Concentration and correspondence of transference interpretations in short-term psychotherapy.

Provides a review of research on the relationship between aspects of transference interpretation and outcome in dynamic psychotherapy. It also presents the results of a recently completed study that focused on 2 aspects of transference interpretations: concentration and correspondence. Significant relationships between each of these 2 aspects and both therapeutic alliance and outcome were found, as well as an interaction effect for outcome. The relationships differed as a function of the patient personality characteristic known as quality of object relations. The results conerning correspondence were consistent with those of previous studies that investigated the correctness of interpretations. The overall findings suggest that (1) variation in technique may make a difference in brief dynamic therapy and (2) variation and impact of technique may have been masked in some previous studies and reviews. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relational interpretations.

We review studies of relational interpretations as predictors of psychotherapy outcome and alliance. Investigations examining frequency of interpretations and outcome have yielded mixed findings. However, studies specifically of transference interpretations have converged toward the conclusion that high rates of transference interpretations can lead to poor outcome, particularly for patients with low quality of object relations. Several studies of the quality of interpretations have yielded consistent findings suggesting that relatively more favorable treatment outcomes are produced when therapists accurately address central aspects of patients' interpersonal dynamics. Few studies that have examined the relation between interpretations and the therapeutic alliance or tested the common clinical notion that interpretations have their greatest impact in the context of a positive alliance. Practice implications based upon this research literature are proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identification and analyses of periodontal pathogens in Taiwan by microbiological tests

The effectiveness of transference interpretation in the psychodynamic psychotherapy of patients with borderline personality disorder has been highly controversial. Both highly expressive approaches that stress the value of transference interpretation and supportive strategies that eschew transference work have been advocated in the literature. We review this literature and identify three emerging trends in thought: (1) Primarily interpretive approaches should be reserved for patients with greater levels of ego strength. (2) Whichever technique is used, a strong therapeutic alliance is the foundation of treatment. (3) Expressive and supportive techniques should not be juxtaposed as polarized opposites; supportive interventions often pave the way for transference interpretation. Our psychotherapy process study revealed that transference interpretations tended to have greater impact--both positive and negative--than other interventions made with patients with borderline personality disorder. We conclude that such factors as neuropsychologically based cognitive dysfunction, a history of early trauma, patterns of object relations involving interpersonal distance, masochistic tendencies, and anaclitic rather than introjective psychopathology are among the patient characteristics that influence the impact of transference interpretation on the therapeutic alliance. Bias toward expressive technique and countertransference issues appear to be relevant to the therapist's difficulty in shifting to a more supportive approach when indicated.     

The management of transference phenomena in the treatment of primitive states.

The author uses an object-relations theoretical perspective to characterize the nature of transference phenomena in intensive psychotherapy with narcissistic, borderline, and psychotic patients. Special emphasis is placed on the central role of the primitive mechanisms of splitting, externalization, and projective identification. This conceptualization is then extended to suggest specific meanings and interpretations of transference and countertransference phenomenology and technical considerations for their management. (9 ref) (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)     

Recommendations for training therapists based on manuals for psychotherapy research.

Discusses the author's treatment manual for supportive-expressive psychoanalytic psychotherapy written to train therapists in this form of treatment. The author addresses the relevance of psychiatric severity for technique, the importance of the therapeutic alliance, the need to make reliable dynamic formulations of the central relationship pattern, the need to focus on convergence of the central relationship pattern with the interpretations, and the need to pay attention to the maintenance of benefits. Typical resistances by trainees to teaching efforts are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical implications of research on brief dynamic psychotherapy II. How the therapist helps or hinders therapeutic progress.

