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)     

Ambiguity in speech

Ambiguity in speech during analysis is one manifestation of transference. Four types of ambiguity are illustrated. Each ambiguity communicates an unconscious wish or intention and the defense against this wish or intention. In each type of ambiguity, transference manifestations are expressed in the form of speech and not alone by its content, as we are accustomed to identifying the transference. Each type of ambiguity within the analysis expresses fear to responsibility and recrimination for libidinal or aggressive intentions. In some patients, the combinative ambiguity or malapropism expresses the fear of reprisal through the transformation into a self-inflicted injury. The pronominal ambiguity may express a feared and wished-for fusion with the analyst. The analyst's ambiguous interpretations are properly used to encourage associations, but at times may reflect lack of understanding and be a manifestation of countertransference.     

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)     

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)     

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)     

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)     

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)     

Suggestion revisited.

Discusses suggestion in psychotherapy and defines it as a body–affective process, an indissociable psychosociobiological entity that acts at an archaic unconscious level far beyond that of transference, mediates the influence of one individual on another, and is capable of producing manifest psychological and physiological changes. Present in all types of therapy, indirect (nondeliberate, nonintentional) suggestion is the element that plays an important role in change and can be observed in hypnotic experimentation. It is further argued that transference and suggestion are phenomena that do not altogether overlap. Suggestion is the condition of transference without which transference could not be established. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Deconstructing the myth of the neutral analyst: an alternative from intersubjective systems theory

A critique is offered of four conceptions of neutrality that have been prominent in the psychoanalytic literature: neutrality as (1) abstinence, (2) anonymity, (3) equidistance, and (4) empathy. It is argued that once the psychoanalytic situation is recognized as an intersubjective system of reciprocal mutual influence, the concept of neutrality is revealed to be an illusion. Hence, interpretations are always suggestions, transference is always contaminated, and analysis are never objective. An alternative to neutrality is found in the investigatory stance of empathic-introspective inquiry. This mode of inquiry is sharply distinguished from the prescribing of self-expressive behavior on the part of analysis, and the distinction is illustrated with a clinical vignette.     

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)     

Difficulties on the pathway to establishing an analytic process: On some vicissitudes of self-reflection during the opening phase of psychoanalysis.

The beginning of a psychoanalysis attempts to establish those aspects of the treatment that define the situation and process as uniquely psychoanalytic. From a classical perspective this entails the creation of a particular therapeutic ambience that encourages the patient to expand his or her capacity for self-reflection on the transference experience. In the present article, the author considers 3 major types of patients for whom the potential for establishing such a situation and process is compromised by various characterological difficulties. Clinical material is used to illustrate the particular way the analytic process is impeded in each of these types, and an attempt is made to systematically relate their difficulties to specific anxieties each experiences in reflecting on transference experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of interpretation on associative freedom.

70 hrs from the psychoanalytic case of Mrs. C, covering the full course of treatment, were scored for associative freedom, number of interventions, and a variety of clinical phenomena (e.g., clarifications, interpretations, different forms of resistance, transference manifestations). Associative freedom significantly increased over the course of treatment and was significantly related to the number of analyst interventions per hour. The relationship was particularly strong in the latter stages of treatment. Three specific types of interventions were found to increase associative freedom in the latter stages of treatment. The effect of each type was found to influence both the session containing the interpretation and the next 3 sessions. This carryover effect was specific to the latter stages of the analysis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating some mind and brain views of transference: the phenomena

Because understanding the underpinnings of transferential learning allows the analyst to more effectively exploit transference in the clinical situation, as well as to advance psychoanalytic theory, the functions and mechanisms of transference phenomena in learning are subjected to an interdisciplinary analysis. Through transference the brain creates hierarchical databases that make emotional sense of the world, especially the world of human relationships. Transference plays a role in defense and resistance clinically; less explored but equally important is the adaptive potential of transference and its effect on an individual's readiness for structural change through the activation of working memory. Most investigators within psychoanalysis have not considered the importance of similarity judgments and memory priming, especially as these help to explain why transference and its proper handling are effective in treatment. Yet there are complex relationships among transference, similarity judgment, and memory priming that tie together psychoanalysis, cognitive psychology, and neurophysiology. Evidence increasingly suggests a relationship between transference and the transfer of knowledge between various content domains (databases) of mind and brain, which is essential to cognitive and emotional learning. There are indications as well that transference decisively facilitates learning readiness ("windows") in general by means of two of its components: free association and spontaneous (self-initiated) activity. The important question of which mind/brain mechanisms motivate transference is not yet understood comprehensively. However, Vygotsky's work on the zone of proximal development (ZPD), M.Stern's teleonomic theory, schema theory, and neural network theory offer further insights into what motivates transference.     

Countertransference in the treatment of pathological narcissism.

Explores literature on countertransference reactions experienced in psychodynamic work with narcissistic clients, examines the various therapist–client variables involved in these reactions, and briefly suggests approaches to understanding and resolving them. Common types of narcissistic transference and countertransference include responses to the mirroring transference, idealizing transference, twinship transference, and negative transference. Underlying principles in understanding and effectively utilizing one's countertransference feelings in psychotherapy include differentiating subjective vs objective countertransference and determining whether to interpret these feelings with regard to both the client's developmental needs and phase of treatment. This is especially important in treating narcissistic clients whose self-esteem is fragile and who are, thus, prone to experience shame and rage reactions. (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)     

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)     

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.