Abstracts for Empirical Studies

Compiled by Caroline Paster

Title:
The Psychotherapy Research Project of the Menninger Foundation:
An Overview

Author:
Wallerstein, Robert S.

Source:
PsychINFO Database Record © 2006 APA,all rights reserved

Abstract:
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 post-termination. 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.

Title:
Follow-up of Psychoanalysis Five to Ten Years after Termination: III. The Relation between the Resolution of the Transference and the Patient-Analyst Match

Author:
Kantrowitz, Judy; Katz, Ann L.; and Paolitto, Frank

Abstract:
As part of a long-term follow-up study of the outcome of psychoanalysis, we examined the relation between the extent of resolution of the transference at termination and the characteristics of the patient-analyst match. For twelve of the seventeen patients interviewed five to ten years after termination of psychoanalysis, the researchers found that the patient-analyst match played a role in the outcome of the analysis. Illustrations of the influence of the match in cases where the transference was resolved and those where it was not are presented.

Title:
Studies on the Efficacy of Child Psychoanalysis

Author:
Fonagy, Peter and Moran, George S.

Source:
PsycINFO Database Record © 2006, APA, all rights reserved

Abstract:
This article summarizes three studies that evaluated the psychoanalytic psychotherapeutic treatment of diabetic children and adolescents with grossly abnormal blood glucose profiles necessitating repeated admissions to hospital. Study 1 used time series analysis to demonstrate that improvements in control were predicted by unconscious themes emerging in the analytic material. Study 2 compared the effect of psychotherapeutic treatment with that of minimal psychological intervention in 2well-matched groups (n = 11). Patients in the treatment group were offered psychoanalytic psychotherapy 3-4 times per week on the hospital ward. The intervention was highly effective in improving the diabetic control of the children, and this improvement was maintained at 1-yr follow-up. Study 3 used single-case experimental design to demonstrate the marked effect of psychotherapeutic help on growth in diabetic children with short stature.

Title:
The Differential Effect of Psychotherapy and Psychoanalysis with Anaclitic and Introjective Patients: The Menninger Psychotherapy Research Project Revisited

Author:
Blatt, Sidney J.

Abstract:
Analyses of the data from the Menninger Psychotherapy Research Project (MPRP) have consistently indicated little difference in the therapeutic outcome between patients seen in psychoanalysis and those seen in psychotherapy. Reanalysis of the data from the MPRP, utilizing a distinction between two broad configurations of psychopathology (Blatt, 1974),(1990a), (Blatt and Shichman, 1983), however, indicates that patients whose pathology focuses primarily on disruptions of interpersonal relatedness and who use primarily avoidant defenses (anaclitic patients), and patients whose pathology focuses primarily on issues of self-definition, autonomy, and self-worth and who use primarily counteractive defenses (introjective patients)differ in their responsiveness to psychotherapy and psychoanalysis. Based on recently developed procedures for systematically evaluating the quality of object representation on the Rorschach, reanalysis of the Menninger data reveals that anaclitic patients have significantly greater positive change in psychotherapy, while introjective patients have significantly greater positive change in psychoanalysis. These statistically significant patient-by-treatment interactions are discussed in terms of their clinical implications as well as the importance of differentiating among types of patients in studies of therapeutic outcome and of therapeutic process.

Title:
The Efficacy of Psychoanalysis for Children with Emotional Disorders

Author:
Target, M. and Fonagy, P.

Source:
Journal of the American Academy of Child and Adolescent Psychiatry, 33, 361-371, 1994

Title:
Effectiveness of Partial Hospitalization in the Treatment of Borderline Personality Disorder: A Randomized Controlled Trial

Author:
Bateman, Anthony and Fonagy, Peter

Abstract:
OBJECTIVE: This study compared the effectiveness of psychoanalytically oriented partial hospitalization with standard psychiatric care for patients with borderline personality disorder.

METHOD:Thirty-eight patients with borderline personality disorder, diagnosed according to standardized criteria, were allocated either to a partially hospitalized group or to a standard psychiatric care (control) group in a randomized controlled design. Treatment, which included individual and group psychoanalytic psychotherapy, was for a maximum of 18 months. Outcome measures included the frequency of suicide attempts and acts of self-harm, the number and duration of inpatient admissions, the use of psychotropic medication, and self-report measures of depression, anxiety, general symptom distress, interpersonal function, and social adjustment. Data analysis used repeated measures analysis of covariance and nonparametric tests of trend.

RESULTS: Patients who were partially hospitalized showed a statistically significant decrease on all measures in contrast to the control group, which showed limited change or deterioration over the same period. An improvement in depressive symptoms, a decrease in suicidal and self-mutilatory acts, reduced inpatient days, and better social and interpersonal function began at 6 months and continued until the end of treatment at 18 months.

CONCLUSIONS: Psychoanalytically oriented partial hospitalization is superior to standard psychiatric care for patients with borderline personality disorder. Replication is needed with larger groups, but these results suggest that partial hospitalization may offer an alternative to inpatient treatment.

