Monitoring the analytic surface

Sprechen und Schweigen in der Psychotherapie

Das Gespräch hat in jeder Psychotherapie eine zentrale Stellung. „Gesprächstherapie“ ist deshalb irreführend für eine besondere Art der Therapeutik. Im Folgenden wird von Analytiker(in) gesprochen, wenn diese Tradition gemeint ist, ansonsten von Therapeut(en) und Therapeutin. Probleme der Vertraulichkeit bei der Erforschung von Gesprächen können gut und sicher gelöst werden. Die Erforschung der therapeutischen Konversation ist weit vorangetrieben, von psychoanalytischer Seite und anderen weltweit. Da so wichtige Gesprächsmomente wie Schweigen und Erzählen vertieft verstanden werden konnten, wird ein „communicative turn“ vorgeschlagen: nicht länger eine jeweilige Psychotherapietheorie als Ausgangspunkt einer Untersuchung zu wählen, sondern das Gespräch selbst. Dazu werden Forschungsergebnisse mit Bezug zur klinischen Arbeit vorgestellt. Sie sind klinisch gehaltvoll.

Psychodynamic Psychotherapy Process Research: A quick ride through what you should know about process (research)

This paper gives an overview of psychoanalytic process research, which brings to light the complexity of psychotherapy sessions. This complexity is so rich that many instruments intended to make the process measurable failed in the past because they initially used a strategy of complexity reduction. This method however did not help to further our understanding of the complexity involved. Three former presidents of the Society for Psychotherapy Research (Stiles, Hill, Elliot 2015) decided to solve the following equivalence paradox: many therapies work successfully though they all follow different theories, produce a heterogeneity of processes and often enough a misfit between what theories maintain to be a good process and their realization in the treatment room. As theories are often compared to maps, a driver would wonder which route to take. But therapists-as-drivers go undaunted - and nevertheless achieve their goals together with their patients. Norcross and Wampold (2018) found that good therapists invent new therapies with every new patient. They hypothesize that it is because of conversation. This is in accord with the 3 former presidents' proposal to return to detailed single case analyses including the micro-analytic power of conversation analysis of which a few insights are outlined in this article.

Rhythm and Blues - Amalie's 152nd session: From psychoanalysis to conversation and metaphor analysis - and back again

Conversation analysis and psychotherapy process research is an evolving field promising new insights for therapeutic practice. As the specimen case of Amalie, especially her 152nd session, has been investigated using various methods - of which we give a short overview - we offer a new analysis of session 152 based on a new transcription which allows for more detailed listening to the prosodic properties of this analytic dyad. Our findings show a) how analyst and patient co-create their common conversational object called psychoanalysis; b) how a lot of up-to-now not described analytical tools are applied, that can be described as "practices"; c) how a "dance of insight" is enacted by both participants in a common creation making patterns of interaction visible from "both sides"; d) how participants create metaphors as conversational and cognitive tools to reduce the enormous complexity of the analytic exchange and for other purposes; e) that prosodic rhythmicity and other prosodic features are best integrated in a threefold model for analytic conversation consisting of "interaction engine", "talking to" and "talking about" the patient. The study is presented as hypothesis-generating research based on verbal, not statistical data.

Pronouns and progress: a psychoanalytic primer

Psychoanalytic psychotherapists have the role responsibility to hover evenly over everything that is said--and not said--in the analytic situation. Pronouns may be worthy of special attention. Just as children demonstrate a predictable course in the acquisition and mastery of pronouns, it may be that the analytic patient also shows a predictable sequence in the deployment of pronouns over the course of a successful treatment. The analytic patient will move from a focus on "They," to joining the analyst in "We," before ultimately separating to become an "I." A third person focus in the opening phase, may, with familiarity, move to second person intimacy, ultimately yielding to first person agency. These grammatical markers occur in the opening, middle and termination/follow-up phases of a successful psychoanalytic treatment, during which the pre-morbid introjects are identified, chewed up, and, eventually nudged aside by the healthier therapeutic-introject, from which a new or renewed identity may emerge. Analysis of the Grimm's fairy tale "The Wolf and the Kids" illustrations the importance of metabolizing old introjects.

