Time and timekeeping in psychoanalysis and psychotherapy

The American Journal of Psychoanalysis -     

Dream frequency in psychoanalysis and psychoanalytic psychotherapy

The authors examine data on dream frequency from 50 patients, half of whom were seen in psychoanalysis and half in psychoanalytic psychotherapy. Frequency, defined as the proportion of sessions where at least one dream is related, is analyzed statistically as a function of sex, age, and type of treatment. Also, treatment outcome is examined as a function of sex, type of treatment, diagnosis, and dream frequency. Psychoanalytic patients are found to have higher dream frequency than the patients in the psychotherapy group. Higher average dream frequency is correlated with a better treatment outcome in both patient groups.     

Clinical wisdom in psychoanalysis and psychodynamic psychotherapy: a philosophical and qualitative analysis

To precisely define wisdom has been an ongoing task of philosophers for millennia. Investigations into the psychological dimensions of wisdom have revealed several features that make exemplary persons "wise." Contemporary bioethicists took up this concept as they retrieved and adapted Aristotle's intellectual virtue of phronesis for applications in medical contexts. In this article, we build on scholarship in both psychology and medical ethics by providing an account of clinical wisdom qua phronesis in the context of the practice of psychoanalysis and psychodynamic psychotherapy. With the support of qualitative data, we argue that the concept of clinical wisdom in mental healthcare shares several of the key ethical dimensions offered by standard models of phronesis in medical ethics and serves as a useful, albeit overlooked, reference point for a broader development of virtue-based medical ethics. We propose that the features of clinical wisdom are pragmatic skills that include, but are not limited to, an awareness of balance, the acceptance of paradox, and a particular clinical manner that maintains a deep regard for the other. We offer several suggestions for refining training programs and redoubling efforts to provide long-term mentorship opportunities for trainees in clinical mental healthcare in order to cultivate clinical wisdom.     

Therapeutic technique in psychoanalysis and psychoanalytic psychotherapy.

As the distinctions between what we consider to be psychoanalysis and what we consider to be psychoanalytic psychotherapy have become more uncertain and more blurred, it follows that it is equally difficult to designate the techniques that would be appropriate and specific for each modality. The problem has been compounded by the fact that in recent years psychoanalysis in the United States has become considerably less homogeneous than in the past and the ego-psychological structural model is no longer the only point of view in the psychoanalytic marketplace. Further, with alterations in the criteria for analyzability, cases which, generally, had not been viewed as suitable for analysis, have been appearing with increasing frequency on psychoanalysts' couches. We have also recognized that the degree of congruence between our expectations from and the results of psychoanalytic treatment was often less than anticipated. It appears that analysts have become considerably less arbitrary about what psychoanalysis is and how a psychoanalysis can be carried out. The author is unable to delineate one technique that is intrinsic to and limited to psychoanalysis. There are, however, differences in degree and emphasis in the ways in which various techniques are applied in the therapy of psychoanalysis as compared to the therapy of psychoanalytic psychotherapy. Special attention is given to the role of a psychoanalytic process and the central place the analysis of resistance plays in psychoanalytic therapy.     

Therapeutic relationship and progress in the first six sessions of individual psychotherapy: A panel analysis

The temporal nature of the associations between client-rated therapist empathy and acceptance, and both client-and therapist-assessed therapeutic progress at sessions 2 and 6 were examined pairwise with cross-lagged panel correlatation (CLPC) and linear structural relationships (LISREL) analyses in 37 clients treated in weekly individual sessions of long-term psycoanalytic and person-centred therapy by 37 experienced therapists. Although none of the cross-lagged differences in the three CLPC analyses which met the necessary conditions for interpretation were significant, two of them approached it, suggesting that session 2 client-rated progress was a stronger determinant of session 6 therapist empathy and acceptance than vice versa. However, the LISREL analyses indicated that while session 2 client-rated progress was unrelated to session 6 therapist acceptance, session 2 therapist empathy was negatively correlated with session 6 client-rated progress. furthermore, both session 2 therapist empathy and acceptance were positively associated with session 6 therapist-rated progress, thereby providing some support for the therapeutic role of these two therapist variables as postulated by person-centred theory.     