Title:
Varieties of Long-Term Outcome among Patients in Psychoanalysis and Long-Term Psychotherapy: A Review of Findings in the Stockholm Outcome of Psychoanalysis and Psychotherapy Project (Stoppp)

Author:
Blomberg, Johan; Broberg, Jeanette; Carlsonn, Jan;Lazar, Anna; Sandell, Rolf; and Schubert, Johan

Abstract:
This paper reports the main findings of a large-scale study of subsidized psychoanalysis and long-term psychotherapy. More than 400 people in various phases, before, during and after subsidized psychoanalysis or long-term psychodynamic psychotherapy, were followed up for a period of three years with personal interviews, questionnaires and official statistics. Our analyses revealed progressive improvement the longer patients were in treatment—impressively strong among patients in psychoanalysis—on self-rating measures of symptom distress and morale. Improvement, however, was equally weak in both groups on a self-rating measure of social relations. Dosage factors(treatment duration and session frequency in combination) partly accounted for the outcome differences between those referred to psychoanalysis and those referred to long-term psychotherapy. Attitudes and ideals among therapists and analysts concerning the goals and means of psychotherapy were also associated with patient outcome, although in rather complex ways. A significant part of the outcome differences between patients in psychoanalysis and in psychotherapy could be explained by the adoption, in a large group of therapists, of orthodox psychoanalytic attitudes that seemed to be counterproductive in the practice of psychotherapy but not in psychoanalysis. It is suggested that this effect may be a negative transfer of the psychoanalytic stance into psychotherapeutic practice and that this may be especially pronounced when the attitudes are not backed up by psychoanalytic training.

Title:
The Cost-Effectiveness of Psychotherapy and Paroxetine for Severe Irritable Bowel Syndrome

Author:
Creed, F.; Fernandes, L.; Guthrie, E.;Palmer, S.; Ratcliffe, J.; Read, N.; et al.

Source:
Gastroenterology, 124(2), 303-317, 2003

Title:
How to Study the ‘Quality of Psychoanalytic Treatments’ and Their Long-Term Effects on Patients' Well-Being: Representative,Multi-Perspective Follow-Up Study

Author:
Beutel, Manfred;Leuzinger-Bohleber, Marianne; Rüger, Bernhard; and Stuhrast, Ulrich

Abstract:
How can we study the ‘quality of psychoanalytic treatments’? The authors attempt to answer this question by discussing a naturalistic, multi-perspective and representative follow-up study of psychoanalyses and long-term psychoanalytic psychotherapies. We studied a representative sample (n = 401) of all the patients who had terminated their psychoanalytic treatments with members of the German Psychoanalytical Association (DPV) between 1990 and 1993. Between 70 and 80 per cent of the patients achieved (average 6.5 years after the end of treatment) good and stable psychic changes according to the evaluations of the patients themselves, their analysts, independent psychoanalytic and non-psychoanalytic experts, and questionnaires commonly applied in psychotherapy research. The evaluation of mental health costs showed a cost reduction through fewer days of sick leave during the seven years following the end of long-term psychoanalytic treatments.The results achieved using non-psychoanalytical instruments are complemented by the richness of the idiosyncratic findings, gained by the psychoanalytic research instruments.

Title:
The Personality Disorders Institute/Borderline Personality Disorder Research Foundation Randomized Control Trial for Borderline Personality Disorder: Rationale,Methods, and Patient Characteristics

Author:
Clarkin, John F.;Kernberg, Otto F.; Lenzenweger, Mark F.; and Raymond Levy, PsyD; Levy, Kenneth N.

Abstract:
The Personality Disorder Institute/Borderline Personality Disorder Research Foundation randomized control trial (PDI/BPDRF RCT) is a controlled outcome study for borderline personality disorder (BPD) in which 90 participants were randomized to one of three manualized and monitored, active psychosocial treatment conditions. These treatments are: (a) Transference-Focused Psychotherapy (TFP; Clarkin, Yeomans, & Kernberg, 1999), a treatment for BPD based on object-relational and psychoanalytic principles first applied to BPD by Kernberg (1996), notable for its particular emphasis on interpretation of object relations activated in the ongoing therapeutic relationship; (b) Dialectical Behavior Therapy (DBT; Linehan, 1993), a popular treatment for BPD, with evidence of efficacy (Linehan, Armstrong, Suarez, Allmon, & Heard, 1991)that emphasizes a balance between acceptance and change in its combination of cognitive-behavioral and Zen principles; and (c) supportive psychotherapy(Rockland, 1992), another object-relational and psychoanalytically basedtreatment for BPD which, in contrast to TFP, eschews transference interpretational places primary emphasis on development of a collaborative engagement with the patient to foster identity development.

Patients received medication, if clearly indicated, according to the treatment algorithm developed by Soloff (2000). This article describes the significance and rationale of the study and the overall design, methods, plan of analysis, and demographic characteristics of the recruited sample of patients.

Title:
A Randomized Trial of the Effect of Four Forms of Psychotherapy on Depressive and Anxiety Disorders

Author:
Knekt, P. and Lindfors, O.

