Freud's "analytic pact": the standard therapeutic alliance

Freud's "analytic pact," as the final therapeutic model he evolved (1937, 1940), places the fundamental rule in a two-person structural framework that operates in a continuum between the inner reality and outer reality of both patient and analyst as these come to center in the analytic situation. To Freund's basic definition of psychoanalysis as related to resistance and transference, a third component is added, the collaboration that has been a feature of the treatment since the beginning. The alliance postulated by the pact relates a helpful physician to a sufferer in a carefully regulated operational field and atmosphere suitable for a particular technique and therapeutic goal. Actually the alliance may be described from the aspect of component combinations as described in different frameworks--structural, topographic, developmental, realistic, adaptive, etc. In diverse forms of analytic or analytically oriented forms of therapy, selected aspects of the alliances receive greater prominence--but a fully informed analytic therapy retains contact with all the elements involved. Organizational aspects of the fundamental rule with respect to the flow of associations and the transient and structured interactions of patient and physician are examined with regard to their dynamic and linguistic features.     

The treatment of tension headache—I. Muscular abnormality and biofeedback

The specificity and efficacy of a short EMG biofeedback treatment were assessed in a selected group of chronic tension-headache cases—those having significantly elevated levels of muscle tension. The effects of training patients to raise/maintain EMG levels were compared to those obtained from patients who were trained to lower tension levels. The results showed little evidence of increased self-control of the muscle despite successful EMG control during six bio-feedback sessions. A progressive and significant reduction in resting level was found only in the groups trained to reduce EMG levels. The treatment proved ineffectual in reducing headache. The implications of the dissociation of muscle tension and headache are discussed both with respect to current views of tension headaches and the role of biofeedback in their treatment.     

Form and content in the conjoint treatment of sexual dysfunction: A controlled study

Forty eight couples with impotence, anorgasmia or loss of libido were randomly allocated to one of three treatment conditions: (i) modified Masters and Johnson (male and female therapist), (ii) modified Masters and Johnson (one therapist) and (iii) marital therapy and relaxation comparison procedure (one therapist). The major variables investigated were type of therapy, number of therapists (one or two) and sex of therapist. Post-treatment and one year follow-up assessments showed no significant difference in outcome between treatment approaches. No significant effects were found for sex of therapist and the interaction between sex of therapist and sex of presenter.     

Training Facilities in Marital and Family Therapy

This survey reports the results of a national survey of training programs in family therapy. Two hundred and forty-five programs responded to the survey questionnaire providing data for the development of a master list of training programs and a general assessment of the nature and magnitude of training efforts in the field. The survey included programs housed in diverse institutional settings. The data indicate the extent of growth and the increasing formalization of professional training in family therapy. A classification system is proposed for distinguishing among the major types of facilities providing family therapy training. Programs are compared in terms of the type, duration, and intensity of the training offered and the number of students enrolled.     

The Parent's Nazi Past and the Dialogue Between the Generations

This paper considers the impact of the Nazi past on the succeeding generation in Germany and on the dialogue between the two generations, using the theoretical framework of the dynamics of delegation — missions entrusted to parents by their children. Those issues became manifest in the course of conjoint family interviews with adolescents and young adults whose parents had been identified with the Nazi past.     

Engaging “Resistant” Families in Treatment

Many families, when presented with the option of family therapy, are less than eager to participate. This paper comprises the second and third parts of a series on engaging “resistant” families. ¹ 1 The first paper in this series, authored by J. M. Van Deusen, M. D. Stanton, S. M. Scott, and T. C. Todd, is entitled “Engaging “Resistant” Families in Treatment: I. Getting the Drug Addict to Recruit His Family Members” and appeared in the International Journal of the Addictions 15 (7): 1069–1089, 1980. A revised and expanded version of Part II is presented in M.D. Stanton, T. C. Todd, and Associates, The Family Therapy of Drug Abuse and Addictions New York, Guilford, in press.
Part II presents 21 principles and a number of techniques and strategies that have been developed for successfuly recruiting such families. These techniques should be applicable for engaging resistant families with all types of presenting problems. Part III provides an analysis of the important variables involved, along with data on cost efficiency and administrative costs. It was found that when therapists had administrative control of their cases, serving in dual roles as both therapists and drug counselors, the recruitment effort was (a) more effective (i.e., complete families, including both parents or parent surrogates, were recruited in 77 per cent of the cases), and (b) twice as cost efficient. Two-thirds of the non-engaged families were not recruited because the index patient would not allow family members to be contacted. Black families were more difficult to recruit than whites. Data on cost efficiency and on the actual administrative costs of recruiting families are also provided. We conclude that the engagement process requires a revision in therapeutic philosophy, since such families are often desperately in need of help but are unavailable unless therapists make a special effort to reach them.     

An Assessment of the Effectiveness of Two Tactics to Reduce Arousal in Crowded Mass Transit Settings1

Studies of crowding in various settings have shown that individuals are aroused and frequently suffer from ill health. Several studies have shown that it is possible to successfully intervene in residential, shopping, and classroom settings to reduce the negative effects of crowding. The present laboratory experiment assessed the effectiveness of two tactics commonly used by passengers in crowded mass transit settings. Results indicated that the two tactics, reading a newspaper or talking to others, failed to reduce arousal. An explanation for the failure of these tactics is offered.     

AN ECOBEHAVIORAL EXAMINATION OF A SIMPLE STRATEGY FOR INCREASING MEALTIME LANGUAGE IN RESIDENTIAL FACILITIES

Typically in large residential facilities for retarded persons, meals are served in an institutional style that does not appear to encourage appropriate peer interactions. An ecological program alternative is serving meals in a family style. The present study was designed to examine both the feasibility of serving family style meals and the effects of family style meal service on mealtime language. Five retarded young adult male residents, who had some conversational skills and appropriate table manners, participated in this study. The experimental design involved a multiple baseline analysis across meals (dinner, lunch, and breakfast). Observers coded the youths' mealtime verbalizations according to the type, content, and direction of the verbalizations and they recorded the length of the meals. The analysis of the verbalization data indicated that during family style meals the participants spoke substantially more often than during institutional style meals. Increases in peer-directed conversation about the meals primarily accounted for the verbalization changes. Family style serving also resulted in the youths spending more time with their meals. In addition, social validation measures suggested that the family style procedures were preferred by the consumers (participants, staff, and concerned community members).