Psychotherapy Research and Psychoanalytic Practice: Commentary on Papers by Lester Luborsky and Hans H. Strupp

I discuss the views of Lester Luborsky (quite optimistic) and of Hans H. Strupp (less so) concerning the accumulating evidence for the favorable impact of psychoanalytic therapy research, as it has grown over recent decades, in shaping clinical psychoanalytic activity. I offer my perspectives on their views of the issues of (a) the effectiveness of psychoanalytic (psychodynamic) therapies vis-à-vis the varieties of nonanalytically based therapies; (b) long-term (time-unlimited) vis-à-vis short-term (time-limited) therapy, (c) the call for empirically supported treatments (ESTs), (d) the call for randomized clinical trials (RCTs), (e) the trend toward “manualization” of therapy approaches, and (f) the light that all these considerations can cast on the extent to which, and how, psychoanalytic therapy helps.     

Delivery of Psychological Interventions by Clinical Neuropsychologists: Current Practice in Australia and Implications for Training

Clinical neuropsychologists are increasingly involved in delivering psychological interventions to people with neurological conditions. This is a key competency for accredited Australian postgraduate neuropsychology courses; however it is not clear how effective courses are in preparing neuropsychologists to deliver interventions. The study aims were to (a) determine the frequency and confidence with which particular types of interventions are delivered by Australian neuropsychologists, (b) examine the availability of opportunities to deliver interventions on clinical placements, (c) identify barriers to delivering interventions in current workplaces; and (d) determine which factors influence the frequency and confidence with which neuropsychologists deliver interventions. An online survey was completed by 114 participants who had graduated from a postgraduate neuropsychology program. Results indicated that respondents delivered different intervention types with varying frequency. They reported limited opportunities to practice these interventions on placements. The majority wanted to be doing more interventions, with lack of time, resources, and adequate training being the major barriers. There were several significant relationships between the frequency and confidence with which respondents delivered interventions and the perceived quality of their postgraduate training. These results highlight the need to consider appropriate postgraduate training options in delivery of interventions, including increasing opportunities to practice interventions on placements.     

The Use of Consultation in Psychological Practice: Ethical,Legal, and Clinical Considerations

The importance of consulting with other professionals to maintain acceptable standards of care is well documented in many health care professions. However, evidence indicates that many psychologists fail to utilize consultation when needed, and that consultation use varies along dimensions such as the education and training of the consultee, the type of setting, number of years in practice, and proximity to available consultants. In this article, we review the research on the use of consultation by psychologists as well as other health care professionals. We discuss the clinical, ethical, and legal implications of seeking consultation as a professional psychologist. Finally, a detailed and practical model for the regular use of consultation is given to improve the routine use of consultation in clinical practice.     

The Sleeping Analyst,The Waking Dreams: Commentary on Papers by Richard A. Chefetz and David G. Mark

The discussion applies the basic psychological concepts of emotion schemas and the referential process to the case material presented by Drs. Richard Chefetz and David Mark. Emotion schemas are types of memory schemas that develop in an interpersonal field. They include subsymbolic processes, symbolic imagery, and linguistic codes, integrated to varying degrees. In treatment both participants come in with their emotion schemas, developed in the course of their lives, activated in the events of the day; communication between analyst and patient occurs on all levels in subsymbolic somato-sensory and symbolic verbal forms. The discussion of Dr. Chefetz's presentation emphasizes the relationships among multiple schemas of self and others, within the patient and between patient and analyst. The discussion of Dr. Mark's three cases focuses on connections and disconnections within the schemas as well as between them and emphasizes the pivotal role of imagery in connecting subsymbolic experience and words, and in the reconstruction of dissociated schemas in the context of the therapeutic relationship.     

The Findings of a Cochrane Meta-Analysis of Couple Therapy in Adult Depression: Implications for Research and Clinical Practice

The association between depressive symptoms and distressed intimate relationships supported the assumption that couple therapy, by focusing on the interpersonal context of depression, might be more effective as a treatment for depression than individual psychotherapy or drug therapy. This issue was addressed by a Cochrane meta-analysis assessing the evidence from clinical trials of couple therapy for depression in comparison with individual psychotherapy, drug therapy, and no/minimal intervention, including fourteen studies with 651 participants. No study was found free of bias and the quality of the evidence was low, with major problems of small sample sizes, missing outcome data, selective reporting, lack of information on random sequence generation and allocation concealment, recruitment of people not representative of clinical practice, and allegiance bias. The meta-analysis showed that both couple therapy and individual psychotherapy improved depressive symptoms at end of treatment and after 6 months or longer, with moderate effect sizes, without any difference between the two treatments. Couple therapy was more effective in reducing couple distress. This effect was larger in studies with distressed couples only and should be considered as relevant in its own right. Couple therapy is a viable option for the treatment of a depressed partner, especially in discordant couples. Future research should address several issues left open to provide a sound empirical foundation for clinical practice.     

A Hierarchical Multiple-Level Approach to the Assessment of Interpersonal Relatedness and Self-Definition: Implications for Research,Clinical Practice,and DSM Planning

Extant research suggests there is considerable overlap between so-called 2-polarities models of personality development; that is, models that propose that personality development evolves through a dialectic synergistic interaction between 2 key developmental tasks across the life span—the development of self-definition on the one hand and of relatedness on the other. These models have attracted considerable research attention and play a central role in DSM planning. This article provides a researcher- and clinician-friendly guide to the assessment of these personality theories. We argue that current theoretical models focus on issues of relatedness and self-definition at different hierarchically organized levels of analysis; that is (a) at the level of broad personality features, (b) at the motivational level (i.e., the motivational processes underlying the development of these dimensions), and (c) at the level of underlying internal working models or cognitive affective schemas, and the specific interpersonal features and problems in which they are expressed. Implications for further research and DSM planning are outlined.     

The Interplay of Subsymbolic and Symbolic Processess in Psychoanalytic Treatment: Commentary on Paper by Steven H. Knoblauch

Bucci's model of emotional communication, developed in the context of her theory of multiple coding and the referential process, is applied to Knoblauch's microanalytic report of his experience of the patient and himself and their interactions during a single session of an ongoing treatment. The referential process is a bidirectional function connecting the diverse sensory, somatic, and motoric representations of the subsymbolic system with imagery and words. The process operates partially and to varying degrees within both participants; in the case presented here, the dissociation among systems is severe, and emotional communication within the dyad occurs at first primarily in subsymbolic, bodily forms. Where gaps in the referential process exist for the patient, the analyst's own experience and associations operate to evoke new connections for her; we see this process in moment-by-moment glimpses of the analyst's experience and his interactions with the patient. Gaps in the reader's knowledge, and possibly the analyst's knowledge, of the patient are discussed.     

The Ability to Identify Criteria: Its Relationship with Social Understanding,Preparation, and Impression Management in Affecting Predictor Performance in a High-Stakes Selection Context

The ability to correctly identify the criteria (ATIC) that are being evaluated in a selection procedure is a relatively new construct attracting attention because of its significant relationship with performance in selection assessments and its potential for explaining their criterion validity. Multiple source data from 319 applicants undergoing a high-stakes medical student selection procedure were used to test a moderated mediation model that extends current understanding of the nomological net of this construct. Results show that ATIC fully mediated the relationship between interview preparation and performance, partially mediated the effect of social understanding on performance, and moderated the effect of impression management on performance. Findings are explained in terms of cognitive theories of cue recognition, and practical implications are discussed.