Source:
Helsinki, Kela, 2004

Title:
The Göttingen Study of Psychoanalytic Therapy:First Results

Author:
Biskup, Joachim; Kreische, Reinhard; Leichsenring, Falk; and Staats, Hermann

Abstract:
Results of a naturalistic study of the effectiveness of psychoanalytic therapy are reported.Outcome data are presented for a sample of N = 36 patients who were treated with psychoanalytic therapy. For a sample of n = 23 of these patients, data for1-year follow-up are available at present. According to the results,psychoanalytic therapy yielded significant improvements in symptoms (Symptom Checklist 90-R, SCL-90-R and rating of psychoanalysts), in interpersonal problems (Inventory of Interpersonal Problems, IIP), in quality of life(Questionnaire of Quality of Life, FLZ), in well-being (Questionnaire of Changes in Experience and Behaviour, VEV) and in target problems defined by the patients(Goal Attainment Scaling, GAS). Large effect sizes between 1.28 and 2.48 were found in symptoms (GSI of the SCL-90-R), interpersonal problems (IIP-total),quality of life (FLZ-total), well-being (VEV) and target problems (GAS). At1-year follow-up, all improvements proved to be stable or even increased. The self-reported improvements in symptoms were corroborated by the ratings of the psychoanalysts. At the end of therapy, 77% of the patients showed clinically significant improvements. In the 1-year follow-up group, this was true for 80%.Further results are presented and discussed.

Title:
Manualized Supportive-Expressive Psychotherapy versus Non manualized Community-Delivered Psychodynamic Therapy for Patients with Personality Disorders: Bridging Efficacy and Effectiveness

Author:
Barber, Jacques P.; Gallop, Robert; Norén, Kristina;Vinnars, Bo; and Weinryb, Robert M.

Abstract:
OBJECTIVE:Time-limited manualized dynamic psychotherapy was compared with community-delivered psychodynamic therapy for outpatients with personality disorders.

METHOD: In a stratified randomized clinical trial, 156patients with any personality disorder diagnosis were randomly assigned either to 40 sessions of supportive-expressive psychotherapy (N=80) or to community-delivered psychodynamic therapy (N=76). Assessments were made at intake and 1 and 2 years after intake. Patients were recruited consecutively from two community mental health centers (CMHCs), assessed with the Structural Clinical Interview for DSM-IV Axis II Personality Disorders, and included if they had a diagnosis of any DSM-IV personality disorder. The outcome measures included the presence of a personality disorder diagnosis, personality disorder severity index, level of psychiatric symptoms (SCL-90), Global Assessment of Functioning Scale score, and number of therapy sessions. General mixed-model analysis of variance was used to assess group and time effects.

RESULTS:In both treatment conditions, the global level of functioning improved while there were decreases in the prevalence of patients fulfilling criteria for a personality disorder diagnosis, personality disorder severity, and psychiatric symptoms. There was no difference in effect between treatments. During the follow-up period, patients who received supportive-expressive psychotherapy made significantly fewer visits to the CMHCs than the patients who received community-delivered psychodynamic therapy.

CONCLUSIONS: Manualized supportive-expressive psychotherapy was as effective as non manualized community-delivered psychodynamic therapy conducted by experienced dynamic clinicians.

Title:
Assessing Personality Change in Psychotherapy with the SWAP–200: A Case Study

Author:
Gazzillo, Francesco; Lingiardi, Vittorio; and Shedler, Jonathan

Abstract:
Many studies document the efficacy of psychotherapy for acute syndromes such as depression, but less is known about personality change in patients treated for personality pathology. The Shedler–Westen Assessment Procedure (SWAP–200; Westen & Shedler, 1999a,1999b) is an assessment tool that measures a broad spectrum of personality constructs and is designed to bridge the gap between the clinical and empirical traditions in personality assessment. In this article, we demonstrate the use of the SWAP–200 as a measure of change in a case study of a patient diagnosed with borderline personality disorder. We collected assessment data at the start of treatment and after 2 years of psychotherapy. The findings illustrate the personality processes targeted in intensive psychotherapy for borderline personality.

Title:
A Programmatic Study of Short-Term Psychodynamic Psychotherapy: Assessment, Process, Outcome, and Training

Author:
Hilsenroth, Mark J.

Abstract:
The author reviews findings from his research program on short-term psychodynamic psychotherapy. A hybrid model of psychotherapy research is outlined that integrates efficacy and effectiveness methodology to examine interrelated issues regarding: (a) psychological assessment, (b) psychotherapy process, (c) treatment outcome, and (d) training of graduate clinicians. The integration of applied clinical research initiatives into a doctoral training program, clinical implications, and directions for future research are also presented.

Title:
Change in Attachment Patterns and Reflective Function in a Randomized Controlled Trial of Transference Focused Psychotherapy for Borderline Personality Disorder

Author:
Clarkin, J. F.;Kelly, K. M.; Kernberg, O. F.; Levy, K. N.;Meehan, K. B.; Reynoso, J. S.; and Weber, M.

Source:
Journal of Consulting and Clinical Psychology

Title:
The Efficacy of Psychoanalytic Psychotherapy for Panic Disorder

Author:
Busch, F.; Clarkin, J.; Leon, A. C.;Milrod, B.; Rudden, M.; Schwalberg, M.; et al.

Source:
American Journal of Psychiatry

Title:
Short-Term Dynamically Oriented Psychotherapy: A Review and Meta-Analysis

Author:
Anderson, Edward M. and Lambert, Michael J.

Abstract:
Twenty-six studies of the effectiveness of short-term dynamic therapy (STDT) were subjected to two meta-analyses. Effect sizes (ES) obtained by each method were similar. STDT attained average ESs of 71 and 34, relative to wait list and minimal treatment groups, respectively. When studies using psychosomatic patients were excluded,STDT achieved an ES of 85, relative to wait list groups. We found no evidence that STDT is superior or inferior to other forms of psychotherapy at post-treatment, although it evidenced a slight superiority at long-term follow-up assessment. There was, in addition, evidence that studies employing manuals or therapists trained in STDT produced larger ESs than those that did not.

