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)     

Interpretive work in short-term individual psychotherapy: An analysis using hierarchical linear modeling.

"Work" and "resistance" responses to interpretation in short-term individual (STI) psychotherapy were examined using a hierarchical linear modeling (HLM) procedure. The relationships between interpretation characteristics and patient responses within therapy were considered. Process data were drawn from 60 STI therapy cases, 30 patients with low quality of object relations (QOR), and 30 patients with high QOR. In 4 instances, the relationships between technique and response were found to vary significantly across cases. One was identified for low QOR patients, and 3 were identified for high QOR patients. Individual differences in initial disturbance and outcome were used to account for the variation of technique-response relationships. Significant findings were limited to the high QOR sample. Initial disturbance was directly related to work in response to a transference oriented approach. The transference focus-work relationship was found to be inversely related to outcome. The results extend previous findings regarding transference technique in STI therapy with high QOR patients. Through capitalizing on within-case variation, HLM can be used to illuminate process-outcome relationships in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Focal adherence in brief dynamic psychotherapy: A comparison of findings from two independent studies.

Findings from 2 independent studies of brief dynamic psychotherapy in Edmonton and Oslo are compared. 43 patients in Oslo and 64 in Edmonton were studied. Both studies indicate that the relationships between specific techniques and outcome are different (and opposite) according to whether patients belong to high or low quality of interpersonal relationships (QOR) subsamples. Focal adherence or correspondence is modestly associated with positive outcome within the high QOR subsamples and substantially associated with negative outcome within the low QOR subsamples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Theory-based research for understanding the process of dynamic psychotherapy.

Research is reviewed on 6 theoretical propositions central to psychodynamic psychotherapy: (1) The establishment of an alliance is important to successful outcome; (2) the patient displays a central relationship theme (transference); (3) transference interpretations are helpful; (4) the therapist aims at accurate interpretations of the transference; (5) the patient gains understanding of self and the relationship pattern; and (6) the patient's improvement is reflected in changes in the relationship pattern, although the pattern is still evident. We suggest concepts that are in need of research development: internalization, resistance, working through, self-understanding and insight, and the therapist's adherence to recommended techniques. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evolution of short-term dynamic psychotherapy: Treatment of the future?

Traces the evolution of short-term dynamically oriented therapy from Freud to present-day clinicians. A variety of forces have led to the current development of this form of short-term therapy, including pressure from 3rd-party payers, demands placed on an overburdened mental health system, and a greater emphasis on effective psychotherapy. The features that distinguish short-term psychotherapy from traditional psychoanalysis are explored. These include an active stance, time limitations, focality, intensification of affect, extensive use of the transference, and T-C-P (transference, current life figures, and significant past figures) interpretations. Areas for future study are explored. It is suggested that standard outcome techniques be used, so comparative studies may be designed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of transference work in the context of therapeutic alliance and quality of object relations.

Objective: Transference interpretation is considered as a core active ingredient in dynamic psychotherapy. In common clinical theory, it is maintained that more mature relationships, as well as a strong therapeutic alliance, may be prerequisites for successful transference work. In this study, the interaction between quality of object relations, transference interpretation, and alliance is estimated. Method: One hundred outpatients seeking psychotherapy for depression, anxiety, and personality disorders were randomly assigned to 1 year of weekly sessions of dynamic psychotherapy with transference interpretation or to the same type and duration of treatment, but without the use of transference interpretation. Quality of Object Relations (QOR)–lifelong pattern was evaluated before treatment (P. H?glend, 1994). The Working Alliance Inventory (A. O. Horvath & L. S. Greenberg, 1989; T. J. Tracey & A. M. Kokotovic, 1989) was rated in Session 7. The primary outcome variable was the Psychodynamic Functioning Scales (P. H?glend et al., 2000), measured at pretreatment, posttreatment, and 1 year after treatment termination. Results: A significant Treatment Group × Quality of Object Relations × Alliance interaction was present, indicating that alliance had a significantly different impact on effects of transference interpretation, depending on the level of QOR. The impact of transference interpretation on psychodynamic functioning was more positive within the context of a weak therapeutic alliance for patients with low quality of object relations. For patients with more mature object relations and high alliance, the authors observed a negative effect of transference work. Conclusion: The specific effects of transference work was influenced by the interaction of object relations and alliance, but in the direct opposite direction of what is generally maintained in mainstream clinical theory. (PsycINFO Database Record (c) 2011 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)     

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.     

