Supportive psychoanalytic psychotherapy for borderline patients: an empirical approach

The author describes a reformulation for research purposes of a supportive psychoanalytic therapy for patients with borderline personality disorder. The major influences on the thinking that led to the modification of prior formulations and the historical background of treatment manuals are described. Supportive treatment is contrasted with transference-focused psychotherapy and dialectic behavior therapy in the interest of creating a clear comparison that lends itself to empirical study.     

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.     

‘Shh … quiet! Here they come.’ Black employees as targets of office gossip

This study explored black employees’ experiences of racial profiling by their white peers through the medium of gossip at a historically white, South African university. Participants consisted of 24 black employees (males = 50%, females = 50%; support staff = 50%, academic staff = 50%). The employees completed a semi-structured interview that elicited their perceptions of the settings in which gossip about black employees occurred, the perceived intentions of such gossip, and their responses to it. The data obtained was thematically analysed. Findings suggested that the gossip targeted black employees who were absent from meetings, and that such gossip undermined the work performance and morale of these employees.     

Is three a crowd? A perspective on countertransference challenges in psychoanalytic couple psychotherapy

Two seemingly unrelated characteristics of psychoanalytic couple psychotherapy may be better understood when juxtaposed. First, countertransference in psychoanalytic couple psychotherapy holds particularly strong intensity. Second, format decisions are central to couple psychotherapy. The use of conjoint and concurrent formats, or variations thereof, has been key in the historical development of couple psychotherapy and remains an area of much debate. Some couple psychotherapists use the format of couple psychotherapy flexibly, using variations of conjoint or concurrent couple psychotherapy, while others adhere strictly to working conjointly. Decisions regarding whether to undertake concurrent or conjoint therapy are not generally linked to countertransference; this article demonstrates that reading decisions regarding format through consideration of countertransference offers a needed perspective for the therapist. Case studies published by psychoanalytic couple therapists are analysed through this prism to demonstrate that changing the format may serve to dilute countertransference. One particular manifestation of countertransference, linked to oedipal dynamics, is explored: countertransferential intensity for couple psychotherapists potentially relates to being faced with their internal parental couple and their unresolved Oedipal strivings. Possible unconscious motivations to change the format of couple psychotherapy need to be carefully considered, as format changes may mask an avoidance of bearing the countertransference.     

WHITE URBAN IMMERSION,INTERSUBJECTIVITY, AND AN ETHICS OF CARE IN SOUTH AFRICA

The past decades have seen a rise in religious and secular responses to inequality that seek to offer those who are relatively wealthy an opportunity to personally engage with impoverished people and places. This article examines three cases of elite white South Africans who intentionally immersed themselves in poor urban environments. In dialogue with the anthropology of ethics, I argue that immersion was seen as an experimental tool for transforming the self and cultivating virtues of empathy and responsibility towards others. In this way, immersion acted as a technology of the self, linking care of the self to care of others. Yet such experimentation was not without risk. Though imagined as a tool that could promote care of the self and care of others, immersion carries with it the potential to reinforce power divides and/or solicit negative moral judgment.     

‘The essay method’ a qualitative method for studying therapeutic dialogues

ABSTRACT

This paper presents a qualitative research method for analysing therapeutic dialogues called ‘the essay method’. A central part of the method uses the format of the literary essay as a model. The method consists of a close monitoring of clinical material guided by an overall psychoanalytic/psychodynamic theoretical frame. It combines both clinical details and global patterns of clinical material and is especially fitted for studying relational qualities of psychotherapeutic dialogues. In this paper, the background for qualitative analysis in studying psychoanalytic material is discussed, and the procedures for using the method are demonstrated. A study of therapeutic competence in a group of student therapists is used as an example of the method in practice, demonstrating that the essay method may have potential for revising theory and establishing new concepts based on empirical findings. The essay method is compared with other qualitative methods, and it is argued that it is suitable for psychoanalytic research.     

Report on ‘A conversation about unintegration,disintegration and integration’ with papers by Anne Alvarez and Edna O'Shaughnessy,chaired by Margot Waddell, 25 february 2005 1

This paper attempts to explore the nature and consequences of trauma in infancy by an exploration of a prototype of trauma when babies are born addicted to heroin. The trauma not only involves a painful withdrawal from the drug and invasive medical procedures carried out in isolation in a special care baby unit, but often also an ongoing cumulative trauma of the lack of availability of a receptive containing parent. The paper raises specific issues about these babies as well as about trauma in general. It examines current psychoanalytic, attachment and other theories about trauma and resilience, and includes an infant observation of a baby in a special care baby unit who was born addicted. A detailed case is presented, illustrated by sequences of drawings by an 11-year-old boy who had been born addicted. These show how the lack of containment of any sort in infancy had profound effects on the child's ability to process his emotional experience in any meaningful way. An attempt is made to evaluate the effectiveness of the psychotherapy using criteria derived from Mary Main's work on disordered/chaotic infants. This involves a shift from disintegration and a lack of resolution of any crisis towards the emergence of the possibility of a hopeful outcome.     

Parent‐infant‐psychotherapy and psychoanalytic treatment: contradiction or mutual inspiration?

Psychoanalysis and parent‐infant‐psychotherapy are compared. Although parent‐infant‐psychotherapy developed from psychoanalysis, it appears at first glance not to be “analytic” with its aim of dealing quickly with the symptoms presented and also with its different setting. The author shows that an analytic approach in understanding the multi‐facetted net of relationships between family members and the infant in its “phantasmic interaction” and a consideration of the implication for analysis of the empirical research carried out in conjunction with parent‐infant‐therapy can lead to a fruitful exchange of ideas. One example of this is research into the correlation between attachment patterns and the processing of conflicts. Furthermore a dialogue between these two disciplines can remind psychoanalysts that a critical discussion of the external circumstances of their methods does not immediately call into question their fundamental approach to therapy: the work in transference on relationship fantasies.