Title:
Does Psychoanalysis Work?

Author:
Bachrach, H.; Galatzer-Levy, R.M.; Skolnikoff, A.; and Waldron, Jr., S.

Source:
New Haven, Yale University Press,2000

Title:
An Open Door Review of Outcome Studies in Psychoanalysis (Second Edition)

Author:
Allison,E.; Clarkin, J.; Fonagy, P.; Gerber, A.; Jones, E.E.; Kächele, H.; Krause, R.; and Perron, R.

Source:
London, International Psychoanalytic Association, 2001(download or order via http://eseries.ipa.org.uk/prev/research/R-outcome.htm)

Title:
Comparative Effects of Short-Term Psychodynamic Psychotherapy and Cognitive-Behavioral Therapy in Depression: A Meta-Analytic Approach

Author:
Leichsenring, Falk

Abstract:
This article reviews the efficacy of short-term psychodynamic psychotherapy (STPP) in depression compared to cognitive-behavioral therapy (CBT) or behavioral therapy (BT). In this review,only studies in which at least 13 therapy sessions were performed have been included, and a sufficient number of patients per group were treated (N ? 20).With regard to outcome criteria, the results were reviewed for improvements in depressive symptoms, general psychiatric symptoms, and social functioning. Six studies met the inclusion criteria. Results: In 58 of the 60 comparisons (97%)performed in the six studies and their follow-ups, no significant difference could be detected between STPP and CBT/BT concerning the effects in depressive symptoms, general psychiatric symptomatology, and social functioning.Furthermore, STPP and CBT/BT did not differ significantly with regard to the patients that were judged as remitted or improved. According to a meta-analytic procedure described by R. Resentful (1991) the studies do not differ significantly with regard to the patients that were judged as remitted or improved after treatment with STPP or CBT/BT. The mean difference between STPP and CBT/BT concerning the number of patients that were judged as remitted or improved corresponds to a small effect size (post-assessment: ? = 0.08,follow-up assessment: ? = 0.12). Thus, STPP and CBT/BT seem to be equally effective methods in the treatment of depression. However, because of the small number of studies which met the inclusion criteria, this result can only be preliminary. Furthermore, it applies only to the specific forms of STPP that were examined in the selected studies and cannot be generalized to other forms of STPP. Further studies are needed to examine the effects of specific forms of STPP in both controlled and naturalistic settings. Furthermore, there are findings indicating that 16–20 sessions of both STPP and CBT/BT are insufficient for most patients to achieve lasting remission. Future studies should address the effects of longer treatments of depression. Title:
The Benefits of Individual Psychotherapy for People Diagnosed with Schizophrenia: A Meta-Analytic Review

Author:
Gottdiener, W. H. and Haslam, N.

Source:
Ethical Human Sciences and Services, 4, 163-187. 2002

Title:
The Effectiveness of Psychodynamic Therapy and Cognitive Behavior Therapy in the Treatment of Personality Disorders: A Meta-Analysis

Author:
Leichsenring, Falk and Leibing, Eric

Abstract:
OBJECTIVE: The authors conducted a meta-analysis to address the effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders.

METHOD: Studies of psychodynamic therapy and cognitive behavior therapy that were published between 1974 and 2001 were collected. Only studies that 1)used standardized methods to diagnose personality disorders, 2) applied reliable and valid instruments for the assessment of outcome, and 3) reported data that allowed calculation of within-group effect sizes or assessment of personality disorder recovery rates were included. Fourteen studies of psychodynamic therapy and 11 studies of cognitive behavior therapy were included.

RESULTS:Psychodynamic therapy yielded a large overall effect size (1.46), with effect sizes of 1.08 found for self-report measures and 1.79 for observer-rated measures. For cognitive behavior therapy, the corresponding values were 1.00,1.20, and 0.87. For more specific measures of personality disorder pathology, a large overall effect size (1.56) was seen for psychodynamic therapy. Two cognitive behavior therapy studies reported significant effects for more specific measures of personality disorder pathology. For psychodynamic therapy,the effect sizes indicate long-term rather than short-term change in personality disorders.

CONCLUSIONS: There is evidence that both psychodynamic therapy and cognitive behavior therapy are effective treatments of personality disorders. Since the number of studies that could be included in this meta-analysis was limited, the conclusions that can be drawn are only preliminary. Further studies are necessary that examine specific forms of psychotherapy for specific types of personality disorders and that use measures of core psychopathology. Both longer treatments and follow-up studies should be included. Title:
The Efficacy of Short-term Psychodynamic Psychotherapy in Specific Psychiatric Disorders: A Meta-Analysis

Author:
Leibing, Eric; Leichsenring, Falk; and Sven Rabung

Abstract:
BACKGROUND: The efficacy of psychodynamic therapy is controversial. Previous meta-analyses have reported discrepant results.

OBJECTIVE: To test the efficacy of short-term psychodynamic psychotherapy (STPP) in specific psychiatric disorders by performing a meta-analysis of more recent studies. We assessed outcomes in target problems, general psychiatric symptoms, and social functioning.

