The effectiveness of psychoanalytic psychotherapy: the role of treatment duration, frequency of sessions, and the therapeutic relationship

This is an effectiveness study of treatment outcome that relies on patients' perception of their mental health during and after psychoanalytic psychotherapy. Ninety-nine outpatients attending the IPTAR Clinical Center (ICC) responded to the Effectiveness Questionnaire (EQ) adapted from that developed by Consumer Reports. Effectiveness is studied from various perspectives. Findings indicated (1) an incremental gain in effectiveness scores from six to over twenty-four months of therapy; (2) an incremental gain with greater session frequency from one to two or three weekly sessions; (3) facilitation of effectiveness by the experience of a positive relationship with the therapist; (4) an interplay between clinical syndrome and treatment conditions. A method giving clinical validity to the quantitative findings is described. Brief summaries of two recorded interviews reveal differential reconstruction of events that had occurred during treatment. The findings are discussed from the vantage point of two hypotheses: cognitive dissonance and internalization of therapeutic experience.     

Procurement time as a determinant of meal frequency and meal duration.

Foraging involves the expenditure of both time and effort in the acquisition of food; animals typically modify their meal patterns so as to reduce these expenditures or costs. The contribution of time, as compared with effort, to the overall cost perceived by an animal is not known. We investigated the effect of foraging time as a cost independent of effort by measuring the meal patterns of rats living in a laboratory foraging simulation in which they earned all their daily intake. They pressed a bar once to initiate an interval (procurement interval) leading to the presentation of a large cup of food from which they could eat a meal of any size. As the length of the interval increased from 1 s to 46 hr, meal frequency decreased regularly. Meal size increased in a compensatory fashion, and total daily intake was conserved through an interval of 23 hr. The changes in meal frequency occurred because of changes in the rat's latency to bar press after each meal. The functions relating meal frequency and size to the procurement interval were of the same shape as those seen when cost is the completion of a bar-press requirement, which entails the expenditure of both effort and time. When the bar-press requirement was increased to 10, meal frequency was reduced, but time and effort did not appear to simply add together in the rat's perception of cost. These data reveal that time is preceived to be a cost by rats foraging in this laboratory environment. These results suggest that the time parameters of foraging are different from those of consumption.     

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.     

The Adult Attachment Interview and psychoanalytic outcome studies

During the last two decades, the Adult Attachment Interview (AAI) has attracted growing interest from psychoanalysts concerned with empirical research. The paper discusses the application of Crittenden's Dynamic-Maturational AAI method for assessing the outcome of psychoanalysis. The aim is to demonstrate, through a case presentation, how therapeutic change can be expressed in the AAI. The pre- and post-treatment interviews of one patient, having completed a four-times-a-week psychoanalysis, are presented. It is demonstrated that the detailed discourse analysis of the AAI, based on transcribed tape-recorded interviews, focuses subtle formal elements of language and speech reflecting dominant patterns of affect regulation and object relating. The AAI text analysis provides possibility for coding procedural memory as conveyed by the handling of the relationship to the interviewer, incorporating the dynamic relationship between researcher and subject and thus complying with a methodological prerequisite regarded by many psychoanalysts as necessary for capturing data that are relevant to psychoanalysis. On this background, the method emerges as promising for psychoanalytic outcome studies.     

The "short-long" reaction time effect in duration programming

The programming processes concerned with response duration were studied in a precueing and in a priming reaction time (RT) paradigm. Participants had to produce a motor response of a specified duration as soon as possible after a response signal (RS) preceded by a warning signal (WS), which could deliver information on 2 response parameters (duration and effector). In Experiment I (precueing; N = 12), 3 effectors (the right hand, the left hand, or the knees) and 3 durations (.7, 2.5, or 5.5 s) were contrasted. Two responses differing in their biomechanical features were required in 2 blocks of trials: Subjects had to accurately time the duration of either a sustained button press or an interval between 2 brief presses. The RT patterns revealed a short-long effect: Shorter RTs were produced before the short duration than before the longer, provided that the duration was not precued. This short-long effect occurred whatever type of response and effector were involved. Two conclusions were reached. First, response duration was included in the motor program elaborated before execution, whatever the biomechanical features of the response; and, second, the program for the short duration was activated on all trials and was used as a basis for programming longer durations when needed. These conclusions were tested in Experiment 2 (priming; N = 12), in which a small proportion of invalid trials concerning duration was provided. Thus, the duration required by the RS differed from that primed by the WS. Two durations (.7 or 2.5 s) and 2 effectors (the index or the middle finger) were involved. In the invalid trials, the responses of short and long durations did not yield any RT differences, thus confirming the particular status of the short duration. This suggests that deprogramming operations (which lengthen the RT) are needed after a RS to produce short response durations but not after a RS to produce long response durations in the invalid trials.     

The effect of marker frequency disparity on the discrimination of gap duration in monkeys

Duration-discrimination thresholds of the silent interval (gap) between two successive tones (markers) were measured in four Japanese monkeys. The task was serial discrimination, and monkeys were required to release the lever when the gap duration decreased from 200 ms. Monkeys successfully acquired the task, and gap thresholds of monkeys were revealed to be larger than previous data with human subjects. Gap thresholds were not affected by marker frequency when the two markers were identical in frequency, though the thresholds increased when large frequency differences existed between markers. The effect of marker frequency disparity on gap thresholds in monkeys is discussed in terms of the difficulty in integrating information from discrete frequency channels.     

The use of momentary time sampling to assess both frequency and duration of behavior

When the time-sampling interval size can be set so it is smaller than both the shortest behavior instance and the shortest interresponse time, momentary time sampling will yield an accurate count of the frequency of behavior occurrence. It will also yield an unbiased estimate of behavior duration.     

