Notes towards a psychoanalytic understanding of the couple relationship

In this paper an attempt is made to demonstrate how a particular orientation to contemporary psychoanalytic concepts may be useful to an understanding of the nature of the marital, or couple, relationship. The unconscious forces which may attract two people to each other, which may influence the patterns of their interaction and which may result in psychic stagnation or development are outlined. The second part of the paper addresses the nature of the therapeutic relationship with the patient couple. A hypothesis is offered regarding possible diagnostic criteria for choosing whether to work with a couple presenting for couple psychotherapy employing one psychotherapist or two psychotherapists working as a co-therapy pair. (The usual practice of myself and my colleagues at the Tavistock Institute of Marital Studies is to see our patient couples with a co-therapist partner).     

Bringing it all back home: how I became a relational analyst

This paper traces the similarities between the cluster of influences that informed my own training and practice as a British developmental Jungian analyst and those that led to the creation of intersubjective and relational analysis in America. Having outlined five main themes of relational analysis, I show how these were anticipated by several trends in British analysis, especially the work of R.D. Laing and the theory of couple interaction developed by the Institute of Marital Studies at the Tavistock Centre in London. I then show the parallels between relational thinking and Jung's approach to clinical practice and discuss some of the dilemmas around the analyst's subjectivity and personal participation in the analytic relationship that are common to both traditions. My aim is to show that a relational approach to the practice of Jungian analysis is both ‘traditional’ and ‘radical’, being rooted in the traditions of the past while opening up pathways towards future development and clinical innovation.     

Treatment manuals and the advancement of psychoanalytic knowledge: The Treatment Manual of the Tavistock Adult Depression Study

This paper has two aims: first, it seeks to understand the absence of treatment manuals in psychoanalysis. Secondly, it summarizes the treatment manual of the Tavistock Adult Depression Study, which describes the form of psychoanalytic psychotherapy whose effectiveness has been evaluated both in the Tavistock Adult Depression Study (TADS); and in the German Die Langzeittherapie bei chronischen Depressionen (LAC) Studie. Throughout the history of psychoanalysis, opinions about treatment manuals, empirical research and their antecedents have been deeply divided. After tracing the often polarized unfolding of these matters, the paper proposes that emotional and cognitive difficulties as well as scientific ones underpin their persistence. It is suggested that greater familiarity with them may lead to better combinations of outcome research and psychoanalysis: for example, the Tavistock manual seeks to match one account of the objects, aims, values, spirit and methods of psychoanalysis (as well as of connected forms of psychoanalytic psychotherapy); and also to meet what is required of treatment manuals by random allocation controlled trials. It has been a crucial element in the above studies of the outcome of long‐term psychoanalytic psychotherapies with chronically depressed patients. After describing the Tavistock Manual, the paper concludes suggesting that, if appropriately constructed, treatment manuals can make a contribution to the advancement of specifically psychoanalytic knowledge.     

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.     

Couple Psychoanalysis in the United Kingdom: Past,Present, and Future

ABSTRACT

The evolution of couple psychoanalysis in the United Kingdom is historically rooted in, and currently supported by, what might be called the Tavistock tradition, which principally derives from the work of Tavistock Relationships, a London-based organization combining clinical practice, training, and research. Practitioners working within this tradition draw on a range of psychoanalytic theories and differ in the ways they are applied in clinical practice and with different client groups, but they are united by their focus on relationship dynamics and how these can be affected by unconscious processes. This article charts how the main ideas and practices associated with the Tavistock tradition of couple psychoanalysis came into being, describes the conceptual building blocks that provide the platform for current training and practice, and identifies nodal points that might indicate directions of growth in the future.     

Learning and teaching the theories of Melanie Klein

I shall attempt to bring together here thoughts of experienced clinicians and teachers who have taught Melanie Klein's theories to child psychotherapists. However, most of the contributors have also taught Klein to clinical trainees in adult psychoanalytic work and to different groups abroad and, in some cases, to already trained psychotherapists or psychoanalysts. Klein's theories are introduced at different stages in the different child psychotherapy programmes in London. For instance, the students at the Tavistock are introduced to Klein's theories before they are necessarily in their own psychoanalysis, while other trainings introduce her theories in the introductory years of the clinical training.

William Halton is one of the longest-running teachers of Klein in the Tavistock Child Psychotherapy Training and brings his 'framework' culled from many years of experience. Maria Rhode has taught the Narrative to students at the Tavistock for many years. Elizabeth Spillius, psychoanalyst, writer and teacher, brings her experiences teaching Klein to non-Kleinians. Karen Proner teaches at the Tavistock, in Italy and the United States.

