A listening-formulating model for psychoanalytic psychotherapy.

Listening for and comprehending unconscious communication is the foundation of all psychoanalytic therapy. The process whereby latent meanings are apprehended and understood involves rhythmic shifts between unfocused and focused forms of attentiveness. Exactly how psychoanalytic listeners formulate hypotheses about unconscious meaning from these oscillating modes of attentiveness is a topic that has not been adequately addressed in the literature. This makes it difficult to "teach" psychoanalytic therapists how to listen deeply and make sense of what they hear. A listening-formulating model is proposed to assist analytic students in hearing and comprehending unconscious communication. The aspects and phases of this model are illustrated by means of a detailed analysis of a clinical vignette. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vitalizing objects and psychoanalytic psychotherapy.

Patients, with some measure of unconscious hope and dread, seek vitalizing objects. These objects, which represent interactional processes, provide persons with subjective and intersubjective experiences of being alive and real. This article proposes that a constitutional structure of vitality, which is initially nonpropositional and preconceptual, is projected onto objects, rituals, and persons. Ideally this provides persons with subjective and intersubjective organizations and meanings of being alive and real. The development, transformation, and expansion of these organizations and experiences are contingent on the complex interplay of trusted significant figures, primary and secondary transitional phenomena, and the person's constitutional capacities. Patients often display varying degrees of constricted abilities to make use of shared objects to feel alive and real. A goal of therapy is facilitating the patient's capacity to risk creating, projecting onto, and making use of socially shared phenomena for more diverse and expansive organizations and meanings of feeling alive and real. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relevance of a psychoanalytic perspective in exploring religious and spiritual identity in psychotherapy.

The attempt to make meaning of the soul is inherent to psychoanalytic inquiry, despite its historical diminution of religion and spirituality. Feminist ideology and multicultural psychology have played a critical role in challenging traditional psychoanalytic conceptions of the practice of religion and spirituality as pathological and/or regressive. Contemporary psychoanalysis that emphasizes two-person psychology, and the intersubjective aspects of the analytic space has also allowed for more open inquiry into the spiritual lives of clients and therapists. Both psychoanalysis and spirituality share the goal of a search for particular aspects of one's identity. This search for one's real or true self becomes particularly poignant for both the therapist and the client, as it is highly reliant on the therapist's and the client's specific religious and spiritual contexts. This paper examines the development of identity as influenced by religious and spiritual beliefs. The author discusses a clinical case to illustrate the complex interaction between religious traditions and individual experiences of religion and spirituality, and related implications of a contemporary psychoanalytic approach to psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Catharsis in psychotherapy: A new perspective.

Reviews contemporary thinking about catharsis in psychotherapy, which is still dominated by J. Breuer and Freud's work with the cathartic method. Psychoanalysts view the fact that Freud abandoned catharsis as evidence of its ineffectiveness, while the emotive therapies developed in the 1960's returned to Freud's earliest view that neurosis results from repressed affect and can be cured by cathartic uncovering. Emotional memories continue to be thought of as foreign bodies lodged in the human psyche and requiring purgation. It is argued that this view divorces people from responsibility for their conduct and encourages a fractionation of human experience into feeling, thought, and action. It is proposed that catharsis is, instead, a label for completing a previously restrained or interrupted sequence of self-expression. It is accompanied by recovery manifestations of some sort, for example, tears or angry shouting. Implications of this view for psychotherapeutic practice are proposed, using examples of patients going through catharsis. It is concluded that therapists should allow catharsis as a means of helping patients discover their predilections, but should recognize this as a preliminary step. After blocked aspects of self have been discovered, then the patient must begin to claim responsibility for choosing more congruent actions and appropriate social expressions, thereby defining a richer, more satisfying existence. (60 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective interpretation of unconscious processes during psychoanalytic psychotherapy.

Describes the use of the prospective approach (PA) to resolve intrapsychic conflict in a 28-yr-old woman who complained of incestuous flashbacks about events that had occurred during her childhood. The PA is a technique for interpreting the latent content of patients' narratives and dreams. It proposes that intrapsychic conflict impairs the patients' predictive abilities. The PA may be implemented during all phases of treatment to examine whether the patient is able to predict the interpersonal outcomes of imminent events. During the initial alliance phase, patients use the therapists' responses to predict upcoming change. During the working-through phase, patients rely on their own perceptions to assess future outcomes. During the termination phase, patients predict outcomes from the responses of significant others. In this case, the S resolved her ambivalence about incest allegedly perpetrated by her father through a series of powerful dreams. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An overview of psychoanalytic psychotherapy with schizophrenics.

