How to study the ‘quality of psychoanalytic treatments’ and their long‐term effects on patients' well‐being: A representative,multi‐perspective follow‐up study3

How can we study the ‘quality of psychoanalytic treatments’? The authors attempt to answer this question by discussing a naturalistic, multi‐perspective and representative follow‐up study of psychoanalyses and long‐term psychoanalytic psychotherapies. We studied a representative sample (n = 401) of all the patients who had terminated their psychoanalytic treatments with members of the German Psychoanalytical Association (DPV) between 1990 and 1993. Between 70 and 80 per cent of the patients achieved (average 6.5 years after the end of treatment) good and stable psychic changes according to the evaluations of the patients themselves, their analysts, independent psychoanalytic and non‐psychoanalytic experts, and questionnaires commonly applied in psychotherapy research. The evaluation of mental health costs showed a cost reduction through fewer days of sick leave during the seven years following the end of long‐term psychoanalytic treatments. The results achieved using non‐psychoanalytical instruments are complemented by the richness of the idiosyncratic findings, gained by the psychoanalytic research instruments.     

The research couple: a psychoanalytic perspective on dilemmas in the qualitative research interview

The relational, collaborative values of the qualitative research paradigm frequently require us to consider sharing the ongoing analysis of data with our research participants for comment and feedback. However, qualitative researchers may experience some tension between balancing participants' narrative accounts with their own analytic perspective and use of psychological theory. In using a psychoanalytic framework to explore this predicament, this paper adopts the notion of the ‘research couple', analogous to the psychotherapeutic ‘analytic couple', to consider possible oedipal dynamics within the qualitative research interview. The paper explores some of the emotional and ethical tensions in analysing and presenting research results and briefly discusses some implications for research training.     

Developmental changes in neural letter‐selectivity: A 1‐year follow‐up of beginning readers

The developmental course of neural tuning to visual letter strings is unclear. Here we tested 39 children longitudinally, at the beginning of grade 1 (6.45 ± 0.33 years old) and 1 year after, with fast periodic visual stimulation in electroencephalography to assess the evolution of selective neural responses to letter strings and their relationship with emerging reading abilities. At both grades, frequency‐tagged letter strings were discriminated from pseudofont strings (i.e. letter‐selectivity) over the left occipito‐temporal cortex, with effects observed at the individual level in 62% of children. However, visual words were not discriminated from pseudowords (lexical access) at either grade. Following 1 year of schooling, letter‐selective responses showed a specific increase in amplitude, a more complex pattern of harmonics, and were located more anteriorly over the left occipito‐temporal cortex. Remarkably, at both grades, neural responses were highly significant at the individual level and correlated with individual reading scores. The amplitude increase in letter‐selective responses between grades was not found for discrimination responses of familiar keyboard symbols from pseudosymbols, and was not related to a general increase in visual stimulation responses. These findings demonstrate a rapid onset of left hemispheric letter selectivity, with 1 year of reading instruction resulting in increased emerging reading abilities and a clear quantitative and qualitative evolution within left hemispheric neural circuits for reading.     

The goals of psychoanalytic treatment: Conceptual considerations and follow‐up interview evaluation with a former analysand1

There has been a long, ongoing discussion of goals in psychoanalytic treatment. Some analysts are even of the opinion that psychoanalysis ought to be goalless (‘just analysing’). The growing number of outcome studies, however, is in need of a generally accepted set of criteria by which treatment results can be judged. The author proposes a definition of the goals of psychoanalysis that covers four areas: the alleviation of symptoms and complaints, changes in life adjustment, changes in personality structure, and procedural goals such as the resolution of the transference neurosis. She illustrates the relevance of this conceptualization by an empirical study that considers the assessments of 19 psychoanalysts discussing statements made by a former patient about her analytic treatment. On the basis of this case, which comes from the follow‐up study of the DPV (German Psychoanalytical Society), reported by Leuzinger‐Bohleber et al. in 2002, the author demonstrates that psychoanalysts use the criteria defined above implicitly in forming their opinions. Moreover, they arrived at similar judgements regarding the treatment's outcome.     

Relational‐Cultural Theory: Fostering the Growth of a Paradigm Through Empirical Research

This study identified empirical literature supporting relational‐cultural theory (RCT) for explaining experiences of individuals, assessing theoretical constructs, and providing an effective treatment option. A systematic review of available literature revealed that (a) RCT was a useful framework for understanding client experiences, (b) there is considerable support for the psychometric validation of RCT constructs, and (c) support for RCT interventions is currently limited. Limitations of studies reviewed, recommendations for future research, and implications for counselors are provided.     

