate current psychedelic research and theory with psychoanalytic theory. These therapeutic factors include: tactful acknowledgment and confrontation of the patient’s behavior and the disclosure to him of the diagnosis of psychopathy; a focus on his resentment toward existence itself; the cultivation of a relationship between the patient and his future self through the engagement of his imagination using mental time travel; the patient’s psilocybin-induced mystical experience which occurred several months into treatment; and finally, the impact of the analyst’s spiritual work that shaped the countertransference. The patient made dramatic improvements subsequent to his mystical experience, and was able to make use of the psychoanalytic work done during the “pre-mystical experience” period of his treatment. This case is an addition to the accumulating evidence for the efficacy of psychedelic-induced mystical experiences, and provides guidance on the provision of psychoanalytic treatment prior to treatment with psychedelic medication.

Narcissistic dimensions and depressive symptoms in patients across mental disorders in cognitive behavioural therapy and in psychoanalytic interactional therapy in Germany: a prospective cohort study

Narcissistic personality traits have been theorised to negatively affect depressive symptoms, therapeutic alliance, and treatment outcome, even in the absence of narcissistic personality disorder. We aimed to examine how the dimensional narcissistic facets of admiration and rivalry affect depressive symptoms across treatment modalities in two transdiagnostic samples. We did a naturalistic, observational prospective cohort study in two independent adult samples in Germany: one sample pooled from an inpatient psychiatric clinic and an outpatient treatment service offering cognitive behavioural treatment (CBT), and one sample from an inpatient clinic providing psychoanalytic interactional therapy (PIT). Inpatients treated with CBT had an affective or psychotic disorder. For the other two sites, data from all service users were collected. We examined the effect of core narcissism and its facets admiration and rivalry, measured by Narcissistic Admiration and Rivalry Questionnaire-short version, on depressive symptoms, measured by Beck's Depression Inventory and Patient Health Questionnaire-Depression Scale, at baseline and after treatment in patients treated with CBT and PIT. Primary analyses were regression models, predicting baseline and post-treatment depression severity from core narcissism and its facets. Mediation analysis was done in the outpatient CBT group for the effect of the therapeutic alliance on the association between narcissism and depression severity after treatment. The sample included 2371 patients (1423 [60·0%] female and 948 [40·0%] male; mean age 33·13 years [SD 13·19; range 18-81), with 517 inpatients and 1052 outpatients in the CBT group, and 802 inpatients in the PIT group. Ethnicity data were not collected. Mean treatment duration was 300 days (SD 319) for CBT and 67 days (SD 26) for PIT. Core narcissism did not predict depression severity before treatment in either group, but narcissistic rivalry was associated with higher depressive symptom load at baseline (β 2·47 [95% CI 1·78 to 3·12] for CBT and 1·05 [0·54 to 1·55] for PIT) and narcissistic admiration showed the opposite effect (-2·02 [-2·62 to -1·41] for CBT and -0·64 [-1·11 to -0·17] for PIT). Poorer treatment response was predicted by core narcissism (β 0·79 [0·10 to 1·47]) and narcissistic rivalry (0·89 [0·19 to 1·58]) in CBT, whereas admiration showed no effect. No effect of narcissism on treatment outcome was discernible in PIT. Therapeutic alliance mediated the effect of narcissism on post-treatment depression severity in the outpatient CBT sample. As narcissism affects depression severity before and after treatment with CBT across psychiatric disorders, even in the absence of narcissistic personality disorder, the inclusion of dimensional assessments of narcissism should be considered in future research and clinical routines. The relevance of the therapeutic alliance and therapeutic strategy could be used to guide treatment approaches. IZKF Münster. For the German translation of the abstract see Supplementary Materials section.

