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.     

Followup of psychoanalysis five to ten years after termination: I. Stability of change

Seven out of 17 patients interviewed in a long-term followup of psychoanalysis showed either improvement in psychological functioning or a retention of psychological gains they had made during the course of psychoanalysis. Six patients deteriorated in their psychological functioning, but their gains were restored with subsequent treatment. Four patients deteriorated in psychological functioning without restoration, whether or not treatment was reentered. Neither analysts' assessments at the time of termination nor patients' assessments of themselves or assessments based on psychological tests one year after termination predicted which patients would improve or retain psychological change. No causal generalizations about factors related to psychological change can be made from these data. Different factors in interaction are suggested to account for the stability and instability of psychological change.     

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.     

Vicissitudes of ideas of cure in analysands and their analysts: a longitudinal interview study

This longitudinal prospective study focuses on analysands' and analysts' implicit ideas of how psychoanalysis might help analysands' psychological problems. Seven analysands and their analysts were periodically interviewed. Single ideas of cure from 75 interviews were inductively categorized. Nine distinct types of cures emerged, representing the wished-for goals of psychoanalysis, as well as the actions to achieve the wished-for changes. Each category might comprise more or less utopian ideas of wished-for cure as well as ideas of an attainable, more limited cure, or combinations of these. The utopian ideas of wished-for cures persisted throughout the psychoanalytic process for more than half the analysands and analysts. The abandonment of these ideas was related to the experienced outcome of psychoanalysis. The relation between the theories of one analysand and her analyst is explored in depth in a case study with special emphasis on the analytic process. The study suggests that the psychoanalytic process might profit from the analyst's observance of such incongruities and an openness to work through them.     

From Drive to Affectivity: Contextualizing Psychological Life

It is the thesis of this article that the shift in psychoanalytic thinking from the primacy of drive to the primacy of affectivity moves psychoanalysis toward a phenomenological contextualism and a central focus on dynamic intersubjective systems. Unlike drives, which originate deep within the interior of a Cartesian isolated mind, affect—that is, subjective emotional experience—is something that from birth onward is regulated, or misregulated, within ongoing relational systems. Therefore, locating affect at the center automatically entails a radical contextualization of virtually all aspects of human psychological life.     

Drives, affects, behavior--and learning: approaches to a psychobiology of emotion and to an integration of psychoanalytic and neurobiologic thought

Drawing on concepts and data from psychoanalysis, neuroscience, ethology, and experimental psychology, this paper suggests that affects are the prime movers of human motivation and have, in addition, these properties: they are neurophysiologically generated, sensationlike signals originating not in classical sensory systems, but in limbic structures; activation of the neurobiologic affect generators reliably triggers motor stereotype--like facial expression, posture, and tone of voice--which in turn transmit the physical data underlying empathy and emotional communication; and appetitively sought pleasant emotions-sensations and aversive dysphoric feelings serve respectively as the ultimate, "brain-synthesized" positive and negative reinforcers of emotional learning. The latter ideas point to derivative hypotheses: that parental nonverbal behavior and communication evoke in children the affects that guide character development and choice of defense, and that these processes are consistent with an affect-reinforced associative learning model comprising both operant and classical conditioning paradigms. Psychoanalysis as therapy, then, may mechanistically rely for its clinical effectiveness on extinctionlike processes in which new experience in the analyst-patient relationship leads to the modulation or extinction of initially crippling signal affects associatively linked to various other affects, appetites, and behaviors. Finally, the core hypotheses mesh both with recent findings from the cellular study of affect and learning mechanisms and with associative learning-unlearning assumptions variably explicit in psychoanalytic writings since the time of Freud's (1895) Project.     

