Audit in psychoanalytic psychotherapy with children and adolescents

The importance of multidisciplinary audit in child and adolescent psychiatry, including the work of child psychotherapists, is discussed. Research is highlighted which shows that certain groups of children in particular benefit from psychoanalytic psychotherapy. The problems related to auditing psychoanalytic psychotherapy are discussed, and a possible method of audit based on peer review of notes, which takes into account both inner and outer change, is presented.

A patient is discussed whose notes have been audited using the audit form. It is suggested that this form of audit has good educational potential as well as ensuring a high standard of patient care.     

Acting,feeling and thinking: psychoanalytic psychotherapy with Tracey

This paper consists of a case study and commentary which formed a part of the inaugural lecture in a series entitled ‘Working with Psychosomatic Issues’*. The audience consisted of psychoanalytic, body psychotherapy and integrative practitioners. The presentation was divided into three parts, (1) an outline of philosophical themes that inform perspectives on health, illness and psychosomatic phenomena, (2) the case study reproduced below and (3) a summary of Winnicott's work (1960, 1966, 1988) on ‘the indwelling of the psyche in the soma’. The case study describes work with a young woman who harms herself through self-hitting and, in addition, expresses other physical manifestations of psychological distress. The core approach of the practitioner is psychoanalytic. The work is informed also by postmodern sensibilities and phenomenological themes.     

Politics in psychotherapy: Therapists' responses to political material

This paper reviews the psychotherapeutic literature that addresses the ways in which political material is engaged with by psychotherapists. The paper explores this in both the traditional and contemporary psychotherapeutic approaches. The paper concludes with a recognition of some of the challenges psychotherapy faces in developing politically sensitive approaches which draw upon the lessons learned across therapeutic theory.     

Concurrent individual and individual-in-a-group psychoanalytic psychotherapy

This paper's thesis is that concurrent individual-in-a-group and individual psychoanalytic psychotherapy can be conducted in conformance with psychoanalytic principles of treatment as well as can individual psychoanalytic psychotherapy alone. American psychoanalysts have shown little interest in group psychotherapy, probably because of earlier criticism that transference is diluted by the greater reality of the therapist in group psychotherapy. This is a misconception extrapolated from the mirror model of dyadic analytic technique. The criticism was formulated during a period when that model was prominent and there was little awareness that the actual personal relationship between patient and analyst played an important facilitating role in the dyadic analytic process, including providing a basis for investiture of transference. Also, the criticism was based on one-session-per-week group psychotherapy, whereas concurrent individual-in-a-group and individual psychoanalytic psychotherapy utilizes two group sessions plus one or two individual sessions per week, enabling a more intensive patient-therapist relationship. Concurrent group and individual psychoanalytic psychotherapy constitutes a contribution to the widening scope of application of psychoanalytic treatment.     

Lines of advance in psychoanalytic psychotherapy

Freud's 1919 paper is taken as a starting-point to review how far we have advanced towards fulfilment of his prophetic remarks about the need to develop psychoanalytic psychotherapy for the masses. A glance is taken back to some of the circumstances and characters involved in Budapest where the paper was given at the 1918 congress, where there was much talk about the need to do something about the war neuroses. Similar pressures led to the founding of the Tavistock Clinic and Cassel Hospital in the UK, long before the start of the NHS. The pressures of both world wars advanced the applications of psychoanalysis; the next wave of pressures may come from NHS changes and entry into Europe. The history of psychoanalytic psychotherapy in the UK is also considered via looking briefly at the history and development of psychoanalytic publications, of the Tavistock Clinic, of psychoanalytic training, of child psychotherapy and the emergence of adult (non-medical) psychotherapy. There have always been tensions between exponents of the pure gold of analysis and the needs of its wider applications. More flexible arrangements and boundaries are necessary if we are to spread psychoanalysis beyond London and to fulfil Freud's own hopes about the large-scale application of psychoanalytic therapy.     

Dream frequency in psychoanalysis and psychoanalytic psychotherapy

The authors examine data on dream frequency from 50 patients, half of whom were seen in psychoanalysis and half in psychoanalytic psychotherapy. Frequency, defined as the proportion of sessions where at least one dream is related, is analyzed statistically as a function of sex, age, and type of treatment. Also, treatment outcome is examined as a function of sex, type of treatment, diagnosis, and dream frequency. Psychoanalytic patients are found to have higher dream frequency than the patients in the psychotherapy group. Higher average dream frequency is correlated with a better treatment outcome in both patient groups.     

Narcissism and childhood recollections: a quantitative test of psychoanalytic predictions

Different psychotherapeutic theories provide contradictory accounts of adult narcissism as the product of either parental coldness or excessive parental admiration during childhood. Yet, none of these theories has been tested systematically in a nonclinical sample. The authors compared four structural equation models predicting overt and covert narcissism among 120 United Kingdom adults. Both forms of narcissism were predicted by both recollections of parental coldness and recollections of excessive parental admiration. Moreover, a suppression relationship was detected between these predictors: The effects of each were stronger when modeled together than separately. These effects were found after controlling for working models of attachment; covert narcissism was predicted also by attachment anxiety. This combination of childhood experiences may help to explain the paradoxical combination of grandiosity and fragility in adult narcissism.     