DESIGN: We identified studies of STPP published between January 1, 1970,and September 30, 2004, by means of a computerized search using MEDLINE,PsycINFO, and Current Contents. Rigorous inclusion criteria, included randomized controlled trials, use of treatment manuals and insurance of treatment integrity, therapists experienced or specifically trained in STPP, treatment of patients with specific psychiatric disorders, reliable and valid diagnostic measures, and data necessary to calculate effect sizes. Studies of interpersonal therapy were excluded. Seventeen studies fulfilled the inclusion criteria. The information was extracted by 3 raters. Effect sizes were calculated for target problems, general psychiatric symptoms, and social functioning using the data published in the original studies. To examine the stability of outcome, we assessed effect sizes separately for end of therapy and follow-up assessment.The effect sizes of STPP were compared with those of waiting-list control patients, treatments as usual, and other forms of psychotherapy.

RESULTS: Short-term psychodynamic psychotherapy yielded significant and large pretreatment-post treatment effect sizes for target problems (1.39),general psychiatric symptoms (0.90), and social functioning (0.80). These effect sizes were stable and tended to increase at follow-up (1.57, 0.95, and 1.19,respectively). The effect sizes of STPP significantly exceeded those of waiting-list controls and treatments as usual. No differences were found between STPP and other forms of psychotherapy. CONCLUSIONS: Short-term psychodynamic psychotherapy proved to be an effective treatment in psychiatric disorders.However, further research of STPP in specific psychiatric disorders is needed,including a study of the active ingredients of STPP. Effectiveness studies should be included.

Title:
Psychodynamic Psychotherapies: Evidence-Based Practice and Clinical Wisdom

Author:
Fonagy, Peter; Higgitt, Anna; and Roth, Anthony

Abstract:
This article is based on an exhaustive review of the psychotherapy outcomes literature, undertaken originally at the instigation of the UK Department of Health by Roth and Fonagy (Department of Health, 1995). We have recently updated this review (Fonagy, Target, Cottrell, Phillips, & Kurtz, 2002; Roth & Fonagy, 2004) and extended it to identify all studies of psychoanalytic psychotherapy. The usual methods for identifying studies were employed (Fonagy, Target, et al., 2002; Roth & Fonagy, in press). The key questions that should be asked of this literature given the current state of research in this area (also see Westen, Morrison, & Thompson–Brenner, 2004)are:

Are there any disorders for which short–term psychodynamic psychotherapy (STPP) can be considered evidence–based?
Are there any disorders for which STPP is uniquely effective as either the only evidence-based treatment or as a treatment that is more effective than alternatives?
Is there any evidence base for long–term psychodynamic psychotherapy (LTPP) either in terms of achieving effects not normally associated with short–term treatment or addressing problems that have not been addressed by STPP?

In this context, short–term therapy is conceived of as a treatment of around 20 sessions delivered usually once weekly.

Title:
Short-Term Psychodynamic Psychotherapies for Common Mental Disorders

Author:
Abbass, A.A.; Hancock, J.T.;Henderson, J; and Kisely S.

Source:
Cochrane Database SystRev. Oct 8; ( 4):CD004687, 2006

Title:
The Place of Psychoanalytic Treatments within Psychiatry

Author:
Fonagy, Peter; Gabbard, Glen O.; and Gunderson, JohnG.

Abstract:
Psychoanalytic treatments may be necessary when other treatments are ineffective. An empirically grounded framework for the use of these treatments involves sources of evidence from both efficacy and effectiveness studies. Preliminary evidence suggests that psychoanalysis appears to be consistently helpful to patients with milder disorders and somewhat helpful to those with more severe disturbances. A greater number of controlled studies are necessary to confirm these impressions. A multi-site process and outcome study is proposed.

Title:
The Empirical Status of Empirically Supported Psychotherapies: Assumptions, Findings, and Reporting in Controlled Clinical Trials

Author:
Westen,Drew; Novotny, Catherine M.; and Thompson-Brenner, Heather

Source:
PsycINFO Database Record (c) 2006 APA, all rights reserved

Abstract:
This article provides a critical review of the assumptions and findings of studies used to establish psychotherapies as empirically supported. The attempt to identify empirically supported therapies(ESTs) imposes particular assumptions on the use of randomized controlled trial(RCT) methodology that appear to be valid for some disorders and treatments(notably exposure-based treatments of specific anxiety symptoms) but substantially violated for others. Meta-analytic studies support a more nuanced view of treatment efficacy than implied by a dichotomous judgment of supported versus unsupported. The authors recommend changes in reporting practices to maximize the clinical utility of RCTs, describe alternative methodologies that may be useful when the assumptions underlying EST methodology are violated, and suggest a shift from validating treatment packages to testing intervention strategies and theories of change that clinicians can integrate into empirically informed therapies.

Title:
When Clinical Description Becomes Statistical Prediction

Author:
Westen, Drew and Weinberger, Joel

Source:
PsycINFO Database Record (c) 2006 APA, all rights reserved

Abstract:
This article reconsiders the issue of clinical versus statistical prediction. The term clinical is widely used to denote 1 pole of 2 independent axes: the observer whose data are being aggregated (clinician/expert vs. lay) and the method of aggregating those data(impressionistic vs. statistical). Fifty years of research suggests that when formulas are available, statistical aggregation outperforms informal, subjective aggregation much of the time. However, these data have little bearing on the question of whether, or under what conditions, clinicians can make reliable and valid observations and inferences at a level of generality relevant to practice or useful as data to be aggregated statistically. An emerging body of research suggests that clinical observations, just like lay observations, can be quantified using standard psychometric procedures, so that clinical description becomes statistical prediction.