Drama and Narration: The Architecture of Psychoanalytic Play

ABSTRACT Beginning with a fantasy interview with Donald Winnicott and William Shakespeare – one in which Winnicott espouses the essential nature of play in psychoanalysis – he then joins Shakespeare in finding a promising set of ideas for psychoanalytic play. These ideas arise out of Shakespeare’s theatrical, play-full world of drama and narrative. Both these sets of ideas then build upon an epistemology based on an information theory of change in psychoanalytic therapy – one which asserts that change is a constant in every living system, and therefore the field of every session of therapy. Thus, in every developing psychotherapy, there becomes an emerging, often unknown “architecture” involving what is ceaselessly changing. This quality of change preserves some basis of order in any treatment (e.g. 1st Order Change). In effect, it is responsible for “keeping the system the ‘same.’” 1st Order Change involves the often unwitting “premises” upon which aspects of both the treatment narrative and drama are organized. It contrasts to a different kind of change (2nd Order Change) which radically changes some of the organizing assumptions (“premises”) of the therapy. 2nd Order Change typically emerges in an unwitting, unpredictable manner, catching both analytic participants by surprise. In other articles over the past two decades, the author has described this in terms of theory about improvisation. Optimizing the creative genius of such moments of play, requires that therapists immerse themselves in the field, in a non-presumptive “bottom-up” phenomenological experiential manner in contrast to the historical “top-down” “prejudices” that the history of theory and practice – within psychoanalysis and from without – often dictate, in terms of what becomes searched for and interpreted. Two case illustrations examine what can emerge when unwitting, unpredictable, preconscious moments of improvising emerge, with unpredictable aspects in entities such as character, narrative, script and so forth. This broad coalescence of ideas leads to the creation of moments of the “heretofore unimaginable” rather than what seems more like the expectable and predictable 1st Order Change world orders most treatments.

Measuring Changes in the Quality of Object Representations during Psychoanalytic Treatment

In this pilot study, we followed 22 patients during their psychoanalytic psychotherapy to monitor changes in the quality of their object representations (father, mother, partner/best friend, self) and level of psychopathology (OQ-45). The Differentiation-Relatedness Scale (DR-S) was used in two semi-structured interviews: Object Relation Inventory (ORI) and two questions of the Adult Attachment Interview (AAI). Results showed that the DR-S ratings are comparable in both interviews for father and mother, with significant changes during therapy for father using the ORI and mother using the AAI. The level of psychopathology also changed significantly during treatment. Despite some shortcomings, the DR-S in combination with the ORI and AAI-questions seems a useful instrument for clinicians to monitor structural change in personality functioning during psychoanalytic psychotherapy.

Logics of Discovery II: Lessons from Poetry-Parataxis as a Method That Can Complement the Narrative Compulsion in Vogue in Contemporary Mental Health Care.

This paper highlights the limitations of narrative logic in mental health care, and in particular of "narrative vigilance"-the tendency to watch over experience via narrativisation, and to tether the concrete particulars of experience to the hypothetical structure of a narrative signification. Narrative logic is grounded in hypotaxis-the syntactic structuring whereby a discourse is characterised by different levels of subordination using linking words that connect, especially in terms of temporal and explanatory consequentiality. I offer an alternative approach based on parataxis-the practice of placing phrases or parts of speech next to each other without subordinating conjunctions. Sentences are juxtaposed without a clear connection; the contrast may generate novel and unexpected combinations between these dissimilar fragments. After distinguishing between parataxis and psychopathological phenomena like disturbances of association, I take inspiration from the work and life of a poet, Johann Christian Friedrich Hölderlin (1770-1843), considered among the greatest. He suffered for half his life from a severe form of mental illness that would perhaps, today, be diagnosed as schizophrenia. In the poems written during his illness, hypotaxis and narrative vigilance seem to blur, and parataxis takes centre stage. The fading of narrative structure in no way coincides with the absence of meaningfulness. Rather, meaningfulness is left to parataxis itself, that is, to the recombining power of words, sentences, and images. Parataxis itself can provide meaningfulness or, at least, provide the soil in which it can germinate. The void of narration opens the door for the fullness of "emergent" connections. In the final part of the paper, with the help of Freud's ideas on the relationship between "analysis" and "synthesis" in psychoanalytic treatment, some implications are derived about the relevance of parataxis to the logics of discovery in psychotherapeutic care, especially that of persons with severe mental conditions.

Introduction to the Section: Nonlinear Dynamic Systems Theory

ABSTRACT Nonlinear Dynamic Systems Theory is discussed by three child, adolescent, and adult analysts who use this theory in their thinking about development from infancy through old age and as a way of understanding the process of change in psychoanalysis. This theory explains how the systems of the brain, the body, the environment, and the culture interact and help determine character formation throughout the life cycle. Examples of development and psychoanalytic treatment are used to demonstrate the application of nonlinear dynamic systems.

Nonlinear Dynamic Systems Theory: Its Use in Understanding Psychological Development and the Process of Change in Psychoanalysis

ABSTRACT Nonlinear Dynamic Systems Theory has been used by researchers in development for over 25 years. This paper demonstrates how this theory applies to psychodynamic development throughout the life cycle and illustrates how it can be used to explain change in psychoanalytic treatment.

