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R S Wallerstein

Publications and source records attributed to R S Wallerstein.

At least 19 recordsLinked to original sources
PubMed1992

Followup in psychoanalysis: what happens to treatment gains?

A recent panel (1989) discussed the feasibility and the desirability of systematic post-treatment followup study of psychoanalytic patients. In this paper, I compare the data bearing on these issues from the Menninger Foundation Psychotherapy Research Project, headed by me, and the Boston Institute Project, headed by Kantrowitz, and I indicate why their data are neither comparable nor adequate enough to warrant the conclusion that their apparent discrepant findings--that in the Menninger project outcome at termination tended to be predictive of the subsequent followup course, while in the Boston project this was not so--are more than chance events. I then present detailed case descriptions of two patients from the Menninger project who were quite similar in character and in illness structure, had seemingly comparable analytic courses, and similar good therapeutic results, but had quite different followup courses, one with further consolidation, and the other with regression. I present some of the determinants of this difference.

Adult↗
PubMed1991

The future of psychotherapy.

Psychotherapy, once the dominant vehicle of psychiatric care, and still the most distinctive aspect of the psychiatric therapeutic armamentarium, is rapidly becoming an endangered species within psychiatry. The author reviews the decline in psychotherapy training since World War II. In the immediate decades following the war, as many as 3,000 hours (50%) of the 3-year residency training program were devoted to the learning and practice of psychoanalytic psychotherapy, under close supervision. The current situation is totally transformed from that earlier period, as psychiatry has grown and diversified with the explosive rise of neurobiology (especially in the areas of molecular biology and molecular genetics), clinical psychopharmacology, competing psychological paradigms (behavioral, family, and social systems) and their therapeutic applications, and community psychiatry, with its preventive, crisis-oriented, and epidemiological approaches. Today, various authoritative bodies recommend as little as 200 hours (2 1/2%) of psychotherapy training out of the 8,000 hours of the current 4-year residency program. The author explores the implications of this significant reduction in psychotherapy training.

Curriculum↗
PubMed1990

Psychoanalysis: the common ground.

This paper carries further the theme I developed in my presidential address in Montreal, 'One psychoanalysis or many?' where I discussed the issue of what holds us together as psychoanalysts sharing a common discipline and science despite our increasing theoretical diversity. My response was that our common ground rested in our shared clinical enterprise in our consulting rooms where we relate comparably to the immediacy of the transference-countertransference interplay with our patients. In this paper I reconsider these perspectives in the light of the specific responses to them, including in the six pre-published statements for the Rome Congress which was dedicated to this theme of exploring our common ground; and I then apply these conceptions in my own comparative assessment of the three plenary clinical presentations of the Rome Congress, drawn from the three major world regions of psychoanalytic activity and presented by adherents of three of the major metapsychological perspectives in our field, the ego psychological, the Kleinian, and the object relational.

Adult↗
PubMed1989

The Psychotherapy Research Project of the Menninger Foundation: an overview.

Studied processes and outcomes of psychoanalysis and psychoanalytic psychotherapy, both expressive and supportive. 42 Ss were followed via initial, termination, and follow-up studies over the entire natural course of treatment, with 100% follow-up 2-3 years posttermination. Some follow-ups extended over the 30-year life span of the study. Detailed case histories and life histories were obtained from all 42 Ss. Psychoanalyses achieved more limited outcomes than predicted; psychotherapies often achieved more than predicted. Supportive mechanisms infiltrated all therapies, psychoanalyses included, and accounted for more of the achieved outcomes (including structural changes) than anticipated. An expanded new categorization of supportive therapeutic mechanisms is proposed, along with an elaboration of expressive therapeutic mechanisms.

Adolescent↗
PubMed1989

Followup in psychoanalysis: clinical and research values.

Psychoanalysis has never developed a tradition of systematic followup study to evaluate outcome and to improve technique and theory for a variety of reasons, partly theoretical, stemming from the conception of the unfolding transference neurosis and its analytic resolution as the precondition for cure, and partly historical, having to do with the happenstance of its development as a private practice-based discipline and training outside of the academic setting. Freud, however, was never bound by such strictures and published whatever post-treatment data he acquired on all his best-known case histories. But following Freud most analysts, with some notable exceptions, eschewed followup activity as unanalytic. It is this tradition that more recent studies like those of Pfeffer in New York and the Psychotherapy Research Project of The Menninger Foundation in Topeka have squarely challenged. Data are presented from the Menninger project dealing specifically with the impact of routine planned followup on issues of treatment termination and resolution and on the nature of the post-treatment period. The degree and kind of patient cooperation with the followup inquiry, the impact of followup on treatment termination and resolution (both impeding and facilitating), and the role of followup intervention in relation to return to formal post-treatment therapy (or consolidating against it), are all discussed.

Adaptation, Psychological↗
PubMed1989

Psychoanalysis and psychotherapy: an historical perspective.