Configurational approach to manifest dream analysis: Possible acceleration of the patient's communication in psychoanalytic psychotherapy

This paper presents an approach to dream analysis utilizing the manifest content of a number of consecutive dreams from the same patient. Following a review of the literature, it is noted that in once-a-week psychotherapy there is often very little time for exhaustive dream analysis to unravel the buried meanings within the latent dream content. Twenty categories have been established for the configurational analysis, which is applied to the analysis of the first eleven dreams of a patient in psychoanalytic psychotherapy. The authors independently analyzed the patient's dreams using each of the 20 categories with high reliability, then combined their contributions. This data was then compared with the treating analyst's independent clinical observations about the twenty categories.     

On the question of the patient's right to tell and the ethical reality of psychoanalysis

This paper calls into question the view that it is ethically legitimate for the patient to say whatever comes to his or her mind: that is, to adhere to the fundamental rule. While there have been some variations in the application of this rule since Freud's time, it remains for many the bedrock of clinical practice, and the patient's right to free-associate has never been questioned. Recent debates on the importance of the analyst's strict confidentiality have highlighted this right. Ethical problems raised by adherence to the fundamental rule are explored through an examination of the general ethical limitations on what one may say to another person, and the special features of the analytic relationship that seem to do away with these limitations. The fact that there are ethical questions about adherence to the fundamental rule draws attention to what the author calls the ethical reality of psychoanalysis. The recognition of this reality has implications for the understanding and handling of ethical dilemmas regarding disclosure, as well as for other ethical issues that may arise in the course of an analysis.     

Reflection on the relationship between psychoanalysis and christianity

Coming to terms with Freud's ideas and attitudes toward religion is prerequisite to any consideration of the compatibility between psychoanalysis and Christianity. In a previous essay and in this one I have attempted to sort out Freud's ambivalence and ambiguity in the area and to point out their relevance to the issue at hand. In this paper I survey and criticize the opinions of a number of writers, as well as putting forward some of my own. I emphasize that the compatibility question is one of value, rather than of fact, and that one's answer to it depends largely on one's conception of psychoanalysis itself. The issue is not clear-cut. Some aspects of psychoanalytic theory and practice appear more reconcilable with Christian theology, ethics, and spirituality than others. A few psychoanalytic tenets seem in direct contradiction to religious ones. I close with an historical-sociological point that I believe has some bearing on the matter.     

A quantitative method for studying the testing supervision process

A quantitative method by Holloway for studying the supervision process in counseling training was adapted for use in psychological testing supervision. Ratings of 80 sessions indicated that most of the 25 potential interactions between the supervisor and trainee occurred in most of the sessions. The rate of occurrence was the lowest for the Emotional Awareness task (21%-24%). The author offers a speculation about how this result may be understood as involving the structured nature of testing. Results suggested that this model could be used as a tool for both practical and theoretical empirical evaluation of the supervision process during training in psychological testing.     

The contribution of ego psychology to understanding the process of termination in psychoanalysis and psychotherapy

Ego psychology is presented as an integrated psychoanalytic developmental theory, including a theory of object relations. The process of termination is employed as one of the many possible illustrations of the usefulness of this theory. Termination is regarded as a process that pervades the treatment from the outset, rather than as the final phase of treatment only, because the treatment process, whether psychoanalysis or psychotherapy, includes continuous promotion of ever-increasing autonomy. Ideally, by the time termination proper takes place, maximum autonomy has been attained. To the definition of autonomy as intersystemic, involving relative independence of the ego from the drives (and from the super-ego), an object-relations dimension is added which extends that definition to include an intrasystemic consideration--namely, relative independence of the self-representation from the object representations. Especially in the treatment of the borderline conditions is the intrasystemic factor cogent because borderline states are characterized by varying degrees of incompletely differentiated self- and object representations. The objective, in the psychoanalysis of neurosis, where self- and object constancy already exist to a large degree, is ego autonomy in the intersystemic sense. In the psychotherapy of the borderline conditions, the objective is greater differentiation of the self-representation from the object representations.