TEACHING MELANIE KLEIN William Halton 10 Lincoln Road London N2 9DL     

A Buddhist contribution to the psychoanalytic psychology of self

The author attempts to integrate the concepts of self used in psychoanalytic theory with the understanding of the nature of self as explained within the Buddhist meditative tradition. He divides different concepts of self in psychoanalytic theory into three major levels of consciousness and abstraction: self as experience, representational self and self as system. The representational level is defined as consisting of unconscious organizing structures of interaction: the system level is a hierarchically higher organization of representations, while the experiential level consists of the moment-to-moment flow of consciousness. He argues that for the sake of theoretical clarity these levels should be differentiated in discussions of self. He then describes the Buddhist psychology of self and tries to show how this perspective can enrich psychoanalytic understanding of the experiential self and of narcissism, which in Buddhist language would be described as clinging to (seeking or avoiding) images of self that arise in the mind. Last, he describes a model of therapeutic development using different levels of self and the interrelationship between them, showing how psychoanalytic psychotherapy and Buddhist insight meditation emphasize different levels of self using complementary rather than mutually exclusive methods.     

Die DPG-Praxis-Studie

All psychotherapeutic methods must be scientifically evaluated. Empirical evaluation of evidence is a prerequisite for acceptance as scientific psychotherapy as well as for payment by health insurance. Currently the psychotherapy methods accepted within the German health system (behavioural therapy, psychodynamic psychotherapy, and analytic psychotherapy) are reviewed by a governmental evaluation committee concerning evidence, necessity and cost-effectiveness. The DPG practice study has basically two aims: 1) to conduct a large naturalistic study to investigate effectiveness, sustainability and economic aspects of psychodynamic and analytic psychotherapy and 2) to offer a framework for psychoanalytic institutes, members, candidates or groups to realize own research ideas by collecting additional data within the study. The present article describes the background, main research questions, structure and design of the DPG practice study with regard to the evaluation questions.     

Analytical Psychology and Science: Adversaries or Allies?

This article examines C. G. Jung's relationship to science as a paradigm and the relationship between the Jungian community and science. The impact of Jungian “isolation” in terms of academic dialogue, cross-theoretical influence, and absence from the public sphere is also discussed. The author examines how findings from science can enhance our functioning as analytic clinicians and improve our ability to communicate the wealth found in analytical psychology to a variety of audiences outside Jungian circles. Finally, research on analytic interaction and analytic theories of the mind/psyche is explored as well as general research that has implications for analytical psychology and psychoanalytic 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.     

Doing things differently: an appreciation of Meltzer’s contribution

In this paper I wish to draw attention to aspects of Donald Meltzer’s ways of working which characterised his practice as a psychoanalyst and which I consider important in appreciating his originality. Several central themes are described and elaborated including: the central relevance of child analysis and the unity of child and adult analysis; the value of working in a clinical group with colleagues; the revision of psychoanalytic theory; joint research and writing projects; Meltzer’s recognition of the power of infant observation as a tool for learning; the commitment to a wider psychoanalytic culture; the particular contribution to the Tavistock child psychotherapy training. Examples from Meltzer’s written archive, both his books and papers, are used to demonstrate and illuminate these themes, alongside clinical material from child psychotherapy work brought to the author’s attention in supervision.     

Working Online During the Contemporary COVID-19 Pandemic1

Within the psychoanalytic school there has been substantial and ongoing debate about the efficacy of teleanalysis. However, as a result of the current COVID-19 pandemic and the online work with which the Jungian analytic community has now had to engage, this paper initially focuses on analysts’ actual experiences of working by teleanalysis. These experiences highlight a range of issues like “Zoom fatigue”, “online disinhibition”, dissonance, confidentiality, the frame and working with new patients. Alongside these issues, there were ample experiences by analysts of both productive psychotherapy apace with analytic work involving transference and countertransference phenomena, all indicating that a genuine and good enough analytic process can occur with teleanalysis. An overview of the research and literature both prior to the pandemic and as a result of it, confirms the validity of these experiences so long as analysts are cognizant of the specifics of such an online modality. Conclusions to do with the question, “what have we learned?”, alongside training, ethics and supervision issues are subsequently discussed.     

Evaluation of psychoanalytic psychotherapy with children: Therapists' assessments and predictions

Meaningful and clinically relevant evaluation of psychoanalytical psychotherapy requires new models for research. Such evaluation needs to take account of the complexities of personality and innerworld change as well as the more simply assessed changes in external behaviour.

A pilot study to develop a suitable methodology is described. These preliminary results are on a consecutive series of twenty in care and adopted children entering psychotherapy at the Tavistock Clinic. The project evolved from a previous study of psychotherapy with severely deprived children (Boston & Szur 1983), but the method could be used with any group of children in psychoanalytic psychotherapy, and possibly also, in an adapted form, with adults.

Therapists' initial aims and predictions are compared with later assessments of both external, and a wide range of internal, changes. Methods of validation are discussed and case-illustrations given.     

