The effectiveness of psychoanalysis in a case study using multi‐perspective methodology: Conflict in choosing a partner due to transgenerational mandate

A case study is presented to evaluate the effectiveness of psychoanalysis and the persistence of its benefits 20 years later in a young woman with severe depression, professional inhibition, and difficulties in partner selection due to transgenerational mandate (TGM). The investigation was carried out with psychoanalytic interviews with the patient and analyst, which were evaluated by both psychoanalytic and non‐psychoanalytic judges following a methodology based on one tested in Germany by Leuzinger‐Bohleber et al. (2003). The psychoanalytic treatment began in the early 1980s in Monterrey, Mexico. The study concludes that the psychoanalysis was effective in assisting with the patient's character disorder and partner selection, mainly because of the therapeutic alliance, the analysis of transference and character, and the patient's increased capacity for mentalization as a result of the interpretation of the TGMs.     

How wide is the widening scope of psychoanalysis and how solid is its structural model? Some concerns and observations

The author advances the thesis that in the past 35 years there has been a relatively silent but nonetheless significant movement within the mainstream of American psychoanalysis toward a more "modest" position. This movement has been stimulated from different sources, sometimes with diverse goals and different programs. One determinant was the reaction to the post-World War II euphoria in regard to psychoanalysis and its possible therapeutic powers. Another element has been the ongoing consolidation of our knowledge and understanding of the ego-psychological, structural-model approach to analytic theory and technique, an approach which emphasizes both intrapsychic conflict and compromise formations. A consequence of this more modest position has been a greater appreciation of the limitations of psychoanalysis as well as the significance of those limitations. This more realistic appraisal of psychoanalysis may not have encouraged the widening scope of the indications for analysis, but the enhanced understanding of its limitations offers the promise of more effective psychoanalytic work in areas that have not been considered ideal for the so-called "traditional" analysis. It is suggested that more sophisticated approaches in the analysis of resistance and character, of "conflict" (in distinction to "diagnoses"), together with a more applicable understanding of the psychoanalytic process, can all contribute to a deepening, if not necessarily widening, of our psychoanalytic endeavors.     

On the efficacy of psychoanalysis.

In this study we critically review the formal research literature pertinent to the outcomes of psychoanalysis and the factors influencing these outcomes. Our inquiry was conducted from a psychoanalytic perspective. We found the research yield consistent with the accumulated body of clinically derived psychoanalytic knowledge, e.g., patients suitable for psychoanalysis derive substantial therapeutic benefit; analyzability and therapeutic benefit are relatively separate dimensions and their extent is relatively unpredictable from the perspective of initial evaluation among seemingly suitable cases. The studies all contain clinical and methodological limitations which are no more substantial than in other forms of psychotherapy research, but they have not substantially advanced psychoanalytic knowledge. This raises challenges for the further development of formal research strategies native to psychoanalysis.     

Beyond the Mainstreams

My interest in the theory and art of psychoanalysis is traced to some of its sources—my childhood and expulsion from Germany in the late 1930s, my experience as a member of a discriminated-against minority, my nonacceptance as a psychologist by American psychoanalytic societies, my invitation to participate in the development of self psychology, and my fortuitous encounter with personal and professional friends who have contributed to the scope of my psychoanalytic endeavors (e.g., to my abiding interest in research and, in particular, the empirical studies of the early mother–infant dyad). I offer this account as evidence of the varied and creative opportunities that await psychoanalysts not outside but beyond the mainstream of American psychoanalysis.     

Female psychology: a review

This paper examines the differences between early psychoanalytic views of female development and current views, illustrating that recent suggested revisions offer an updated preliminary theoretical framework. The clinical implications of the differing views are discussed, and examples (two from the psychotherapy of children and a third from the psychoanalysis of a young woman) are offered to demonstrate particular clinical issues, such as penis envy and genital anxiety. It is postulated that the outcome of psychoanalytic treatment of women is markedly affected by the different clinical formulations and conceptualizations that result from different views. Further, the psychoanalytic terminology can contribute in subtle ways to ambiguity, distortion, and lack of clarity regarding female psychology.     

Organizational Structure and the Establishment of Psychoanalytic Identification: Commentary on Paper by Randall Lehmann Sorenson

This commentary addresses two themes: parallels between religious and psychoanalytic education and the question of group survival in a world of competitive groups, whether religious (“strict” vs. “weak”) or psychoanalytic (differing psychoanalytic approaches). “Strict” religious education involves teaching both critical thinking and identification with the particular religion. This blend of critical thinking and identification with psychoanalysis is crucial in psychoanalytic education. We want to graduate students who see themselves as psychoanalysts rather than as being “interested” in psychoanalysis. This goal is accomplished when students have close, positive experience with personal analysts, supervisors, and teachers who are strongly committed to psychoanalysis but in a manner that encourages students to think critically and find their own psychoanalytic perspective. With regard to the second theme, I discuss how our narcissistic commitment to one or another psychoanalytic model interferes with open integration of new insights. Individual analysts privately integrate competing ideas in their own idiosyncratic ways. When these individuals publicly represent competing psychoanalytic groups, however, they tend to emphasize differences among these groups. They then find ways to appropriate new ideas as extensions of their own evolving tradition. In this way, a theoretical school is able to integrate new developments while preserving its own identity.     