Premorbid functioning and outcome in schizophrenia: A cumulative analysis.

Reexamines the relationship between premorbid social functioning (PSF) and outcome in schizophrenia and, in the process, explicates a method of cumulative analysis of published data. Averaging correlations across studies provides an estimate of the strength of relationship between 2 variables with greatly reduced sampling error. Correcting the variance of correlations across studies produces a confidence interval for the extent of variation in population correlations, if any. Correlations were obtained from studies that vary with regard to context, follow-up length, and measures used. However, little or no variation in correlations was found once the effect of sampling error was removed. Both component and composite measures of PSF and outcome are examined. Relationships among PSF and outcome variables are considered, as well as relationships between these groups of variables. The cumulative method greatly clarified the available data. Premorbid competence and outcome are very strongly related. (58 ref) (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)     

Psychoanalytic therapy of the borderline patient: Treating the fusion-separation contradiction.

The thesis of the article is that borderline psychopathology can be successfully treated by psychoanalytic therapy, and the principles of this treatment are outlined. Borderline psychopathology is defined as fusion in close relationships and reality adaptation in other situations. Thus, the major treatment issue is seen as the resolution of the transference psychosis. The article makes a distinction between overt and covert transference psychosis and demonstrates how both forms may be treated through interpretive means. A case treated in this manner is used to demonstrate the resolution of the transference psychosis with primary reliance on interpretation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring transference: Can we identify what we have not defined?

Transference is both a key concept and a complex phenomenon in psychoanalytic counseling. The Missouri Identifying Transference Scale is an important effort in measuring transference. The development of a tool to measure a theoretical construct, however, must rest on a solid definitional base; K. D. Multon, M. J. Patton, and D. M. Kivlighan (see record 199600458-001) need to provide such a base if their scale is to be maximally useful for understanding the relationships among transference as a concept, the measurement of transference, and clinical process and outcome. A wish list for the study and understanding of transference is included. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynamic, dyadic, intersubjective systems: An evolving paradigm for psychoanalysis.

Presents an overview of some of thebasic tenets of dynamic systems theory. Conflict, transference, resistance, and the unconscious are viewed as dynamically emergent properties of self-organizing, nonlinear, dyadic, intersubjective systems. The author cites the works of developmentalists E. Thelen and L. Smith (1994) who conceptualize mental activity as a dynamic, dyadic, and intersubjective system. The conception of development as evolving and dissolving attractor states of intersubjective systems richly illuminates the processes of pattern formation and change in psychoanalysis. The author contends that effective interpretations are seen as perturbations of the therapeutic system that permit new organizing principles to come into being. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of transference in short-term dynamic psychotherapy.

Reviews progress in the theory and technique of work with transference in short-term dynamic psychotherapy (STDP). It has been suggested that while the roots of current work with transference in STDP go back as far as Freud's original development of the construct, evolution in technique has been in need of clarification. Major challenges (e.g., S. Ferenczi, 1921 [1950]) to Freud's views are described. Transference work in major current approaches to STDP (e.g., D. Malan, 1963, 1976) is highlighted. Recommendations for working with transference in STDP stress an active, interpersonal approach to transference manifestations that act as resistance to the therapeutic focus. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The early history of boundary violations in psychoanalysis

The notion of professional boundaries is a relatively recent addition to psychoanalytic practice. Freud and his early disciples indulged in a good deal of trial and error as they evolved psychoanalytic technique. The study of these early boundary violations illuminates the study of the evolution of the concepts of transference and countertransference. The recent publication of the correspondence between Freud and Jung, between Freud and Ferenczi, and between Freud and Jones has provided us with extraordinary insights into the boundary transgressions that occurred in the early days of psychoanalysis. The boundary violations of the analytic pioneers have contributed to the legacy inherited by future generations of analysts. Institutional resistance to addressing these difficulties in contemporary psychoanalytic practice may relate in part to the ambiguities surrounding boundaries in the training analysis itself.     

