Research in the consulting room

Psychoanalysis, this paper argues, has since its inception practised an effective method of research based on the clinical consulting room, and this explains its success in generating new knowledge over a long period. Different sciences evolve research methods which are appropriate to their particular objects of study. The clinical research method is well adapted to the distinctive object of study of psychoanalysis?-?the variety of unconscious states of mind. Convergences between psychoanalytic and more conventionally scientific methods, including experimental studies, are greatly to be welcomed, but the paper nevertheless suggests that additions to psychoanalytic understanding will continue to come mainly from clinical work with children and adults. Selon l'auteur, la psychanalyse a pratiqué dès ses débuts une méthode de recherche fort efficace, basée sur ce qui se déroule dans le cabinet de consultation clinique; c'est cela, dit-il, qui explique son succès à faire naître, depuis fort longtemps, de nouvelles connaissances. Chaque discipline scientifique développe sa propre méthode de recherche, censée s'appliquer à ses objets d'étude spécifiques. La méthodologie clinique est bien adaptée à l'objet d'étude spécifique de la psychanalyse, à savoir la diversité des états psychiques inconscients. S'il convient, bien évidemment, à accueillir certaines convergences entre la méthode psychanalytique et d'autres, plus classiquement scientifiques (y compris les études expérimentales), l'auteur prétend néanmoins que des avancées dans la compréhension psychanalytique continueront à surgir principalement du travail clinique auprès d'enfants et d'adultes. In questo articolo si sostiene che la psicoanalisi ha fin dal suo esordio messo in pratica un metodo di ricerca efficace basato sul lavoro clinico nella stanza di consultazione, e questo spiega come sia stato possibile produrre con successo nuova conoscenza nell'arco di un lungo periodo. Scienze diverse sviluppano metodi di ricerca appropriati ai loro particolari oggetti di studio. Il metodo di ricerca clinico si adatta bene all'oggetto peculiare di studio della psicoanalisi - la molteplicita' degli stati mentali inconsci. Ben vengano le convergenze tra il metodo psicoanalitico e altri metodi scientifici piu' convenzionali, compresi gli studi sperimentali, ma nell'articolo si suggerisce che nuove aggiunte al sapere psicoanalitico continueranno a venire soprattutto dal lavoro clinico con adulti e bambini. Dieser Artikel argumentiert, dass Psychoanalyse seit ihren Anfängen eine effektive Forschungsmethode, basierend auf dem klinischen Behandlungszimmer, praktizierte und dies erklärt ihren Erfolg, neues Wissen über eine lange Zeit hinweg zu schaffen. Verschiedene Wissenschaften erschaffen Forschungsmethoden, die jeweils ihren Studienobjekten angemessen sind. Die klinische Forschungsmethode ist dem bestimmten Studienobjekt der Psychoanalyse -die Verschiedenheit von unbewussten Gemütszuständen, angepasst. Konvergenzen zwischen psychoanalytischen und konventionelleren Wissenschaftsmethoden, einschliesslich experimenteller Studien, sollten sehr willkommen geheissen werden, aber der Artikel schlägt vor, dass Zusätze zum psychoanalytischen Verstehen hauptsächlich weiterhin aus der klinischen Arbeit mit Kindern und Erwachsenen kommen werden.     

Remarriage Beliefs as Predictors of Marital Quality and Positive Interaction in Stepcouples: An Actor–Partner Interdependence Model

Using an Actor–Partner Interdependence Model, we examined remarriage beliefs as predictors of marital quality and positive interaction in a sample of 179 stepcouples. Three beliefs were measured using subscales from the Remarriage Belief Inventory (RMBI) including success is slim, children are the priority, and finances should be pooled. Several significant actor and partner effects were found for both wives' and husbands' beliefs. Wives' marital quality was positively associated with their own beliefs that finances should be pooled and negatively associated with their own beliefs that success is slim. Wives' reports of their own and spouses' positive interaction were both positively associated with their beliefs that finances should be pooled. Their reports of spouses' positive interaction were also negatively associated with husbands' beliefs that success is slim. Husbands' marital quality was positively associated with wives' beliefs that children are the priority, positively associated with their own beliefs that finances should be pooled, and negatively with success is slim. Positive interaction for husbands was positively associated with wives' beliefs that finances should be pooled and negatively associated with their own beliefs that success is slim. Finally, husbands' reports of positive interaction for their spouses were positively associated with wives' beliefs that finances should be pooled. Implications for future research utilizing dyadic data analysis with stepcouples are addressed.     