On the need of fundaments in psychoanalytic thinking

The questions concerning the foundations of psychoanalytic knowledge have been pressing from the beginning. Beside as a therapeutic practice, Freud conceived psychoanalysis as a science, maintaining that like other sciences psychoanalysis should have sound empirical and conceptual fundaments. Freud claimed that there is an inseparable bond (ein Junktim) between cure and acquiring knowledge in psychoanalysis. One of his aims in developing a metapsychology (analogously to metaphysics) was to explicate the conceptual structure of psychoanalytic knowledge. After Freud psychoanalysts have not reached a consensus in the questions concerning the foundations. What kind of foundations does psychoanalytic knowledge need? Are they to be found from the psychoanalytic practice and research on the couch, or rather from metapsychological constructions? In what way should psychoanalysis rely on external scientific research? The article addresses these questions, arguing that even though psychoanalytic work and knowledge do gain justification from various external sources, in the end psychoanalysis stands on its own foundations. It is further argued that especially under the prevailing plurality of theoretical and clinical approaches, psychoanalysis does not have – and does not need – a foundation that could not be further questioned. Thus a coherentist picture of psychoanalysis is defended.     

Therapeutic technique in psychoanalysis and psychoanalytic psychotherapy.

As the distinctions between what we consider to be psychoanalysis and what we consider to be psychoanalytic psychotherapy have become more uncertain and more blurred, it follows that it is equally difficult to designate the techniques that would be appropriate and specific for each modality. The problem has been compounded by the fact that in recent years psychoanalysis in the United States has become considerably less homogeneous than in the past and the ego-psychological structural model is no longer the only point of view in the psychoanalytic marketplace. Further, with alterations in the criteria for analyzability, cases which, generally, had not been viewed as suitable for analysis, have been appearing with increasing frequency on psychoanalysts' couches. We have also recognized that the degree of congruence between our expectations from and the results of psychoanalytic treatment was often less than anticipated. It appears that analysts have become considerably less arbitrary about what psychoanalysis is and how a psychoanalysis can be carried out. The author is unable to delineate one technique that is intrinsic to and limited to psychoanalysis. There are, however, differences in degree and emphasis in the ways in which various techniques are applied in the therapy of psychoanalysis as compared to the therapy of psychoanalytic psychotherapy. Special attention is given to the role of a psychoanalytic process and the central place the analysis of resistance plays in psychoanalytic therapy.     

Anna Freud: The Hampstead War Nurseries and the role of the direct observation of children for psychoanalysis

The psychoanalytic tradition of direct observation of children has a long history, going back to the early 20th century, when psychoanalysis and the emerging field of 'child studies' came into fruitful contact in Freud's Vienna. As a leading figure in the attempted integration of direct observation with the new psychoanalytic knowledge emerging from the consulting room, Anna Freud played a crucial role in the emergence of this field. But her major contribution to the theory and practice of observing children came during the Second World War, when she founded the Hampstead War Nurseries. The author describes in detail this important period of Anna Freud's career, and discusses the impact it had on later work. He explores the theoretical contribution that Anna Freud made in the post-war years to the debate about the place of direct observation in psychoanalysis, and concludes that Anna Freud's 'double approach' (direct observation plus analytic reconstruction) still has a great deal to offer as a method of both psychoanalytic research and education.     

Psychoonkologische Therapie und Psychoanalyse: ein Widerspruch?

Psycho-oncological psychotherapy and therapeutic work with severely somatically ill patients seems to be an area of limited interest in psychoanalysis. For example, case reports of psychoanalytic treatment with terminally ill patients are rare. This stands in contradiction to the importance of the fear of dying and death (wish) in psychoanalytic theory construction (e.g. narcissism theory). In addition to the obvious differences between psycho-oncological therapy and psychoanalysis, such as limited time perspective, the need for a flexible setting and dealing with the depth of regression, there are also important similarities and in particular the therapeutic work on early unconscious defence processes and coping with the fear of death. The theoretical and clinical work of the French psychoanalyst Michel de M’Uzan on experiences in psychoanalytic treatment of dying patients are an important example but are not well known in the German psychoanalytic community. The way psychotherapists deal with their own separation anxiety and fear of death is still a major issue and a barely appropriately reflected phenomenon, which possible represents a mutual confrontation (or an impossibility?) of psychotherapeutic work with dying patients.     