Job‐seeking,adaptation and re‐employment experiences of the unemployed: a 3‐year follow‐up

The aim was to find predictors of employment status (Employed, Active Job‐Seeker, Not a Job‐Seeker) with a 3‐year longitudinal design. Also predictors of the quality of re‐employment were studied. Initially unemployed Finnish men and women were followed‐up. Of the original sample (n=559), 318 (56.9%) responded to the questionnaire. Baseline health and participation in labour market interventions were not predictive of employment status. Passive baseline job‐seeking and female gender were predictive of being a passive job‐seeker 3 years later. Good vocational education was central for high‐quality re‐employment. Long duration of unemployment and high baseline level of psychological distress were predictive of a perceived need for adjustment in the new job. Copyright © 1999 John Wiley & Sons, Ltd.     

Changes in disengagement coping mediate changes in affect following mindfulness‐based cognitive therapy in a non‐clinical sample

Past research has shown that mindfulness‐based interventions increase positive affect in non‐clinical populations. However, the mechanisms underlying this increase are poorly understood. On the basis of previous empirical and theoretical accounts, we hypothesized that a decreased use of disengagement coping strategies in daily life would explain the benefits of a mindfulness‐based intervention in terms of increased positive affect. We analysed the data of 75 healthy adult participants (58 women; 17 men) of different ages (M = 49 years old; SD = 13; age range 19–81) who had been randomly allocated to 8‐week Mindfulness‐Based Cognitive Therapy (MBCT) or to a waitlist control group. The results confirmed our hypothesis: Participants in the MBCT group showed significant improvements in positive affect compared to the control group, with decreased use of disengagement coping styles mediating these improvements. The implications of this study are discussed.     

Telling stories to communicate the value of the pre‐employment structured job interview

In an effort to bridge the scientist–practitioner gap in the employee selection, some researchers have advocated telling stories to better communicate the value of evidence‐based hiring practices to human resource (HR) professionals. In this paper, we conducted two experiments that examine the efficacy of storytelling for overcoming managers’ resistance to use structured job interviews. In two experiments, we found that participants who read a story regarding the effectiveness of structured interviews, as opposed to receiving evidence‐based advice, reported more favorable attitudes toward structured job interviews. Serial mediation analysis revealed that the observed attitude change was mediated by an increase in narrative transportation and reduction in counterarguing. Implications for using stories in communicating the value of evidence‐based HR practices are discussed.     

Identification from CCTV: Assessing police super‐recogniser ability to spot faces in a crowd and susceptibility to change blindness

Police worldwide regularly review closed‐circuit television (CCTV) evidence in investigations. This research found that London police experts who work in a full‐time “Super‐Recogniser Unit” and front line police identifiers regularly making suspect identifications from CCTV possessed superior unfamiliar face recognition ability and, with higher levels of confidence, outperformed controls at locating actors in a bespoke Spot the Face in a Crowd Test. Police were also less susceptible to change blindness errors and possessed higher levels of conscientiousness and lower levels of neuroticism and openness. Controls who took part in Spot the Face in a Crowd Test actor familiarisation training outperformed untrained controls, suggesting this exercise might enhance identification of persons of interest in real investigations. This research supports an accumulating body of evidence demonstrating that international police forces may benefit from deploying officers with superior face recognition ability to roles such as CCTV review, as these officers may be the most likely to identify persons of interest.     

Five‐year outcomes of ADHD diagnosed in adulthood

There is a dearth of long‐term follow‐up studies of adults diagnosed with ADHD. Here, the aim was to evaluate long‐term outcomes in a group of ADHD patients diagnosed in adulthood and receiving routine psychiatric health care. Adults diagnosed with any type of ADHD (n = 52) and healthy controls (n = 73) were assessed at baseline and at a 5‐year follow‐up, using Global Assessment of Functioning (GAF), Clinical Global Impression (CGI), Brown ADD Scale (BADDS) and Adult ADHD Self‐Report Scale (ASRS). A multivariate regression method was used to identify factors predicting 5‐year outcomes, including baseline ratings, medication intensity, comorbidity, intelligence quotient (IQ), age, and sex. After 5 years, ADHD patients reported fewer and/or less severe symptoms compared to baseline, but remained at clinically significant symptom levels and with functional deficits. Baseline self‐reports of ADHD symptoms predicted their own 5‐year outcome and low baseline functioning level predicted improved global functioning at follow‐up. Factors previously reported to predict short‐term outcomes (i.e., medication, comorbidity, IQ, age, and sex) did not anticipate long‐term outcomes in present study.     

