Reuniting the psychic couple in analytic training and practice: A candidate's experience.

In the course of training at a comparative psychoanalytic institute, the author fixed upon a technical question: how to find optimal psychological distance from her patients. She struggled to integrate the diverse perspectives that the literature provided on this question. She also became aware of a conflictual phantasy of a polarizing internal mother and father that underlay her interest in the question. A dream about her work with a control patient eventually allowed her, with the aid of both supervisor and personal analyst, to work through the phantasy, and to bring her internal "psychic couple" into creative contact with one another. As a result, her capacity to analyze her patient increased. The author concludes that when supervisors and seminar leaders (in addition to the candidate's analyst) make themselves available to unconscious aspects of a candidate's learning process, institutes provide a more spacious container for psychoanalytic development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Traditional versus "new therapies."

Comments on S. A. Appelbaum's article (see record 1983-13146-001) which discussed new "human potential" therapies. The current author opines that while it is gratifying that Appelbaum (September 1982) could see how psychoanalytic therapy could benefit from some of the criticisms offered by the "new therapies," the assumption in the article that traditional equals psychoanalytic is a disservice to all those nonpsychoanalytic therapies that have been around for many years. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What about the kids? Parenting and child adjustment in the context of couple therapy.

Little research examines parenting and children's adjustment when couples engage in therapy. We examined how couples with and without children improve with couple therapy and whether they also report improvements in parenting and child adjustment. With up to twenty six sessions of couple therapy, 134 couples, 68 of whom had children, showed improved marital satisfaction during treatment, which was ultimately maintained over the 2-year follow-up, regardless of whether they had children. Couples married relatively longer, both with and without children, evidenced greater improvement. Couples with children reported less conflict over child rearing and better child adjustment during treatment, but only improvements in the former were maintained. Conflict over child rearing mediated the relationship between marital distress and child adjustment over therapy and the 2-year follow-up. These preliminary results suggest that couples in therapy may decrease their conflict over child rearing during treatment and they may be able to maintain these gains for at least two years following treatment; moreover, over the course of treatment, this decreased conflict is tied to improved child adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outcomes of couples with infidelity in a community-based sample of couple therapy.

Infidelity is an often cited problem for couples seeking therapy, but the research literature to date is very limited on couple therapy outcomes when infidelity is a problem. The current study is a secondary analysis of a community-based sample of couple therapy in Germany and Austria. Outcomes for 145 couples who reported infidelity as a problem in their relationship were compared with 385 couples who sought therapy for other reasons. Analyses based on hierarchical linear modeling revealed that infidelity couples were significantly more distressed and reported more depressive symptoms at the start of therapy but continued improving through the end of therapy and to 6 months posttherapy. At the follow-up assessment, infidelity couples were not statistically distinguishable from non-infidelity couples, replicating previous research. Sexual dissatisfaction did not depend on infidelity status. Although there was substantial missing data, sensitivity analyses suggested that the primary findings were not due to missing data. The current findings based on a large community sample replicated previous work from an efficacy trial and show generally optimistic results for couples in which there has been an affair. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The psychotherapy of the elderly self.

Reviews the book, The psychotherapy of the elderly self by Hyman L. Muslin (see record 1992-98107-000). The purpose of this book is to describe the extension of psychoanalytic therapy in the Kohut mode to the elderly. Specifically the author describes the changes the elderly must cope with, the impact these changes have on the elderly self, and the kind of psychotherapy that will best help them cope with these changes. This book has a rather narrow focus, and is likely to be of interest mostly to those engaged in the Kohutian version of psychoanalytic psychotherapy. It does not present much material that is likely to be of help to those engaged in the more general practice of psychology with aged individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couple therapy from the perspective of self psychology and intersubjectivity theory.

