The analytic process in psychoanalysis and psychotherapy: from the interpersonal to the intrapsychic level

The current debate over the conflicting interpersonal and intrapsychic views of the analytic process may or may not help us to distinguish between psychoanalysis and analytic psychotherapy. A comparison of psychoanalysis in the English-speaking world--especially in the United States--with French psychoanalysis reveals the features that unite and at the same time divide these different psychoanalytical tendencies, both of which are the heirs to Freud's thought, in terms, in particular, of the setting (couch and chair) and of technique (interpretation, transference analysis and technical neutrality). Whereas all psychoanalytic work belongs within the framework of an interpersonal relationship, that relationship becomes meaningful only when linked to the intrapsychic dimension, which alone can open the way to the unconscious and to infantile sexuality.     

An overview of the treatment of severe narcissistic pathology

This paper provides an overview of narcissistic personality disorders as they present clinically along a spectrum of severity ranging from the best functioning forms of pathological narcissism to the most threatening to the patient's psychosocial and physical survival. It proposes a general interpretive psychoanalytic stance with all these clinical syndromes that range from standard psychoanalysis to a specific psychoanalytical psychotherapy for the most repressive and life threatening conditions that may not respond to standard psychoanalysis proper. This general psychoanalytic approach is placed into the context of related developments in contemporary psychoanalytic understanding of pathological narcissism and its treatment.     

Evidence-based medicine,psychoanalysis and psychotherapy

SUMMARY

The scientific status of psychoanalysis is a matter of importance to both theorists and clinicians in psychiatry. The empirical evidence for both the theory and the practice of psychodynamic practice is much greater than is generally recognised. There is strong evidence for the effectiveness of psychoanalysis and psychoanalytically oriented therapy. the future of psychoanalysis depends on this evidence. We will discuss both the evidence and reasons why it is overlooked in certain quarters, and review the developing neuro-cognitive understanding of the mechanisms that underlie psychoanalytical processes.     

Psychoanalyse und Psychotherapie, Bildung und Erziehung

Psychotherapy and psychoanalysis form a contrast – in particular in German-speaking countries – comparable to that between education and “Bildung”: psychotherapy and education intentionally and purposefully influence the patient or pupil whereas psychoanalysis and “Bildung” pursue the ideal of a development process which is to a great extent free from outside influences. The present paper aims to show that these seemingly contrasting pairs have been artificially differentiated into extremes. Both are supposed to solve the following paradoxes: the educational paradox “How is freedom possible under constraint?” and the psychoanalytical paradox “How is independence possible under dependency?” It might, however, be possible to overcome the unfruitful contrast in both cases and to keep the feared paradox in abeyance.     

Encounters with the Universal and Cultural in Psychoanalytic Psychotherapy

The role played by socio-cultural factors in psychoanalytic psychotherapy from the vantage point of both the client and the therapist is elucidated. The position conferred upon culture throughout the history of psychoanalysis from classical to contemporary perspectives is briefly reviewed with special reference to the practice of psychoanalysis in India. A case study having relevance to the present theme is discussed where ignorance of factors salient to Indian culture adversely affected the outcome. Attention is given to internal and external pressures that prompted the therapist to take the stand. It is argued that the therapist may tread the difficult path between cultural universalism and cultural relativism rather than committing to either of them in order to do justice to psychoanalytical clinical work.     

Self-analysis and post-termination improvement after psychoanalysis and long-term psychotherapy

Long-term follow-up studies of long-term psychoanalytically oriented psychotherapy or psychoanalysis are extremely rare, and few have focused on the post-treatment process itself. In the Stockholm Outcome of Psychoanalysis and Psychotherapy project, one of the results was that patients in psychoanalysis continued to improve after termination to a higher degree than patients in long-term psychotherapy. In this study 20 patients selected from the project were interviewed on two occasions, one and two years after termination, in order to explore how they described their post-treatment processes. The interviews were studied qualitatively using a multiple case study design, and categories of different types of post-treatment development were created from these case studies. Results indicate that the variation within treatment groups is large, and that development may continue in several ways after termination. The most striking difference between psychoanalysis and psychotherapy was not, as hypothesized, in the self-analytic function, but in various self-supporting strategies described by former analysands but not by former psychotherapy patients. However, only self-analysis was significantly correlated with post-termination improvement across both treatments. Three patients improving after termination and three deteriorating are described in detail as illustrations. Some methodological constraints of the design limit the generalizeability of results.     

