A model‐based process to improve robustness in Multicriteria Decision Aiding interventions

A model‐based process is a methodological approach that facilitates interventions in new and ill or not structured problem situations. It is oriented towards improving the robustness of the intervention and its results in an incremental definition of both the problem formulation and the model, in order to reduce the uncertainty that is not only associated with the model parameters but also with the model structure, and sometimes also with the problem formulation. The nature and results of this approach, which consider the interaction between an analyst and the actors of the decision system as the decision aiding core, are proposed in relation to some actual interventions.     

What do we learn in psychoanalytic training?

Can one define the aims of psychoanalytic training that most analysts would agree upon? For more than a decade the EPF Working Party ‘End of Training Evaluation Project (ETEP)’ has worked on this issue. Summarizing results of this work the author describes a set of basic elements every developing analyst should have learned or internalized during his training. His assertion is that most analysts notwithstanding their theoretical orientation could agree upon these necessary requirements for a successful ending of psychoanalytic training. These elements are demonstrated in the ability to understand the emotional demand of a patient in every session and the often ensuing emotional storm, to appreciate and deeply understand the value of free association, to preserve a neutral stance, to think in terms of transference and countertransference, and to think conceptually about what is happening and what one is doing in the session.     

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.     

Contemporary transference work and the analytic attitude: aims and methods--a clinical workshop

There are various ways of working as an analyst, and there are various ways of utilizing the concept and the phenomena of transference‐countertransference. I hope to draw an adequate picture of a way of working that is called ‘working‐in‐the‐transference’ as distinct from ways of working that ‘analyse transference’. The former has long been practised by many Jungians as well as by many psychoanalysts. As a method, it has aroused controversy in both groups, and is frequently both misunderstood and imitated. It can arouse strong anxiety. It can appear narrow and restrictive. It famously precludes a gamut of activities in which many analysts engage. Is working‐in‐the‐transference old fashioned, or does it deserve to be increasingly appreciated? Can it offer support and validation whilst remaining true to its conception? It was hoped that these questions would be addressed in the clinical material brought to the workshop. The emphasis in the workshop was on active participation and it was hoped that those attending would bring their clinical concerns for discussion.     

The analyst's narrative function: Inventing a possibility

This article describes a psychic function common to analysts that was gradually revealed through clinical work with children. It is a psychic quality derived from function α, which involves analysts’ capacity for reverie – their narrative function. The author presents two clinical situations where this function developed in the analytic field in relation to patients’ difficulty in symbolizing. In the first case there was an early traumatic experience unavailable for representation. The analyst lent the patient her ability to represent and produced a narrative that made it possible to create a world of phantasies and transform nightmares into ‘dreamable’ dreams. In other words, she removed the quality of unbearable, irrepresentable reality that characterized those raw experiences encrypted in the psyche. In the second case the analyst's narrative function sought to connect with the isolation, the shell that housed a child suffering from an autistic disorder whose ability to represent had not been established. The analyst provided meaning for the patient's repetitive, stereotyped play, thus weaving the child's subjectivity and gradually introducing a notion of alterity. The author seeks to show how this function, in the thematic construction of the session, facilitated both the working‐through of a traumatic situation (with the ability to share representations) and the constitution of the psychic fabric.     

Writing about patients: IV. patients' reactions to reading about themselves

When analysands read about themselves in reports, their reactions range from anger, disappointment, or condemnation to a sense of appreciation or even idealization of the analyst. The eleven interviews reported here reflect only conscious responses; the unconscious layers were not probed for. It should be kept in mind also that the analysts of these patients might report very different stories. Other limitations are the small sample size and the representation only of patients who volunteered. Nonetheless, the information they provide may help analysts consider how and when writing about patients may influence their representation of themselves, the analyst, and analysis itself.     

