Change after long-term psychoanalytic psychotherapy

Psychoanalytic psychotherapy in clinical practice is traditionally a long-term treatment conducted by well-trained psychotherapists. However, very few studies have been published that evaluate the effects of such treatment. To redress this lack of studies, 55 individuals selected for long-term psychoanalytic psychotherapy (average, 3 years) were invited to participate in a naturalistic study. The psychotherapists had a mean of 15 years of professional experience. The 36 patients who completed psychotherapy manifested a substantial reduction in symptomatic suffering and decreased levels of character pathology, as measured by the Karolinska Psychodynamic Profile (KAPP) and the Karolinska Scales of Personality. Generally, such changes were not found in the individuals who did not engage in treatment. In the therapy group, improvements were found on eight KAPP subscales defining different aspects of character: Intimacy and Reciprocity, Frustration Tolerance, Regression in the Service of the Ego, Coping with Aggressive Affects, Conceptions of Bodily Appearance and their Significance for Self-esteem, Sexual Function, Sexual Satisfaction, and Personality Organization. The results indicate that individuals who engaged in psychotherapy improved their capacity to handle crucial aspects of life and reduced their symptomatic suffering.     

The unconscious ego-ideal and analytic group psychotherapy

The theoretical position of this paper is that the essential character of the ego-ideal, a part of superego functioning, is unconscious, universal, and functions automatically. Precursors to superego development and ego-ideal formation begin at early preoedipal levels, and derivations in adult behavior contain primitive aspects. Ego-ideal is perfectionistic and impossible to obey;therefore, projection of this phenomenon as well as its activity leads to disappoinment, anger, anxiety, depression and despair. Pseudomoral injunctions frequently rationalize and disguise early primitive aspects of unconscious superego development and ego-ideal formation. These points are illustrated by clinical material, showing the therapeutic action in the group which leads to a modification of this critical, self-defeating aspect of adult functioning.Copyright, 1987, Washington Square Institute for Psychotherapy and Mental Health, which published this paper in No. 14 of the Group Psychotherapy Monograph Series, after the paper had been presented at the Fourteenth Annual Conference of the Group Psychotherapy Department, and presented by invitation at the ninth congress of the International Association of Group Psychotherapy, Zagreb, Yugoslavia, August 1986.Dr. Edwards was formerly an Associate Supervisor and Faculty Member in the Group Department at the Postgraduate Center for Mental Health.     

The ego-ideal,the leader and analytic group psychotherapy

The theoretical position of this paper is that the essential character of the ego-ideal, a part of superego functioning, is unconcious and functions automatically. Precursors to superego development and egoideal formation begin at early pre-oedipal levels, and derivations in adult behavior contain primitive aspects. Ego-ideal is perfectionistic and impossible to obey; therefore, projection of this phenomena as well as its activity leads to disappointment, anger, anxiety, depression and despair. Pseudomoral injunctions frequently rationalize and disguise early primitive aspects of unconscious superego development and egoideal formation. These points are illustrated and interpreted by clinical material. The therapeutic action of the group and its leader, through the complexity of transference and projection, to help modify this critical, selfdefeating aspect of adult functioning is described.     

The group-as-a-whole approach in Foulksian group analytic psychotherapy

The group analytic group-as-a-whole approach of Foulkes privileges the concept of the group matrix. The term matrix is a metaphor for the network of all individual mental processes, the psychological medium in which they meet, communicate, and interact. The developing group matrix acts both as a container and as a holding environment for the psychic processes of the individual members in the group context. The concept of coherency is evoked to describe the process of the developing capacity of a group to be therapeutic. The concept of coherency is applied both to conscious and to unconscious mental process.     

Reality in analytic group psychotherapy: Beyond transference and countertransference

This study reports the results of a questionnaire, applied to therapists and their patients in 14 analytic therapy groups. It was found that the patients studied had an accurate perception of the group reality in the following dimensions: therapists' preferences for the members in their groups; power position held by each member in the group; and therapeutic benefit achieved by members in the group. Support was given to the existence of a relation among popularity, power position and therapeutic benefit; members who rated high in one of these variables generally were assigned a high position in the other two, and vice versa. These results suggest that patients in analytic group psychotherapy can be objective in their perceptions of the group reality, and that these perceptions are not always distorted by transference. The idea that, no matter how low-disclosing therapists remain, the patients in their groups will perceive their attitudes and feelings was supported by patients' accuracy in perceiving their therapists' preferences for members in their groups. These findings indicate the important role played by reality and the real relationship in psychoanalytic group psychotherapy.     