New interpretative styles: Progress or contamination? Psychoanalysis and phenomenological psychopathology1

Psychoanalysis has started to recoup, often quite implicitly, a more phenomenological stance, ever since psychoanalysts have started working with borderline and psychotic patients. As many of these patients have commonly been through traumatic experiences, psychoanalysts have been using an approach that questions the role of traditional psychoanalytical interpretation and pays more attention to the patient's inner conscious experiences; this approach is characteristic of a specifi c form of contemporary psychiatry: phenomenological psychopathology, founded by Karl Jaspers in 1913 and developed into a form of psychotherapy by Ludwig Binswanger, with his Daseinsanalyse. If what we could call a phenomenological ‘temptation’ has been spreading over psychoanalysis, so too has a psychoanalytical ‘temptation’ always been present in phenomenological psychopathology. In fact, even though this branch of psychiatry has led us towards a deeper understanding of the characteristics of psychotic being‐in‐the‐world, its therapeutic applications have never been adequately formalised, much less have they evolved into a specifi c technique or a structured psychotherapeutic approach. Likewise, phenomenological psychotherapy has always held an anaclitic attitude towards psychoanalysis, accepting its procedures but refusing its theoretical basis because it is too close to that of the objectifying natural sciences. Psychoanalytic ‘temptation’ and phenomenological ‘temptation’ can thus be considered as two sides of the same coin and outline a trend in psychoanalytic and phenomenological literature which points out the fundamental role of the patient's inner conscious experiences in the treatment of borderline and psychotic patients.     

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.     

Die Verantwortung der Psychoanalyse für die Psychotherapie

Whether psychoanalysis can take over the responsibility for psychotherapy when it is not operating as a part of psychoanalysis but on its own is a question which has currently become significant again. The present paper gives an affirmative answer, but under certain limiting conditions only. Psychoanalysis can take responsibility for psychotherapy. It can base this on the fact that the definition of “depth psychological psychotherapy” binds psychotherapy—as it is usually called—to psychoanalysis. How this is possible in practice is determined during the training. The training at the Michael-Balint-Institute in Hamburg is presented which partly occurs jointly and partly separately, in this way representing the reality of the two separate fields linked to each other and yet independent. The common ground is constituted by the basic principles of psychoanalysis. As an example of this common ground, the seminar on the technique of diagnosis and treatment, which is part of the early curriculum, is discussed in detail. Later on in the training, the two curricula separate more and more, each taking over its own responsibility. Not only questions of the contents but also formal aspects have to be considered. There are good reasons for establishing an independent Institute for Psychotherapy which runs the necessary arrangements together with the Institute for Psychoanalysis, from which it derives, and also remains close to the latter. Finally, it is pointed out that all of this is only possible when respecting each other’s work. Independent psychotherapy is not less valuable than psychoanalysis, but simply something else.     

'This is not psychoanalysis': On the stony way of the Danish Psychoanalytical Society

When Freud founded the International Psychoanalytical Association (IPA), he wanted a network of local groups responsible for psychoanalytic training. The groups would function as ‘headquarters whose business it would be to declare: All this nonsense is nothing to do with analysis; this is not psychoanalysis. Today, with psychoanalytic pluralism, Tuckett (in press) has asked ‘Does anything go? He has pointed out that the psychoanalytic community has been increasingly willing to accept within its ranks apparently very varied approaches to theory and practice, and that this increasing diversity has many negative consequences for psychoanalytic institutions and especially for training schemas. The aim of this paper is to give an example of psychoanalysis that ‘did not go’, and how that led to a shaky start for the new Danish Psychoanalytical Society, with confusing boundary relations between psychoanalysis and psychotherapy and no training institute. Beginning with the written psychoanalytical contribution of the three founders of the Danish Society, the paper will try to identify factors that contributed to the ‘shaky start’. The paper will also examine how stones were removed from the path, thus paving the way for the members of the Society to discover ‘competent psychoanalysis’.     