Transference,relationship and the analyst as object: Findings from the North American Comparative Clinical Methods Working Party

Data from the North American Comparative Clinical Methods (CCM) Working Party a is used to 1) explore how psychoanalysts in North America conceive and address the transference and the relationship between analyst‐analysand and 2) to study what kinds of ‘objects’ psychoanalysts become, explicitly and implicitly, within psychoanalytic treatments. The North American CCM Working Party closely studied 17 clinical cases presented by North American psychoanalysts across the spectrum of analytic schools at their meetings. We found that the 17 analysts fell into three different groupings according to the internal consistency of their method and their approaches to transference, relationship and analyst‐as ‐object. We also found that analysts' individual work, while heavily influenced by their schools of thought, also involved unique interpretations of their particular paradigms.     

Reflections on Bion's 'elements of psychoanalysis' Experience, thought and growth

This paper aims to follow, in Bion's conception of analytic work, an axis of refl ection organized around three preoccupations: favoring emergence of emotional experience, symbolic elaboration of that experience and resuming growth through symbolic thought. The overarching issue and condition of all three is the capacity to contain the largest possible range of transferential and countertransferential facts in analytic sessions. This range is likely to be reduced if the analyst listens to the experience of a session with too great a number of theoretical elements in mind. Hence the dictum 'To listen without memory and desire', which will be commented upon here in parallel with the process of abstraction, a process serving in Bion's writings the purpose of dealing both with the epistemological problem of communication among analysts and with the clinical problem of receptiveness to the unknown.     

Rank disagreement: A comparison of multi-criteria methodologies

A number of multi-criteria decision support techniques have emerged in recent years that use varying computational approaches to arrive at the most desirable solution and thereby ‘recommend’ a course of action. Decision makers who use the results of this analytic work should be assured that the computational schemes used by their supporting analysts or decision support software produce the appropriate solutions. We conducted a series of simulation experiments that compared the top-ranked options resulting from the computational algorithms that support Multi-Attribute Value Theory (MAVT) and three methods that are reported in the literature that allow rank reversals, the change in rank order of two options when an unrelated option is added or deleted from the analysis: the Analytical Hierarchy Process (AHP), Percentaging and the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS). We also included a Fuzzy algorithm proposed by Yager to gauge its consistency with the other algorithms, even though it is not subject to rank reversals. These experiments demonstrated that the MAVT and AHP techniques, when provided with the same decision outcome data, very often identify the same alternative as ‘best’. The other techniques are noticeably less consistent with MAVT, the Fuzzy algorithm being the least consistent. The situations under which the most frequent and significant differences occurred were dependent upon the method. The results of our experiments indicate that other issues (e.g. the processes used for problem structuring and the elicitation of value weights) are likely to be of greater significance to problem outcome (based on our experience) than the choice between the computational algorithms of MAVT and AHP. The results cause us to be concerned about the use of the other methods.     

Analytic Confidence and Political Decision‐Making: Theoretical Principles and Experimental Evidence From National Security Professionals

When making decisions under uncertainty, it is important to distinguish between the probability that a judgment is true and the confidence analysts possess in drawing their conclusions. Yet analysts and decision‐makers often struggle to define “confidence” in this context, and many ways that scholars use this term do not necessarily facilitate decision‐making under uncertainty. To help resolve this confusion, we argue for disaggregating analytic confidence along three dimensions: reliability of available evidence, range of reasonable opinion, and responsiveness to new information. After explaining how these attributes hold different implications for decision‐making in principle, we present survey experiments examining how analysts and decision‐makers employ these ideas in practice. Our first experiment found that each conception of confidence distinctively influenced national security professionals' evaluations of high‐stakes decisions. Our second experiment showed that inexperienced assessors of uncertainty could consistently discriminate among our conceptions of confidence when making political forecasts. We focus on national security, where debates about defining “confidence levels” have clear practical implications. But our theoretical framework generalizes to nearly any area of political decision‐making, and our empirical results provide encouraging evidence that analysts and decision‐makers can grasp these abstract elements of uncertainty.     

A quantitative analysis of accuracy,reliability and bias in judgements of functional analyses

Functional analysis can be considered a diagnostic assessment that behavior analysts use to determine behavioral function. Such a diagnosis ultimately requires a yes or no decision (i.e., a variable maintains a behavior, or it does not) that is determined by both subjective (clinical judgement) and objective (data) variables. Accurate and reliable identification of function is essential for successful treatment, yet behavior analysts' interpretation of data relies on their ability to detect visual differences in graphed data. Some research indicates that behavior analysts have questionable reliability in their visual analysis. To further examine the reliability, accuracy, and bias in visual analysis of functional analysis graphs, we simulated functional analysis results and surveyed 121 BCBA-Ds experienced in visual analysis. We then examined reliability of responses and used a signal detection theory approach to analyze accuracy and bias. Findings suggest that reliability and accuracy of judgements are questionable, and exploration of decision aids is warranted.     