Peers and siblings: their neglect in analytic group psychotherapy

Peer and sibling history, transference, and theory construction, have been neglected in analytic group psychotherapy. One main reason for this neglect has been the belief that current psychoanalytic theory, individual and group, sufficiently accounts for the understanding of peer and sibling phenomena. Furthermore, peer transferences in the therapy group have been considered derivative of transferences to the leader. An argument is made for considering peer and sibling history, transference, and theory construction important in their own right. This argument is supported by a therapy group example. Implications for practice and theory are discussed.     

Brief crisis group psychotherapy versus the initial sessions of long-term group psychotherapy: An exploratory comparison

An attempt was made to specify the therapist behaviors characteristic of the brief crisis group (BCG) approach, to assess how patients experience BCG on dimensions of session impact and group climat, and to describe the changes possible from BCG on measures of outcome by contrasting this modality with the initial sessions of traditional long-term therapy groups in a preexperimental design. Data obtained from four eight-session BCGs and three beginning long-term groups (LTG) were used for analyses. Patients were administered the Session Evaluation (SEQ) and Group Climate (GCQ) Questionnaires at the end of each group session. Two judges sat in on each session and coded the types of therapist interventions using the Therapist Behavior Categories (TBC) system. Aspects of self-esteem and symptomatology were assessed as indices of change over the 8-week period in a pre-post fashion. Therapists in BCG evidenced a distinct pattern of interventions during midpoint group sessions (sessions 3–6), placing a greater emphasis on challenging patient perceptions and providing information than their LTG counterparts. The therapists' use of self as an issue in BCG increased as termination approached and apparently served a more limited function than in LTG. Patients in BCG reported a more rapid development of a working group and experienced greater session benefit. Patients in BCG also reported lower levels of conflict and avoidance and a greater decrease in these resistance behaviors. As expected, BCG patients reported substantially greater improvement on most outcome dimensions at the end of the 8-week period. Results are considered as clarifying the approach to and impact of BCG psychotherapy.An earlier version of this paper was presented at the 15th Annual Meeting of the Society for Psychotherapy Research, Lake Louise, Alberta, June 19–23, 1984.     

Acting-out: its functions within analytic group psychotherapy and its transformation into dreams

In group processes, acting-out has diverse functions, all of them equally important. It has an intrapsychic, interpersonal, and group dynamic function. Not only may it be understood as a form of resistance, but also in its communicative and reparative potential. The authors investigate the thesis that acting-out also contains the seed for change, thus helping patients divest themselves of pathological behavior. Using a group process as an example, this article shows how boundaries can be drawn between past and present experiences while using the communicative and reparative functions of acting-out. Unconscious psychodynamics can then be transformed from acting-out into dreams.     

Culture-sensitive functional analytic psychotherapy

Functional analytic psychotherapy (FAP) is defined as behavior-analytically conceptualized talk therapy. In contrast to the technique-oriented educational format of cognitive behavior therapy and the use of structural mediational models, FAP depends on the functional analysis of the moment-to-moment stream of interactions between client and therapist. This distinctive feature makes FAP particularly sensitive to the challenges posed by cultural differences between client and therapist. Core elements of FAP philosophy are invoked to argue that this vulnerability paradoxically implies an increased ability to capture and use relevant issues in the therapy process with culturally different clients. This argument focuses FAP's preference for concrete behavior over theoretical modeling, its emphasis on functional principles rather than topographically defined techniques, and its inclusion of the therapist's behavior in the assessment of clients' clinically relevant behavior. Suggestions are given concerning how academic and practical training and personal experience may be used to foster sound multicultural practice.     

Self-analysis and post-termination improvement after psychoanalysis and long-term psychotherapy

Long-term follow-up studies of long-term psychoanalytically oriented psychotherapy or psychoanalysis are extremely rare, and few have focused on the post-treatment process itself. In the Stockholm Outcome of Psychoanalysis and Psychotherapy project, one of the results was that patients in psychoanalysis continued to improve after termination to a higher degree than patients in long-term psychotherapy. In this study 20 patients selected from the project were interviewed on two occasions, one and two years after termination, in order to explore how they described their post-treatment processes. The interviews were studied qualitatively using a multiple case study design, and categories of different types of post-treatment development were created from these case studies. Results indicate that the variation within treatment groups is large, and that development may continue in several ways after termination. The most striking difference between psychoanalysis and psychotherapy was not, as hypothesized, in the self-analytic function, but in various self-supporting strategies described by former analysands but not by former psychotherapy patients. However, only self-analysis was significantly correlated with post-termination improvement across both treatments. Three patients improving after termination and three deteriorating are described in detail as illustrations. Some methodological constraints of the design limit the generalizeability of results.