Reviews issues in long-term psychoanalytically oriented psychotherapy with schizophrenic patients. The schizophrenic's conflict is traced to the symbiotic phase of development. Three types of therapeutic relationships are outlined in which the therapist is either maternal, open to his/her own regression, or analytically neutral. Four stages in the transference are described: an out-of-contact delusional stage, a distorted stage, an ambivalent stage, and a stage of symbiotic relatedness. Contraindications and alternatives to transference interpretations are explored as well as types of interpretations. A dual-axis framework for ordering the theories and the psychotherapeutic techniques is provided. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Noninterpretive interventions in psychoanalysis and psychotherapy: A developmental perspective.

One of the more important issues confronting psychoanalysis and psychotherapy seems to involve the clinical and theoretical aspects of so-called noninterpretive interventions. Advances in infant research, developmental psychology, and clinical theory may aid in shedding new light on the role and mechanisms of action of a variety of noninterpretive interventions and clinical concepts, including validation and confirmation, mirroring, clarification, "holding environment," negative therapeutic reactions, and others. In addition, these advances may enhance the understanding of the nature of change in psychoanalysis and psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Termination from a psychoanalytic perspective.

The following principles of termination have been derived from the confluence of psychoanalytic and other perspectives: (a) The timing of the termination is determined by the patient; (b) the frequency of meetings should be reduced and a final appointment scheduled some time after the second-to-last meeting; (c) the patient's stressors, previous dominant ways, and new ways of responding should be reviewed; (d) what the patient believes was accomplished should be discussed, (e) the therapist should inquire what was helpful and hurtful; (j) the therapist should inquire, if appropriate, whether there is something negative about the therapy leading the patient to terminate; (g) the therapist should equalize the relationship; and (h) the patient should be invited to correspond in the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Premature termination in the midst of psychotherapy: Three psychoanalytic perspectives.

Reviews the perspectives of the drive/structural, object relations, and self-psychology models as to premature termination. A case history is presented of a man in his late twenties who ended therapy after 2.5 yrs. Examining the commonalities in the application of the 3 models, a central issue is apparent: the man's conflicts over dependency. Whether these conflicts are construed as resistance to experiencing passive feminine desires, as separation–individuation conflicts, or as fears of retraumatization by an unattuned self-object, issues of dependence are central to the patient's leaving treatment prematurely. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative efficacy of individual and group psychotherapy: A meta-analytic perspective.

Recent reviews of the group psychotherapy literature indicate that group is a beneficial and cost-effective treatment format. However, collective findings on the differential efficacy of group when compared with individual therapy remain problematic, incomplete, or controversial. To remedy this problem, the authors conducted a meta-analysis of 23 outcome studies that directly compared the effectiveness of the individual and group therapy formats when they were used within the same study. Results were consistent with previous reports that indicated no difference in outcome between the group and individual formats. This finding generally held true when client, therapist, methodology, treatment, and group variables were examined for possible relationship with effect sizes comparing group and individual therapy. Results bolster past findings that group therapy can be used as an efficacious cost-effective alternative to individual therapy under many different conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive psychology, epistemology, and psychotherapy: A motor-evolutionary perspective.

Argues for the integration of the principles of cognitive psychology and epistemology into a motor-evolutionary metatheory. Implications for psychotherapy are explored of the view that people are active construers of the world, guided by (largely tacit) abstract knowledge structures that grow via trial and error. These include the importance of adopting a critical but respectful attitude toward traditions of clients and therapists; the importance of variation and error; and the centrality of tacit knowledge, limitations on consciousness, and planned adaptation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The differential effectiveness of group psychotherapy: A meta-analytic perspective.

The differential effectiveness of group psychotherapy was estimated in a meta-analysis of 111 experimental and quasi-experimental studies published over the past 20 years. A number of client, therapist, group, and methodological variables were examined in an attempt to determine specific as well as generic effectiveness. Three different effect sizes were computed: active versus wait list, active versus alternative treatment, and pre- to posttreatment improvement rates. The active versus wait list overall effect size (0.58) indicated that the average recipient of group treatment is better off than 72% of untreated controls. Improvement was related to group composition, setting, and diagnosis. Findings are discussed within the context of what the authors have learned about group treatment, meta-analytic studies of the extant group literature, and what remains for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reducing psychotherapy dropouts: Maximizing perspective convergence in the psychotherapy dyad.

Reviews 3 decades of research addressing premature termination of psychotherapy. Client, therapist, interpersonal dyadic, and administrative variables have been extensively investigated. Because of a variety of methodological problems, this literature is highly contradictory, and results are difficult to reconcile, with only socioeconomic status (SES) and ethnicity emerging as consistent predictors of dropout. Treatment matching studies have evaluated the effects of maximizing similarity (or convergence) and minimizing perspective divergence within the therapeutic dyad. Research looking at interactive and multidimensional factors such as working alliance, client satisfaction and expectations, client likability, and pretreatment preparation has proven useful. This research suggests that psychotherapy dropouts might be minimized if differences between therapists' and patients' perspectives on therapeutic enterprise are acknowledged and recognized as legitimate targets for intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mixed anaclitic-introjective psychopathology in treatment-resistant inpatients undergoing psychoanalytic psychotherapy.