Improvements in Unmarried African American Parents' Rapport,Communication, and Problem‐Solving Following a Prenatal Coparenting Intervention

This report examines effects of a coparenting intervention designed for and delivered to expectant unmarried African American mothers and fathers on observed interaction dynamics known to predict relationship adjustment. Twenty families took part in the six‐session “Figuring It Out for the Child” (FIOC) dyadic intervention offered in a faith‐based human services agency during the third trimester of the mother's pregnancy, and completed a postpartum booster session 1 month after the baby's arrival. Parent referrals for the FIOC program were received from a county Health Department and from OBGYNs and Pregnancy Centers in the targeted community. All intervention sessions were delivered by a trained male–female paraprofessional team whose fidelity to the FIOC manualized curriculum was independently evaluated by a team of trained analysts. At both the point of intake (“PRE”) and again at an exit evaluation completed 3 months postpartum (“POST”), the mothers and fathers were videotaped as they completed two standardized “revealed differences” conflict discussions. Blinded videotapes of these sessions were evaluated using the System for Coding Interactions in Dyads. Analyses documented statistically significant improvements on 8 of 12 variables examined, with effect sizes ranging from moderate to large . Overall, 14 families demonstrated beneficial outcomes, 3 did not improve, and 3 showed some signs of decline from the point of intake. For most interaction processes, PRE to POST improvements were unrelated to degree of adherence the paraprofessional interventionists showed to the curriculum. However, better interventionist competence was related to decreases in partners' Coerciveness and Negativity and Conflict, and to smaller increases in partner Withdrawal. Implications of the work for development and delivery of community‐based coparenting interventions for unmarried parents are discussed.     

Mid‐ and Long‐Term Effects of Family Constellation Seminars in a General Population Sample: 8‐ and 12‐Month Follow‐Up

In a previous randomized controlled trial (RCT), short‐term efficacy of family constellation seminars (FCSs) in a general population sample was demonstrated. In this article, we examined mid‐ and long‐term stability of these effects. Participants were 104 adults (M = 47 years; SD = 9; 84% female) who were part of the intervention group in the original RCT (3‐day FCS; 64 active participants and 40 observing participants). FCSs were carried out according to manuals. It was predicted that FCSs would improve psychological functioning (Outcome Questionnaire OQ‐45.2) at 8‐ and 12‐month follow‐up. Additionally, we assessed the effects of FCSs on psychological distress, motivational incongruence, individuals’ experience in their personal social systems, and overall goal attainment. Participants yielded significant improvement in psychological functioning (d = 0.41 at 8‐month follow‐up, p = .000; d = 0.40 at 12‐month follow‐up, p = .000). Results were confirmed for psychological distress, motivational incongruence, the participants’ experience in their personal social systems, and overall goal attainment. No adverse events were reported. This study provides first evidence for the mid‐ and long‐term efficacy of FCSs in a nonclinical population. The implications of the findings are discussed.     

The Evaluation of Family Functioning by the Family Assessment Device: A Systematic Review of Studies in Adult Clinical Populations

A large body of research, documenting the impact of a family's functioning on health outcomes, highlights the importance of introducing the evaluation of patients' family dynamics into clinical judgment. The Family Assessment Device (FAD) is a self‐report questionnaire designed to assess specific dimensions of family functioning. This qualitative systematic review, which follows PRISMA guidelines, aimed to identify the FAD's clinimetric properties and to report the incremental utility of its inclusion in clinical settings. A thorough literature search was performed, using both computerized and manual searches, yielding a total of 148 studies that were included in this review. The FAD has been extensively used in a variety of research contexts. In the majority of studies it was able to discriminate between clinical populations and controls and among groups of patients with different illnesses. The FAD also showed good test–retest and concurrent reliability, and modest sensitivity to change after treatment. FAD‐dysfunctional family functioning was related to several patient clinical outcomes, including lower recovery rates and adherence to treatment, longer recovery time, poorer quality of life, and increased risk of relapse and drop‐out. The present review demonstrates that the FAD is a suitable instrument for the evaluation of family functioning both in clinical and research settings.     