In this second of a two-part article, we describe how the therapist's interpretations promote therapeutic progress. Any therapist behavior that is in accord with the patient's plan will be helpful to the patient, but interventions that are at cross purposes with the patient's plan will not be helpful. The implications of the plan concept for brief dynamic therapy are described and contrasted with other key technical, concepts such as transference interpretations, therapeutic alliance, and interpretive activity. The importance of understanding the patient's plan and intervening in accord with it are illustrated in several case vignettes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bearable and unbearable guilt: a Kleinian perspective

Material is presented from four analytic sessions with a patient who seems unable to bear guilt. The first two illustrate defenses against guilt; the last two show the incipient experience of guilt and, finally, the ability to suffer conscious guilt. The author questions interpretations that address defenses against guilt but fail to help the patient bear the guilt. Such interpretations can make the analyst prey to a sadomasochistic enactment in the transference whereby the patient expiates the guilt and reverts to not recognizing what he or she does to objects. The ability to bear guilt is increased by a diminution of the patient's destructiveness and by the mobilization of love.     

Intersubjective observations on transference love.

In this article, the clinical phenomenon of transference love is used to make 3 contributions: (a) to illustrate how the intersubjective field can encompass more than just patient and therapist, (b) to provide an intersubjective framework for understanding transference love, and (c) to demonstrate how selfobject and antidote functions of the therapeutic relationship can alternate within the same patient–therapist dyad as figure and ground. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Shaping and reinforcing transference.

Patient statements can be categorized as referring to the external environment (E), the patient (P), or the therapist (T). It is proposed that by selective shaping and reinforcement of T statements and nonreinforcement of E and P statements, the incidence of T statements can be increased. The emission of T statements is seen as an operational definition of transference behavior in which the patient is conditioned to emit T statements in the abstract but must draw from experience to supply the content of those statements. This direct conditioning procedure has been shown to lead to the rapid emergence of the transference relationship. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In the last analysis: archetypal themes in the analysis of an elderly patient with early disintegrative trauma

Aspects of the analysis of an elderly patient with early disintegrative experiences are described: separation anxiety, an internalized attack upon vitality, and the fear of dependency were prominent features of the transference/countertransference relationship, while the search for meaning as death drew nearer continued to be the central theme. The patient's many dreams reveal a wealth of images whose complex interlinkings provided evidence of a heightened and energized individuation process aiming at the integrity of personality.     

A study of the dilemmas involved in work with schizophrenic patients.

Discusses some of the difficulties involved in transference and its handling with schizophrenic patients, using the treatment of a 22-yr-old chronic schizophrenic male as an illustration. Two major findings have emerged since Freud's contention that the schizophrenic could not form a transference relationship: The schizophrenic can form a transference relationship to the therapist, although (1) it may be of a different kind than that of the neurotic, and (2) for some therapists it is no longer the major tool of therapy. As the nature of the relationship changes from that of one whole person relating to another to that of a mother relating to a child, there is a shift in therapeutic technique. Whereas, in the former relationship, interpretation of the transference is primary, in the latter, the context or the setting for that interpretation becomes primary. The therapist must create a safe environment for schizophrenics as they regress to dependence. The therapist must be willing and able to merge with the patient, to be mother to the infant patient. This stance requires the utmost from the therapist, and thus countertransference acquires major importance in this work. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An empirical approach to studying psychoanalytic process.

This study was a pilot attempt to investigate psychoanalytic process from an empirical perspective. We randomly selected early and late sessions from an audiotaped psychoanalysis (N = 324 sessions) and scored them using a modified form of the Gill-Hoffman (1982) system. We analyzed these scores via Markov models and comparative probability tests. The coding scheme was reliable, although the percentage of interrater agreement for ratings of patient insight was low. Despite this measurement error, the study yielded interesting findings concerning early and late hours. Across early and late sessions, interpretations facilitated patient transference insight, compared to other interventions within the same hours. The patient was somewhat more likely to follow one insight with a second during late hours. There were several other suggestions of longitudinal change toward greater patient mastery. We also explored the interrelationship between type of interpretation and patient productivity of transference insight. The findings indicated that the piloted method represents a useful way to pinpoint theoretically important interactions for empirical investigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developing a new narrative: The woman therapist and the male patient.