Title:
The Characteristics, Identification, and Applications of Frames

Author:
Dail, Hurtful and Teller, Virginia

Abstract:
FRAMES (Fundamental Repetitive and Maladaptive Emotion Structures) provide a multipurpose research tool for assessing psychopathology, the psychotherapeutic process and, finally, the treatment outcome. We outline the clinical and theoretical assumptions that underlie and motivate FRAMES, along with the aims of an ongoing research program. We describe four methods for identifying FRAMES, ranging from our original justified intuition (Method A) to the present systematic set of reliable procedures (Method D). The reliability of necessary judgments, the validity of findings and the strengths and weaknesses are discussed. The FRAMES approach has been successfully used to analyze verbatim transcripts of recorded psychoanalytic and psychotherapy sessions and videotapes and coded records of the behavior of three-year-old children. By applying the FRAMES method to an initial evaluation interview, we demonstrate its usefulness on quite different clinical material.

Title:
Conscious and Unconscious Processes: Psychodynamic, Cognitive, and Neurophysiological Convergences

Author:
Bond, J. A.; Brakel, L. A. W.; Hertel, R.K.; Shevrin, H.; and Williams, W. J.

Source New York, Guilford Press,1996

Title:
Psychoanalysis and Cognitive Science: A Multiple Code Theory

Author:
Bucci, W.

Source:
New York, Guilford, 1997

Title:
How Expert Clinicians’ Prototypes of an Ideal Treatment Correlate with Outcome in Psychodynamic and Cognitive-Behavioral Therapy

Author:
Ablon, J.S. and Jones, E.E.

Abstract:
An innovative methodology is presented for identifying and assessing change process in psychoanalytic treatments. Using the Psychotherapy Process Q-set (PQS), a panel of experienced psychoanalysts developed a prototype of an ideal psychoanalytic hour. This prototype was then applied to verbatim transcripts of three archived treatment samples: psychoanalyses, long-term analytic therapies, and brief psycho dynamic therapies. The degree to which these treatments fostered an analytic process as represented by the prototype was measured quantitatively. Analytic process was significantly more present in psychoanalyses than in the long-term analytic therapies, which, in turn fostered significantly more analytic process than did brief psychodynamic therapies. The study demonstrates that, given descriptive language that does not represent a particular theoretical perspective, analysts can agree on a definition of analytic process, and that analytic process can be operationalized and quantitatively assessed. A second study demonstrates that despite consensus on its definition, there is not just one proper analytic process; rather, there are change processes unique to each dyad. Two quantitative case studies illustrate how each analytic pair has a unique interaction pattern linked to treatment progress. These dyad-unique "interaction structures" are recurrent, mutually influencing patterns of interaction, the experience, recognition, and comprehension of which appear to be a fundamental component of therapeutic action. A bi-personal model is described that attempts to bridge theories of therapeutic action that focus on insight and self-understanding and those that emphasize the patient's experience of the therapist.

Title:
Understanding Transference:The Core Conflictual Relationship Theme Method (Second Edition)

Author:
Luborsky, L. and Crits-Christoph, P.

Source:
Washington, D.C., American Psychological Association,1998

Title:
The Effectiveness of Psychoanalytic Psychotherapy: The Role of Treatment Duration, Frequency of Sessions, and the Therapeutic Relationship

Author:
Freedman, N.; Frosch, A.;Hoffenberg, J.D.; and Vorus, N.

Source:
Journal of the American Psychoanalytic Association 47, 741-772, 1999

Title:
Alliance Predicts Patients' Outcome beyond In-Treatment Change in Symptoms

Author:
Barber, Jacques P.; Connolly, Mary Beth; Crits-Christoph, Paul; Gladis, Lynn; and Siqueland, Lynne

Source:
PsycINFO Database Record (c) 2006 APA, all rights reserved

Abstract:
The authors examined the relations among therapeutic alliance, outcome, and early-in-treatment symptomatic improvement in a group of 86 patients with generalized anxiety disorders,chronic depression, or avoidant or obsessive-compulsive personality disorder who received supportive-expressive dynamic psychotherapy. Although alliance at Sessions 5 and 10, but not at Session 2, was associated with prior change in depression, alliance at all sessions significantly predicted subsequent change in depression when prior change in depression was partialed out. The results are discussed in terms of the causal role of the alliance in therapeutic outcome.

Title:
Psychoanalysis - With Whom, For What,and How? Comparisons with Psychotherapy

Author:
Blatt, S.J.and Shahar, G.

Abstract:
If psychoanalytic treatment is to survive in the era of evidence-based medicine and managed care systems,empirical evidence is needed to demonstrate its unique nature and effectiveness.To address this need, comprehensive analyses were conducted of data from the Menninger Psychotherapy Research Project (Wallerstein 1986). These analyses addressed three questions:

What are the differences in outcome between psychoanalysis (PSA) and supportive-expressive psychotherapy (SEP)?
With what types of patient, and in what ways, are these two psychodynamic treatments differentially effective?
Are these differences in outcome the consequence of possibly different mechanisms of therapeutic action?

PSA was found to contribute significantly to the development of adaptive interpersonal capacities and to the reduction of maladaptive interpersonal tendencies, especially with more ruminative, self-reflective, introjective patients, possibly by extending their associative capacities. SEP, by contrast, was effective only in reducin g maladaptive interpersonal tendencies and only with dependent, unreflective, more affectively labile anaclitic patients, possibly by containing or limiting their associative capacities.

