Speaking the unspeakable: institutional reactions to boundary violations by training analysts

The work of a COPE study group on boundary violations is summarized, with particular focus on the impact on institutes and societies of sexual misconduct by training analysts. Difficulties in evaluating such situations are discussed, and the dynamics of institutional avoidance explicated. In addition, psychodynamic themes that are commonly observed in analysts who engage in sexual boundary violations with their patients are elaborated. Finally, suggestions are made for managing, through existing mechanisms, instances of boundary violations by training analysts.     

Writing about patients III: Comparisons of attitudes and practices of analysts residing outside and within the USA

When analysts write about patients, they find themselves in a position of conflict. Their first loyalty is to their patients and maintaining confidentiality. However, they are also committed to advancing scientific knowledge in the psychoanalytic field. The attitudes and practices of 36 analysts residing outside the USA, who published articles using clinical material from their patients, are reported. Their attitudes and practices are compared with those of 30 author-analysts residing within the USA, who had been previously interviewed. Among the 66 analysts, geographic region was not a basis for distinguishing differences in attitudes or practices. Slightly more than twice as many analysts use only disguised material as regularly ask permission of their patients to write about them. The decision to use only disguise is somewhat more frequent for analysts who reside outside the USA than for those living within it. Analysts around the world are increasingly concerned about the accessibility of published material. More analysts have come to believe that it is necessary to ask permission before publishing material. Some analysts also believe that the request itself, and the patients reading written material about themselves, focus issues that are central to patients' characters and confl icts that can then be explored analytically.     

Does a panel discussion on analytic technique have any effect on an audience of analysts?

This is a report of a followup study to determine whether attending a panel discussion group on post-termination patient-analyst contact influenced the analytic audience's attitude on that subject. A questionnaire about post-termination contact was given to 21 analysts who did not attend the discussion group and to 45 analysts before they attended. The same questionnaire was given again to both groups six months later. Responses by the 21 analysts who had not been present remained essentially unchanged. Responses of the 45 analysts, after attending the discussion group, when compared to responses of an earlier group of 300 analysts, showed an increase in the proportion of analysts who said, in reference to psychoanalytic psychotherapy patients, either that they hoped to hear from the patient or that they would like the patient to return to see them at some specified period after treatment termination. Attendance at the discussion seems responsible for a significant effect on the analytic audience's attitude on post-termination patient-analyst contact.     

A successful trial utilizing the Leuzinger-Bohleber methodology for evaluation of psychoanalytic treatment: Preliminary report

Utilizing audio-recorded psychoanalytic interviews of both patients and their analysts, group discussions of these interviews, and the application of questionnaires commonly used in psychotherapy research, the authors investigate the potential use of the Leuzinger-Bohleber methodology as an objective evaluative instrument to assess the quality of psychoanalytic treatment. Preliminary study results were obtained through interviews conducted with seven analysts and their respective patients, three of whom were treated with psychoanalysis (three or more sessions per week, for a duration of no less than one year) and four with psychotherapy (one or two sessions per week, for a duration of no less than one year). Patients were found to be eager to participate, and no adverse experiences were reported by analysts, patients or the research team. In addition to the interviews, further data were obtained through review of mailed-in questionnaires completed by 21 patients. The authors present both preliminary observations regarding the methodology as a whole, as well as the detailed results of one specifi c case subject treated with psychotherapy. Review of study fi ndings supports the utilization of this methodology as an evaluative instrument which may ultimately advance current knowledge of the process and outcome of psychoanalytic treatment.     

When theory and practice diverge: gender-related patterns of referral to psychoanalysts.

This study tests the hypothesis that female analysts, relative to male analysts, receive a disproportionately small percentage of male referrals. Referral patterns for 170 analysts from four institutes accredited by the American Psychoanalytic Association were examined. One thousand, five hundred and ten patients referrals were studied. The findings were extremely robust and offered dramatic confirmation of our hypothesis. The major implications of the study are as follows: (1) Women analysts receive relatively few adult male referrals, making it difficult for them to gain requisite clinical experience with men. (2) Analysts and nonanalysts alike demonstrate a reluctance to refer male patients to female analysts. (3) Adult referrals, including those made by analysts, are significantly influenced by the issue of gender match between patient and analyst. (4) Analysts' behavior with regard to making referrals does not correspond to explicit clinical theory regarding how analysts make referrals--specifically, the extent to which gender influences the referral process is not adequately described by theory. We believe that these findings are of some concern from the standpoint of analytic education and that they also raise questions regarding unacknowledged aspects of how gender match between patient and analyst enters into clinical decision making.(ABSTRACT TRUNCATED AT 250 WORDS)     