Psychotherapy in the aesthetic attitude

Abstract: Drawing upon the writings of Jungian analyst Joseph Henderson on unconscious attitudes toward culture that patients and analysts may bring to therapy, the author defines the aesthetic attitude as one of the basic ways that cultural experience is instinctively accessed and processed so that it can become part of an individual's self experience. In analytic treatment, the aesthetic attitude emerges as part of what Jung called the transcendent function to create new symbolic possibilities for the growth of consciousness. It can provide creative opportunities for new adaptation where individuation has become stuck in unconscious complexes, both personal and cultural. In contrast to formulations that have compared depth psychotherapy to religious ritual, philosophic discourse, and renewal of socialization, this paper focuses upon the considerations of beauty that make psychotherapy also an art. In psychotherapeutic work, the aesthetic attitude confronts both analyst and patient with the problem of taste, affects how the treatment is shaped and ‘framed’, and can grant a dimension of grace to the analyst's mirroring of the struggles that attend the patient's effort to be a more smoothly functioning human being. The patient may learn to extend the same grace to the analyst's fumbling attempts to be helpful. The author suggests that the aesthetic attitude is thus a help in the resolution of both countertransference and transference en route to psychological healing.     

Decision Pattern Analysis as a General Framework for Studying Individual Differences in Decision Making

This paper investigated decision pattern analysis (DPA) as a general and standard framework for studying individuals' consistent decision making behavior within and between contexts. DPA classifies decisions on the basis of judgement accuracy and the goal orientation of the decided‐upon action. Over repeated decisions, patterns of individuals' decision behavior are described by five variables: competence, optimality, recklessness, hesitancy and decisiveness. A fictitious medical decision making test and three standard cognitive ability tests (extended with confidence ratings and a ‘submit answer for marking’ decision) were used to investigate the psychometric properties of these DPA variables. Internal consistency of the decision patterns ranged from good to excellent. Convergent validity was assessed via cognitive abilities, metacognitive confidence and a control criterion imposed on confidence that determines the decision to be made: the point of sufficient certainty. Personality variables were included to assess discriminant validity. As hypothesised, cognitive abilities showed positive correlations with competence and optimality. High confidence, low points of sufficient certainty and a greater discrepancy between them were associated with higher decisiveness and recklessness, and lower hesitancy. Personality measures showed mixed and generally weak correlations with the DPA variables. These convergent and discriminant results also held after controlling for all variables in regression. The results provide preliminary psychometric support for DPA as a general framework of behavioral decision making. DPA has the potential to be exploited in many contexts for uses that, to date, have been unachievable in a psychometrically valid manner. Copyright © 2015 John Wiley & Sons, Ltd.     

Sequential decision making: An aggregate scheduling methodology

Recent studies of sequential decision making performance have utilized optimal dynamic programming solutions as the criteria for evaluating the quality of human decisions. The difficulties incumbent in increasing the dimensionality of dynamic programming formulations effectively prohibit their extension beyond the case of a single decision variable. In the following article an alternative optimization formulation for a two-decision-variable case is presented, followed by the development of a corresponding one-decision-variable problem. In addition, related methodological problems limiting the comparability of results among previous studies are presented. It is suggested that the proposed problem formulation and its accompanying interpretation for the decision maker largely eliminate these previous methodological problems. Furthermore, the problem formulation permits quantification of the relative weights that should optimally be placed on future decision periods in the multiple-stage decision problem.     

