Writing about patients III: Comparisons of attitudes and practices of analysts residing outside and within the USA

When analysts write about patients, they find themselves in a position of conflict. Their first loyalty is to their patients and maintaining confidentiality. However, they are also committed to advancing scientific knowledge in the psychoanalytic field. The attitudes and practices of 36 analysts residing outside the USA, who published articles using clinical material from their patients, are reported. Their attitudes and practices are compared with those of 30 author-analysts residing within the USA, who had been previously interviewed. Among the 66 analysts, geographic region was not a basis for distinguishing differences in attitudes or practices. Slightly more than twice as many analysts use only disguised material as regularly ask permission of their patients to write about them. The decision to use only disguise is somewhat more frequent for analysts who reside outside the USA than for those living within it. Analysts around the world are increasingly concerned about the accessibility of published material. More analysts have come to believe that it is necessary to ask permission before publishing material. Some analysts also believe that the request itself, and the patients reading written material about themselves, focus issues that are central to patients' characters and confl icts that can then be explored analytically.     

EXAMINING RATING SOURCE VARIATION IN WORK BEHAVIOR TO KSA LINKAGES

We examined Work Behavior to knowledge, skill, or ability linkage ratings for 9 jobs to determine the degree to which differences in the ratings were due to rater type. We collected ratings from incumbents and 2 types of job analysts: project job analysts (analysts knowledgeable of the job) and nonproject job analysts (analysts with very little or no knowledge of the job). In our analyses of the data, we calculated means, standard deviations, effect sizes, and correlations for each rater type, as well as compared the reliability of the ratings. We also estimated variance components for each job by conducting generalizability analyses ( Brennan, 1983 ; Shavelson, Webb, & Rowley, 1989 ). Our findings indicate that the level of linkage ratings is similar across rater types, that it is important to obtain ratings from multiple raters regardless of rater type, and that ratings from job analysts may be more reliable than those of incumbents.     

A renaissance for Freud's Papers on Technique

The analyst depicted in Freud's Papers on Technique (1911-1915) struggles to split the patient's stubborn desire by reframing it as memory. In contrast, after the structural theory was adopted, analysts could picture themselves as liberating rather than struggling with patients, since their design was to show that the patient's fears are unrealistic. But North American analysts have come to doubt their ability to rule on what is and isn't realistic. They thus find themselves again struggling with stubborn desires, not just easing fears. Their solution has been to emphasize--and thus detach from--enactments. These analysts would seem to be even more in need of the old ideals of procedure than were "classical" analysts, who thought they could use "reality" as a standard.     

When theory and practice diverge: gender-related patterns of referral to psychoanalysts.

This study tests the hypothesis that female analysts, relative to male analysts, receive a disproportionately small percentage of male referrals. Referral patterns for 170 analysts from four institutes accredited by the American Psychoanalytic Association were examined. One thousand, five hundred and ten patients referrals were studied. The findings were extremely robust and offered dramatic confirmation of our hypothesis. The major implications of the study are as follows: (1) Women analysts receive relatively few adult male referrals, making it difficult for them to gain requisite clinical experience with men. (2) Analysts and nonanalysts alike demonstrate a reluctance to refer male patients to female analysts. (3) Adult referrals, including those made by analysts, are significantly influenced by the issue of gender match between patient and analyst. (4) Analysts' behavior with regard to making referrals does not correspond to explicit clinical theory regarding how analysts make referrals--specifically, the extent to which gender influences the referral process is not adequately described by theory. We believe that these findings are of some concern from the standpoint of analytic education and that they also raise questions regarding unacknowledged aspects of how gender match between patient and analyst enters into clinical decision making.(ABSTRACT TRUNCATED AT 250 WORDS)     

THE EFFECT OF THE ANALYST'S GENDER AND OTHER FACTORS ONPOST-TERMNATION PATIENT-ANALYST CONTACT: CONFIRMATIONBY A QUESTIONNAIRE STUDY

This questionnaire study was designed to confirm and further explore an earlier finding of a gender difference in post-termination patient-analyst contact, as well as to assess whether practices regarding post-termination contact have changed in the five-year interval since the first study. The hypothesis that women analysts are more likely to have post-termination contact with their analysands than men analysts was confirmed by the present study. Analysts who report thinking frequently about their most significant analyst are contacted by a much larger proportion of prior patients than those who rarely think about their analyst. Further, women analysts are more likely to feel they benefited from the analysis they consider their most significant analysis, and to feel positively about that analyst. In 1994, analysts were much more accepting of and more likely to propose post-termination contact than in 1989. What the analyst reports he/she says to the patient is associated with the likelihood of such contact.     

Does a panel discussion on analytic technique have any effect on an audience of analysts?

This is a report of a followup study to determine whether attending a panel discussion group on post-termination patient-analyst contact influenced the analytic audience's attitude on that subject. A questionnaire about post-termination contact was given to 21 analysts who did not attend the discussion group and to 45 analysts before they attended. The same questionnaire was given again to both groups six months later. Responses by the 21 analysts who had not been present remained essentially unchanged. Responses of the 45 analysts, after attending the discussion group, when compared to responses of an earlier group of 300 analysts, showed an increase in the proportion of analysts who said, in reference to psychoanalytic psychotherapy patients, either that they hoped to hear from the patient or that they would like the patient to return to see them at some specified period after treatment termination. Attendance at the discussion seems responsible for a significant effect on the analytic audience's attitude on post-termination patient-analyst contact.     