I have reviewed the historical unfolding of psychoanalytic (or dynamic) psychotherapy as a therapeutic application of psychoanalytic theory directed towards patients not considered appropriate for proper psychoanalysis. I have divided this history into three phases. The first phase that I call the prehistory of dynamic psychotherapy is the period of Freud's development of psychoanalysis as a distinctive therapy for mental illness and its clear differentiation from the varieties of suggestive therapies in vogue at the time. The second phase (from the 40s to the late 70s) is the period of the development of psychoanalytically-based expressive and supportive psychotherapies related to but clearly separate from proper psychoanalysis in terms of specific techniques, goals, and the portions of the psychopathological spectrum against which each is directed. I call it the period of psychoanalytic consensus. The third current phase, from the late 70s to date, I call the period of fragmented consensus. The leading protagonists in the forging of the second phase consensus, brought to its fullest expression in the landmark publications of 1954, have now diverged widely in their perspectives on these issues as expressed in a 1979 Symposium, 25 years after.

Europe↗
PubMed1989

The future of psychoanalysis.

We have tried, in a necessarily kaleidoscopic and highly condensed manner, to highlight our perspectives on the foreseeable future of psychoanalysis, along a number of interrelated but clearly distinct dimensions. Our discussion has dealt with the nature of our field as a science and also as a discipline, the nature of the training for it, the nature of its research, and the nature and scope of its professional practice. In all of these areas, matters seem both more complex and less clear-cut than they were in the immediate post-World War II period when we entered the field, which is now forty years ago in the approximately one-hundred-year-old history of psychoanalysis. We did not discuss in any detail the International Psychoanalytical Association or the American, its component through which we have our international membership. We have, however, via the IPA Newsletter, given voice to the organizational struggles of the International: the April 1989 issue of the Newsletter carries our account of the organizational changes within the IPA during the last four years and what we think they mean in relation to some of the issues discussed in this article. The fuller story of how our changing psychoanalytic life and identities are reflected in our institutional structures, as well as a more detailed specification of the future directions we have tried to chart in our inquiry, all deserve separate extended treatment and more complete justification.

Forecasting↗
PubMed1988

Psychoanalysis, psychoanalytic science, and psychoanalytic research--1986.

The present standing of psychoanalysis as a science and the vitality of psychoanalytic research effort are reviewed. The two are interdependent, since the possibilities for empirical research rest on the necessary assumption that psychoanalysis is indeed enough a science to be susceptible to knowledge advance by the (research) methods of science. Concerning our status as a science, I review attacks on our scientific credentials (both from within our ranks and without) by the logical positivists, by the hermeneuticists (a rubric comprising a variety of hermeneutic, phenomenological, exclusively subjectivistic, and/or linguistically based conceptualizations of our field), and the most recent by the philosopher of science, Adolf Grünbaum. I try to demonstrate what I feel to be the failure of each of these assaults, and why I feel there is no reason to see psychoanalysis as anything other than a scientific psychology and, therefore, in theory amenable to empirical research approaches. I then review the history and the current status of these systematic research efforts in psychoanalysis, and the reasons why these have been far less in scope and in accomplishment than has been possible or than has been needed. Here I have focused especially on research involving technique and our theory of change and cure--i.e., research on the analytic process; on what changes take place (outcome) and how those changes come about or are brought about (process).

Adaptation, Psychological↗
PubMed1988

One psychoanalysis or many?

This paper describes the historic development of psychoanalysis, the singular product of the genius of one man, Sigmund Freud, and which he made such strenuous efforts through his lifetime to maintain as a unified enterprise, defining out dissidents (like Adler, Jung, etc.), into what has become in the almost half-century since his death a science and a discipline characterized by an increasing diversity or pluralism, of theoretical perspectives, of linguistic and thought conventions, and of distinctive regional, cultural, and language emphases. I discuss both the understanding of this theoretical diversity and what, in the face of it, holds us together as common adherents of a shared psychoanalytic science and profession. My thesis is that what unites us is our shared focus on the clinical interactions in our consulting rooms, the phenomena encompassed by the 'present unconscious' (the Sandlers) or the 'clinical theory' (George Klein). When we look beyond that to an explanatory structure within which to conceptualize the genetic-developmental process, normal and abnormal mental functioning, psychopathology and its reversal (cure) i.e. the realm of the 'past unconscious' or the 'general theory', we posit our various theoretical, linguistic or thought perspectives, i.e.--at this stage of our historical development--our metaphors or our various explanatory symbolisms. Some implications of this viewing of our various theoretical perspectives in psychoanalysis (ego psychological, object-relational, self-psychological, Kleinian, Bionian, Lacanian, etc.) as but metaphoric expressions, are reviewed.

Austria↗
PubMed1986

Psychoanalysis as a science: a response to the new challenges.

Few theoretical issues in psychoanalysis have been more constantly argued than the status of our discipline as a science. For long the attack has been from the logical positivists and the extensions of their argument by Karl Popper. Over recent decades the debate about the place of our metapsychology has intensified the concerns about our scientific status. In this paper I respond briefly to the logical positivist, the Popperian, and the information-processing systems theory arguments and then develop at greater length a response to the two current, most widespread philosophy-of-science assaults upon our credibility as science, that of the hermeneuticists (Ricoeur, Habermas, Gadamer, and others), and the newest, that of the philosopher, Adolf Grünbaum.

Humans↗