The development of a psychoanalytic outcome study: choices, conflicts, and consensus

This article tells the story of the development of an outcome study of psychoanalysis and describes the debate that took place over critical methodological issues. The protocol committee included career psychotherapy researchers who have conducted rigorous outcome studies, clinical psychoanalysts, study methodologists, and a statistician with clinical trial expertise. The committee worked for two years to develop the study design. This project is based on the premise that clinical psychoanalysis is a treatment. Areas specifically addressed are the goals and hypothesis of the study, inclusion and exclusion criteria, choice of psychotherapies as comparison treatments, definition of treatments and selection of therapists, use of medication, development of a treatment adherence measure, randomization of patient assignment vs. patient self-selection, and primary outcome measures. The execution of this outcome study will require significant effort and resources. A positive result would boost the standing of psychoanalysis, but the results may not support the primary hypothesis that there are therapeutic benefits unique to psychoanalysis and that psychoanalysis can effect demonstrable changes in a patient's mental life and adaptation that are not achieved by treatments of different orientation and/or lesser intensity. However, more important than whatever specific results emerge is what executing such a study requires of our field: the process of addressing the clinical issues that a study design requires, the creation of a network of analysts around the country working on a common project, and the joining of the clinical psychoanalytic community with a community of psychodynamic researchers.     

What's Possible? What Matters? Reply to Commentaries

The three discussants agree that a definition of psychoanalysis tied to session frequency is problematic and needs to change. Yet none supports my recommendation to redefine the practice of psychoanalysis in terms of the practitioner's training. This prompted me to look more closely at my proposal and push my thinking further. I argue that psychoanalysis, like many other professions, needs to define its practice as the application of its complex and evolving knowledge and skill base, grounded in its unique field of inquiry. Although there are individual exceptions, the inculcation of this knowledge and skill base is generally best accomplished through psychoanalytic training. This assertion, however, rests on the premise that our training curricula keep pace with our rapidly evolving field of inquiry and knowledge. To further clarify my vision I examine the nature of psychoanalytic expertise. I suggest that such expertise amounts to the inculcation and integration of a large number of psychoanalytic frames of reference. I contend further that the nature of contemporary psychoanalytic theories is such that important psychoanalytic frames of reference are proliferating more rapidly than in the past, that the relationships among them are becoming more complex, and that consequently the application of psychoanalytic theory to practice is also becoming more complex. Psychoanalytic training programs need to recognize this expanding complexity and revise curricula and pedagogic methods on an ongoing basis to reflect this evolution within our field.     

The Task of the Translator

This discussion reflects closely on Dominique Scarfone’s call to consider psychoanalysis as a practice founded on ethics, and to rely on this premise in charting a fundamental common ground such that has eluded psychoanalysis for most of its history. Out of the three points Scarfone centers on, I dedicate most attention to the third—psychoanalysis as modeled on the notion of translation—because I find his suggestion inspiring, and promising toward the goals he sets for his paper. Building on the basis Scarfone offers in this context with the help of ideas developed by Walter Benjamin and Emmanuel Levinas, I suggest that the vision that can pull us together as psychoanalysts indeed relies on an ethics of attending to the other’s speech, its meaning as well as its fundamental yet complicated striving for comunicability. More specifically, we need to recognize that words can hide our need to say them. That what we say obscures our vulnerability and shame. That when we try to recall, the language we speak is distorted by the personal and historical forces collaborating to make us forget ourselves. I argue that the task of the psychoanalytic translator is therefore to uncover and resignify the scattered, coded fragments; to help us restore our ability to tell our stories; and to recognize that more than everything, we want to tell them.     

“Generative Co-Constructions”: An Exploration of the Analyst’s Influence and Desire: Commentary on Paper by Richard Almond

In this commentary on Almond’s (this issue) paper, in which he asks us to consider ways in which his personality/history/psychodynamics played a significant role in his younger women patients becoming pregnant, the author questions Almond’s premise that we can know what “real-life effects” we have on our patients, when so much that occurs in psychoanalysis happens in mutually unconscious and procedural realms. In addition, the author critiques Almond’s archaic and reductive conceptions of gender and sexuality, which feel particularly problematic as they interpenetrate with his fantasies of his impact and pivotal role in their pregnancies.     

PSYCHOANALYSIS IN SCANDINAVIA: PART ONE

During recent years, the neurosciences have entered into a dialogue with psychoanalysis, which has opened new perspectives for their integration. Despite these developments, reservations remain concerning the reducing effects of the neurosciences by overtly or covertly hiding the core elements of psychoanalysis. However, Freud made an explicit parallel between psychoanalysis and physics in their relationship with the unknown reality, and in their task of filling in gaps in knowledge. Freud's epistemological view implies that the relationship with the unknown reality unites rather than separates psychoanalysis from other sciences. On the other hand, in the clinical realm, Freud emphasized the autonomy of psychoanalysis. Instead of offering causal explanations, the value of the neurosciences to psychoanalysis depends on how well the knowledge derived from them can be integrated in psychoanalysis and given a clinical meaning. The primacy of clinical relevance also pertains to the findings of empirical outcome research.     

