[Shadow of history upon psychoanalytic therapy].
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The concept of truth in Freud's Metapsychology is a modern idea: a subject-related and pragmatic modification of the traditional concept of correspondence. But more important is the proof of a new implicit understanding of truth which becomes clearer in reation to the archaic conception of truth (alétheia) in the Oedipus tragedy. Freud finds in this drama not only the Oedipus complex, but also the tragic process of disclosure represented in the tyrant's struggle to uncover the reality (being) behind appearances which exhibits a certain similarity to the progress of psychoanalytic therapy.
The experience of intense painful aloneness is a common event in the lives of borderline patients, especially those closer to the psychotic spectrum. This experience is defined as an intrinsic aspect of the borderline personality defect and consists of a relative or total inability to remember positive images or fantasies of sustaining people in the patient's present or past life, or being overwhelmed by negative memories and images of these people. The development of borderline aloneness is related to a possible developmental failure, defined by Piaget, Fraiberg, and A.-M. Sandler. These workers describe the child's development of object permanence and evocative memory capacity (Piaget's sensori-motor stage VI). We postulate that a major borderline vulnerability is the tenuous achievement of the capacity for affective object permanence and its regressive loss to recognition memory or earlier when under specific stresses. We relate our hypotheses to possible empathic parental failures during the substages of separation-individuation, especially the rapprochement sub-phase. The treatment implications of our formulations are discussed, with an emphasis on the clarification of the need for the therapist's availability and the use of transitional objects during times of the patient's loss of his affective cognitive capacities. These regressive experiences often emerge as a core transference manifestation during psychoanalytic therapy with borderline patients, and often become the basis of significant therapeutic work.
Given the specific problems of the physically sick, the psychoanalytic therapy of psychosomatic patients normally calls for modification of treatment concepts that have proved viable for patients with mental disorders (neuroses) alone. The patients' difficulty in experiencing and expressing the experience of feelings as well as the fixation on one kind of physical complaint make it essential that the patient be unconditionally 'accepted' and offered translation aids so that within the patient-doctor relationship the 'mute' physical complaints can be assisted towards verbalisation and new emotional experiencing. The kind of special treatment forms indicated is determined by the extent of healthy personality elements. Here, in addition to nonverbal procedures, such techniques as combined inpatient--outpatient group psychotherapy, the subject of the present follow-up study, have proved to be helpful.
Using a 3 X 3 X 3 factorial design, clinical psychologists' (N = 204) evaluations were obtained of the methodology of a bogus psychotherapy outcome experiment that varied on the outpatient population treated and the results. Three types of neurotic outpatients were treated in the bogus study, and the experiment's results indicated that psychoanalytically oriented therapy was more effective than behavior therapy, behavior therapy was more effective than psychoanalytically oriented therapy, or psychoanalytically oriented therapy and behavior therapy were equally effective. The third independent variable was psychologists' theoretical orientation (psychodynamic, behavioral, or eclectic). A significant Orientation X Results interaction was obtained, and the results suggest that psychodynamic clinicians are biased against outcome research that demonstrates the superiority of behavior therapy.
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The interpretive use of dreams has become an established part of all dynamic psychotherapies. Their usefulness in sex therapy has thus far not been acknowledged. For the psychodynamically oriented sex therapist dreams can be particularly valuable in furnishing an understanding of those unconscious factors that cause sexual dysfunction, those that perpetuate dysfunction, and those that interfere with efforts to treat the dysfunction. By utilizing and integrating dream material into the sex therapy format, treatment is more likely to be successful and in a shorter period of time than can be accomplished by either sex therapy or psychoanalytic psychotherapy alone.
Certain personality defects noted during psychoanalytic therapy are expressions of temperament. Using a 72-item temperament index, the author analyzed 101 patients with respect to depressive, irritable, manic, paranoid and shizoid subscales. At least one such "temperament" was present in two-thirds of the borderline and in one-third of the neurotic patients. The temperament-positive borderline patients usually had a close relative with a schizophrenic or primary affective disorder. Several cases exhibiting temperament abnormalities are presented and modifications of analytic psychotherapy to deal more effectively with them are outlined.
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The author suggests there is a temporal sequence of therapies for schizophrenia, in a continuum of somatic, large-group, small-group, and individual modalities. The therapies arrange themselves in the same order when considered on the parameters of individualized care, treatment population, location, targets and goals, and techniques. By matching the four kinds of treatments, and their goals and areas of efficacy, with the schizophrenic's spectrum of changing needs, the clinician can determine what treatment is most appropriate for a patient at a particular time.
The family can be viewed as a natural group which includes a mutual influence phenomenon. Intervention follows relationship building and assessment and is geared towards helping the family members challenge and change dysfunctional coding, decoding and structural transactions which inhibit the family group from meeting its idividual psychological needs.
The technique the authors call"two-marriage therapy" (conjoint cotherapy by a married cotherapy team) has been developed to help the couple in a marital crisis confront the elusive nature of marriage, a being with self-images and unconscious deceptions, different from, but not separate from, the images and unconscious deceptions of the separate spouses. The key to the two-marriage analysis os discovering the limitations of cooperative relationships based on roles and expectations and the exploration of a mode of concern we term "coliberation". This paper attempts to show how the presence of a married cotherapy team facilitates this process and adds a significant salutary perspective on the marriage in conflict.
The paper presents arguments in favor of the use of mental imagery for therapeutic purposes. Several existing imagery approaches to psychotherapy are critically examined and suggestions for future inquiry are offered. The intimate relation between imagery and the affective-somatic processes is stressed.
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