[Correction Notice: An erratum for this article was reported in Vol 25(2) of Psychoanalytic Psychology (see record 2008-03991-018). Throughout the article, "Couples therapy" should read as "couple therapy," and "self-psychology" should read as "self psychology."] Central tenets of self-psychology and intersubjective systems theory (e.g., Stolorow & Atwood, 1992) are applied to the understanding and treatment of couple. The concepts of selfobject needs, unconscious organizing principles, and learned relational patterns are used to conceptualize common couples difficulties. A treatment approach is outlined, involving: (1) listening from within each partner's subjective perspective; (2) establishing a therapeutic dialogue through which each partner's selfobject needs, ways of organizing experience, and patterns of relating can gradually be empathically illuminated and transformed; and (3) facilitating new relational experiences with the couples therapist and eventually between the partners. Four concepts of self psychology that are particularly useful with some of the most challenging aspects of couples work are then discussed. Finally, the judicious use of directive interventions with couples is discussed as consistent with this perspective. A case example is used throughout the paper to illustrate key points. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couple discord and depression in couples during couple therapy and in depressed individuals during depression treatment.

The association between depression and relationship distress as well as the impact of treatment for the one on the other was examined across 2 treatment-seeking samples: individuals seeking treatment for depression (N = 120) and couples seeking marital therapy (N = 134 couples). Although there was a baseline association between depression and distress across the 2 samples, relationship distress was far more prevalent among those being treated for depression than was depression for those seeking marital therapy. There was a reliable association between changes in the primary problem (e.g., relationship distress in the couple therapy study) and changes in the secondary problem (e.g., depression in the couple therapy study). However, overall effects on secondary problems were quite small. Neuroticism played a complex, moderating role across the 2 samples, strengthening and weakening the association between depression and relationship distress depending on the sample and gender, replicating previous findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Leone (2008).

Reports an error in "Couple therapy from the perspective of self psychology and intersubjectivity theory" by Carla Leone (Psychoanalytic Psychology, 2008[Jan], Vol 25[1], 79-98). Throughout the article, "Couples therapy" should read as "couple therapy," and "self-psychology" should read as "self psychology." (The following abstract of the original article appeared in record 2008-00996-006.) Central tenets of self-psychology and intersubjective systems theory (e.g., Stolorow & Atwood, 1992) are applied to the understanding and treatment of couple. The concepts of selfobject needs, unconscious organizing principles, and learned relational patterns are used to conceptualize common couples difficulties. A treatment approach is outlined, involving: (1) listening from within each partner's subjective perspective; (2) establishing a therapeutic dialogue through which each partner's selfobject needs, ways of organizing experience, and patterns of relating can gradually be empathically illuminated and transformed; and (3) facilitating new relational experiences with the couples therapist and eventually between the partners. Four concepts of self psychology that are particularly useful with some of the most challenging aspects of couples work are then discussed. Finally, the judicious use of directive interventions with couples is discussed as consistent with this perspective. A case example is used throughout the paper to illustrate key points. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substituting the forest for the trees: Social networks and the prediction of romantic relationship state and fate.

This research focused on perceptions held by heterosexual couples' friendship network concerning the couple's relationship. In a three-wave longitudinal study, we examined (a) whether these perceptions were similar to the couple's views of the relationship, (b) whether they predicted current relationship state and future fate, and (c) how they compared with the couple's perceptions in predicting fate. Consistent with within-dyad idealization, results from a North American sample indicated that network perceptions of relationship state were significantly more negative than those held by a couple. Although both the couples' and the total networks' perceptions predicted fate, friends of the female couple member were particularly successful at predicting relationship dissolution. An examination of possible mechanisms whereby friends may come to possess particularly predictive perceptions supported the role of couple-disclosure in this process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couple and individual adjustment for 2 years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy.

Follow-up data across 2 years were obtained on 130 of 134 couples who were originally part of a randomized clinical trial comparing traditional versus integrative behavioral couple therapy (TBCT vs. IBCT; A. Christensen et al., 2004). Both treatments produced similar levels of clinically significant improvement at 2 years posttreatment (69% of IBCT couples and 60% of TBCT couples). Both treatments showed a "hockey-stick" pattern of change in which satisfaction dropped immediately after treatment termination but then increased for most of follow-up. The break point when couples reversed courses and gained in satisfaction occurred sooner for IBCT than TBCT couples, and those couples who stayed together generally fared better in IBCT than in TBCT. Finally, there was evidence of greater stability during follow-up in IBCT than in TBCT couples. There was little change in individual functioning over follow-up, but when change occurred it was strongly related to change in marital satisfaction. Given that this sample was selected for its significant and chronic distress, the data are encouraging about the long-term impact of behavioral couple therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analyzing Nonindependent Outcomes in Couple Therapy Using the Actor-Partner Interdependence Model.

