Psychotherapy Process Measure Research and the Evaluation of Psychotherapy Orientation: A Narrative Analysis

This article discusses the need for a systematic method that enables researchers to evaluate integrative therapy approaches using a range of therapy process measures. The Narrative System Process Coding (NPCS; Angus, Hardtke, & Levitt, 1996) is proposed as such a method, and is applied with the Experiencing Scale (Klein, Mathieu, Gendlin, & Keisler, 1970) and the Levels of Client Perceptual Processing (LCPP; Toukmanian, 1986) to three brief good outcome integrative therapy modalities to illustrate this need. The study found higher Experiencing Scale scores to be most strongly related to an experiential approach to therapy and to the NPCS internal narrative processes. Higher LCPP scores were most strongly related to the NPCS reflexive narrative process and to a perceptual-processing approach. The discussion initiates a discourse on the importance of explicating process measures' origins when comparing different therapy approaches in order to allow for the meaningful consolidation of process research findings.     

Some Thoughts on the Integration of Narrative and Humanistic/Existential Approaches to Psychotherapy

Although humanistic and narrative approaches to psychotherapy make some different assumptions about the nature of the human condition and emphasize different aspects of human functioning in their therapeutic endeavors, I argue here that the underlying assumptions of these two approaches reflect a common view of humanness, thus making these two approaches candidates for attempts at integration. Four areas of commonality are discussed in detail: (a) life as a process of continual development, (b) the nature of experience and the process of meaning creation, (c) the nature of psychological dysfunction, and (d) the nature and importance of human relationships. The implications of these commonalities for the practice of therapy from an integrated perspective are explored in an extended case example.     

Philosophy,Logic, Science,History

Analytic philosophy is sometimes said to have particularly close connections to logic and to science, and no particularly interesting or close relation to its own history. It is argued here that although the connections to logic and science have been important in the development of analytic philosophy, these connections do not come close to characterizing the nature of analytic philosophy, either as a body of doctrines or as a philosophical method. We will do better to understand analytic philosophy—and its relationship to continental philosophy—if we see it as a historically constructed collection of texts, which define its key problems and concerns. It is true, however, that analytic philosophy has paid little attention to the history of the subject. This is both its strength—since it allows for a distinctive kind of creativity—and its weakness—since ignoring history can encourage a philosophical variety of “normal science.”     

THE USE OF THE ANALYST AND THE SENSE OF BEING REAL: THE CLINICAL MEANING OF WINNICOTT'S “THE USE OF AN OBJECT”

“The Use of an Object and Relating through Identifications” (1968) represents Donald Winnicott's theoretical and clinical legacy. The author develops this concept from a clinical point of view, through the analysis of a woman with psychotic functioning. He reflects upon the dramatic quality of risks inherent in the processes linked to the use of the object with seriously disturbed patients. He explores different meanings of the analyst's survival, linking it to the analyst's response. The processes of the use of the object—that is, the encounter between the patient's potential destructiveness and the analyst's capacity to respond through his own judicious subjectivity—let the patient experience the analyst's capacity to keep his own subjectivity, authenticity, and creativity alive. It is starting from the traces of this live object that patients gradually form their own personal sense of being real.     

The specifi city of torture as trauma: The human wilderness when words fail1

The author attempts to situate the specifi city of torture‐understood as the product of political violence and of totalitarian states‐within the historical framework of the concept of trauma in psychoanalysis. When the mind and social ties are simultaneously affected, the intrapsychic and transpersonal aspects of the suffered damage intertwine in a complex and unique web. The author aims to dismantle the notion of victim, considering it both stigmatizing and inaccurate. The goal is not just to identify the after‐effects and the disabilities suffered by those affected by torture, but also to integrate their experiences and their narratives into a life project. Rather than individual psychopathology, this essay refl ects upon those phenomena of suggestion and hypnosis that are at work in human groups under ordinary conditions and that are exacerbated under social crises, following the Freudian axis developed in Group psychology and the analysis of the ego.     