Between certainty and uncertainty--observations on psychoanalysis in Russia

'Diversity', the theme of our conference, carries a subversive sub-text in totalitarian societies. This is one of the themes presented as the current revival of psychoanalysis in the more democratic post-Communist Russia is explored. The history of psychoanalysis in Russia is summarized with a focus on its politicization, which led to initial interest in its theory (by way of a misapprehension of its tenets), and then to ultimate suppression of psychoanalytic thinking as an ideology deemed antagonistic to the totalitarian regime. In contrast, features of psychoanalysis and democracy are explored for their mutual affinities. The background of the resourceful new generation of analytic therapists is discussed, especially in regard to their experience of the parallel meanings of the word 'repression' (political, psychological). There is a persistence of some traits in patients and practitioners alike that are referable to past repression, such as the newness of verbal treatments, the inhibition of psychological curiosity, the ambivalent lure of certainty, and the pressure of authoritarian introjects. It is noted that psychoanalysis has its own history of a posture opposed to pluralism and diversity, which deepens the dialogue on the mutual engagement between psychoanalysis and the vicissitudes of its history in Russian culture.     

Negative support of significant others affects psychological adjustment in breast cancer patients

Significant others play an important role in providing support in patients' lives, but some types of support negatively affect the patients. This study was conducted in early-stage breast cancer patients to examine the structure of support, which was provided by their significant others and assessed negatively by the patients, and to identify negative support relating to the psychological adjustment of these patients. Thus, we first conducted interviews among 28 breast cancer patients to identify these support items assessed as negative; next, we conducted a questionnaire survey using the resulting items in 109 postoperative patients who had early-stage breast cancer. We performed exploratory and confirmatory factor analyses and obtained a valid second-order factor structure, including superordinate factors (excessive engagement, avoidance of problems and underestimation) and subordinate factors (overprotection, encouragement and management). Among these factors, the avoidance of problems was the only factor to be negatively associated with psychological adjustment of the patients, suggesting that these patients receive problem-avoiding support. The results of our study suggest that such problem-avoiding support from significant others can be counter-productive and potentially worsen the psychological adjustment of breast cancer patients.     

Factors influencing online control of video-aiming movements performed without vision of the cursor

A modulation of the primary impulse of manual/video-aiming movements performed without visual feedback has been reported. In the present study, we show that this modulation is modified (a) with increased practice, (b) the use of an aligned visual display, and (c) the availability of visual feedback on alternated trials. However, this modulation was not as efficient as that observed in a normal vision condition, which underlines the primary role of vision to ensure endpoint accuracy. Moreover, this modulation was observed only on the extent component of the task. This last observation indicates that proprioception can be used to modulate the extent component of goal-directed movements but that vision is necessary to modulate their direction.     

Freud's psychoanalysis: A moral cure

That psychoanalytical treatment in its classical Freudian sense is primarily a moral or ethical cure is not a very controversial claim. However, it is far from obvious how we are to understand precisely the moral character of psychoanalysis. It has frequently been proposed that this designation is valid because psychoanalysis strives neither to cure psychological symptoms pharmaceutically, nor to superficially modify the behaviour of the analysand, but to lead the analysand through an interpretive process during which he gradually gains knowledge of the unconscious motives that determine his behaviour, a process that might ideally liberate him to obtain, in relation to his inner desires, the status of a moral agent. There resides something appealing in these claims. But it is the author's belief that there is an even deeper moral dimension applying to psychoanalytical theory and praxis. Freudian psychoanalysis is a moral cure due to its way of thematizing psychological suffering as moral suffering. And this means that the moral subject – the being that can experience moral suffering – is not primarily something that the psychoanalytical treatment strives to realize, but rather the presupposition for the way in which psychoanalysis theorizes psychological problems as such.     

Contemplative/emotion training reduces negative emotional behavior and promotes prosocial responses