Title:
Assessing Change in Analysis Terminable

Author:
Andrews, E.; Bernard, A.;Fatzer, K.; Josephs, L.; and Streich, S.

Source:
Journal of the American Psychoanalytic Association, 52, 1185-1214, 2004

Title:
On Analytic Process

Author:
Ablon, J.S. and Jones, E.E.

Source:
Journal of the American Psychoanalytic Association,53(2):541-568, 2005

Title:
Analysis of the Patient-Therapist Relationship in Dynamic Psychotherapy: An Experimental Study of Transference Interpretations

Author:
Svein, Amlo; Bøgwald,Kjell-Petter; Heyerdahl, Oscar; Høglend, Per; Marble, Alice; Sjaastad, MaryCosgrove; and Sørbye, Øystein

Abstract:
OBJECTIVE: The purpose of this study was to measure the effects of transference interpretations (the assumed core active ingredient) in dynamic psychotherapy, using an experimental design.

METHOD: One hundred patients were randomly assigned to two groups. One group received dynamic psychotherapy over 1 year, with a moderate level of transference interpretations, while the other group received dynamic psychotherapy with no transference interpretations. The most common axis I disorders were depression and anxiety disorders. Forts patients fulfilled the general criteria for personality disorder. Seven experienced psychotherapists treated patients in both groups. Five full sessions from each treatment were rated by two evaluators with process measures in order to document treatment integrity. Outcome variables were the Psychodynamic Functioning Scales, Inventory of Interpersonal Problems Scale-Circumplex version, Global Assessment of Functioning Scale, and Symptom Checklist-90-R.Quality of Object Relations Scale (lifelong pattern) and personality disorders were preselected as possible moderators of treatment effects. Change was assessed using linear-mixed models. Clinically significant change was also calculated.

RESULTS: The authors could not demonstrate differential treatment effects between the groups. However, the moderator analyses showed that transference interpretations were more helpful for patients with a lifelong history of less mature object relations. Small negative effects were observed for patients with mature object relations. CONCLUSIONS: The authors could not show differences in average effectiveness between treatments. However, the moderator analyses indicated that treatment worked through different active ingredients for different patients. Contrary to common expectation, patients with poor object relations profited more from therapy with transference interpretations than from therapy with no transference interpretations.

Title:
Relation of the Therapeutic Alliance with Outcome and Other Variables: A Meta-Analytic Review

Author:
Davis, M. Katherine; Garske, John P.; and Martin,Daniel J.

Source:
PsycINFO Database Record (c) 2006 APA, all rights reserved

Abstract:
To identify underlying patterns in the alliance literature, an empirical review of the many existing studies that relate alliance to outcome was conducted. After an exhaustive literature review, the data from 79 studies (58 published, 21 unpublished) were aggregated using meta-analytic procedures. The results of the meta-analysis indicate that the overall relation of therapeutic alliance with outcome is moderate, but consistent, regardless of many of the variables that have been posited to influence this relationship. For patient, therapist, and observer ratings, the various alliance scales have adequate reliability. Across most alliance scales, there seems to be no difference in the ability of raters to predict outcome. Moreover, the relation of alliance and outcome does not appear to be influenced by other moderator variables, such as the type of out comemeasure used in the study, the type of outcome rater, the time of alliance assessment, the type of alliance rater, the type of treatment provided, or the publication status of the study.

Title:
A Review of Therapist Characteristics and Techniques Positively Impacting the Therapeutic Alliance

Author:
Ackerman, S.J. and Hilsenroth, M.J.

Source:
Clinical Psychology Review 23, 1-33, 2003

Title:
The Psychological Unconscious: A Necessary Assumption for All Psychological Theory?

Author:
Dickman, S.and Shevrin, H.

Source:
American Psychologist, 35, 421-434,1980

Title:
Mommy and I Are One: Implications for Psychotherapy

Author:
Silverman, Lloyd H. and Weinberger, Joel

Source:
PsycINFO Database Record (c) 2006 APA, all rights reserved

Abstract:
Presents evidence to support the thesis that there are powerful unconscious wishes for a state of oneness with "the good mother of early childhood" and that gratification of these wishes can enhance adaptation. Data come from experiments that used the subliminal psychodynamic activation method with over 40 groups of Ss from varied populations, including schizophrenics, neurotics, and normal students. These studies have reported that the 4-msec exposure of stimuli intended to activate unconscious symbiotic like fantasies (usually the words “Mommy and I are one”) produced ameliorative effects on different dependent variables in a variety of settings. It is proposed that patient-therapist relationship factors in psychotherapy, seen by many as a common agent of change in different forms of treatment, owe their effectiveness partly to their having activated these symbiotic like fantasies.Further studies are outlined that would provide a more definitive test of this proposition. (107 ref)

Title:
Transference in Interpersonal Relations: Inferences and Affect Based On Significant-Other Representations

Author:
Andersen, S.M. and Baum, A.

Abstract:
Based on an information-processing model of transference and a recent experimental demonstration of transference, defined in terms of "biased inference and memory" (Andersen & Cole, 1990), the present research examined the transfer of affective responses to a new individual, as in schema-triggered affect (Fiske, 1982). Using idiographic stimulus-generation procedures and a nomothetic experimental design, we exposed subjects to a description of a new, unknown person, allegedly seated next door. The description resembled either a positively or negatively toned significant other from the subject's own life or from another subject's life. As predicted and replicating previous work, subjects mis remembered the target person as having more representation-consistent features when the target resembled their own significant other rather than someone else's. Moreover, and also as predicted,subjects transferred more representation-consistent affect to this same target person. The data are discussed in terms of conceptions of transference and basic aspects of social cognition.

