Followup in psychoanalysis: clinical and research values

Psychoanalysis has never developed a tradition of systematic followup study to evaluate outcome and to improve technique and theory for a variety of reasons, partly theoretical, stemming from the conception of the unfolding transference neurosis and its analytic resolution as the precondition for cure, and partly historical, having to do with the happenstance of its development as a private practice-based discipline and training outside of the academic setting. Freud, however, was never bound by such strictures and published whatever post-treatment data he acquired on all his best-known case histories. But following Freud most analysts, with some notable exceptions, eschewed followup activity as unanalytic. It is this tradition that more recent studies like those of Pfeffer in New York and the Psychotherapy Research Project of The Menninger Foundation in Topeka have squarely challenged. Data are presented from the Menninger project dealing specifically with the impact of routine planned followup on issues of treatment termination and resolution and on the nature of the post-treatment period. The degree and kind of patient cooperation with the followup inquiry, the impact of followup on treatment termination and resolution (both impeding and facilitating), and the role of followup intervention in relation to return to formal post-treatment therapy (or consolidating against it), are all discussed.     

Changing psychic structure through treatment: criteria for change

The author outlines his clinical observations during the "middle game" of psychoanalysis, leading to recognition that structural change is taking place. "Middle game," "structure," process, and content are defined and critically discussed. Illustrative clinical vignettes are offered. The presentation emphasizes the importance of an active and resolving transference "struggle"; in addition, more traditionally noted criteria are briefly touched on, e.g., development of observing ego and treatment alliance, changes in dream function and communication, and the reviewing of the neurosis and transference during the termination phase as instances of mourning and working through. The concept of optimal psychobiological function in the service of a homeostatic principle is discussed.     

Emotional disturbance and the development of self-consciousness in adolescence

The development of self-consciousness and its relationship to emotional disturbance was examined in early and late adolescence. The Imaginary Audience Scale was administered to emotionally disturbed and nondisturbed adolescents. As predicted, results indicated that self-consciousness decreased with age in nondisturbed adolescents. For the emotionally disturbed adolescents, the development of self-consciousness in temporary situations did not follow consistent patterns, as indicated by interaction effects. A significant negative relationship was found between intelligence test scores and self-consciousness in the disturbed group. The findings support the premise that social-cognitive shifts found in early to late adolescence are disrupted in disturbed populations. The mediating role of social experience as a factor in cognitive and emotional development is discussed.     

Visual control of movement patterns and the grammar of action

In this experiment adult subjects copied three types of material (letters, reversed letters and geometric shapes) with and without sight of the hand and the writing trace. Without vision the number of movement segments decreased and the sequence and direction of movements were altered. This means that subjects did not use a fixed stored representation to produce items nor did they obey the rules of Goodnow and Levine's (1973) grammar of action. When spatial location is made more difficult by the removal of vision, movement production is simplified to reduce the number of relocations required. The use of consistent directions of movement depends on the ability to use visual control of spatial location.     

The Social Phobia and Anxiety Inventory: concurrent validity with a clinic sample

The Social Phobia and Anxiety Inventory (SPAI) is an empirically derived self-report inventory developed as a specific measure of social phobia. The current investigation included two studies. The first examined the correlation of the SPAI with daily social behavior of a clinic sample of social phobics. The results indicated that the SPAI provides a reasonable indication of the distress experienced during daily social encounters in three dimensions: behavior, cognitions, and overall distress. The second study examined the validity of the SPAI with reference to the somatic response and avoidance behavior of social phobics. The results indicated that the somatic items of the SPAI are related to the somatic response of social phobics and that performance on the SPAI is associated with avoidance behavior in an anxiety-producing task.     

Research-structured vs clinically flexible versions of social learning-based marital therapy

The purpose of this study was to compare our structured research-based version of marital therapy from a social learning perspective with a clinically flexible version of the same treatment where treatment plans were individually-based and there was no specific number of treatment sessions. Thirty distressed married couples were randomly assigned to one of these two treatments. Assessment of outcome was based on global marital satisfaction, spouse reports of functioning in specific areas, and direct observational measures of communication. At posttest there were no differences in efficacy between structured and flexible treatments, although both treatments led to significant improvements. At a 6-month follow-up couples treated with the structured format were more likely to have deteriorated and flexibly treated couples were more likely to have maintained their treatment gains.     

Infants' perception of rhythm: categorization of auditory sequences by temporal structure

We presented 7- to 9-month-old infants with repetitions of three- or four-tone sequences characterized by a particular rhythmic structure. We then evaluated their detection of changes in rhythmic structure in the context of randomly presented variations in tempo (rate) and frequency. Infants successfully differentiated between three-tones sequences with 1, 2 (X XX) and 2, 1 (XX X) structure as well as four-tone sequences with 2, 2 (XX XX) and 3, 1 (XXX X) structure. In other tasks, they indicated their ability to discriminate between contrasting tempos in the context of frequency variations. We conclude, then, that infants can categorize auditory sequences on the basis of rhythm and also on the basis of tempo.     

The composition of imaginal transformations

Three experiments examine the performance of composite imaginal spatial transformations using tasks in which people perform pairs of distinct imaginal transformations either in close succession or simultaneously. The principal aim of the investigation is to determine, for both modes of composition, whether imaginal transformations combine interactively or noninteractively to determine the temporal course of imaging performance. Specifically, does the time to imagine a given composite transformation reflect the independent contributions of its component transformations, or do component transformations have different effects within different composites? Results obtained under a number of distinct task conditions are most consistent with the proposal of noninteractive composition. However, the temporal effects of particular imaginal transformations are neither consistent nor readily predictable across different task conditions. Implications of these results for analogue-spatial models, task demand, and procedural accounts of imaging are discussed.     

Neuronal models of cognitive functions

Understanding the neural bases of cognition has become a scientifically tractable problem, and neurally plausible models are proposed to establish a causal link between biological structure and cognitive function. To this end, levels of organization have to be defined within the functional architecture of neuronal systems. Transitions from any one of these interacting levels to the next are viewed in an evolutionary perspective. They are assumed to involve: (1) the production of multiple transient variations and (2) the selection of some of them by higher levels via the interaction with the outside world. The time-scale of these "evolutions" is expected to differ from one level to the other. In the course of development and in the adult this internal evolution is epigenetic and does not require alteration of the structure of the genome. A selective stabilization (and elimination) of synaptic connections by spontaneous and/or evoked activity in developing neuronal networks is postulated to contribute to the shaping of the adult connectivity within an envelope of genetically encoded forms. At a higher level, models of mental representations, as states of activity of defined populations of neurons, are discussed in terms of statistical physics, and their storage is viewed as a process of selection among variable and transient pre-representations. Theoretical models illustrate that cognitive functions such as short-term memory and handling of temporal sequences may be constrained by "microscopic" physical parameters. Finally, speculations are offered about plausible neuronal models and selectionist implementations of intentions.