A systematic review of the effectiveness of psychoanalysis,psychoanalytic and psychodynamic psychotherapy with adults with intellectual and developmental disabilities: progress and challenges

Objectives: This systematic review aimed to critically appraise the literature on the efficacy and effectiveness of psychoanalysis, psychoanalytic and psychodynamic psychotherapy in adults with intellectual and developmental disabilities (IDD). Method: A systematic search of electronic databases was carried out. The methodological quality of the studies was assessed using a quality assessment tool and comparisons were made with a review of the quality of research on the effectiveness of cognitive behavioural therapy (CBT) for people with IDD. Results: The search yielded 13 papers which provided evidence for the effectiveness but not efficacy of psychoanalytic and psychodynamic psychotherapy; but none were found for psychoanalysis. The quality of the research was generally poor compared to the current research on the effectiveness of CBT. Conclusions: Positive outcomes have been indicated for psychoanalytic and psychodynamic psychotherapy with people with IDD. Larger scale, more controlled research is necessary to advance the evidence base.     

‘Mr K’ – A successful case of analytic oriented therapy documented empirically: the role of the therapeutic relationship and reflexive self-awareness

A successful case of analytic treatment over the course of 250 sessions is described from different perspectives, including considerations from the two-year follow-up. The therapeutic alliance and the patient’s experiencing were evaluated. Pre-treatment diagnosis was validated via diagnostic interview. Symptoms and interpersonal problems were assessed at intervals. Data were analysed using two different time-series analyses. Aspects of agency with regard to mentalizing capacity were assessed with the Metacognitive Assessment Scale. We obtained the following main results: (1) Symptoms and interpersonal problems improved continuously until the end of treatment. Symptom severity fell to below the clinical cut-off. This successful outcome remained stable at the two-year follow-up. (2) The therapeutic relationship improved during the therapeutic process. (3) The patient’s capability for reflexive self-awareness, operationalized as experiencing, decreased. (4) The metacognitive mastery of the patient increased. The following conclusions were made after combining the empirical data with the clinical observations: (1) Mr K improved clinically in terms of symptoms, self-regulation and interpersonal problems as a result of his gaining affect control. (2) The patient’s experiencing does not capture a positive outcome in all cases. (3) Aspects of agency (i.e. metacognitive mastery) deserve further attention in psychoanalytic treatments.     

“You Just Know It’s the Only Thing You Can Think”: A Conversation with Chodorow

ABSTRACT

Nancy Julia Chodorow (1944–) is a pioneer feminist theorist who brought together academic fields of sociology, anthropology, and psychoanalysis in her work related to feminist theories and psychoanalysis. Her first book, The Reproduction of Mothering: Psychoanalysis and the Sociology of Gender (1978 Chodorow, N. J. (1978; second ed. 1999). The reproduction of mothering: Psychoanalysis and the sociology of gender. Berkeley: University of California Press. [Google Scholar]), gave primacy to a more generalized account of the developmental and familial origins of prevalent psychological differences between femininity and masculinity from a psychoanalytic sociological viewpoint. Her later books, Femininities, Masculinities, Sexualities: Freud and Beyond (1994 Chodorow, N. J. (1994). Femininities, masculinities, sexualities: Freud and beyond. Lexington, KY: University Press of Kentucky. [Google Scholar]), The Power of Feelings: Personal Meaning in Psychoanalysis, Gender, and Culture (1999 Chodorow, N. J. (1999). The power of feelings: Personal meaning in psychoanalysis, gender, and culture. New Haven, CT: Yale University Press. [Google Scholar]), and Individualizing Gender and Sexuality: Theory and Practice (2012 Chodorow, N. J. (2012). Individualizing gender and sexuality: Theory and practice. New York and London: Routledge.[Crossref] , [Google Scholar]), bring in a rich interplay among socio-structural influences (i.e., culture) as well as intra- and inter-psychic dynamic processes, emphasizing more the importance of individuality and subjectivity. Based on an interview I had with Chodorow on the development of her thought, this paper gives Chodorow’s account of her personal history and academic background, current manifestations in feminist social science research and feminist psychoanalysis based on her contribution and legacy, and reflective narratives on the unfolding of feminist and psychoanalytic theories from the 1970s onward. Chodorow’s note to the next generation of feminist psychotherapists is also included.     