Subjective well‐being in times of social change: Congruence of control strategies and perceived control

This paper investigates the association between perceptions of broader changes in the social‐ecological context and individuals’ subjective well‐being (SWB). Macro‐level societal changes such as globalization or demographic change give rise to new demands for individual functioning at work and/or in the family. Such new demands associated with social change are stressful and likely to be related to lower levels of SWB. Being active agents, individuals attempt to deal with social change and its increasing demands to protect their SWB. The present study investigates which kinds of control strategies are most effective in protecting one's SWB. Specifically, we predicted that control strategies of goal engagement will be most effective under conditions of perceived high control, and control strategies of goal disengagement will be most effective under conditions of perceived low control. In a large sample of 2537 German adults, work‐ and family‐related demands associated with social change were found to be negatively linked to SWB. Moreover and in line with the motivational theory of lifespan development, control strategies of goal engagement and disengagement were beneficial for SWB to the extent that they matched the perceived control of the demands associated with social change.     

The fieldwork model: An anthropological perspective on the process of change in long-term psychoanalytic psychotherapy

The question of what takes place in the psychoanalytic consulting room, and whether it has any therapeutic effect on the patient, has consistently been behind various criticisms of the long-term psychoanalytically informed therapies. When it comes to goal-oriented talking therapies –the only ones favoured by the state mechanism – statistical proof of their efficacy is thought of as proof of their scientific value. However, disciplines such as social anthropology have consistently based their complex understanding of social phenomena in qualitative data. This article draws upon the anthropological fieldwork model. It also looks at how anthropological theory has evolved as a result of the increasing centrality of the fieldwork model and a gradual acceptance of the inter-subjective process. It aims to highlight how lived experience, the paradigm on which the fieldwork model is based, constitutes a highly effective way of understanding in depth the patient and the patient's history. Such understanding is in turn the main factor behind profound and lasting psychological change. It is argued here that psychotherapy research and practice could be enhanced by following the example of anthropological qualitative research.     

Perception of line‐up suggestiveness: effects of identification outcome knowledge

Research on the hindsight bias has shown that knowledge of an event outcome makes the observed outcome appear more predictable than it does in the absence of outcome knowledge. It was hypothesised that perceptions of the suggestiveness of a line‐up would be similarly influenced by knowledge of a witness' identification decision, with a positive identification of the suspect increasing, and a negative non‐identification decreasing, perceived suggestiveness. The ratings of undergraduate students (N = 50) in Experiment 1 showed the predicted influence of positive outcome, whereas negative outcome had no demonstrable influence. In contrast, Experiment 2, conducted with police trainees (N = 126) and with the line‐up presented in the context of a criminal investigation, partially supported the predicted influence of negative, but not positive, outcome. The discrepant findings are discussed in terms of the cognitive mechanisms underlying the hindsight bias and the implications for real‐life judgements of line‐up suggestiveness. Copyright © 2010 John Wiley & Sons, Ltd.     

Using time‐lagged panel data analysis to study mechanisms of change in psychotherapy research: Methodological recommendations

The introduction of novel methodologies in the past decade has advanced research on mechanisms of change in observational studies. Time‐lagged panel models allow us to track session‐by‐session changes and focus on within‐patient associations between predictors and outcomes. This shift is crucial as change in mechanisms inherently takes place at a within‐patient level. These models also enable preliminary casual inferences, which can guide the development of effective personalised interventions that target mechanisms of change, used at specific treatment phases for optimal effect. Given their complexity, panel models need to be implemented with caution, as different modelling choices can significantly affect results and reduce replicability. We outline three central methodological recommendations for use of time‐lagged panel analysis to study mechanisms of change: (a) taking patient‐specific effects into account, separating out stable between‐person differences from within‐person fluctuations over time; (b) properly controlling for autoregressive effects; and (c) considering long‐term time trends. We demonstrate these recommendations in an applied example examining the session‐by‐session alliance–outcome association in a naturalistic psychotherapy study. We present limitations of time‐lagged panel analysis and future directions.     