The nonindependent components of couple data require data-analytic strategies tailored to the interpersonal processes occurring between relationship partners. This article examines the benefits of a specifically dyadic analytic method, the actor-partner interdependence model (APIM), for evaluating interpartner influence across time. Both conceptual and methodological features of the APIM are exemplified by applying this model to observations of negative and positive affect and global distress in spouses participating in a randomized trial of couple therapy. In addition to elucidating specific advantages of the APIM relative to alternative data-analytic strategies, the current results shed new light on previous findings from a comparative treatment outcome study evaluating behavioral and insight-oriented approaches to couple therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychoanalytic process and Freud’s concepts of transference and transference neurosis.

The author investigates the concept of psychoanalytic process as it relates to the capability for defining the specificity of psychoanalytic treatments. The concept is traced back to its origin in Freud’s understanding of transference and transference neurosis. The author suggests that this process should be understood as an issue in which via “just-like-interpretations” contents of the patient’s transference enter into consciousness in the guise of a transference neurosis. These newly built substitutive formations are then removed by “just-like-it-was-interpretations” and changed into other substitutive formations. As this process can only be instigated by psychoanalytic measures, it is, therefore, the process itself that defines the specific difference of psychoanalytic treatments. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Dynamic Systems and the Therapeutic Action of the Analyst: II. Clinical Application and Illustrations.

The author presents a dynamic systems approach to psychoanalytic practice. It depicts psychoanalysis as an activity-dependent, experientially based treatment in which the analyst's behavior toward a patient effects change in how the patient organizes and interprets self-experience and relates to others. The neurobiological and relational components of this approach are reviewed, and their implications for psychoanalytic process and technique are described. Several clinical vignettes illustrate the technical application, dynamic process, and therapeutic action of a dynamic systems perspective on psychoanalytic treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The changing psychoanalytic organization and its influence on the ego ideal of psychoanalysis.

Freud's effort to protect his work and simultaneously make it available as a scientific contribution led to an organizational structure for psychoanalysis whose rigidity impaired its science. Psychoanalytic institutes may be reinvigorated by recreating the ethos of Freud's original group. The author suggests that parallel academies be created, the nuclei of which might be authorities who already hold academic appointments. Gathering around them a range of graduate students from various disciplines, they could provide the basis for interchange among the students and among themselves, and could open opportunities for other colleagues to develop their own similar specialized interests. Creating such a broad psychoanalytic community would also potentially enlarge the pool of candidates for psychoanalytic training as those graduate students sought greater psychoanalytic proficiency. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

An interrogation of the relational turn: A discussion with Stephen Mitchell.

The point of this commentary is to engage in a discussion about relational ideas with the leading exponent of this position, S. Mitchell (see record 1998-00310-001). He has set forth important views that are recognized and discussed by contemporary analysts. The author's engagement in this dialogue grows out of her interest in increasing clarity, consistency, and greater warrant and rationality for the position that ultimately emerges. The author initially addresses the writings of a couple of important hermeneutic philosophers to highlight their ties to an Enlightenment tradition, a tradition that Mitchell suggested most contemporary philosophers eschew. She then takes up the issue of validity and utility because it is believed that these issues are often entangled in the psychoanalytic discourse. Lastly, the author addresses what she thinks is a serious divergence of views; her interest is in establishing psychoanalysis on an empirical base, one that is consistent with data emerging from the neurobiological sciences, and she stresses the need to join both the hermeneutic and scientific aspects of psychoanalysis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Low-level relationship aggression and couple therapy outcomes.