Du bébé à la famille : de l’observation du nourrisson à la thérapie familiale psychanalytique : au-delà des différences de pratique, quelques points de convergence

Psychoanalytic family therapy and infant observation according to the Esther Bick method differ a priori in their aims. One is a psychotherapeutic device while the other is a training course for psychotherapists. Both approaches have psychoanalytic theory, its epistemology and ethics, as their common basis. The clinicians are guided by the families they meet, whether they are suffering or “normally well”. Thinking jointly about these two systems makes it possible to overcome the debate that opposes the “real baby”, of direct and developmental observation, and the “true baby”, reconstructed on the couch. In fact, the observer in training is witness to the narration of fantasmatic and transgenerational elements, weaving a psychic cradle that welcomes the “real baby” and where the construction of the “true baby” begins. Family therapists are naturally attentive to these plural constructions and imaginaries, and to the claims of these eternal babies that families still carry within them. Both approaches involve attention to the archaic, to affective and sensory experiences, and both rely on the group: the observer witnesses the birth or remodeling of the family group, while the support group participates in the transformation of the observed material in search of elaboration. In the same way, the neo-group, composed of the family therapists and the families, supports a space of containing reverie, which facilitates the re-establishment of a new form of fantasmatic circulation. The observer, by his presence, modifies the family system in which he is in fact included, families testify to the benefit they derive from these meetings, and therapeutic applications at home have thus been set up to support families in difficulty, while at the same time, practitioners defend the interest of psychoanalytical family work in perinatal care. The articulation of these two systems gives us a glimpse of fruitful perspectives for training, prevention and psychotherapeutic support.

Inoperative Love and Social Well-Being in the Face of Oppression: A Psychoanalytic-Agambenian Developmental Perspective and Its Implications for Psychoanalytic Therapy.

The author depicts, relying on several of Giorgio Agamben's philosophical concepts as well as a psychoanalytic developmental perspective, the origins and features of inoperative love and spaces, especially as they pertain to oppressive situations wherein social, political, and economic apparatuses undermine the psychosocial well-being of individuals, families, and communities. In addition, the author conceptualizes psychoanalytic therapy as an inoperative space wherein patients actualize their capacity for impotentiality and experience singularity and rapport.

A Model Applied Anthropologist-Psychoanalyst in the Mexican Sierra: A Profile of Doren Slade

Abstract This brief article summarizes the life and work of Dr. Doren Leslie Slade (1945-2019) while honoring her legacy, as she stands as a role model of an eclectic applied anthropologist turned psychoanalyst. She conducted intensive field research among the Nahuat of the North Sierra of Mexico's state of Puebla, concentrating on the town of Chignautla. Her focus was on aspects of the Chignautecos' quotidian corpus of beliefs – which she defined as their cosmology - that have survived for centuries, as she narrated it originally in her doctoral dissertation for the University of Pittsburgh. Years later, back home in New York City, Doren became one of the few anthropologists to obtain the difficult license to provide psychoanalytic therapy in the U.S. Then, in 1992, she published a landmarking thick ethnographic book based on her field research, but also armed with her new insights, if retrospectively, as an experienced practicing psychoanalyst. Her multi-faceted professional career is exemplary of an applied/practicing anthropologist.

Literature Study of Client Problems Psychoanalytic Criteria

This study aims to describe the use of psychoanalytic counseling on clients. This research is a type of literature study where the writer looks for references from articles, books, and other references that are in accordance with the discussion of the research article material. The advantages of counseling include that clients can find out about what problems they are actually not aware of because this approach explores internal conflicts that occur within individuals and we as counselors help clients to understand the problem and find what is the cause of the problem and formalize it to the client so that the client one of the weaknesses of the psychoanalytic approach is that counseling with this approach is considered less efficient in terms of time and cost because the time needed in therapy is quite long and costs a lot of money because digging into the client's past cannot be done only by just one meeting and make the client become bored in the therapy process. The conclusion of this study is that in the psychoanalytic approach, human beings are basically deterministic, which is determined by psychic energy and self-experience. Therefore, in counseling and psychoanalytic therapy, it emphasizes the re-establishment of a healthy personality structure in clients, by raising things in the unconscious into consciousness.

Morbid jealousy and destructive envy— considerations from a case history

In this article I want to illustrate some of the problems emanating from envy and jealousy through a clinical case where my patient was initially described by the referrer as suffering from morbid jealousy. Differences in envy and jealousy are referred to. The question is raised of whether this young man had not sufficiently worked through his envy, as described by Sohn, in order to have the capacity to experience jealousy at the time of the killing. Also, why might he have remained so jealous after the killing? Changes were apparent following his four years of twiceweekly psychoanalytic psychotherapy treatment and I hope readers will send any comments, criticisms, or disagreements to the journal editors in order to open a discussion.