The Divergent Paths of Behavior Analysis and Psychology: Vive la Différence!

Twenty years ago I suggested that behavior analysts could effect a quiet and covert takeover of the American Psychological Association (APA). I gave as precedents the operation of similar initiatives in the nineteenth and twentieth centuries, the Darwinian-inspired X-Club, and the psychoanalytically-oriented Secret Ring. Though a conscientious program of working within established APA bylaws and rules, behavior analysts could ensure that behavior analysts were nominated for every significant elective position within the APA, and move to get their colleagues placed in appointive positions, such as journal editorships, review boards, and major committees. This would be one approach to remake psychology along behavioral lines, which was an early ambition of B. F. Skinner. The community of behavior analysts ignored my suggestion, and instead pursued the path of creating an independent discipline of practitioners, one with its own degree-granting programs, conventions, journals, and legal regulation. This effort has been immensely successful, although much critical work remains to be done. In retrospect, I was wrong to suggest changing psychology from within, and I have been delighted to witness the emergence of our new and independent field.     

A note on the history of the Norwegian Psychoanalytic Society from 1933 to 1945

The Norwegian analysts, who were trained in Berlin before 1933, were drawn into a struggle against fascism, informed by politically leftist analysts who worked at the Berlin Institute. The Norwegian group, including the analysts Wilhelm Reich and Otto Fenichel, were committed to Marxist or social democratic ideologies in order to fight down fascism and Nazism. They were a source of inspiration but also of conflict. After the war the leadership of the IPA was sceptical about the Norwegian group because of its former connections with Die Linke, as well as its relations with Wilhelm Reich. This paper in part considers the courageous efforts of Nic Waal, whom Ernest Jones used as a delegate and courier to solve problems for the IPA and who was unjustlytreated after the war.     

On becoming a psychoanalyst

One has the opportunity and responsibility to become an analyst in one's own terms in the course of the years of practice that follow the completion of formal analytic training. The authors discuss their understanding of some of the maturational experiences that have contributed to their becoming analysts in their own terms. They believe that the most important element in the process of their maturation as analysts has been the development of the capacity to make use of what is unique and idiosyncratic to each of them; each, when at his best, conducts himself as an analyst in a way that reflects his own analytic style; his own way of being with, and talking with, his patients; his own form of the practice of psychoanalysis. The types of maturational experiences that the authors examine include situations in which they have learned to listen to themselves speak with their patients and, in so doing, begin to develop a voice of their own; experiences of growth that have occurred in the context of presenting clinical material to a consultant; making self-analytic use of their experience with their patients; creating/discovering themselves as analysts in the experience of analytic writing (with particular attention paid to the maturational experience involved in writing the current paper); and responding to a need to keep changing, to be original in their thinking and behavior as analysts.     

Psychoanalysis and the United States research university: current trends

In this essay the author describes the status of the humanities within United States research universities, and notes that there is a place in the research university for clinical analysts with non-quantitative research interests, who are seen as humanities scholars by other humanities specialists. He discusses the current trend in psychoanalytic research in the United States, which perpetuates an historically well-known divide between quantitative and non-quantitative investigators, and causes non-quantitative clinician-researcher analysts to seek a workplace outside organized analysis, as it exists within the American Psychoanalytic Association. He goes on to describe the way a clinical analyst with a strong non-quantitative research commitment has found a supportive home for his investigations in a humanities institute in a research university. That analyst has been welcomed as a colleague by university-based humanities scholars, and has found that those collegial relationships offer creative freedom and interdisciplinary stimulation. The author notes that a cadre of analysts, enriched by such experiences, will be better equipped to bridge the divide which exists between non-quantitative and quantitative analytic researchers, for the benefit of psychoanalytic research in the future. The author also illustrates the benefits experienced by university-based humanities scholars when they collaborate with clinical analysts, and suggests this makes stronger ties between psychoanalysis and research universities more likely in the future.     

Psychoanalytic practice in the early postgraduate years

As a pilot investigation for a longitudinal study of psychoanalytic careers, a survey was conducted of analysts who graduated during the last fifteen years from the Columbia University Center for Psychoanalytic Training and Research. Graduates were asked to describe both their analytic practice and their interest in pursuing appointment as training and supervising analysts. The 23-item questionnaire was completed by 67 of 102 potential respondents (66%). The study identified two subgroups of graduates: those who were not certified and were not training analysts (GAs), 78% of the sample, and certified and training analysts (CAs, TAs), 22% of the sample. GAs started a mean of 1.4 new analytic cases since graduation, as compared to CAs and TAs, who started a mean of 5.4 and 8.3 new cases, respectively. CAs and TAs also saw more twice-weekly therapy cases than did GAs. Once-weekly therapy was the most commonly practiced treatment for all subgroups. Interest in becoming a TA was highest during the first five postgraduate years and was lower among non-TAs five to fifteen years after graduation. Only one of the CA respondents met current APsaA immersion criteria for training analyst appointment.     

