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.     

The facilitative interpersonal skills method: Difficult psychotherapy moments and appropriate therapist responsiveness

The Facilitative Interpersonal Skills (FIS) task is a performance test of therapists’ use of common relational skills (e.g. empathy, building expectations). The FIS method includes (a) materials that simulate difficult client moments on video, which are used to collect therapists’ responses to these situations; and (b) independent ratings of these responses. Many of the FIS items are informed by psychotherapy processes that have been linked to outcome and facilitative conditions that have been reframed as individual therapist skills (e.g. alliance bond capacity). Overall, the FIS has predicted psychotherapy outcome. A single study is described in which FIS predicted the therapist effect using multilevel modelling of a large sample of clients who were nested within therapists. We also summarise two additional outcome studies that used experimental designs. One future direction is to better understand how therapists form responses to these difficult moments. We conclude that forming an optimal therapeutic response during challenging, emergent in‐session situations involves responsiveness (Stiles et al., 1998), or finding a response that fits the clients’ needs within any moment.     

The development and content of an interpersonal psychotherapy group for postnatal depression

Postnatal depression (PND) usually causes distressing symptoms for sufferers and significant impairments in relationships. Group Interpersonal Psychotherapy (IPT-G) provides the experienced therapist with a brief, focused, and manualized approach to helping women recover from the debilitating effects of PND. This paper describes the background and development of IPT-G for PND. The evidence for the effectiveness of individual and group IPT formats with this population is summarized. The triad of theories underpinning IPT are discussed with an emphasis on the important role of attachment styles during the transition to parenthood. Its strengths, which include its unique package of targets, tactics, and techniques, are highlighted. The benefits and challenges of IPT-G are also explored, and the results of a randomized controlled trial are summarized. Finally, a case study illustrates how IPT-G specifically addresses the social role transitions, conflicts, losses, and social isolation that mothers commonly experience.     

The interpersonal circle as a heuristic model for interpersonal research

In this article, I review major advances in the development of the interpersonal circle and its measurement, as delineated by Timothy Leafy (1957) and his colleagues. In my early work (Lorr & McNair, 1963, 1965), an interpersonal Behavior Inventory consisting of manifest behavioral statements was constructed. The 14 categories were found to fit a circular order in several samples. Studies using LaForge and Suczek's (1955) Interpersonal Check List, and Wiggins's (1979) Interpersonal Adjective Scales further established the value of Leary's conceptions and extended them. Several major theorists, researchers, and clinicians including Benjamin, Carson, Horowitz, Kiesler, and Wiggins have been inspired by Leary and, in many cases, have extended his ideas in ways not originally envisioned. Recent research (e.g., Hofstee, de Raad, & Goldberg, 1992; Millon, 1987) demonstrated the pertinence of the interpersonal conception of personality to the 5-factor model and personality disorders.     

Auditive analysis (a new method in group psychotherapy research

The principle of auditive analysis is that the type and degree of different emotional states expressed in the voices of the mentally ill are analyzed as accurately as possible. Patients receiving group centred non-directive treatment were examined by this method and the results were compared with those obtained by sociometric tests. It was found that patients, and also psychotherapists, with high standards of auditive ability were accepted into the group and were popular, whereas persons with poor auditive ability were rejected by the group. Experiments with the same method in the GDR yielded the same results as in the USSR. The application of this method as a means of checking the success of training in group centres non-directive therapy is being considered.     

Mobilizing self through short-term dynamic interpersonal psychotherapy: a preliminary report

Background: The key features of short-term dynamic interpersonal psychotherapy (STDIP) are outlined along with the background of its development. Preliminary data demonstrating functional improvement in a small case series of patients is presented.

Methods: Nineteen patients were evaluated at commencement and end of therapy in a pilot study. Instruments used were the Childhood Trauma Questionnaire (CTQ); Beck Depression Inventory (BDI); Brief Symptom Inventory (BSI); COPE (Coping Style Questionnaire); Relationship Styles Questionnaire (RSQ) and Social Adjustment Scale-Self Report (SAS-SR).

Results: This cohort had significantly elevated scores on the CTQ. They demonstrated substantial improvement on measures including the BDI, and several subscales of BSI, COPE, RSQ and SAS-SR.