The Analyst’s Bodily Sensations as Important Information in Clinical Work

ABSTRACT

Analysts use many different methods and therapeutic tools to understand the associations and struggles of their patients. This article suggests that, in addition to other matters we pay attention to for this purpose, it is useful for analysts to also pay attention to physical sensations that they might experience either during a session, or at other times when they are thinking about their work with the patient. I believe that the analyst’s solid familiarity with her own life history and conflicts, helps the analyst understand why her body experienced particular sensations when it did, and what, if anything, this adds to her understanding of her patient. Such understanding can then be shared with the patient, to deepen and enhance the analytic work. I also caution against a casual misuse of such a process.     

What's true and whose idea was it?

In this paper, the author explores the idea that psychoanalysis at its core involves an effort on the part of patient and analyst to articulate what is true to an emotional experience in a form that is utilizable by the analytic pair for purposes of psychological change. Building upon the work of Bion, what is true to human emotional experience is seen as independent of the analyst's formulation of it. In this sense, we, as psychoanalysts, are not inventors of emotional truths, but participant observers and scribes. And yet, in the very act of thinking and giving verbally symbolic 'shape' to what we intuit to be true to an emotional experience, we alter that truth. This understanding of what is true underlies the analytic conception of the therapeutic action of interpretation: in interpreting, the analyst verbally symbolizes what he feels is true to the patient's unconscious experience and, in so doing, alters what is true and contributes to the creation of a potentially new experience with which the analytic pair may do psychological work. These ideas are illustrated in a detailed discussion of an analytic session. The analyst makes use of his reverie experience-for which both and neither of the members of the analytic pair may claim authorship-in his effort to arrive at tentative understandings of what is true to the patient's unconscious emotional experience at several junctures in the session.     

The Emperor's clothes: Some serious problems in psychoanalytic training

The author discusses some of the key problems in psychoanalytic training, in particular those problems that stem from the power differential between training analysts and students in training. One effect of this differential can be that some students feel a pressure to comply with their teachers and supervisors, even their training analyst, in ways that can be seriously detrimental to their development. Further, when something goes wrong in a student's training, how is this to be viewed by those in charge of the training? Also, how are complaints dealt with? Is suffi cient weight given to external reality? Too often training analysts, and training committees, get into pathologising a student in a process that should be recognised as ‘wild analysis in committee’, rather than considering more carefully the external realities that may be affecting a student's progress in the training. This ‘analysis’ in committee should never be allowed. There is an urgency for immediate changes to be made in psychoanalytic training so that the problems discussed, with more care being taken, should be prevented from happening. Too often, however, an institutional resistance to change dominates discussions in committee, and in society meetings, with the result that little or no change takes place even after years of debate.     

Faith and the practising analyst

Abstract: In this brief essay, I reflect on three questions: What is ‘faith’ in a modern and post‐modern cultural context? Do I, a Jungian analyst, have ‘faith’ or do I not? Does having ‘faith’ or not make a difference in the practice of analysis? I make reference to Jung's understanding of ‘faith’ and his frequent disclaimers about making metaphysical claims. I conclude that a post‐credal ‘faith’ is possible for contemporary Jungian analysts, that I do have such a faith personally, and that in my experience this makes a significant difference in analytic practice at least with some patients. Traditional faith statements must be translated into depth psychological terms, however, in order for them to be applicable in post‐modern, multicultural contexts.     

Psychoanalytic case presentations in a weaving thoughts group: On countertransference and group dynamics

This article summarizes experiences of psychoanalytic case presentations in weaving thoughts (WT) peer groups. The format is presented and illustrated using a session with a group of analysts. In this setting, the frame of the presentation is guaranteed by the moderator. One aim is to create a group setting with many parallels to the analytic situation. A second aim is to discourage members from becoming enmeshed in destructive group functioning, such as internal disputes that may block a deeper understanding of the material. Classical psychoanalysis permits the analyst to reflect behind the patient on the transference-countertransference interplay. However, such reflections may be marred by undetected countertransference problems. Different supervision formats have different ways of helping the analyst with them. The WT format 'copies' the analytic session to the group, hence each member associates to the material in peace. Meanwhile the presenter looks, metaphorically speaking, at the web of their associations at his or her own pace. This may help him or her to confront and reflect on unresolved countertransference issues. This article indicates the method's similarities and differences compared with other formats. Arguments are supported by a child psychotherapy session, but the method is equally suitable for adult case material.