Binding legacies: ancestor,archetype and Other

This article discusses the multicultural interconnection between Jungian analysts’ training and Africanist training candidates. The importance of ancestral lineage and archetypal influences in the clinical setting are explored for better understanding of issues related to the transference and therapeutic interventions. A discussion of racial relations and racism is addressed as a frequently missing element in the psychoanalytical training of future Jungian analysts.     

Policy analysis and knowledge use

Public policy analysis is a major link in the network of knowledge use. Without analysts’ intermediary role, research would be used less for policy choice and relatively more for predecision enlightenment. However, the knowledge use network may not give enough incentives for researchers to supply needed knowledge or for analysts to seek it. Though Washington, D.C., analysts can seek help from personal networks and from agencies such as the Congressional Research Service, those farther from Washington may use research less effectively. Both groups may also fail to provide incentives for its production (i.e., to overcome academic researchers’ interests in promoting disciplinary theory over practical application). An efficient indexing system for policy-related research might serve as an incentive, if it could help producers of knowledge to be rewarded for its use.     

Hope and Dread in Mutuality and Asymmetry Regarding the Analytic Setting: Reply to Commentaries

The challenging commentaries to the discussion on the analytic setting help to clarify the various meanings this concept have to us as analysts, supervisors, theoreticians, and members of the analytic community. This sharing of our thoughts, experiences, and feelings helps refine the dilemmas we share as relational analysts regarding the setting as structure or as process. As I see it, the challenge of being a relational analyst lies in the tension between affording mutuality while retaining the asymmetry that enables a deepening of the mutuality regarding the analytic setting.     

Relational Psychoanalysis and the Inner Life: Commentary on Cooper,Corbett, and Seligman

Relational analysts know that their experience feels private and contemplative during a significant portion of their working hours. A consideration of the inner life, both the analyst’s and the patient’s, is part of relational praxis. Yet relational analysts also recognize that they are continuously involved with their patients, even at those very same quiet moments. Cooper, Corbett, and Seligman recognize both these parts of relational clinical work and argue that both are necessary. Making this argument explicit is important for its own sake, but also because analysts from other schools sometimes write as if there is no place in relational clinical practice for a quiet consideration of the inner life. Two examples of such criticism are offered, in both of which relational analysts are described as being too focused on social interaction and too little on the inner life. I offer my own version of the kinds of arguments about privacy and contemplation offered by Cooper, Corbett, and Seligman. I then make the case that all psychoanalytic theories come with risks of excess. Relational and interpersonal theories come with the risk of an overenthusiastic embrace of clinical interaction, whereas more intrapsychic theories carry the risk of attending too little to the impact on their patients of present-day relatedness—which is just as likely to have unconscious roots as the inner life.     

Narcissistic temptations to cross boundaries and how to manage them

The narcissism of analysts is considered here from the perspective of the narcissistic temptations of boundary crossing. The literature on boundary crossing in psychoanalysis has focused minimally on the more ordinary, nonsexual temptations analysts face with their patients. Narcissistic temptations with particularly impressive patients are explored. What analysts find impressive in their patients depends both on what patients bring and on what analysts need. This paper aims to heighten analysts' awareness of their narcissistic needs in treating patients who tempt them too much. The goal is for analysts to be able to catch and then examine their narcissistic excitement with such patients in order to avoid compromising the treatment. Danger signs and ways of managing the problems they point toward are presented.     

Behavior analysis and education: An unfulfilled dream

This paper presents the author's view of why the promise for education visualized by early behavioral researchers is as yet unrealized. It points out that behavior analysis has had an important impact on special education but has had much less influence on teaching practice in regular classrooms. This is not seen as the fault of educators who have failed to embrace procedures developed by behavior analysts. Rather, the author contends, behavior analysts have failed to develop procedures that fit the ecology of the regular classroom. Those developed often require too much additional effort thereby punishing those who attempt their use. Another factor hindering widespread adoption is that behavior analysts have failed to disseminate their procedures and have not participated widely in undergraduate training of teachers. The paper concludes by noting that our success in special education provides a model for behavior analysts interested in regular education. By developing procedures that result in increased academic performance for entire classrooms without punishing the teachers who implement them, by making those procedures available commercially and by publishing in journals teachers read, and finally by participating more widely in undergraduate training, the unfulfilled dream of what behavior analysis has to offer education can be achieved.     

信息提供者数量对职务信息完整性的影响

本研究探讨3种不同实验情境下,信息提供者数量对职务分析信息完整性及击中完整性的影响。方差分析表明:a)4名任职者可提供足够完整的职务信息;b)职务分析员数量与信息完整性的关系在情境间不稳定;c)职务分析实践中,采用4名任职者提供信息最合理,如可排除动机因素影响,采用3名任职者提供信息最合理;d)采用4名分析员凭经验提供职务信息最合理;如可阅读职务说明书,采用3名分析员最合理。