Charles Rycroft’s Contribution to Contemporary Psychoanalytic Psychotherapy

Charles Rycroft played a significant part in gaining psychoanalysis understanding and intellectual acceptance within the wider intellectual community of post-war Britain. However he became gradually disaffected with the schisms and inward-looking character of UK psychoanalysis in its post-controversial discussions phase. He was ahead of his time in his interest in psychoanalysis as semantics, links between psychoanalysis and evolutionary and attachment theories, literary resonances with psychoanalytic thinking, and of the role of support as well as interpretation as a mutative agent. Renewed interest in his writings is long overdue.     

Psychoanalysis and the Catholic Church in Italy: the role of Father Agostino Gemelli, 1925-1953

Agostino Gemelli, a Catholic priest, psychiatrist, administrator, and educator, was an important figure in the early history of psychoanalysis in Italy. He was one of the few establishment figures to grapple with Freud's ideas in Italy during the first half of the twentieth century, a period during which Italy, compared to the rest of Europe and to the United States, was relatively impermeable to psychoanalysis. One of the factors that contributed to this was the opposition of the powerful Catholic Church, which identified in psychoanalysis a challenge to its authority. The author argues that Father Gemelli's shifting positions about psychoanalysis between 1925 and 1953 reflected the exigencies of his historical circumstances. Gemelli was able to identify in psychoanalysis an integrated view of the human condition in stark opposition to the brutal reductionism of psychiatry in Italy at that time, but also encountered in it elements intolerable to the Church. Examining specifically what it is that Gemelli could accept of psychoanalysis, and what needed to be rejected, between 1925 and 1953, illustrates the particular challenge posed by psychoanalysis to Catholicism in Italy.     

Someplace in Mind

This paper is a meditation on the interpenetration of mental and physical, particularly architectural, place. Its premise is that the relationship between person and place is transitional, ever in flux, person continually defining place into a continuous reality, and reality perpetually placing person. Further, this interchange occurs against the backdrop of an inconceivable void whereby the very terms of the interchange can be nullified. Such a void is unconscious and outside in the sense that it is outside what can be known. The matter of opening the inside to the outside becomes an endeavor shared by psychoanalysis and by architecture, notably sacred architecture. The exchange between inside and outside is considered using as examples the body, Freud's office, Disneyland, and the cathedral. Implications are extrapolated as to the provisional nature of the self.     

Relational Psychoanalysis Potential Usefulness with Black South African Clients

The aim of this article is to suggest that relational psychoanalysis may be a useful approach for working with clients from indigenous African cultures. In particular, the article considers the utility of relational psychoanalysis to understanding and enacting the therapeutic relationship with clients from an indigenous African cultural background. The notion of “we” self from the perspective of African cultures is a case in point for possible compatibility between relational psychoanalysis and black clients who come from background that place a high value on communal or “we” selves. An integrative therapy that combines African worldviews and relational psychoanalysis is possible.     

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.     

Family matters The descendants of Freud and Jung

A brief history of what it has meant to be a Jungian analyst and/or analytical psychologist in the United States and England is portrayed. At first the differences between psychoanalysis and analytical psychology were very great, and there was great animosity between the two schools. The conflict was much stronger in the United States than in England where Jungians developed a much better rapport with psychoanalysis. Recent theoretical developments within psychoanalysis, such as the development of self theory and intersubjectivity, as well as speaking about religious issues in a new way, have brought psychoanalysis closer to analytical psychology. On the other hand, analytical psychology has been enriched by an increased awareness of the importance of developmental issues and transference and countertransference. The implications for both psychoanalysis and analytical psychology are explored.     

精神分析在日本的传播与发展

综述了精神分析在日本的传入与发展。包括:(1)精神传入日本的历史轨迹,如心理学、精神医学、文化学视角的传播;(2)精神分析在日本的发展,如精神分析疗法的推广,精神分析理论的运用;(3)日本对精神分析的评价。     

The case for neuropsychoanalysis: Why a dialogue with neuroscience is necessary but not sufficient for psychoanalysis

Recent advances in the cognitive, affective and social neurosciences have enabled these fields to study aspects of the mind that are central to psychoanalysis. These developments raise a number of possibilities for psychoanalysis. Can it engage the neurosciences in a productive and mutually enriching dialogue without compromising its own integrity and unique perspective? While many analysts welcome interdisciplinary exchanges with the neurosciences, termed neuropsychoanalysis, some have voiced concerns about their potentially deleterious effects on psychoanalytic theory and practice. In this paper we outline the development and aims of neuropsychoanalysis, and consider its reception in psychoanalysis and in the neurosciences. We then discuss some of the concerns raised within psychoanalysis, with particular emphasis on the epistemological foundations of neuropsychoanalysis. While this paper does not attempt to fully address the clinical applications of neuropsychoanalysis, we offer and discuss a brief case illustration in order to demonstrate that neuroscientific research findings can be used to enrich our models of the mind in ways that, in turn, may influence how analysts work with their patients. We will conclude that neuropsychoanalysis is grounded in the history of psychoanalysis, that it is part of the psychoanalytic worldview, and that it is necessary, albeit not sufficient, for the future viability of psychoanalysis.     