THE EFFECT OF THE ANALYST'S GENDER AND OTHER FACTORS ONPOST-TERMNATION PATIENT-ANALYST CONTACT: CONFIRMATIONBY A QUESTIONNAIRE STUDY

This questionnaire study was designed to confirm and further explore an earlier finding of a gender difference in post-termination patient-analyst contact, as well as to assess whether practices regarding post-termination contact have changed in the five-year interval since the first study. The hypothesis that women analysts are more likely to have post-termination contact with their analysands than men analysts was confirmed by the present study. Analysts who report thinking frequently about their most significant analyst are contacted by a much larger proportion of prior patients than those who rarely think about their analyst. Further, women analysts are more likely to feel they benefited from the analysis they consider their most significant analysis, and to feel positively about that analyst. In 1994, analysts were much more accepting of and more likely to propose post-termination contact than in 1989. What the analyst reports he/she says to the patient is associated with the likelihood of such contact.     

Ferenczian Elasticity in the Analysis of an Adolescent

Psychoanalytic work with adolescents poses a challenge for analysts who adhere to standard analytic technique as many adolescents who need analytic intervention resist such a structured approach to analysis. The author finds that elasticity of technique is currently widely used by analysts when working with this difficult age group even though they may be unaware that this is, in fact, a Ferenczian technique. Clinical examples are presented to illustrate how frequently the technique is used in cases of resistant, troubled youth. The author outlines an approach that is sensitive to these resistances and makes compromises in technique based on the principle that engaging a troubled youth in a therapeutic venture is preferable to refusing treatment based on the patient’s not being able to adhere to standard analytic technique. In this sense, Ferenczi was an early herald of the type of contemporary analytic work that is practiced currently especially with a difficult population of patients.

     

Boundaries and postanalytic contacts in institutes

The work of a COPE study group on boundaries is presented, with particular focus on post-termination contact after the training analysis. Through the use of clinical examples evocative and illustrative of the complexity of postanalytic contacts and relationships in the training analysis situation, a number of dilemmas are identified that former analysts and patients face when they meet as colleagues after the training analysis is over. These dilemmas, it is argued, have implications for the conduct and effectiveness of the training analysis and for the institutional cultures and power relations that evolve within institutes.     

Desire and the female analyst

The literature on erotic transference and countertransference between female analyst and male patient is reviewed and discussed. It is known that female analysts are less likely than their male colleagues to act out sexually with their patients. It has been claimed that a) male patients do not experience sustained erotic transferences, and b) female analysts do not experience erotic countertransferences with female or male patients. These views are challenged and it is argued that, if there is less sexual acting out by female analysts, it is not because of an absence of eros in the therapeutic relationship. The literature review covers material drawn from psychoanalysis, feminist psychotherapy, Jungian analysis, as well as some sociological and cultural sources. It is organized under the following headings: the gender of the analyst, sexual acting out, erotic transference, maternal and paternal transference, gender and power, counter-transference, incest taboo - mothers and sons and sexual themes in the transference.     

Was bringt ?GRAS��?

Autonomous groups in the sense of GRAS (group analysis seminars) are groups without leaders. The small groups come together for self-experience within the framework of GRAS (Gruppenanalyse-Seminare, founded by Michael Lukas Moeller in 1977). Their members are group analysts who continue to participate in long-standing small groups on self-experience after completing their educational training as group analysts in GRAS. Participants of these groups (14 women and 11 men, average age 57.7 years) were interviewed about their experiences within GRAS and the subjective effects on their life. The interviews were evaluated in a qualitative research design. The findings show that the effects of GRAS are estimated to be extensive and very positive for private and professional life. The main modus to be in the group is experienced as retentive, acceptive and inspiring. Autonomous groups in the sense of GRAS form an important background of experience for trained group analysts themselves and continuously stimulate personal advancement and mental health.     