Contemplative practices are believed to alleviate psychological problems, cultivate prosocial behavior and promote self-awareness. In addition, psychological science has developed tools and models for understanding the mind and promoting well-being. Additional effort is needed to combine frameworks and techniques from these traditions to improve emotional experience and socioemotional behavior. An 8-week intensive (42 hr) meditation/emotion regulation training intervention was designed by experts in contemplative traditions and emotion science to reduce "destructive enactment of emotions" and enhance prosocial responses. Participants were 82 healthy female schoolteachers who were randomly assigned to a training group or a wait-list control group, and assessed preassessment, postassessment, and 5 months after training completion. Assessments included self-reports and experimental tasks to capture changes in emotional behavior. The training group reported reduced trait negative affect, rumination, depression, and anxiety, and increased trait positive affect and mindfulness compared to the control group. On a series of behavioral tasks, the training increased recognition of emotions in others (Micro-Expression Training Tool), protected trainees from some of the psychophysiological effects of an experimental threat to self (Trier Social Stress Test; TSST), appeared to activate cognitive networks associated with compassion (lexical decision procedure), and affected hostile behavior in the Marital Interaction Task. Most effects at postassessment that were examined at follow-up were maintained (excluding positive affect, TSST rumination, and respiratory sinus arrhythmia recovery). Findings suggest that increased awareness of mental processes can influence emotional behavior, and they support the benefit of integrating contemplative theories/practices with psychological models and methods of emotion regulation.     

Random Thoughts on Couple Therapy in a Postmodern Society

The postmodern period in psychoanalysis has had a considerable impact and influence on the psychotherapeutic process in both psychoanalysis and psychotherapy. The paradigm shift, reflected in the work of the intersubjectivists, rationalists, and social constructivists, has shifted emphasis from a one-person psychology to a two-person psychology. Implications for treatment are numerous. The change in emphasis affects not only how individual treatment is conducted but also couple therapy and group therapy. In considering the impact of these recent changes, the author notes the wide range of influences that inform her couple and group therapy. Although the current paradigm shift offers much, it seems to be an extension of earlier influences from self psychology, motivational systems, and attachment theory and of findings from neuropsychology. The author concludes that her couple work has also been intuitively informed by the implicit experience of the intersubjective field of group therapy.     

Ovarian cancer patients' psychological distress: the role of physical impairment, perceived unsupportive family and friend behaviors, perceived control, and self-esteem.

Although research has indicated that illness-related and interpersonal stress are associated with greater psychological distress among cancer patients, little empirical attention has been given to mechanisms that account for these relationships. In the present study, 2 mechanisms for the association between illness-related stress (physical impairment) and interpersonal stress (family and friend unsupportive responses) and psychological distress of 143 ovarian cancer patients were examined cross-sectionally. Separate structural equation models tested whether physical impairment impacted patients' distress via decrements in perceived control over their illness and whether unsupportive behaviors impacted patients' distress via decrements in patients' self-esteem. Results supported the proposed models and suggest that perceived control and self-esteem are 2 mechanisms for explaining how illness-related and interpersonal stress may be associated with psychological distress among women with ovarian cancer.     

Who founded Buddhism? Notes on the psychological effectiveness of religious objects

Starting with an outline of Buddhist history from a psychoanalytic perspective, this paper uses ideas from philosophy and psychoanalysis to consider the nature of the psychological effectiveness of religious objects. It suggests that the development of the devotional cult of Buddhas ‘without form’ such as Amitābha, at‐first‐glance surprising when juxtaposed with the founding vision of Gautama Siddhartha, tells us a great deal about the psychological needs that impel the evolution of religious thinking. Distinguishing religious objects from mythological ones, it argues that ‘religious objects’ are, more specifically, allegorical objects that can be encountered in the second person; that these may not always be well described as ‘illusion’; and that they may in some cases be better understood as providing opportunities for experience that, like the transference in psychoanalysis, may have far‐reaching psychological impacts.     

The Adult Attachment Interview and psychoanalytic outcome studies

During the last two decades, the Adult Attachment Interview (AAI) has attracted growing interest from psychoanalysts concerned with empirical research. The paper discusses the application of Crittenden's Dynamic-Maturational AAI method for assessing the outcome of psychoanalysis. The aim is to demonstrate, through a case presentation, how therapeutic change can be expressed in the AAI. The pre- and post-treatment interviews of one patient, having completed a four-times-a-week psychoanalysis, are presented. It is demonstrated that the detailed discourse analysis of the AAI, based on transcribed tape-recorded interviews, focuses subtle formal elements of language and speech reflecting dominant patterns of affect regulation and object relating. The AAI text analysis provides possibility for coding procedural memory as conveyed by the handling of the relationship to the interviewer, incorporating the dynamic relationship between researcher and subject and thus complying with a methodological prerequisite regarded by many psychoanalysts as necessary for capturing data that are relevant to psychoanalysis. On this background, the method emerges as promising for psychoanalytic outcome studies.     