The couch as icon

The couch has always been an integral part of psychoanalytic practice. It has even become a cultural icon representing psychoanalysis itself. However, minimal evidence exists in the psychoanalytic literature that using the couch is necessary or even necessarily helpful to establish a psychoanalytic process and conduct an analysis. Furthermore, it can potentially be harmful to patients such as those who have experienced early loss and trauma or who have significant ego organizational problems. Therefore, the use of the couch per se does not seem well suited as a defining criterion of psychoanalysis. To the extent that it may be clinically valuable, the use of the couch should be more carefully considered and critically examined.     

Discussion: Application of Psychoanalytic Developmental Understanding to Three Early Intervention Programs

Discussion is made of the application of psychoanalytic developmental understanding to three early intervention programs. One program that was highly ambitious in its aim of preventing aggressive behavior in children attending elementary school was effective but may have attempted to achieve too much. One, involving an assistance program in a public school for boys who had lost their fathers, was extremely successful in helping the boys to express and deal with their feelings verbally rather than through undesirable behavior. The third program provided services for very young children that developmentally were extremely useful to them. Discussion is made of the value of these programs not only to the children involved but also to the teachers and mental health care personnel who worked with them.     

Ethical Presence in the Psychoanalytic Encounter and the Role of Apology<Superscript>*</Superscript>

This paper discusses aspects of ethical presence in psychoanalysis, and the possible use of apology in the therapeutic process. The author roughly delineates two periods in the history of psychoanalysis regarding the ethical dimension—the early classical period which is influenced by Freud’s ethics of honesty, which gradually evolves towards the more recent intersubjectively-influenced period, necessitating the assimilation of an ethics of relationships. It is suggested that explicit theorizing of the ethical dimension into psychoanalysis offers added value to its effectiveness, and a framework is presented for combining relational, intersubjectively informed ethical dialogue, with contributions of classical technique, enriching the therapeutic potential of psychoanalytic work.     

A training analysis for psychoanalytic psychotherapists

For historical reasons, psychoanalytic psychotherapy has been regarded as a second-class treatment in comparison with psychoanalysis, and standards for training in it have lagged behind those for psychoanalysis. However, psychoanalytic psychotherapy is the treatment of choice for many healthier (or higher-level) patients who cannot receive analysis for any reason, and also for a large population of more-disturbed patients who are not appropriate for psychoanalysis. Mastering techniques of psychoanalytic psychotherapy may be as difficult as mastering those of psychoanalysis, and should require comparable theoretical training, supervision, and personal treatment. This "development lag" in the training of psychoanalytic psychotherapists has taken place for several reasons: (1) Psychoanalytic ideas first emerged in America in the context of a new movement toward an electric, but dynamic psychiatry from which psychoanalysis had to establish its separate identity. (2) Psychotherapy was associated with techniques of suggestion and manipulation from which psychoanalysis wished to separate. (3) Because psychotherapy was seen as an inferior form of therapy which required little training, institutes were slow in being established, and reluctant to require a "training analysis." It is suggested that with the full training of psychoanalytic psychotherapists, this discipline may be regarded as a profession comparable to psychoanalysis. It is further suggested that the optimal treatment for the full training of the psychoanalytic psychotherapist is psychoanalysis, and that a "training psychotherapy" is not an adequate substitute, but may provide a transitional step to resolve initial resistances and to prepare the therapist for a training analysis.     

What's Possible? What Matters? Reply to Commentaries

The three discussants agree that a definition of psychoanalysis tied to session frequency is problematic and needs to change. Yet none supports my recommendation to redefine the practice of psychoanalysis in terms of the practitioner's training. This prompted me to look more closely at my proposal and push my thinking further. I argue that psychoanalysis, like many other professions, needs to define its practice as the application of its complex and evolving knowledge and skill base, grounded in its unique field of inquiry. Although there are individual exceptions, the inculcation of this knowledge and skill base is generally best accomplished through psychoanalytic training. This assertion, however, rests on the premise that our training curricula keep pace with our rapidly evolving field of inquiry and knowledge. To further clarify my vision I examine the nature of psychoanalytic expertise. I suggest that such expertise amounts to the inculcation and integration of a large number of psychoanalytic frames of reference. I contend further that the nature of contemporary psychoanalytic theories is such that important psychoanalytic frames of reference are proliferating more rapidly than in the past, that the relationships among them are becoming more complex, and that consequently the application of psychoanalytic theory to practice is also becoming more complex. Psychoanalytic training programs need to recognize this expanding complexity and revise curricula and pedagogic methods on an ongoing basis to reflect this evolution within our field.     