Transference issues concerning victims of violent crime and other traumatic incidents of adulthood.

This article examines transference in the assessment and treatment of trauma resulting from incidents of adulthood, with particular focus on the experience of victims of violent crime. In furtherance of treating the individual rather than a diagnosis, such as posttraumatic stress disorder, it proposes the term violence-based parataxic distortion (V-PD) to differentiate between projections and distortions based on traumatic experiences of the crime as distinct from transference reactions that relate to past object relationships, specifically with significant others from early development, self-organization, and characterological formation. The interplay between transference reactions, V-PDs, and the real relationship is examined, with illustrations. It is noted that distortions may arise regarding organizations, institutions, and governmental entities, as well as individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intrapsychic variables and the patient's environment as factors in prognosis.

Reviews prognostic factors in hospitalized psychiatric patients, noting that previous reviews stressed the unidimensionality of both predictor and criterion variables. In the light of research in the past 11 yrs the unidimensional view is considered no longer tenable. The stress on psychological tests and other measures of intrapsychic adjustment as prognostic indices leads to a narrow conceptualization of prognosis as a "measurement of a disease process." The patient's environment also relates to outcome of illness and may account for some reported relationships between intrapsychic variables and prognosis. It is concluded that moderator effects, which are being reported more frequently, must be considered in any future prognostic studies. (2 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On-Site Nonlinear Hysteresis Curves and Dynamic Soil Properties

Strong motion records at five vertical array sites in Japan are used to examine soil shear modulus and material damping as a function of shear strain during large earthquakes. Acceleration data from the sites are processed directly for evaluation of site shear stress-strain hysteresis curves for different time windows of the record. Results of the analysis demonstrate a significant nonlinear ground response at the sites with surface peak ground accelerations exceeding 90 gal. The results of shear stress-strain hysteresis curves are also used to estimate variation of soil shear modulus and material damping characteristics with shear strain amplitude at each site. The identified shear modulus-shear strain and damping ratio-shear strain relationships are in general agreement with published laboratory results. These response interpretations are also compared with the results of a frequency-domain analysis by using the spectral ratio (uphole∕downhole) technique. There is general agreement between the time- and frequency-domain results. The results illustrate the significance of the site nonlinearity during strong ground motions as well as the accuracy of the dynamic soil properties obtained from laboratory tests.     

The use of the cochlear microphonic response as an indicant of auditory sensitivity: Review and evaluation.

The validity of the use of the cochlear microphonic (CM) isopotential function as an index of auditory sensitivity was assessed by (a) examining the characteristics of CM recordings to determine if there were any sources of bias inherent in the technique that might influence its representation of sensitivity, (b) qualitatively comparing the shapes of CM and behavioral "audiograms" of 16 animal species obtained in previous studies, and (c) making a quantitative estimate and statistical evaluation of the correspondence between the 16 pairs of audiograms. Potential high frequency bias was found in the CM recording technique, which would be expected to reduce the correspondence between CM isopotential functions and behavioral audiograms. Examination of the 16 pairs of audiograms showed that on the average, the use of a linear rule to predict behavioral audiograms from CM isopotential functions could account for more than 40% of the variance in the behavioral data. The lack of a well-defined region of maximum sensitivity in the CM audiograms was the most consistent shape discrepancy between the 2 data sets. Moreover, the CM audiogram was only an indicator of relative, not absolute, sensitivity. Several possibilities for improving the correspondence between behavioral and CM audiograms are suggested. (58 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)