“This beastly science…”: On the reception of psychoanalysis by the composers of the Second Viennese School, 1908–1923

This paper explores the links between psychoanalysis and music in Vienna between the years 1908 and 1923, focusing in particular on two members of the highly influential Second Viennese School, the composers Alban Berg and Anton Webern. While there is little evidence of an actual interaction between Freud and his circle and contemporaneous musicians in Vienna, this paper discusses the direct personal and professional contact Webern and Berg had with Freud, and also with Freud's one-time colleague Alfred Adler; Berg's wife Helene also underwent psychoanalytic treatment. Both composers documented their experiences with and feelings about psychoanalysis, offering critical insights into the reception of psychoanalysis in musical circles in Vienna, and into the actual connections between psychoanalysis and Vienna's most important musical figures. This paper examines Berg and Webern in the context of Freud's Vienna, Adler's musical background and his treatment of Webern, and Berg's knowledge of psychoanalysis and strong ambivalence towards his wife's psychoanalytic treatment, and concludes by considering Berg's opera Wozzeck (1925) as an example of a musical work influenced by contemporary Viennese attitudes towards psychoanalysis.     

Part IV: Capstone Papers for the Psychoanalysis Minor

ABSTRACT

After the Chicago class culminates, a number of our students go on to complete the psychoanalysis minor, which requires a capstone paper that can deal with theoretical issues in psychoanalysis or relate psychoanalysis to the subjects of their majors, such as literature, psychology/neuroscience, or their own independently designed majors. We include three representative papers.     

Should Psychoanalysis Become a Science?

I wish to formulate in broad outline an approach to the conceptualization of psychoanalysis that is divested from theory. This view sees the core of psychoanalysis as a humanistic practice, first and foremost guided by the individuality of the dyadic encounter, rather than as a science. I will not argue for any particular view of psychoanalysis. Instead I marshal a series of considerations from the humanities, to frame a conceptualization of psychoanalysis as a clinically based interpretive discipline having a unique mission. Finally, I will present a futuristic hypothetical scenario whose aim is to show why psychoanalysis will remain a viable enterprise basically as conceived by Freud.     

The Interpersonal Field: Its Place in American Psychoanalysis

Today the concept of the interpersonal field, while seldom credited to those who created it, is widely used in psychoanalysis. After reviewing how the concept of the field defines interpersonal and relational psychoanalysis, I take up the rejection of the idea in American mainstream psychoanalysis in the decades just after it was proposed by Sullivan and Fromm, why that rejection took place, and how the entire discipline of psychoanalysis in North America might have fared if the idea had been widely recognized earlier than it was.     

“The indestructible,the barbaric principle”: The Role of Schelling in Merleau-Ponty’s Psychoanalysis

The aim of this paper is to examine Merleau-Ponty’s idea of a “psychoanalysis of Nature” (Merleau-Ponty in The visible and the invisible. Northwestern University Press, Evanston, 1968). My thesis is that in order to understand the creation of a Merleau-Pontean psychoanalysis (together with the role the unconscious plays in this psychoanalysis), we need to ultimately understand the place of Schelling in Merleau-Ponty’s late thought. Through his dialogue with Schelling, Merleau-Ponty will be able to formulate not only a psychoanalysis of Nature, but also fulfil the ultimate task of phenomenology itself; namely, of identifying “what resists phenomenology—natural being, the ‘barbarous’ source Schelling spoke of” and situating it precisely at the heart of phenomenology (Merleau-Ponty in Signs. Northwestern University Press, Evanston, p 178, 1964b). The plan for studying this natural psychoanalysis is threefold. First, I provide an overview of the role psychoanalysis plays in the 1951 lecture, “Man and Adversity,” focusing especially on this lecture as a turning point in his thinking. Second, I chart how Merleau-Ponty’s psychoanalysis is informed by the various ways in which the unconscious is formulated in his thought, leading eventually to a dialogue with Schelling. Accordingly, in the final part of the paper, I trace the role of Schelling’s thought in the creation of a Merleau-Pontean psychoanalysis. As I argue, what distinguishes this psychoanalysis is the centrality of Schelling’s idea of the “barbaric principle,” which manifests itself as the notion of an unconscious indexing an “excess of Being” resistant to classical phenomenology (Merleau-Ponty in Nature: course notes from the college de France. Northwestern University Press, Evanston, p 38, 2003).