Notes for a Definition of the Concept of Psychoanalytical Epistemology

The first part of the article describes the epistemic ambiguities that psychoanalysis has generated through both a sometimes unstructured information. Accordingly, a historically out-moded 'scientist' model has erroneously been taken as valid and scientific. The second part illustrates the extent to which predominant psychoanalytical currents now share common ground with epistemology and the cognate sciences, breaking out of the epistemic solipsism which for too long led psycholanalysis to believe it could be self-referential. This critical examination of old and new ground is thus an analysis of the referents on which psychoanalysis has based its theoretical postulates. It is desirable that this analysis be extended to include the whole discipline of psychoanalytical research, thereby becoming a mental given for the psychoanalyst, not least on account of the enormous benefit of epistemic reflexion on the adoption of the instruments of knowledge. Over the last few years this development has allowed psychoanalytical theory to be considered on a par with the results of philosophy and the philosophy of science, thereby ending the false and anti-scientific aristocracy of thought which made psychoanalysis a prisoner of itself for almost a century. approach and a lack of updated epistemological     

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.     

Psychoanalysis in Austria after 1933-34

Our essay focuses on major developments of the history of psychoanalysis during the fascist and National Socialist years in Austria and sheds light on the re-establishment of psychoanalysis after World War II. With the consolidation of National Socialism in Germany in 1933 and Austro-fascism in 1934, any psychoanalytical reflection that was critical of political and cultural trends was extinguished. Vienna - once again - became the center of the psychoanalytical movement in Central Europe, taking over the role Berlin had played during the twenties. But, during the Austro-fascist system, psychoanalysis was isolated from an important part of its public. Psychoanalysts reacted by adopting an attitude of political abstinence, accompanied by self-censorship, they concentrated on training and clinical work, or they went into exile. Austria's Anschluß to the National Socialist Third Reich led to the final destruction of psychoanalysis. Nearly all Viennese analysts were affected by the anti-Jewish measures of the National Socialists and almost all of them fled the country. During the war years, a small group of people under the leadership of August Aichhorn tried to continue psychoanalytic training. Its members refounded the Viennese Psychoanalytical Society in early 1946. But, scientific traditions were broken and tendencies of anti-enlightenment, especially clerical and catholic prejudices, had continued from the time of Austrofascism and Nationalsocialism. The last chapter of our essay summarizes the research topics and the main historiographical studies done in the field.     

Recent theoretical convergences in psychoanalysis and their epistemological importance

In this paper, the author starts by examining the recent occurrence of an increasing receptivity and critical exchange between different schools of psychoanalytical thought. Among its consequences have been convergences in the understanding of countertransference, especially through the hypotheses of projective identification and countertransferential enactment. The prevalence of these hypotheses points towards the fact that the community of analysts is bringing about an informal and convergent clinical research conducted by a wide and heterogeneous range of its members. The importance and epistemological relevance of this kind of 'informal clinical research' for the construction of psychoanalytical knowledge is emphasised. This process in psychoanalysis is compared with the evolution of knowledge in other scientific areas, highlighting their similarities and their differences. The author shows how Freud's 'mystic writing-pad'model can be expanded to represent the object of psychoanalytical investigation and to bring a better understanding of the reason why the hypotheses of projective identification and countertransferential enactment occupy such a central position in psychoanalysis. In addition, consideration is given to how this kind of research can help in the difficult task of finding criteria for the evaluation of different psychoanalytical concepts. Finally, the author demonstrates how, using this approach, some of the important divergences in contemporary psychoanalysis can be viewed from a new perspective.     

Problems in contemporary psychoanalytic theory: II. Lines of advance

In the theoretical development to come in psychoanalysis, an "inclusive" strategy is recommended, allowing for conflicting points of view to exist side by side waiting for a new integrating theory to emerge. Until such a theory is at hand, the term "psychoanalysis" will remain a rather loose heading for several psychoanalytic subcultures. It is argued, both clinically and theoretically, in favour of giving the organizing function of the ego a central position in the forthcoming theory. Some consequences of this "organizational" point of view are discussed in relation to: ( a ) diagnostic classification, ( b ) the distinction between psychoanalysis and psychoanalytically oriented psychotherapy, and (c) the theoretical language of psychoanalysis. In conclusion som requirements for a future theory of psychoanalysis are proposed.     