Utilizing data from the Riggs-Yale Project, 45 male and 45 female 18-29-year-old treatment-resistant inpatients undergoing intensive psychoanalytically oriented treatment were studied. Twenty-seven mixed-type anaclitic-introjective inpatients were compared with 29 "pure" anaclitic and 34 "pure" introjective inpatients. At intake, mixed-type inpatients were more clinically impaired (i.e., were more symptomatic, cognitively impaired, and thought disordered) and more vulnerable (i.e., less accurate object representations and more frequently used maladaptive defense mechanisms) in comparison with clearly defined anaclitic and introjective patients. Mixed-type patients, however, improved significantly more in the course of psychoanalytically oriented treatment, in terms of clinical functioning (i.e., symptoms, cognitive functioning) and psychological vulnerability (i.e., utilization of more adaptive defense mechanisms). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

From dissociation to negotiation: A relational psychoanalytic perspective on multiple personality disorder.

Presents a model for conceptualizing the dynamics and treatment of multiple personality disorder (MPD) that integrates trauma/dissociation theories with postclassical psychoanalytic perspectives. MPD is conceptualized as a chronic trauma syndrome and as a particular variation of narcissistic personality organization involving an overreliance on omnipotent defenses, the collapse of intersubjective experiencing, and derailments of the developmental lines of aggression, fantasy, and the use of transitional phenomena. Emphasis on empathy, recognition, confrontation, and interpretation from within the transference-countertransference matrix is recommended to facilitate contactful dialog and negotiation in the interpersonal world and between traumatically dissociated, often opposing, aspects of the self. The MPD patient's capacities for mutuality, paradoxical experiencing, and restorative fantasy are seen as central to integration. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

"Interpreting in the dark": Race and ethnicity in psychoanalytic psychotherapy.

Discusses the impact of race and ethnicity on the psychotherapeutic process of 3 patients in psychoanalytic psychotherapy with an African-American therapist. Race and ethnicity remain topics that engender anxiety in social and clinical discourse. Psychoanalytic literature on race has been hampered by incomplete conceptualizations and overgeneralizations that often limit its clinical utility. Clinical examples are used to explore the way in which attention directed at racial issues provides a framework for the treatment alliance and illuminates key transferences and resistances. Discussion of racial issues is most fruitful when racial themes are situated in bodily and social contexts and when the meaning that race has in the therapy dyad is negotiated by patient and therapist, apart from idealized or socially correct conceptualizations from outside of the treatment situation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conceptualizing the therapeutic alliance from a psychoanalytic perspective.

Defines the therapeutic alliance as the patient's active collaboration in the work of psychotherapy or psychoanalysis. The failure to differentiate alliance from transference has in part led to the skepticism regarding the concept of alliance. The patient's active use of the treatment process as a resource for self-understanding and constructive change constitutes his/her collaboration. The nature of collaboration varies with the type of treatment. The alliance depends significantly upon the patient's ability to maintain an observing ego; the activation of transferences significantly affects this process. The alliance is influenced by a core of object relations capacities that are essential to forming a trusting relationship. Defining alliance as patient collaboration makes a sharp distinction between technique and alliance. It is suggested that a scale devised to assess the degree of collaboration, based on this conceptualization, by the present 3rd author and colleagues (1983) provides an instrument for future research. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Co-therapists and the creation of a functional psychotherapy group: A group dynamics perspective.

This article supports Dugo and Beck's (1997) proposal that co-therapy teams should move through the early phases of their own development as a team before meeting with a therapy group. Effective leaders facilitate group development by meeting the needs of the group at various stages. To do this, co-therapists must agree on the nature of those needs. Co-therapists need to develop a united front, a shared purpose, and a shared action plan. If these are lacking, the chances of successful outcomes are diminished. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief psychotherapy and adult development.

Contends that models of brief psychotherapy that have evolved from the analytic tradition present the patient as suffering from some form of enduring disorder, unaltered by time or by life experiences. Psychotherapy is conceived as a one-time effort, definitive in the focal area selected, and involving therapist activity to overcome the patient's inertia or resistance to change. A contrasting model is proposed using the basic assumption that human beings continue to grow and develop throughout adult life and will seek to overcome obstacles to that development. In this model, the therapist facilitates health-seeking initiatives, and the overall goal of therapy is to mitigate obstacles to normal growth. Brevity of intervention places a burden on the therapist to tailor skills to the individual patient. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)