Boys will be boys: a pre‐line‐up gameplay has beneficial effects on boys' but not girls' identification performance

Fifty children, aged between 4 and 7 years, underwent a sequential photo line‐up procedure in order to identify a man they had met the previous day. Half of the participants engaged in a pre‐procedure gameplay with the female interviewer. It was hypothesised that the game would stimulate rapport building and would ultimately result in an increased performance during the line‐up procedure. The beneficial effect was indeed observed, but only for the male participants. This finding suggests that gameplay may be a fruitful strategy to decrease child witness discomfort and to increase participation. Copyright © 2006 John Wiley & Sons, Ltd.     

“Hearing voices”: Auditory hallucinations as failure of top‐down control of bottom‐up perceptual processes

Auditory hallucination is a key characteristic of schizophrenia that seriously debilitates the patient, with consequences for social engagement with others. Hallucinatory experiences are also observed in healthy individuals in the general population who report “hearing voices” in the absence of an external acoustic input. A view on auditory hallucinations and “hearing voices” is presented that regards such phenomena as perceptual processes, originating from speech perception areas in the left temporal lobe. Healthy individuals “hearing voices” are, however, often aware that the experience comes from inner thought processes, which is not reported by hallucinating patients. A perceptual model can therefore, not alone explain the difference in the phenomenology of how the “voices heard” are attributed to either an inner or outer cause. An expanded model is thus presented which takes into account top‐down cognitive control, localized to prefrontal cortical areas, to inhibit and re‐attribute the perceptual mis‐representations. The expanded model is suggested to be empirically validated using a dichotic listening speech perception paradigm with instructions for top‐down control of attention focus to either the right or left side in auditory space. It is furthermore suggested to use fMRI to validate the temporal and frontal lobe neuronal correlates of the cognitive processes involved in auditory hallucinations.     

Development of social problem‐solving strategies and changes in aggressive behavior: A 7‐year follow‐up from childhood to late adolescence

The aim of this study was to predict a stability of aggressive behavior on the basis of social problem‐solving strategies. Subjects were a total of 120 children, but complete follow‐up data were available only in 47 cases. Their aggressive behaviors were peer rated, and problem‐solving strategies were assessed in childhood subjects being 10 years on average, and 7 years later. Association between a development of social strategies and changes in aggressive behavior was studied with personality‐oriented pattern analyses. The main finding was that a development of strategies predicted a stability or changes of aggressive behavior very well. Aggressive strategies, both in childhood and in adolescence, as well as a lack of constructive alternatives characterized permanently aggressive subjects. Turning from nonaggressive to aggressive behavior was also explained by aggressive problem‐solving strategies, while a positive development, i.e., turning from childhood aggressive to adolescent nonaggressive behavior, was possible only if a person had never used aggressive strategies. Agreement between behavior and strategies was higher among girls. The findings supported a claim that intervention of aggressive behavior may be possible by modifying social strategies. Aggr. Behav. 25:269–279, 1999. © 1999 Wiley‐Liss, Inc.     

Process‐orientated psychoanalytic work in initial interviews and the importance of the opening scene

From the very first moment of the initial interview to the end of a long course of psychoanalysis, the unconscious exchange between analysand and analyst, and the analysis of the relationship between transference and countertransference, are at the heart of psychoanalytic work. Drawing on initial interviews with a psychosomatically and depressively ill student, a psychoanalytic understanding of initial encounters is worked out. The opening scene of the first interview already condenses the central psychopathology – a clinging to the primary object because it was never securely experienced as present by the patient. The author outlines the development of some psychoanalytic theories concerning the initial interview and demonstrates their specific importance as background knowledge for the clinical situation in the following domains: the ‘diagnostic position’, the ‘therapeutic position’, the ‘opening scene’, the ‘countertransference’ and the ‘analyst's free‐floating introspectiveness’. More recent investigations refer to ‘process qualities’ of the analytic relationship, such as ‘synchronization’ and ‘self‐efficacy’. The latter seeks to describe after how much time between the interview sessions constructive or destructive inner processes gain ground in the patient and what significance this may have for the decision about the treatment that follows. All these factors combined can lead to establishing a differential process‐orientated indication that also takes account of the fact that being confronted with the fear of unconscious processes of exchange is specific to the psychoanalytic profession.