Voices from the Inaudible: The Patients Speak by Theodor Reik

Fifty-one inpatients, hospitalized on average for 21 days, were studied by means of discharge debriefing interviews. An unstructured, mandatory, and functionally heterogeneous psychotherapy group was compared with a structured, voluntary, and functionally homogeneous psychotherapy group. Statistical analysis of the patients' valuation of the group psychotherapy experiences and of their rankings of traditional group psychotherapy curative factors were performed. Results demonstrated that group psychotherapy was a highly valued component of the overall inpatient treatment. Structural modifications aimed at increasing the here and now, and interpersonal focus of the group meetings, such as the use of patient agendas and group rehashes, significantly affected the patients' group experiences. A comparison of both types of inpatient groups with an outpatient group psychotherapy sample suggests certain guidelines for the goal setting and conduct of inpatient group psychotherapy, recognizing the specific and heterogeneous needs and capacities of the patients treated.     

Modern ego psychology

This paper reviews the history of ego psychology, describing problems in the theory that have perhaps contributed to subsequent theory development and theoretical splintering. The present status of ego psychology is then described, with a focus on broadly accepted general principles. A proposal/prediction is then made regarding efforts to integrate the main schools and splinter groups. It is argued that the ego's method of synthesizing aspects of experience will help integrate divergent metapsychological viewpoints.     

The growth and transformation of American ego psychology

The roots of ego psychology trace back to Sigmund Freud's The Ego and the Id (1923) and "Inhibitions, Symptoms and Anxiety" (1926), works followed by two additional fundaments, Anna Freud's The Ego and the Mechanisms of Defense (1936) and Heinz Hartmann's Ego Psychology and the Problem of Adaptation (1939). It was brought to full flowering in post-World War II America by Hartmann and his many collaborators, and for over two decades it maintained a monolithic hegemony over American psychoanalysis. Within this framework the conceptions of the psychoanalytic psychotherapies evolved as specific modifications of psychoanalytic technique directed to the clinical needs of the spectrum of patients not amenable to psychoanalysis proper. This American consensus on the ego psychology paradigm and its array of technical implementations fragmented several decades ago, with the rise in America of Kohut's self psychology, geared to the narcissistic disorders, and with the importation from Britain of neo-Kleinian and object-relational perspectives, all coinciding with the rapid growth of the varieties of relational psychoanalysis, with its shift in focus to the two-person, interactive, and co-constructed transference-countertransference matrix. Implications of this intermingled theoretical pluralism (as contrasted with the unity of the once dominant ego psychology paradigm) for the evolution of the American ego psychology are spelled out.     

Cognitive ego psychology and the psychotherapy of learning disorders

The single most common referral problem in middle childhood and adolescence is academic underachievement and learning failure. Yet, the term “learning disorder” lacks specificity as a diagnostic entity and offers no guidelines for psychotherapy. An appreciation of the developmental processes by which the undifferentiated, unstructured, self-less and objectless newborn becomes a more fully developed, self-sufficient individual, capable of adaptive functioning and formal academic learning is encompassed in contemporary psychoanalytic conceptions of the separation-individuation process. This theory provides an organizing, theoretical base for diagnosis and treatment of learning disorders. Based on these conceptions, we discuss therapeutic techniques which are appropriate to the level of developmental arrest at each of the phases of the separation-individuation process.