Discusses the impact of the participants' gender on the therapeutic dialog, in particular the relationship of women therapists to male patients, using data obtained in 13 interviews with female analysts, therapists, or students. Two issues were found to be distinctive to the woman therapist: the contradictory terrain of female authority and the meaning of intimacy with women, given the residues of the separation/individuation process. The preoedipal maternal transference, the possible defensive uses of the erotic transference (e.g., issues concerning power), and the merging of aggressive and sexual impulses are discussed vis-à-vis the dyad of the woman therapist and the male patient. Issues of fantasy and hostile transference are also discussed. (66 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The analysis of the transference in the here and now and Essential papers on transference analysis.

Reviews the books, The analysis of the transference in the here and now by Gregory Bauer (see record 1994-97149-000) and Essential papers on transference analysis, also by Gregory Bauer (see record 1994-97131-000). These are companion volumes which present an excellent, systematic understanding of Bauer's contemporary approach to Here and Now Transference Analysis in psychodynamic and psychoanalytic practice. The here-and-now method highlights the use of the affective immediacy of the relationship between the patient and therapist to "clarify, explore and modify interpersonal conflict rather than as a springboard for discussing the genetic determinants of conflict." Bauer focuses on reactions and behavior patterns that are transference based, as opposed to focusing on the transference neurosis seen as the systematic development and interpretation of fantasies and attitudes that are highly organized and displaced onto the therapist. The former is viewed as a less intense variation of the latter; both are felt to be a part of the same transference continuum. Bauer's volumes provide the clinician with an excellent overview and primer on Here and Now transference analysis, as well as its history, conceptual underpinnings and techniques for using it in the therapeutic relationship. The analytic and psychodynamic practitioner alike will find these books an invaluable addition to their professional libraries. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How is transference assessed? Evaluation of the 290th session from the clinical perspective

In modern view, the transference process is both repetition and change. To grasp specific relationship patterns systematically different content-analytical methods are used in the context of singles case studies. FRAMES, BIP (PERT) and CCRT, as demonstrated in the foregoing articles by H?lzer, Herold, Deserno et al. place various accents: expressed emotions, interpersonal experience, and the central relational conflict. They do not lead only to a concentrated reconstruction of the respective situational dynamics obtained according to known rules; they also seem to be able to confirm the clinical experience that repetition and change meet in the patient-analyst relationship.     

Prediction of dropping out in time-limited, interpretive individual psychotherapy.

Predictors of dropping out were investigated for patients who participated in time-limited, interpretive individual psychotherapy in a randomized clinical trial. A sample of 22 dropouts was compared with a sample of 22 matched completers on pretherapy and therapy process variables. A modified Vanderbilt Psychotherapy Process Scale was used to assess patient hostility and patient and therapist exploration and focus on transference. Pretherapy predictors, which included demographic, diagnostic, and initial disturbance outcome variables, did not significantly differentiate the two groups. Therapeutic alliance, dynamic and supportive work, patient exploration, and focus on transference significantly differentiated dropouts from completers. For dropouts, there was a weaker alliance, less work, less exploration, and greater focus on transference. Examination of the last session of dropouts revealed a nonproductive pattern characterized by resistance and transference interpretation. Implications and limitations associated with the study are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Weakenings and repairs of the working alliance in short-term psychotherapy.

Investigated how the weakening and repair of the working alliance in short-term psychotherapies relates to change in therapy. In 6 short-term, time-limited therapies involving 4 therapists and 6 patients, weakenings and repairs were identified with a unitized process ratings scale. Though the data must be considered preliminary, interesting relations emerged. Patients with greater ego strength had a higher initial quality of alliance with their therapist and were better able to work to repair any weakenings. These patients also exhibited a growing use of observing ego in their increasing ability to initiate talk about weakenings. Highest levels of patient alliance were preceded by high levels of therapist repair action. The success with which weakenings and repairs were handled was predictive of the general outcome of therapy. Surprisingly, more frequent interpretations of transference allusions were associated with poor outcome. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)