The negative as potential prognostic marker of outcome in psychotherapy

From 73 patients, 10 with the best, and 10 with the worst outcomes after psychotherapy were compared statistically for the frequency of 'not' and 'never' at commencement of psychotherapy, and for change in their frequency after therapy. A highly statistically significantly difference was found at commencement of psychotherapy in that the negative was used more frequently by the worst outcome group (p=.006). No significant differences were found for change in frequency after therapy. Thus, the frequent use of the negative at commencement of psychotherapy seems to predict a poor outcome.

Changes in semantic uses of first person pronouns as possible linguistic markers of recovery in psychotherapy

OBJECTIVE

To examine changes in linguistic markers in the course of psychotherapy, drawing on Frege's logic of relations to define semantic variables distinct from syntactic variables.

METHOD

From a sample of 73 patients, 10 patients with the best and 10 patients with the worst outcomes were selected. Forty transcribed sessions of each outcome group were compared statistically for change between commencement and termination of psychotherapy in: (i) the syntactic usage of first person pronouns ('I', 'me', 'we', 'us', 'implied I', 'implied me'); (ii) semantic usage of first person pronouns (expressing alpha, omega, or unclear positions); and (iii) non-pronoun linguistic variables (passive voice, negative, copula, auxiliary verbs expressing a sense of obligation).

RESULTS

There were no significant differences between the best and worst outcome groups in the change of either syntactic usage, or of the non-pronoun linguistic variables. However, the outcome groups differed significantly in the change of their semantic usage (alpha: p = 0.002; omega: p = 0.028): The best outcome group showed an increase of alpha positions and a decrease of omega positions, whereas the worst outcome group showed the inverse (i.e. decrease of alpha and increase of omega positions).

CONCLUSIONS

Results suggest only semantic, that is meaning-driven, usage of first person pronouns marks recovery in the course of psychotherapy. If replicated, this finding could be used to monitor treatment responses. Replication in other kinds of treatment could mean these semantic changes are markers of recovery more generally than in psychotherapy.

A semiotic model of mind

A theory of signs is presented to arrive at a model of mind that provides a smooth transition from inanimate matter to the thinking brain. Principles of information theory and semiotics are invoked to create a conceptual scheme that can contribute to an understanding of the "mind-body problem." The thesis is pursued that in living systems, as opposed to inorganic ones, there occurs the phenomenon of semiotic transmission of information. The result is a "dualistic-materialist" position; the dualism arises from the fact that at the beginning of life a set of processes comes into being different from those of the inorganic world. This model has implications for psychology and psychoanalysis. It allows for semiotic systems at different levels--e.g., the molecular, the neural network, the language system, and higher mental functions--to be integrated. Analytic concepts such as free association, clinical technique, feedback systems, personality structure, transference, and repetition compulsions can be understood in both biological and semiotic terms. This model interdigitates with linguistic studies already done in psychoanalysis, as well as with biological models extrinsic to the field.

When do interpretations make a difference? A partial answer to Fliess's Achensee question

Interpretations seem to matter most (at least in the case of Mrs. C) when the analyst feels included in the patient's thoughts. During hours of this kind (Related hours, scoring high on the cooccurrence of first- and second-person pronouns such as me/you), the analyst's interpretations are more comprehensive and probing; he intervenes earlier and more often within the session; and his specific interpretations have a greater effect on the patient's associations, as measured by an increased frequency of specific discourse markers. Low-scoring hours, with relatively few pronominal references to the analyst, were characterized by more superficial interpretations; later and fewer interventions; a greater tendency for the analyst to misunderstand the patient's productions; and a decreased effect of specific interventions. Special care was taken to protect the findings from the dangers of suggestion (the Achensee question).

Understanding therapeutic action in the analytic situation: a second look at the developmental metaphor

A root metaphor for the psychoanalytic therapeutic process is the mother-infant caretaking relationship. This developmental metaphor has assumed a dominant role for some analysts in how the psychoanalytic process and therapeutic relationship are conceptualized. In this paper, a distinction is made between two uses of the developmental metaphor--naïve and informed. The naïve view as commonly applied constrains our view of the unique relationship between analyst and analysand. The informed view takes into account current research in early social development that has emerged in the last decade of empirical studies with infants, young children, and their parents. While the parent-child relationship may be an inexact model for the analytic connection, some of the implications of the former, as they become more clearly understood in the course of careful research, may provide useful information about how change does or does not occur as a result of the analytic process, and how an analytic process needs to be in place in the analysand before that change can occur.