Individual‐Oriented Relationship Education: An Evaluation Study in Community‐Based Settings

The effects of relationship education aimed at individuals, rather than couples, have not yet been widely investigated. However, increasingly, relationship education is provided to large and diverse groups of individuals who may be in varying stages of relationships. Several programs have been developed to strengthen relationship competencies among single individuals as well as among partnered individuals who, for a variety of reasons, seek relationship education without their partners. The current study is an exploratory evaluation study that examined self‐reported outcomes for 706 single and partnered individuals who attended Within My Reach classes delivered in community‐based agencies. Participants were from diverse backgrounds and exhibited many of the risk factors for poor relationship outcomes including unemployment, low income, and childhood experience of abuse or neglect. Pre‐post analyses indicated that the program was beneficial for both singles and partnered individuals. Singles reported increased belief in ability to obtain healthy relationships. Partnered individuals reported increased relationship quality, relationship confidence, and reduced conflict. Regardless of relationship status, participants also reported improvement in general relationship and communication skill. Results support the utility of individual‐oriented relationship education for singles and partnered individuals with diverse background characteristics.     

Reliability and Validity of a Short Version of the General Functioning Subscale of the McMaster Family Assessment Device

The General Functioning 12‐item subscale (GF12) of The McMaster Family Assessment Device (FAD) has been validated as a single index measure to assess family functioning. This study reports on the reliability and validity of using only the six positive items from the General Functioning subscale (GF6+). Existing data from two Western Australian studies, the Raine Study (RS) and the Western Australian Child Health Survey (WACHS), was used to analyze the psychometric properties of the GF6+ subscale. The results demonstrated that the GF6+ subscale had virtually equivalent psychometric properties and was able to identify almost all of the same families who had healthy or unhealthy levels of functioning as the full GF12 subscale. In consideration of the constraints faced by large‐scale population‐based surveys, the findings of this study support the use of a GF6+ subscale from the FAD, as a quick and effective tool to assess the overall functioning of families.     

Child Maltreatment in DSM‐5 and ICD‐11

Child maltreatment is widespread and has a tremendous impact on child victims and their families. Over the past decade, definitions of child maltreatment have been developed that are operationalized, face valid, and can be reliably applied in clinical settings. These definitions have informed the revised Diagnostic and Statistical Manual (American Psychiatric Association, 2013) and are being considered for the International Classification of Disease–11 (World Health Organization). Now that these definitions are available in major diagnostic systems, primary healthcare providers and clinicians who see children and families are poised to help screen for, identify, prevent, and treat child maltreatment. This article reviews the definitions of maltreatment in these diagnostic systems, along with assessment and screening tools, and empirically supported prevention and intervention approaches.     

Revisioning Fordham's ‘Defences of the self’ in light of modern relational theory and contemporary neuroscience

This paper explores the evolution of Michael Fordham's ideas concerning ‘defences of the self’, including his application of this concept to a group of ‘difficult’ adult patients in his famous 1974 paper by the same name. After tracing the relevance of Fordham's ideas to my own discovery of a ‘self‐care system’ in the psychological material of early trauma patients (Kalsched 1996 ), I describe how Fordham's seminal notions might be revisioned in light of contemporary relational theory as well as early attachment theory and affective neuroscience. These revisionings involve an awareness that the severe woundings of early unremembered trauma are not transformable through interpretation but will inevitably be repeated in the transference, leading to mutual ‘enactments’ between the analytic partners and, hopefully, to a new outcome. A clinical example of one such mutual enactment between the author and his patient is provided. The paper concludes with reflections on the clinical implications of this difficult case and what it means to become a ‘real person’ to our patients. Finally, Jung's alchemical views on transference are shown to be useful analogies in our understanding of the necessary mutuality in the healing process with these patients.     

On integrating Jungian and other theories

This paper consists of reflections on some of the processes, subtleties, and ‘eros’ involved in attempting to integrate Jungian and other analytic perspectives. Assimilation of other theoretical viewpoints has a long history in analytical psychology, beginning when Jung met Freud. Since its inception, the Journal of Analytical Psychology has provided a forum for theoretical syntheses and comparative psychoanalysis. Such attempts at synthesizing other theories represent analytical psychology itself trying to individuate.