Narcissistic temptations to cross boundaries and how to manage them

The narcissism of analysts is considered here from the perspective of the narcissistic temptations of boundary crossing. The literature on boundary crossing in psychoanalysis has focused minimally on the more ordinary, nonsexual temptations analysts face with their patients. Narcissistic temptations with particularly impressive patients are explored. What analysts find impressive in their patients depends both on what patients bring and on what analysts need. This paper aims to heighten analysts' awareness of their narcissistic needs in treating patients who tempt them too much. The goal is for analysts to be able to catch and then examine their narcissistic excitement with such patients in order to avoid compromising the treatment. Danger signs and ways of managing the problems they point toward are presented.     

A note on the history of the Norwegian Psychoanalytic Society from 1933 to 1945

The Norwegian analysts, who were trained in Berlin before 1933, were drawn into a struggle against fascism, informed by politically leftist analysts who worked at the Berlin Institute. The Norwegian group, including the analysts Wilhelm Reich and Otto Fenichel, were committed to Marxist or social democratic ideologies in order to fight down fascism and Nazism. They were a source of inspiration but also of conflict. After the war the leadership of the IPA was sceptical about the Norwegian group because of its former connections with Die Linke, as well as its relations with Wilhelm Reich. This paper in part considers the courageous efforts of Nic Waal, whom Ernest Jones used as a delegate and courier to solve problems for the IPA and who was unjustlytreated after the war.     

The course of 253 analyses from selection to outcome

Two studies of the clinical work of experienced psychoanalysts are presented. Study I is a retrospective study of all the analytic work--161 cases--of sixteen analysts from 1973 to 1977, including their evaluations of the treatments at outcome. Study II is a prospective study of the ninety-two cases started in analysis by a group of twenty analysts between 1984 and 1989 and followed to termination, including their reports. The history of each treatment as reported and evaluated by the analyst is examined in terms of: nature of the population, the analyst's view of the case when the initial recommendation was made, duration of treatment, therapeutic benefit, rating of analyzability at termination of treatment, nature of the termination, and cases changed to psychotherapy. Some old shibboleths are challenged as perspective on both the limitations and achievements of psychoanalysis emerges from the findings of the study.     

Our Literature as the Problem Child of Psychoanalysis Commentary on Paper by Drew Westen

This paper is a response to an essay by Drew Westen. The author agrees with many of Westen's arguments about problems in the psychoanalytic literature and adds that the psychoanalytic literature has always been a problem for psychoanalysis. If we think of psychoanalysis as an ongoing experiment, then its “trials” are all the analytic sessions that have been conducted. Our “literature” has never systematically drawn on those. Westen critically scrutinizes certain habits that, in his view, haunt our literature, but that we do not explicitly note or disown as conceptual contrivances we mean to get rid of, while they are often misguiding clinical thinking and practice. I suggest that a fascinating question riding below the waves of Westen's paper is why patients and analysts accept this situation. I suggest that we all treat psychoanalysis as wisdom, art, relationship, skill, and something other than the application of established scientific findings because we recognize and accept it as that kind of human activity. It is unclear if patients care whether or not their analysts are scientists, but it is clear that analysts are not optimistic about sifting the research literature and finding clear clues to more effective clinical thinking, work, or writing.     

Relational Psychoanalysis and the Inner Life: Commentary on Cooper,Corbett, and Seligman

Relational analysts know that their experience feels private and contemplative during a significant portion of their working hours. A consideration of the inner life, both the analyst’s and the patient’s, is part of relational praxis. Yet relational analysts also recognize that they are continuously involved with their patients, even at those very same quiet moments. Cooper, Corbett, and Seligman recognize both these parts of relational clinical work and argue that both are necessary. Making this argument explicit is important for its own sake, but also because analysts from other schools sometimes write as if there is no place in relational clinical practice for a quiet consideration of the inner life. Two examples of such criticism are offered, in both of which relational analysts are described as being too focused on social interaction and too little on the inner life. I offer my own version of the kinds of arguments about privacy and contemplation offered by Cooper, Corbett, and Seligman. I then make the case that all psychoanalytic theories come with risks of excess. Relational and interpersonal theories come with the risk of an overenthusiastic embrace of clinical interaction, whereas more intrapsychic theories carry the risk of attending too little to the impact on their patients of present-day relatedness—which is just as likely to have unconscious roots as the inner life.     