Increasing evidence supports the efficacy of conjoint therapies that focus on intimate partner violence for couples who engage in mild to moderate physical aggression but want to preserve the relationship and end the aggression. However, there has been no examination of how this population responds to couple therapy that does not have a specific focus on aggression. This lacuna in the research literature is of concern because couples with a history of low-level aggression often seek couple therapy, but couple therapy without a focus on violence is thought to potentially exacerbate aggression. In the current study, the authors examined the efficacy of non-aggression-focused behavioral couple therapy for couples with and without a history of mild physical aggression. One hundred thirty-four couples, 45% of whom had experienced low-level aggression in the year prior to therapy, completed up to 26 sessions of couple therapy and 2 years of follow-up assessments. Results demonstrated no significant differences in relationship and individual outcomes by history of aggression. In addition, couples maintained very low levels of physical aggression during and after treatment and showed reductions in psychological aggression when relationship and individual functioning improved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Premature termination in couple therapy with veterans: Definitions and prediction of long-term outcomes.

Premature termination (PT) has been identified as widespread in individual, family, and couple therapy. Unfortunately, research on PT utilizes numerous definitions of PT without providing guidance on which definition may be most clinically useful. The current study investigated seven definitions of PT (three based on therapist ratings and four based on quantitative measures) utilizing a sample of 177 couples seeking treatment at two Department of Veterans Affairs medical centers. Results indicated that PT occurred in 50–80% of couples; however, agreement between the definitions of PT was generally only in the slight to fair range, making it difficult to determine whether a particular couple was ready to terminate treatment. Additionally, many commonly used definitions of PT were unrelated to level or maintenance of relationship functioning following treatment. In contrast, two definitions of PT (ending treatment in the distressed range and therapist-rated likelihood of future unhappiness) significantly predicted larger decreases in relationship satisfaction during the 18 months following therapy, as well as lower levels of satisfaction and relationship stability 18 months after termination. Additionally, long-term relationship functioning was especially poor when both these definitions of PT were met, suggesting that both qualitative and quantitative definitions should inform decisions about termination in couple therapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Combat and human existence: Toward an intersubjective approach to combat-related PTSD.

The author proposes a short-term, intersubjective model for treating combat-related post-traumatic stress disorder (PTSD). Psychodynamic approaches to adult-onset PTSD lack the evidence and popularity of other approaches because adult-onset traumas are fundamentally distinct from the developmental, or childhood-based, traumas that psychoanalysis evolved to treat. An approach based in intersubjective systems theory can address this problem. The writings of Robert Stolorow (2007) in Trauma and Human Existence, which the author first read while deployed to Iraq as a psychiatrist, fundamentally changed his understanding of trauma and its treatment. The author gives an overview of Stolorow's ideas about trauma, and then describes his six-phase short-term intersubjective treatment approach. Extensive case material from a treatment that occurred in Iraq illustrates each of these phases. The author then compares his and Stolorow's views to those of other contemporary relational psychoanalytic writers. Future directions include the manualization and empirical testing of this approach in order to determine its replicability, its utility for therapists who lack extensive psychoanalytic training, and its generalizability to populations with adult-onset trauma outside the military. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Effect of client feedback on couple psychotherapy outcomes.

Using outcome data to monitor the progress of treatment and the therapeutic alliance, also known as “client feedback” or “patient-focused research,” has yielded impressive results in individual psychotherapy. Client feedback has demonstrated reductions in premature terminations and improved psychotherapy outcomes. However, little research has been conducted using this paradigm with couples receiving therapy. The purpose of this study was to investigate whether the effectiveness of client feedback would extend to couple therapy. Results from a randomized couple clinical trial conducted in a naturalistic setting indicated that couples in a client feedback condition demonstrated statistically significantly more improvement compared with couples receiving treatment as usual and that improvement occurred more rapidly. Also, 4 times as many couples in the feedback condition reported clinically significant change by the end of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Superblind": Supervising a Blind Therapist With a Blind Analysand in a Community Mental Health Setting.

This article describes the 3-year psychoanalytic treatment of a blind female client by a blind female therapist supervised by a sighted man. The author focuses primarily on issues tied to each party's personal experience of blindness. Interpersonal psychoanalysis, which was the modality of supervision and therapy, is considered a cultural approach to psychoanalytic treatment. The author (the supervisor in the triad) suggests that the individuals involved treated each other, and were treated, with regard to their shared visual problems in ways that were influenced by previous relationships and the way that the culture in which the members were embedded treats disability in general. In the present, these cultural and relational expectations, influenced by the past, were played out between patient and therapist, between therapist and supervisor, and in the decisions and policies of the clinic system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)