Does anything go? Towards a framework for the more transparent assessment of psychoanalytic competence1

It has been difficult to know what does and does not constitute competent psychoanalytic work and so equally difficult to assess when it is being practised and when it is not. This makes difficult any form of disciplined evaluation of the outcome of training, which has a series of problematic outcomes for psychoanalytic practice, psychoanalytic institutions and the relationship to allied disciplines and professions. In this paper, the author considers how far it might be possible to devise a framework for assessment of training programmes within a disciplined psychoanalytic pluralism. The aspiration is to develop a transparent framework, based on an empirically supported demonstration of analytic capacity. The framework needs to be sensitive and subtle, and to be able to withstand challenge. It needs to take cognisance of the twin facts that there is more than one way to practise psychoanalysis and that it is necessary to avoid ‘anything goes’. Drawing on an ongoing project undertaken by European IPA institutes, the author describes some of the problems colleagues have been experiencing in European institutes, because they have not had available transparent criteria for assessment. He outlines a preliminary form of a proposed method for making more transparent and supportable assessment. The author intends for this paper to inspire hope, enquiry and debate.     

The ‘inseparable bond between cure and research’: clinical case study as a method of psychoanalytic inquiry

Abstract

Since Freud's own time, there has been great deal of debate about the most appropriate research methodology for investigating psychoanalytic psychotherapy [Fonagy, Journal of Child Psychotherapy, 29 (2): 129 – 136, 2003 Fonagy, P. 2003. ‘The research agenda: the vital need for empirical research in child psychotherapy’. Journal of Child Psychotherapy, 29(2): 129–136. [Taylor &; Francis Online] , [Google Scholar]; Rustin, Journal of Child Psychotherapy, 29 (2): 137–145, 2003 Rustin, M. 2003. ‘Research in the consulting room’. Journal of Child Psychotherapy, 29(2): 137–145. [Taylor &; Francis Online] , [Google Scholar]]. The single case study, which has a long tradition both within child psychotherapy and the wider research field, has been widely criticised as an approach to research, even while its contribution to clinical practice, the development of new ideas and teaching have been acknowledged. After reviewing the history of case study as a research method, this paper argues that there are a broad range of approaches to the study of the single case, each of which may be appropriate depending on the particular research question. Each of these approaches, however, must respond to the three perceived weaknesses of the clinical case study as a research method: the ‘data problem’, the ‘data analysis problem’ and the ‘generalisability problem’. This paper outlines the nature of these criticisms and, using many examples of actual research projects, suggests various ways in which the criticisms can be addressed, in order for the single case study to re-gain its place at the heart of psychoanalytic research.     

Does timeframe adjustment of the Life Orientation Test-Revised assess optimism as a state?

ABSTRACT

Optimism is prospectively associated with superior health outcomes in cardiac patients, making it an attractive target for well-being interventions in this population. However, optimism measured by the Life Orientation Test-Revised (LOT-R) has largely been considered a static, dispositional construct. Among 125 patients with a recent acute coronary syndrome who received a positive psychology intervention, we assessed the properties of a modified LOT-R that changed the timeframe of items from general dispositional statements to queries about ‘right now.’ We aimed to learn whether this modified LOT-R was more dynamic than the original LOT-R via administration of both instruments at three timepoints over the 16-week study period. Contrary to our hypothesis, this modified LOT-R showed no greater change in mean score or intra-individual variance than the original LOT-R over 16 weeks. This suggests that simply changing the timeframe of the LOT-R may not facilitate assessment of more state-like optimism in medical patients.     

Does awareness of speech as a sequence of phones arise spontaneously?

It was found that illiterate adults could neither delete nor add a phone at the beginning of a non-word; but these tasks were rather easily performed by people with similar environment and childhood experiences, who learned to read rudimentarily as adults. Awareness of speech as a sequence of phones is thus not attained spontaneously in the course of general cognitive growth, but demands some specific training, which, for most persons, is probably provided by learning to read in the alphabetic system.     

Supervision as oversight: A new era in the history of psychoanalytic practice and training?