Is three a crowd? A perspective on countertransference challenges in psychoanalytic couple psychotherapy

Two seemingly unrelated characteristics of psychoanalytic couple psychotherapy may be better understood when juxtaposed. First, countertransference in psychoanalytic couple psychotherapy holds particularly strong intensity. Second, format decisions are central to couple psychotherapy. The use of conjoint and concurrent formats, or variations thereof, has been key in the historical development of couple psychotherapy and remains an area of much debate. Some couple psychotherapists use the format of couple psychotherapy flexibly, using variations of conjoint or concurrent couple psychotherapy, while others adhere strictly to working conjointly. Decisions regarding whether to undertake concurrent or conjoint therapy are not generally linked to countertransference; this article demonstrates that reading decisions regarding format through consideration of countertransference offers a needed perspective for the therapist. Case studies published by psychoanalytic couple therapists are analysed through this prism to demonstrate that changing the format may serve to dilute countertransference. One particular manifestation of countertransference, linked to oedipal dynamics, is explored: countertransferential intensity for couple psychotherapists potentially relates to being faced with their internal parental couple and their unresolved Oedipal strivings. Possible unconscious motivations to change the format of couple psychotherapy need to be carefully considered, as format changes may mask an avoidance of bearing the countertransference.     

Transference focused psychotherapy: overview and update

This paper describes a specific psychoanalytic psychotherapy for patients with severe personality disorders, its technical approach and specific research projects establishing empirical evidence supporting its efficacy. This treatment derives from the findings of the Menninger Foundation Psychotherapy Research project, and applies a model of contemporary psychoanalytic object relations theory as its theoretical foundation. The paper differentiates this treatment from alternative psychoanalytic approaches, including other types of psychoanalytic psychotherapy as well as standard psychoanalysis, and from three alternative non-analytical treatments prevalent in the treatment of borderline patients, namely, dialectic behavior therapy, supportive psychotherapy based on psychoanalytic theory, and schema focused therapy. It concludes with indications and contraindications to this particular therapeutic approach derived from the clinical experience that evolved in the course of the sequence of research projects leading to the empirical establishment of its efficacy.     

Group affective learning in training for psychotherapy and psychoanalysis

This paper describes The Group Affective Model, a method for teaching psychoanalytic concepts and their clinical application, using multi‐channel teaching, process and review in group settings, and learning from experience in an open systems learning community for psychoanalysts and psychotherapists. This innovation arose in response to criticism of existing methods in psychoanalytic education that have subordinated the primary educational task to that of the training analysis. Noticing this split between education and training analysis, between cognition and affect, and between concepts of individual and group unconscious processes, we developed the Group Affective Model for teaching and learning psychoanalysis and psychotherapy in an open psychological space in which students and faculty experience individual and group processes of digestion, assimilation, and review, which demonstrate the concepts in action and make them available for internalization selectively. We discuss our philosophy and our educational stance. We describe our institution and our participants. We give examples of teaching situations that we have studied to provide some insight about assimilation and internalization of the concepts and clinical approaches being taught. We discuss the transferability of the Group Affective Model to other teaching settings and psychoanalytic training institutions and propose it as the fourth pillar of psychoanalytic training, next to analytic treatment, clinical supervision, and didactic seminars.     

Psychoanalysis at the Millennium: A Personal Odyssey

A review of my development from psychology intern and research assistant to the psychoanalytic tester and theoretician David Rapaport at the Menninger Clinic in the 1940s, through my career psychological testing and my psychoanalytic training in the Western New England Institute and my working successively at the Austen Riggs Center, Yale Department of Psychiatry, Yale Student Mental Health Center, Cornell Department of Psychiatry, and eventually private practice in New York City. During this period, I rose to the academic rank of Professor and the analytic position of Training Analyst. I have written extensively: first on testing, then more or less in turn on psychoanalytic ego psychology, action language for psychoanalysis, feminist issues, narrative in psychoanalysis, and the contemporary Kleinians of London. This memoir traces the intellectual continuity that characterizes these writings and my continuing development as a psychoanalyst—my first ambition and great love.     

Übertragung und Gegenübertragung in Verhaltenstherapie und Psychoanalyse

Most psychotherapists and researchers agree that a good relationship essentially contributes to therapeutic change. The psychoanalytic concepts transference and countertransference which describe fundamental aspects of the psychotherapeutic relationship have now become integrated into behavior therapy. These concepts, however, are used differently in psychoanalysis as well as in behavior therapy. This makes the communication between psychotherapists coming from different orientations difficult. Therefore, a research approach which describes the important verbal and nonverbal elements of a helpful therapeutic interaction independently from therapeutic orientation could help to evaluate their effectiveness in different psychotherapeutic methods. In this way a culture of integration into psychotherapy could be encouraged.     

Approaches to evaluation

This paper offers some informal thoughts about audit and research studies in a psychotherapy or counselling context, drawing on the author's background in a difficult area of evaluation: the outcomes of psychoanalytic psychotherapy for children and adolescents. Reasons for therapists' difficulties with the idea of evaluation studies are considered, and possible designs for feasible research projects are briefly discussed. Examples of different strategies within one area are given, to illustrate the way in which different approaches can be patched together to yield important findings, and to overcome the limitations of any one approach. the place of audit in relation to research is also briefly discussed.