Working with Italian patients in Munich – The case of Penelope1

Abstract

With their book Psychoanalytic perspectives on migration and exile (1989), L. Grinberg and R. Grinberg (1984) opened up a new clinical field, which had been neglected for a long time in the psychoanalytic community, although Freud’s multilinguistic competence had greatly contributed to the creation of psychoanalysis. With their book The Babel of the unconscious, Jacqueline Amati Mehler, Simona Argentieri, and Jorge Canestri were able to confirm the hypothesis that it is possible to help multilingual patients to integrate the different aspects of their self which are bound to their mother tongue and to their foreign tongue(s), and thus to allow them to develop a new identity. The author, who has been a psychoanalyst in Munich since 1999, works every day with his Italian patients in this new clinical field, that is in their common mother tongue and at the two levels of their old Italian and their new German identity. Through the detailed presentation of a clinical case, he furthermore shows how, on the one hand, the migration creates a new space in which therapy actually becomes possible, and on the other hand, not only therapy, but also the kind of relationship developed by the patients to their “new country” plays a decisive role in the whole process. Such a frame proved to be particularly good for the emergence, revisitation, and reelaboration of the transgenerational trauma around which the case of Penelope is centered. The author further assumes that the theme of “migration and identity” is becoming more and more important in our globalized world, with clinical consequences whose elaboration requires a specific cultural and technical preparation.     

Should supportive measures and relational variables be considered a part of psychoanalytic technique? Some empirical considerations

This article presents some quantitative findings from a survey of 89 psychoanalysts (all members of the American Psychoanalytic Association or the International Psychoanalytical Association) about their own experiences in analysis. A comprehensive questionnaire was used to collect retrospective data about (1) how participants felt they benefited from their analyses and (2) how they remembered their analysts’ technique, personality, and style of relating. A correlational analysis found that, according to our participants’ ratings, the most beneficial analyses were associated with having a caring and emotionally engaged analyst who possessed positive relational and personality qualities, used supportive techniques in addition to classical techniques, and pursued therapeutic as well as analytic goals. Outcomes rated as successful were also associated with experiencing a good ‘fit’, a good working relationship, and a positive therapeutic alliance. Our results support the call for an expanded view of acceptable analytic technique (e.g. Schacter and Kächele, 2007) .     

The clinical language of Sándor Ferenczi: Introductory and methodological considerations

Abstract

Reflecting in the present paper on the legitimacy of a work to collect together the ideas, concepts, and terms of Sándor Ferenczi, the author will explore, through a series of questions and answers, the following points: why it is so clear-cut that Ferenczi should be included in the company of those great psychoanalytic authors who might be deemed entitled to such a study; whether Ferenczi possessed his own language, and if this was the case, when and how he acquired it; what we mean when we refer to Ferenczi’s idiomatic language, and how we can profitably identify this language and bring it into focus; how, in practice, such a text should be organized; what its audience and function would be; and how it would be used by readers and students of Ferenczi.     

The Ferenczi cult: its historical and political roots

I examine how Sándor Ferenczi has survived in the cultural memory of psychoanalysis, and why myths and legends have been created around his life and work. It seems that he could not escape the fate of the founding fathers of psychoanalysis, most notably, that of Freud and Jung: their life and work have become an object of cultic respect for the followers, diabolic figures for the enemies. Quasi-religious cultivation of the “great man” is an often observable phenomenon in literature, politics, history and in science, and it has several political and ideological functions. These functions may help to increase the inner cohesion and the group identity of the cultic community, to defend the group against external threats. Psychoanalysis has always been vulnerable to myth formation; first, for obvious sociological reasons, and, secondly, for reasons originating in the nature of therapy. The cultic functions can be realized in several ways, such as, for example, the ritualization of the transmission of knowledge, and the “biography as passion” that is, attempts to create a biographical narrative in which all life history moments crystallize around the great man's central theme. Most of the biographies on the life of great psychoanalysts are of this kind – and Ferenczi is no exception. A historiography of psychoanalysis must follow the path of modern historiography in general, which attempts at deconstructing both myths and counter-myths about persons, events and processes, in political, as well as in cultural and intellectual history. By examining the structure of myth formation about psychoanalysts we can learn a lot about how ideas are operating in changing social contexts.