When the Third is Dead: Memory,Mourning, and Witnessing in the Aftermath of the Holocaust1

The origins of psychoanalysis, as well as the concerns of our daily endeavors, center on engagement with the fate of the unbearable – be it wish, affect, or experience. In this paper, I explore psychological states and dynamics faced by survivors of genocide and their children in their struggle to sustain life in the midst of unremitting deadliness. Toward this continuous effort, I re‐examine Freud’s theoretical formulations concerning memory and mourning, elaborate André Green’s concept of the ‘Dead Mother’, and introduce more recent work on the concepts of the ‘third’ and ‘thirdness’. Throughout, my thoughts are informed by our clinical experience with the essential role of witnessing in sustaining life after massive trauma. I bring aspects of all these forms of knowing to reflections about a poem by Primo Levi entitled Unfinished business and to our own never finished business of avoiding denial while living in an age of genocide and under the aura of uncontained destructiveness.     

Stigma and Discrimination in Health-Care Provision to Drug Users: The Role of Values, Affect, and Deservingness Judgments

This study examined the role of values, affect, and deservingness judgments in health professionals' views of patients with stigmatized conditions (e.g., drug dependence). Participants were 277 nurses who responded to a survey containing 2 scenarios of a nurse providing high- or low-quality care to a patient with a condition related to prolonged use of alcohol or heroin. Affective responses to the patient were more positive for nurses with higher self-transcendence values, and more negative for nurses with higher conservation values. Deservingness judgments were predicted by positive and negative affect toward the patient, but not by attributions of responsibility for drug use. Deservingness judgments emerged as strong predictors of nurses' satisfaction with the provision of high- or low-quality care. The findings imply that the deservingness judgments made by nurses reflected strong entitlement norms concerning the provision of proper care for patients that were independent of patients' perceived responsibility for their condition.     

Mysticism,Reality, Illusion,and the Freudian Critique of Religion

Freud's critique of religion cannot be fully understood if his ontogenetic perspective is explored outside of his phylogenetic perspective. The former allows for illusionistic thought processes that are orthogonal to reality claims. The latter requires consideration of empirical claims to truth within a social psychological perspective. It is only the phylogenetic perspective that allows Freud to maintain that religion is delusional, whether or not it is also illusional. Freud's rejection of "as if" philosophies as exemplified by Vaihinger is based upon his refusal to allow religious truth claims to escape their empirical, social foundations. Recent efforts to revive psychological theories of religion rooted only in illusionistic thought, as exemplified in the use of Winnicott's conceptualization, must confront social psychological issues similar to those articulated within Freud's phylogenetic view. A mystical reading of Freud is suggested in which claims to truth within psychoanalysis, science, and religion can be confronted in an empirical and inherently social manner.     

An introduction to the reading of Bion

The author suggests that a good deal of the confusion that arises in the course of reading Bion derives from the fact that Bion's analytic writing is comprised of two periods of work that involve markedly different conceptions of psychoanalysis. These two periods require of the reader very different ways of reading and generate contrasting experiences in reading. Bion, in passages in Learning from experience (1962) and Attention and interpretation (1970), offers advice to the reader regarding how he would like his 'early' and 'late' work to be read. The author treats the experience of reading these passages as ports of entry into the fundamental tenets underlying Bion's widely differing conceptions of the psychoanalytic enterprise. The experience of reading early Bion generates a sense of psychoanalysis as a never completed process of clarifying obscurities and obscuring clarifications, which enterprise moves in the direction of a convergence of disparate meanings. Incontrast, the experience of reading Bion's later work conveys a sense of psychoanalysis as a process involving a movement toward infinite expansion of meaning. The author offers a detailed account of an analytic experience which he discusses from a point of view informed by Bion's work, particularly his late work.