Taking its cue from Ekstein's analysis of the history of supervision (1960), this article proposes that there is a new historical era emerging in Britain, a phase that could be characterised as the ‘regulatory phase’. It is argued that in the future the clinical supervisor of psychoanalytic work will be positioned as ‘overseer’, with the consequence that what might be overlooked/not seen in the new regulatory climate is the notion of a psychoanalytically informed practice as a practice of the questioning of knowledge and its effects. Further, it considers how the effect of the proposed regulatory framework for psy-practice in the UK elides the current distinction between ‘practitioner/analyst’ and ‘trainee/candidate’. Thus psychoanalytically informed practitioners are re-positioned as candidates for authorisation as state licensed psy-practitioners. A clinical example, based loosely on Freud's account of his analysis of the young female homosexual, draws attention to the specifics and problematics of the competencies for analytic work and its supervision proposed by the Health Professions Council, Skills for Health and research for University College London, which envisages a future role of supervisors as the overseers of standardised interventions.     

Does treatment really make psychopaths worse? A review of the evidence

We aimed to evaluate critically the evidence behind the perceived inverse association between the degree of psychopathy as reflected by a high score on the Hare Psychopathy Checklist-Revised (PCL-R) and treatment response. A literature search with the key identifiers of PCL-R (or its derivatives) and treatment response produced 24 studies that were then systematically evaluated. This showed that only three studies were of an appropriate research design to answer the question and of these, none met our standard for an acceptable study. We conclude therefore that the commonly held belief of an inverse relationship between high-scores on the PCL-R and treatment response has not been established.     

Understanding violence: Does psychoanalytic thinking matter?

A coherent psychoanalytic theory of violence has been hindered by the very few psychoanalysts who have actually worked with violent patients, by political allegiance to certain psychoanalytic schools of thought, a naïve belief that all violence is typically not intentional, but rather a problem of impulse control, and the lack of understanding of recent neurobiological findings concerning aggression. Although intensive psychoanalytic treatment is usually not appropriate for violent individuals, the authors assert that a comprehensive understanding of violent behavior from a psychoanalytic perspective is of relevance for all mental health practitioners interested in the nature of human aggression. Actual violence is informed by bodily enactments and regressions to primitive subjective states; the effects of trauma on representation and symbolic functioning; the demarcation between affective and predatory violence; and understanding how all of our mental processes, including cognitions, wishes, memories, unconscious phantasies, ego-defenses, and object relations, are originally rooted in the body. The authors review the historical psychoanalytic literature on violence and critique contemporary psychoanalytic theorizing regarding the etiology of violent behavior in the light of some neurobiological research findings. They conclude with treatment recommendations for those clinicians whose patients have been violent toward others.     

Does representational momentum reflect a distortion of the length or the endpoint of a trajectory?

Observers viewed a moving target, and after the target vanished, indicated either the initial position or the final position of the target. In Experiment 1, an auditory tone cued observers to indicate either the initial position or the final position; in Experiment 2, different groups of observers indicated the initial position or the final position. Judgments of the initial position were displaced backward in the direction opposite to motion, and judgments of the final position were displaced forward in the direction of motion. The data suggest that the remembered trajectory is longer than the actual trajectory, and the displacement pattern is not consistent with the hypothesis that representational momentum results from a distortion of memory for the location of a trajectory.     

On the function of a ‘break’ within the psychoanalytic double session

This article considers theoretical and clinical implications of the practice of ‘double sessions’ as defined by two consecutive sessions of psychotherapy divided by a 10-minute break. Limited existing literature of ‘double sessions’ is critiqued and the therapeutic significance of the 10-minute break provides the focus for this article with reference to the Lacanian practice of ‘scansion’. The author draws on relevant therapeutic experience and case material to elucidate the potential benefits of the introduction of double sessions with particular client groups. It is argued that the break provides the opportunity to access often hidden archaic defences as the effects of rupture and reconnection are worked through. Equally, the separation of the break allows the patient's immediate associations following the end of the first session to be brought immediately back into the work. The practice is problematised in relation to potential contraindications with particular patient groups and this, in turn, elucidates the conceptual differences between Freudian/Lacanian and object relations traditions.     