Changes in the level and quality of object relations in psychoanalysis: followup of a longitudinal, prospective study

As part of a prospective, longitudinal study of suitability for and outcome of psychoanalysis, 22 patients were evaluated for changes in the level and quality of their object relations. These patients had been accepted for supervised analysis with candidates in training by senior analysts who had diagnosed them as neurotic. The majority of these patients reported difficulties in relationships as at least one of their reasons for originally seeking psychoanalytic treatment. Prior to beginning analysis, each patient was given a battery of psychological tests. One year after the termination of analysis, the test battery was readministered and a followup interview was conducted separately with each patient and analyst. Ratings of change based on patient and analyst interviews and comparisons of psychological tests before and after treatment all showed statistically significant improvement in the level and quality of object relations for this patient group. The results of this study support what is often observed in clinical practice, that psychoanalysis has a positive effect on the level and quality of a patient's object relations.     

Student outcomes after 1 year of front line staff implementation of the PEAK curriculum

Systems‐level interventions built by behavior analysts often rely on others to implement, and this may be especially true in public education settings where behavior analysts are scarce. This study evaluated the effectiveness of the Promoting the Emergence of Advanced Knowledge Direct Training (PEAK‐DT) curriculum when implemented by school teachers and direct care staff. Thirty‐nine children with autism took part in the study (19 PEAK, 15 control), where the experimental group received applied behavior analytic instruction through the PEAK‐DT curriculum, and the quasi‐randomized control group received training as usual. The PEAK‐DT assessment was first administered to the participants at the onset of the study and again following 1 year. Participants who received PEAK training gained more skills on the PEAK‐DT assessment compared to the control group (PEAK: M = 16.0, SD = 17.8; control: M = 6.1, SD = 14.4, F(1,33) = 10.66, p < .05), suggesting that systems level implementation of behavior analytic procedures can be effective in teaching language skills as prescribed in a packaged curriculum designed by behavior analysts.     

The role of reality testing in psychoanalysis: followup of 22 cases

As part of a prospective, longitudinal study of psychoanalytic outcome, 22 patients were evaluated for changes in their level of reality testing. These patients had been accepted for supervised psychoanalysis with candidates in training by senior analysts who had diagnosed them as neurotic. Psychological tests given prior to the beginning of analysis indicated, however, that more than one third of our sample demonstrated serious distortions in their perceptions of reality. When psychological tests administered one year after the completion of analysis were compared with these pretreatment tests, no significant improvement was found in the level of reality testing for the group as a whole. However, when excluding two patients who had suffered major traumas in the year following psychoanalysis, significant improvement in reality testing was found for the remaining 20 patients. Post-treatment interviews with the treating analysts revealed that in the course of analysis itself, approximately one third of these patients showed some disturbance in reality testing; only three of these patients showed significant improvement in the level of their reality testing during treatment. These findings suggest that while patients may not present clinically with evidence of impaired reality testing, such evidence may be available in psychological testing, and may become apparent in the course of the treatment.     

Behavior analysis and the study of human aging

As the population of older adults continues to rise, psychologists along with other behavioral and social scientists have shown increasing interest in this age group. Although behavior analysts have contributed to research on aging, the focus has been on applications that remedy age-related deficits, rather than a concern with aging as a developmental process. In particular, there has been little interest in the central theoretical questions that have guided gerontologists. How does behavior change with advancing years, and what are the sources of those changes? We consider the possibility that this neglect reflects the long-standing commitment of behavior analysts to variables that can be experimentally manipulated, a requirement that excludes the key variable—age itself. We review the options available to researchers and present strategies that minimize deviations from the traditional features of behavior-analytic designs. Our comments are predicated on the view that aging issues within contemporary society are far too important for behavior analysts to ignore.     

The Disappearing (or Ghost) Mother Transference: In Search of the Available Mother Within

As analysts, we speak of maternal transference as if it were a unitary phenomenon. We are trained to expect intense, powerful transference reactions. Yet there is a group of female patients who have a specific type of transference that lacks intensity. These patients often present by not presenting. I term this phenomenon the disappearing (or ghost) mother transference. This transference is quiet and does not create much stress. Using a case example, I will define this particular type of object relationship and discuss an alternative technique in treating these patients. It is my premise that these women must discover for themselves, at their own time and in their own way, the caring, living, available mother in the analyst.