Conclusions: The small numbers and naturalistic design preclude firm conclusions however the results suggest that STDIP can be used to successfully treat patients, notwithstanding a history of childhood trauma.     

Relational measures in psychotherapy research on process and outcome: a commentary on the studies

Using Benjamin's (2000) Structural Analysis of Social Behavior, we evaluated change in "self-directed" affiliation and autonomy and prediction of treatment response and relapse/recurrence among adult outpatients with recurrent major depressive disorder consenting to acute phase cognitive therapy (A-CT; Beck, Rush, Shaw, & Emery, 1979; N=156); A-CT responders randomized (N=84) to 8 months of continuation phase cognitive therapy (C-CT; Jarrett, 1989; Jarrett et al., 1998; Jarrett & Kraft, 1997) or assessment-only control; and C-CT and control patients entering a 16-month, assessment-only follow-up (N=74). Self-directed affiliation and autonomy increased after A-CT, and C-CT further increased affiliation and autonomy. Affiliation and autonomy did not predict A-CT response, but lower affiliation and higher autonomy pre-A-CT predicted relapse/recurrence post-A-CT. We discuss potential clinical implications of these results and present case examples to illustrate patterns of change.     

Sudden gains in interpersonal psychotherapy for depression

Sudden, precipitous improvements in depressive symptom severity have been identified as occurring among unipolar depressed individuals. These "sudden gains" have been associated with superior acute treatment outcome in several treatment modalities, including cognitive therapy. A better understanding of sudden gains may provide insight into the mechanisms of action in these and other psychotherapies. One efficacious therapy that has been overlooked in sudden gains research is interpersonal psychotherapy (IPT; Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2000). Comprehensive guide to interpersonal psychotherapy. New York: Basic Books). The present research examined the rates and concomitant features of sudden, precipitous improvements in depressive symptomotology among 185 women receiving IPT for recurrent depression. Sudden gains, defined using extant criteria for the Beck Depression Inventory, were assessed over 12 weeks of acute IPT treatment for depression and occurred for 33.5% of the sample. Sudden gains were not associated with diagnostic and demographic characteristics or with differential likelihood of achieving depression remission with IPT monotherapy during active treatment. Further, those with sudden gains were no more likely to maintain their recovery through maintenance treatment. The lack of impact of sudden gains on eventual outcome is discussed in terms of potentially disparate emphases and mechanisms of change between IPT and cognitive-behavioral therapy (CBT).     

Online data collection for psychotherapy process research.

A preliminary investigation addressed the feasibility of using a specially designed online database to collect psychotherapy session impact and therapist-client alliance data and compared these online measures to published results of their paper-and-pencil counterparts. Participants drawn from a psychology department clinic, a student counseling center, and community agencies visited an online site to report on each of their sessions. Some clients and therapists visited the online database on a regular basis; however, client recruitment and participation was problematic. Equivalence between the online and paper-and-pencil forms was supported, with minor qualifications, by comparable distributions of participant responses on the measures' scales. More direct contact with clients might increase their participation.     

The learning process in combined psychotherapy

The American Journal of Psychoanalysis -     

Questionnaire for recording interpersonal value judgments in group psychotherapy

Interpersonal estimation is a factor that is of importance to both the patient-therapeut relationship and the climate prevailing within the psychotherapy group. This contribution describes a questionnaire which permits interpersonal estimations in group psychotherapy to be expressed numerically. It enables identification of differences between the estimations given by different patients and also the patient's reception of other patient's estimations of himself. The questionnaire is used for weekly measurements of changes in connection with the diagnostic work accompanying group psychotherapy for neurotic maldevelopments.     

A process research approach to the development of method in group dream work

This paper describes the development of a procedure for group work that is purely oriented toward the interpretation of dreams. Whereas other group dream work methods have tended to be unsystematic or atheoretical, the present method is operationalized in clearly defined steps and is derived from the analytical psychology of Jung. In an ongoing research process, procedural refinements have been indicated, and a step that focuses on the affective component of the dream has been incorporated. The therapeutic advantages of the new additions to the method are described. Generally the research indicates that the method is therapeutically beneficial and is not prone to deleterious effects. This paper demonstrates the value of a process research approach to the development of method in group dream work.A version of this paper was presented at the 25th International Congress of Psychology, Brussels, July 1992. Preparation of this article was assisted by a Rhodes University research grant.