Does accuracy matter? A review of the consequences of accurate personality impressions as a function of context and content

What are the implications of seeing others as they see themselves? That is, does viewing others accurately have consequences, positive or negative, to relationship evaluations (e.g., liking)? To address this, the current article provides a comprehensive review of the personality accuracy literature and discusses related work from the self-verification and empathic accuracy domains. We specifically explore whether the consequences of accurate perceptions could be influenced by two key categories of moderators: the context of the impression (e.g., high vs. low stakes) and content of the impression (e.g., desirability of traits). Lastly, we discuss future directions to aid our understanding of this question.     

Is there a special psychoanalytic love?

Although the analyst's role mandates a degree of detachment, analysts have often said that they offer patients a special kind of love. They have tended to equate that love with understanding, thus neutralizing the paradox but also diluting the love. When something more resembling a loving affect is sought, the suggestions include the love a scholar feels for his subject, the love that accompanies immersion in great literature, and love that is self-generated by deliberate efforts to move toward the patient or to generate empathy in oneself. But a form of love may also arise from the analyst's unique and relatively pure acquaintance with a person's "appeal," by which is meant the patient's effort to elicit responses from the analyst. Although the awareness of transference most obviously tends to immunize him, it also gives him a poignant "insider's" feel of the patient's appeal, since he is the target of that appeal while being unencumbered by the myriad considerations that would color his perception were he to regard himself as a proper object.     

Selecting a patient or initiating a psychoanalytic process?

The defences provoked in the analyst by the anxieties associated with the difficult tasks of ‘assessment’ and ‘selection’ for psychoanalysis can result in a tendency to think in terms of ‘hurdles to be cleared’ by potential psychoanalytic patients, rather than ‘opening the gates’. This can result in a diminution of the analyst's capacity to enlist and sustain a psychoanalytic stance. Only within a psychoanalytic frame can a meaningful psychoanalytic process unfold, at all stages of a potential patient's movement from their first contact through to, possibly, entering into an analysis. The author illustrates the value of this thinking by describing the work of the London Clinic of Psychoanalysis where there has been a shift of emphasis in psychoanalytic consultation towards working with individuals on their potential to initiate a psychoanalytic process, and away from the sole aim of ‘selection of a suitable patient’. In this paper, the author notes that when institutional culture and practice supports psychoanalytic identity, this makes it more possible to recognize and articulate the anxieties provoked by the ‘emotional storm’ inevitable in psychoanalytic consultation, and the draw towards unhelpful enactment that may otherwise obscure the initiation of a psychoanalytic process that may or may not result in analytic treatment. Illustrative case material from the Clinic is presented.     

Representative design: Does the addition of a defender change the execution of a basketball shot?

ObjectiveThe aim of this study was to examine the influence of a defender on the performance of a motor skill from an invasion sport.DesignHighly skilled basketball players performed different variations of basketball shots using a randomised test schedule.MethodParticipants completed a total of 30 test trials comprising 6 trials of 5 different shot types in both defended and undefended conditions.ResultsThe presence of a defender led to significant changes in several behavioral measures including faster shot execution times, longer jump times, and an increase in the amount of time that the ball spent in the air as it travelled to the basket after being released from the shooter's hand. These behavioral changes were accompanied by an overall decline in shooting accuracy of over 20%. Defended shots also tended to elicit greater amounts of movement variability which, when interpreted in conjunction with the other findings, suggests that participants were attempting to adapt their movements to accommodate for the changing demands of the performance environment. Comparisons across different shot types revealed that the influence of the defender was generally context and task dependent.ConclusionsThe results have important implications for representative task design, and highlight how the manipulation of key information sources can have a marked effect upon behavioral responses.     

Steady as a rock: Does the steady state represent cognitive fossilization?

A study was performed in which data were obtained from adults and children with respect to their control of the inflexional morphology of the Spanish verbal system. Results indicate that adults have inferior knowledge of the paradigm compared to the children. Based on the types of errors committed, it is argued that linguistic knowledge may be more an ability to analogize correctly than to follow (unconscious) rules. Implications for GB (Government and Binding) theory and first and second language acquisition are discussed.     

Which reality in the psychoanalytic session?

The author discusses how the analyst's theory influences what happens in the psychoanalytic session, and, in particular, how it determines which of several possible realities become the focus of attention. An overview of Bionian thought and how it informs the author's way of working is provided. In elaborating his use of the narrative level in the session and other key concepts, the author presents three brief clinical vignettes.