Sollen Psychoanalytiker Psychotherapeuten ausbilden?

With respect to the radical changes in psychotherapeutic education as a consequence of the Law for Psychotherapy that has been put into force, the author elaborates on political, medical and strategic aspects. It is of special interest whether psychoanalysts having had the “monopoly” of training in depth psychological therapy should further take responsibility for the training in and the development of this method. Meanwhile, other therapeutic schools are claiming depth psychological psychotherapy for themselves and they deny the essential role of psychoanalysis as a foundation of it. In addition, the psychoanalytic institutes themselves do not agree on this issue. A further aspect of the question is that of marketing strategies: in order to survive, it is for psychoanalytic institutes at a time of lessening interest in standard psychoanalytic training important to offer training in depth psychological therapy with its comparatively less expensive and less extensive curriculum. But the essential question remains: should psychoanalysts train psychotherapists and take responsibility for an independent depth psychological therapy, or not? The author calls for a separate profound education in depth psychology taught by psychoanalysts in order to maintain a positive atmosphere for psychoanalysis e.g. in clinical institutions. He agrees with the IPV that this would help to solve “the crisis of the psycho analysis”. Finally, some of the most important, unsolved questions referring to a separate and profound education in depth psychology are presented and possible solutions are offered. It is of crucial importance to take up again the discussion within the psychoanalytical associations and to adjust their medical as well as political attitude to the new ways depth psychology is taught at psychoanalytical institutes.     

Der Weg der Psychoanalyse nach Japan

The establishment of psychoanalysis in Japan was a consequence of opening the country to the influence of the western world by the Meiji restitution of 1868. Thus western psychological thought was also spread to Japan. On this basis, psychoanalysis developed through personal contacts and experiences of individuals and infiltrated into intellectual circles and finally into psychiatry. The establishment of two psychoanalytical societies, one for analysts and one where also lay people had access led to a specific and unique organizational structure. The ??Japanese way?? of psychoanalysis is on the one hand characterized by the confrontation with Buddhism and on the other by specific applications which reflect a certain reserve in the Japanese society to the ??standard procedure?? of psychoanalytic therapy. In this way psychoanalysis in Japan implants a diversity into the international discourse which opposes the current trend towards general homogenization.     

WORKING WITH RELIGION: OFTEN NEGLECTED ASPECTS OF TRANSFERENCE AND COUNTERTRANSFERENCE

The author contends that psychoanalytic theory has generally presented religious beliefs as developmentally immature or pathological. This viewpoint has resulted in a neglect of religion on the part of psychoanalysts and an avoidance of their religious life by patients. Even though there has been an evolution from the traditional Freudian foundational approach to religion as an “illusion” to the inclusion of psychoanalytical training within some Christian institutes and attributions that psychoanalysis, itself, is a religion, religious beliefs should be included in psychotherapy because they can become involved in transference and countertransference issues in ways that are ignored if religious issues are not discussed in therapy. The author presents clinical material to illustrate this problem.

     

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.     

The development of therapeutic attitudes during and after psychotherapy training

The aim of this study was to explore changes in psychotherapeutic attitudes of students during training in psychodynamic psychotherapy and the first few years after it. Forty-six students were asked to answer a therapeutic identity questionnaire at three times during training and at one time after it. Twenty-one students completed the questionnaire on all four occasions. The questionnaire assessed attitudes on nine scales relating to beliefs about curative elements in psychotherapy, therapeutic style, and basic assumptions about psychotherapy and human nature. At the beginning of training, students had a clear psychoanalytical orientation, similar to that of their supervisors. From the last year of training, after supervision had ended, and continuing during the post-training period, students distanced themselves from the psychoanalytical orientation and their supervisors toward a more eclectic position. This development may reflect the formation of an autonomous therapeutic identity.