Therapeutic technique in psychoanalysis and psychoanalytic psychotherapy.

As the distinctions between what we consider to be psychoanalysis and what we consider to be psychoanalytic psychotherapy have become more uncertain and more blurred, it follows that it is equally difficult to designate the techniques that would be appropriate and specific for each modality. The problem has been compounded by the fact that in recent years psychoanalysis in the United States has become considerably less homogeneous than in the past and the ego-psychological structural model is no longer the only point of view in the psychoanalytic marketplace. Further, with alterations in the criteria for analyzability, cases which, generally, had not been viewed as suitable for analysis, have been appearing with increasing frequency on psychoanalysts' couches. We have also recognized that the degree of congruence between our expectations from and the results of psychoanalytic treatment was often less than anticipated. It appears that analysts have become considerably less arbitrary about what psychoanalysis is and how a psychoanalysis can be carried out. The author is unable to delineate one technique that is intrinsic to and limited to psychoanalysis. There are, however, differences in degree and emphasis in the ways in which various techniques are applied in the therapy of psychoanalysis as compared to the therapy of psychoanalytic psychotherapy. Special attention is given to the role of a psychoanalytic process and the central place the analysis of resistance plays in psychoanalytic therapy.     

Supportive psychoanalytic psychotherapy for borderline patients: an empirical approach

The author describes a reformulation for research purposes of a supportive psychoanalytic therapy for patients with borderline personality disorder. The major influences on the thinking that led to the modification of prior formulations and the historical background of treatment manuals are described. Supportive treatment is contrasted with transference-focused psychotherapy and dialectic behavior therapy in the interest of creating a clear comparison that lends itself to empirical study.     

Unity in duality: The synthesis of individual and group psychoanalytic psychotherapy

Contrary to the notion that individual and group therapy tap differing psychic functions, developmental levels, or therapeutic goals, in this paper the two modalities are seen as parts of an integrated whole, to be understood via the metaphorical and symbolic communications in each; each is a holographic reflection of the whole, the two together being internally consistent. Different levels of defensive operations may be observable in each, but taken together they reflect the entirety of the patient's psyche. The group's developmental level as well as the active use of this integrative approach by the therapist are also important. Clinical illustrations are presented.Paper presented at the Xth International Congress of Group Psychotherapy, Amsterdam, August 1989. The author acknowledges with gratitude the numerous invaluable contributions by Ms. Anna Aragno in the preparation of this paper.     

Ericksonian hypnosis and psychoanalytic psychotherapy: The anatomy of an effective partnership

This article presents a detailed case report of the utilization of Ericksonian hypnotherapy and psychoanalytic psychotherapy in treating a young woman who had been positively diagnosed as suffering from lupus, an auto-immune disorder. The hypnosis relationship is presented as the safe and secure holding environment which short-circuits the reactive-independent defensive stance that the auto-immune patient erects to remain invulnerable, out-of-touch with the oral level of his psyche. As the analytically focused indirect suggestions make the oral level more accessible, the healing process is facilitated. The author holds that this patient could not have been reached without an approach that integrated the holding environment of the hypnosis relationship with the analytic topography aimed at the oral level.     

Administration of the thematic apperception test: Contributions of psychoanalytic psychotherapy

Psychodiagnosis has given more to than it has received from psychotherapy. Some psychological tests may benefit from the wisdom accrued and embodied in the psychoanalytic situation. Using the well known projective instrument, the Thematic Apperception Test (TAT), guided by the intent to make the use of the test more consistent with the psychoanalytic situation and contemporary projective theory, it is suggested that the basic TAT instruction be modified and that greater attention be paid to an explicit theoretical rationale by which the cards are selected and presented. Inviting the patient to collaborate in a self-interpretation of the TAT can serve as an assessment of the patient's capacity for introspection and the development of the working alliance. It is further suggested that psychoanalytic developmental theory can function as an epigenetic organizer of the patient's TAT protocol.This research was supported by the Veterans Administration. The author is grateful for the inspirational and thoughtful comments of Drs. Marvin Acklin, Murray Tieger, and Edwin Wagner.     

On the process of the psychoanalytic psychotherapy with the borderline depressive patient

Abstract

A certain subgroup of borderline patients often presents depressive symptomatology (either chronic or periodic) and an underlying borderline personality organization.

In this article, the effort is directed at elucidating the psychoanalytic psychotherapeutic process of these borderline depressives by presenting clinical fragments of several psychotherapeutic cases.

The process goes through periods of activation of the patient's depressive or primitive mental functioning, which also reflects on the therapist's countertransference.

The capacity of the therapist to tolerate and elaborate on his patient's projections, facilitates the development of the therapist-patient communication and plays a significant role in the therapeutic outcome itself.     

Implications of attachment theory for working in psychoanalytic psychotherapy

John Bowlby's Attachment Theory is being increasingly operationalised in the world of developmental research, but as yet its implications for clinical work are relatively less discussed. This paper addresses the issue of the measurement of attachment patterns and how knowledge of these can inform psychoanalysts’ work with their patients. It looks at the implications of Attachment Theory at all stages of the therapeutic process, but concentrates particularly on how it can help with the crucial phase of building the working alliance.