BEFORE BABEL: REFLECTIONS ON READING AND TRANSLATING FREUD

The author offers some thoughts on reading and teaching Freud, on translating Freud, on translation in general, and on a possible kinship between translation and the psychoanalytic process. His reading of Freud's works, and the years he spent translating them into Hebrew and editing Hebrew editions of his writings, have made a deep and salient impression on his personal psychoanalytic palimpsest. The author began this labor prior to his psychoanalytic training and has no doubt that, to this day, the experience greatly shapes not only his attitude toward Freud himself, but also the nature of how he listens to patients and the way he thinks and writes about psychoanalysis.     

Disrupted narrative and narrative symbol

In this article a specific type of narrative, which often appears in analytic sessions, is discussed. It is characterized by a seemingly ordinary, everyday topic and by a peculiar disruption of the narrative flow. The threefold structure of this type of narrative is described, along with its main characteristics. One element of this type of narrative is very similar to symbolic content or complex symbolic structures, e.g. dreams, the sort of material that can be used for the purpose of interpretation. The similarities as well as the differences are elaborated in the article. Thanks to the observed general structure and ‘symbolic’ nature of some parts of the narrative, it is easy to notice some of the unconscious elements, which are not familiar to the patient's ego, and to make an interpretation. Because these elements are close to the threshold of consciousness, the patient willingly accepts an interpretation based on them. This is especially true for patients whose dominant function is thinking. A temporary, working name for this type of narrative is proposed in the article: ‘disrupted narrative’ ? and for its disruptive part ‘narrative symbol’.     

Clinical issues in analyses over the telephone and the internet

There is professional consensus that teleanalysis, the practice of psychoanalysis conducted remotely using the telephone and the Internet, is increasing in response to more mobility in the population. But there is controversy as to whether the use of technology leads to a dilution of analysis or to adaptive innovation that is clinically effective and true to the tenets of psychoanalysis. The author reviews the psychoanalytic literature and shows the development of analytic thinking about this technology-assisted practice of psychoanalysis. She summarizes analysts' perceptions and experiences of the advantages and disadvantages, and considers the indications and contra-indications. She focuses on the clinical concerns that arise in terms of the frame, resistance, and the development of analytic process through the unconscious communication of internal objects, unconscious fantasy, transference and countertransference. She gives vignettes from the analysis of a man with trauma-related depression to address the concerns raised and to support her argument that analysis using the telephone and the Internet is a viable, clinically effective alternative to traditional analysis where necessary.     

The shadow of familiarity: a contributor to the intersubjective field

This paper examines the influence of familiarity on the progress of analysis. It is proposed that familiarity is a particular aspect of the intersubjective field which emerges over time and begins to shape and influence the behaviours, perceptions, thoughts, and feelings of the participants. It is also proposed that states of familiarity can have facilitative or defensive functions in an analytic relationship and that it is an influence co-created in the field. The experience of familiarity operates as background to our various foreground concerns in analytic work and therefore exists primarily as an implicit, rather than explicit, experience in analysis. Defensive familiarity often creates a feeling of relatedness that is subtly unrelated, a form of pseudo-intimacy. Parallels between defensive familiarity and related concepts are examined including defences against the unknown, role responsiveness, romantic love, the image of the stranger, and unformulated experience. This paper concludes with two case examples and a discussion of procedural knowledge in the implicit domain as an explanatory framework for the understanding of familiarity states in the analytic setting.     

Bearing the unbearable: ancestral transmission through dreams and moving metaphors in the analtyic field

Abstract: This paper explores how untold and unresolved intergenerational trauma may be transmitted through unconscious channels of communication, manifesting in the dreams of descendants. Unwitting carriers for that which was too horrific for their ancestors to bear, descendants may enter analysis through an unconscious need to uncover past secrets, piece together ancestral histories before the keys to comprehending their terrible inheritance die with their forebears. They seek the relational containment of the analytic relationship to provide psychological conditions to bear the unbearable, know the unknowable, speak the unspeakable and redeem the unredeemable. In the case of ‘Rachael’, initial dreams gave rise to what Hobson (1984) called ‘moving metaphors of self’ in the analytic field. Dream imagery, projective and introjective processes in the transference‐countertransference dynamics gradually revealed an unknown ancestral history. I clarify the back and forth process from dream to waking dream thoughts to moving metaphors and differentiate the moving metaphor from a living symbol. I argue that the containment of the analytic relationship nested within the security of the analytic space is a necessary precondition for such healing processes to occur.