A mixed-model for psychoanalytic education*

Abstract

If psychoanalysis is to avoid total marginalization, something has to be changed in the way future generations are prepared for working with patients and doing research. Reformation of psychoanalytic education may easily be the crucial issue when it comes to the survival of psychoanalysis. Its current organizational scheme has been criticized for various reasons, and various models of its structure have been proposed. I advocate a model that would combine the best features of the university education (training in clinical skills together with philosophy of science and research methodology) with personal analysis as part of psychoanalytic institutes. Although universities can remedy some of the problems of psychoanalytic institutions, they cannot contain the subjective experience of being analyzed.     

Out of the consulting room and into the world: hermeneutic dialogue, phronesis, and psychoanalytic theory as practice

One of the relics of positivism has been an underappreciation of the moral and ethical dimensions of psychoanalytic theory and practice. In a positivist metapsychology, cure and therapeutic gain were often defined instrumentally, with relatively little consideration given to aspects of human experience (e.g., moral, cultural, spiritual) that did not fit within a positivist framework. Conceptual and paradigmatic shifts in psychoanalysis have occurred, in part, because of the inability of the classical model to provide a language that adequately captures deeply felt human values and beliefs. Aided by hermeneutic and postmodern influences, many contemporary psychoanalytic theories are beginning to focus greater attention on the notion that analytic therapy is empowered by a set of ethical convictions, beliefs, and commitments, which are tied to a certain understanding of the good life. Along these lines, the author argues that developing a fresh understanding of the moral and ethical dimensions of psychoanalysis requires elaborating a new ontology of human subjectivity and social life. The author offers a sketch of how this gargantuan task might be started by integrating psychoanalysis within a hermeneutic perspective on dialogue, by suggesting that it would be helpful to view psychoanalysis as promoting Aristotelian practical wisdom or phronesis, and by rethinking psychoanalytic theory and interpretation as a form of practice.     

Obsessive-Compulsive Disorder: Current Views

Obsessive-compulsive disorder has been of central interest to psychoanalysis since Freud's early papers, most particularly in the “Rat Man” case. This early literature spelled out with great clarity the presumed development, psychodynamics, and meaning of obsessional and compulsive symptoms. Unfortunately, since Anna Freud's 1969 review of the subject, virtually nothing has appeared in the psychoanalytic literature that has added to our understanding of the disorder or enhanced the very limited therapeutic influence of psychoanalysis in such cases. Meanwhile, there has been an avalanche of contributions from biological psychiatry and behavioral psychology that have propounded different theories of pathogenesis and have laid claim to significant therapeutic effectiveness. If psychoanalysis is to have credibility in this field, it will have to enlist itself in multidisciplinary research efforts directed toward enriching our knowledge about the psychodynamics and the biological substrate of this illness (more common than once believed) and the efficacy of our efforts to treat it.     

In the Name of Psychoanalysis: Persistent Controversies and Evolution in Psychoanalysis: A Review of Impossible Training: A Relational View of Psychoanalytic Education by Emanuel Berman

In his book Impossible Training, Emanuel Berman stresses the historical roots of current standards of psychoanalytic training and demonstrates the persistence of controversies that have been present in psychoanalysis and psychoanalytic training from their inception. This perspective, of psychoanalysis and psychoanalytic education as evolving, encourages candidates and practitioners to be participants and creative voices in an evolving field rather than rote followers learning a trade. The author proposes ways that the transference of educators to the younger generation of psychoanalysts can facilitate or interfere with the training of candidates. Berman is applauded for shedding light on current controversies in psychoanalytic education by showing their roots in historical controversies. However, the author points out Berman's tendency to overvalue his side of the controversy rather than embrace controversy itself as in the best interest of the evolution and development of the field.     

The French model of psychoanalytic training: Ethical conflicts1

Research on psychoanalytical education within the IPA may be clarified by reflecting on the ethic behind each of the three main models (Eitingonian, French and Uruguayan). In fact, the ethic underpinning psychoanalytical education, whatever the model, is confronted by irreducible conflicts between transmitting psychoanalysis by means of analytical experience or by means of academic teaching. Transmission by experience is essentially based on the ethic of psychoanalytic practice, which is difficult to regulate through institutional standards, whereas the academic aspect can be evaluated by objective and public criteria. The importance of both aspects and their relative weight in the training process depend on the conception of psychoanalysis underlying each model. This paper will look primarily at the French training model, the essentially analytical aspects of which favour the transmission of the very ethical foundations of psychoanalytic practice itself: the application of the method both as a working tool and as a tool of evaluation. It presupposes expanding the observation and analysis of transference beyond the framework of treatment to that of supervision. From this analysis, the paper will attempt to demonstrate how the French model proposes dealing with the inevitable conflicts between transmission by means of analysis and training by means of apprenticeship.