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.     

The effect of Parkinson's disease on time estimation as a function of stimulus duration range and modality

The present research sought to investigate the role of the basal ganglia in timing of sub- and supra-second intervals via an examination of the ability of people with Parkinson's disease (PD) to make temporal judgments in two ranges, 100-500 ms, and 1-5 s. Eighteen non-demented medicated patients with PD were compared with 14 matched controls on a duration-bisection task in which participants were required to discriminate auditory and visual signal durations within each time range. Results showed that patients with PD exhibited more variable duration judgments across both signal modality and duration range than controls, although closer analyses confirmed a timing deficit in the longer duration range only. The findings presented here suggest the bisection procedure may be a useful tool in identifying timing impairments in PD and, more generally, reaffirm the hypothesised role of the basal ganglia in temporal perception at the level of the attentionally mediated internal clock as well as memory retrieval and/or decision-making processes.     

The effect of timeout duration on frequency of aggression in hospitalized children with conduct disorders

Timeout has been shown to be an effective procedure in the treatment of aggressive behaviors. Previous research, however, has not provided evidence to support the use of a particular timeout duration in the treatment of aggressive behavior. This study compared the effectiveness of four different timeout durations (1, 5, 10, and 20 min) in the treatment of aggressive behavior in hospitalized children with conduct disorders. Results did not support the use of extended periods of timeout, but suggested that 5 min duration was as or more effective than the other tested durations.     

Space and time in psychoanalytic listening1

The analytic situation is by definition traumatic because it evokes hilflosigkeit, the state of helplessness of the newborn infant, which is the prototype of the traumatic situation, and at the origin of the experience of anxiety. The author addresses the chain of associations between the state of helplessness, repetition compulsion, trauma, infantile sexuality, pleasure and displeasure, which lie at the core of the transference experience, and which find their ultimate expression in the analyst's listening. The discovery of the compulsion to repeat instituted a paradigmatic shift in Freud's formulations, emphasizing the process of repetition of trauma, and instituting a link between the network of concepts indicated above. In the clinical example discussed, the author defines the psychoanalytic process by the primacy of sexuality, the erotic passivation in the transference that evokes the traumatic childhood sexual scene. Sexuality and sexual phantasies are at the centre of the elaboration of meaning. Furthermore, the author distinguishes between two types of interpretations, namely ‘open’ and ‘closed’.     

Phoneme-monitoring reaction time and preceding prosody: Effects of stop closure duration and of fundamental frequency

In an earlier study, it was shown that listeners can use prosodic cues that predict where sentence stress will fall; phoneme-monitoring RTs are faster when the preceding prosody indicates that the word bearing the target will be stressed. Two experiments which further investigate this effect are described. In the first, it is shown that the duration of the closure preceding the release of the target stop consonant burst does not affect the RT advantage for stressed words. In the second, it is shown that fundamental frequency variation is not a necessary component of the prosodic variation that produces the predicted-stress effect. It is argued that sentence processing involves a very flexible use of prosodic information.     

The relation between physical stimulus properties and the effect of foreperiod duration on reaction time

Seven subjects were used in an experiment on the relation between signal modality and the effect of foreperiod duration (EP) on RT. With visual signals the usually reported systematic increase of RT as a function of FP duration (1, 5 and 15 s) was confirmed; with auditory signals no difference was found between FP's of 1 and 5 s while the effect at 15 s was equivalent to that found at 5 s with the visual signal. The results suggest that besides factors such as time uncertainty the FP effect is also largely dependent on the arousing quality of the signal.     

Effects of outcome and trial frequency on the inverse base-rate effect

The inverse base-rate effect is a bias in contingency learning in which participants tend to predict a rare outcome for a conflicting set of perfectly predictive cues. Although the effect is often explained by attention biases during learning, inferential strategies at test may also contribute substantially to the effect. In three experiments, we manipulated the frequencies of outcomes and trial types to determine the critical conditions for the effect, thereby providing novel tests of the reasoning processes that could contribute to it. The rare bias was substantially reduced when the outcomes were experienced at equal rates in the presence of predictive-cue frequency differences (Exp. 2), and when the predictive cues were experienced at equal rates in the presence of outcome frequency differences (Exp. 3). We also found a consistent common-outcome bias for novel cue compounds. The results indicate the importance of both cue and outcome frequencies to the inverse base-rate effect, and reveal a combination of necessary conditions that are not well captured by appealing to inferential strategies at test. Although both attention-based and inferential theories explain some aspects of these data, no existing theory fully accounts for these effects of relative novelty.     

The politics of time: Deleuze,duration and alter-globalisation

Alex Callinicos, in An Anti-Capitalist Manifesto, criticises Gilles Deleuze's work for its ostensible apolitical aestheticism, and for its correlative undermining of the concept of authenticity so important to political activism. He accordingly valorises the November 1999 mass protests in Seattle against the WTO and economic globalisation as expressing reinvigorated neo-Marxist social critique and rejuvenated belief in authenticity. Both of these, he maintains, are underpinned by insight into the problematic politico-economic excesses of neoliberalism and recognition of the philosophical limitations of post-structural thought, particularly that of Deleuze. Against the backdrop of such criticism, this article considers the value of Deleuze's (and Félix Guattari's) politicisation of time and memory, as a heuristic device that renders conspicuous the durational concerns currently animating the alter-globalisation struggle. Durational concerns which, since the Second World War, have been successively marginalised through developmental time and neoliberal time, and which now face displacement, yet again, through attempts (such as those of Callinicos) to subsume them within the time of dialectical materialism. Arguably, this move threatens to curb the diverse temporalities currently being produced by alter-globalisation supporters, using the internet and related digital media, as part of a tactical effort to resist neoliberal hegemony.