The goals of psychoanalytic treatment: Conceptual considerations and follow‐up interview evaluation with a former analysand1

There has been a long, ongoing discussion of goals in psychoanalytic treatment. Some analysts are even of the opinion that psychoanalysis ought to be goalless (‘just analysing’). The growing number of outcome studies, however, is in need of a generally accepted set of criteria by which treatment results can be judged. The author proposes a definition of the goals of psychoanalysis that covers four areas: the alleviation of symptoms and complaints, changes in life adjustment, changes in personality structure, and procedural goals such as the resolution of the transference neurosis. She illustrates the relevance of this conceptualization by an empirical study that considers the assessments of 19 psychoanalysts discussing statements made by a former patient about her analytic treatment. On the basis of this case, which comes from the follow‐up study of the DPV (German Psychoanalytical Society), reported by Leuzinger‐Bohleber et al. in 2002, the author demonstrates that psychoanalysts use the criteria defined above implicitly in forming their opinions. Moreover, they arrived at similar judgements regarding the treatment's outcome.     

Performance as annihilation or integration?1

What happens when the analyst has the impression of being annihilated by the patient? Analysts have a tendency to use more general, i.e. simplifying, constructions such as destructiveness, psychosis or death instinct as explanatory models. In the authors' view, these constructions in the end evade rather than mirror clinical reality. More recent research points to promising possibilities of differentiation, e.g. psychotic mechanisms which are‐as yet undiscussed‐based on Freud's notion of the partial ‘rent in the relation between ego and external world’. These findings emphasize the restitutive function of a symptom or disturbance, i.e. destruction of a relationship which hinders the therapeutic process and which is not understood initially, instead of solely stressing the destructive meaning in a tabooing gesture. The concept of performance attempts to replace simplifying models with a discriminant process, and will be preliminarily defined and explained in delineation to terms already in use such as acting out, enactment, and role responsiveness. The authors explore the question of how the perception of unthought certainty in the performance can either be recognized as a blueprint, i.e. organizing activity, or as the destruction of the relationship so that a new one can emerge. The evidence from a detailed clinical example shows that many treatments can fail at this point and demonstrates how an understanding of performance in this sense offers a chance for integrating processes that otherwise impede treatment.