Title:
The Relation of Attachment Status, Psychiatric Classification, and Response to Psychotherapy

Author:
Fonagy, Peter; Gerber, Andrew; Kennedy, Roger; Leigh,Tom; Mattoon, Gretta; Steele, Howard; Steele, Miriam; and Target, Mary

Source:
PsycINFO Database Record (c) 2006 APA, all rights reserved

Abstract:
The relation of patterns of attachment and psychiatric status was studied in 82 non psychotic inpatients and 85 case-matched controls using the Adult Attachment Interview (AAI). AAI transcripts rated(masked to case vs. control status and treatment) were classified using M. Mainand R. Goldwyn's (unpublished manuscript) system. Psychiatric patients,diagnosed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.) I and II structured interviews, were more likely to be classified as preoccupied and unresolved with respect to loss or abuse. On Axis 1, anxiety was associated with unresolved status, and AAI scales were able to discriminate depression and eating disorder. On Axis II,borderline personality disorder (BPD) was linked to experience of severe trauma and lack of resolution with respect to it. BPD patients were also rated significantly lower on a scale measuring awareness of mental states. Preliminary outcome results suggest that individuals rated as dismissing on the AAI are more likely to show improvements in psychotherapy.

Title:
Source Amnesia, Mis attribution, and the Power of Unconscious Perceptions and Memories

Author:
Bornstein, Robert F.

Abstract:
A review of the empirical literature on implicit(i.e., unconscious) perception and memory reveals that S. Freud's (1910/1955,1914/1956) hypotheses in this area were remarkably prescient in some respects.The implications of experimental research for psychodynamic models of symptom formation, transference analysis, and the curative components of insight-oriented therapy are discussed. Changes in terminology that can help bridge the gap between cognitive science and psychodynamics are outlined, and the heuristic value of strengthening existing connections between these disciplines is emphasized.

Title:
Anxiety,Signal Anxiety, and Unconscious Anticipation: Neuroscientist Evidence for an Unconscious Signal Function in Humans

Author:
Wong, Philip S.

Abstract:
A central tenet of psychoanalysis, and arguably of any comprehensive theory of mind, is the existence of a psychological unconscious. Years of clinical investigation into the nature of unconscious processes have facilitated the development of psychoanalysis as a clinical method. Empirical investigations of unconscious mental processes, however, have lagged behind clinical inquiry. With few exceptions, attempts to understand unconscious processes using rigorous experimental controls have remained sequestered in scientific domains other than psychoanalysis, where they have proliferated recently. In view of this recent upsurge of research on unconscious processes outside of psychoanalysis, efforts to integrate such knowledge into general theories of psychopathology and clinical investigation are critical. In this paper, an interdisciplinary approach is taken to the study of one aspect of unconscious mental functioning—what Freud originally termed signal anxiety.Signal anxiety is examined using information from cognitive psychology and learning theory, psychophysiology, behavioral neuroscience, and psychoanalytic theory. Though the original concept of signal anxiety is supported by recent research, it is concluded that signal anxiety is probably best thought of not as the affect of anxiety but as a subset of unconscious mental processes that have a signal function of anticipating danger. Such unconscious anticipatory processes are a general feature of the mind that includes responses to both real and imagined (neurotic) appraisals of a situation. The neurophysiological structures and processes associated with unconscious anticipation in humans are just beginning to be understood.

Title:
A New Language for Psychoanalytic Diagnosis

Author:
Shedler,Jonathan

Source:
Journal of the American Psychoanalytic Association; 50(2):429-456, 2002

Title:
Refining Personality Disorder Diagnosis:Integrating Science and Practice

Author:
Shedler, Jonathan and Westen, Drew

Abstract:
OBJECTIVE: Personality disorder researchers are currently evaluating a range of potential solutions to problems with the DSM-IV diagnostic categories. This article proposes changes to the diagnostic categories and criteria based on empirical findings from a national sample of patients with personality disorder diagnoses.

METHOD: The Shedler-Westen Assessment Procedure (SWAP-200) is a personality assessment tool designed to capture the richness and complexity of clinical personality descriptions while providing reliable and quantifiable data. A national sample of experienced psychiatrists and psychologists used the SWAP-200 to describe either their conceptions (prototypes) of personality disorders (N=267) or current patients with personality disorder diagnoses (N=530).

RESULTS:Clinicians’ conceptions of personality disorders and their descriptions of actual patients overlapped with the DSM descriptions but also differed in systematic ways. Their descriptions were clinically richer than the DSM descriptions and placed greater emphasis on patients’ mental life or inner experience. The study identifies potential diagnostic criteria that may be more defining of personality syndromes than some of the current DSM criteria.

CONCLUSIONS: Diagnostic criterion sets should be expanded to better address the multiple domains of functioning inherent in the concept of personality and should more explicitly address patients’ mental life or inner experience. The authors offer recommendations for revision of the diagnostic categories and criteria and also propose a prototype matching approach to personality disorder diagnosis that may overcome limitations inherent in the current diagnostic system.

Title:
Countertransference Phenomena and Personality Pathology in Clinical Practice: An Empirical Investigation

Author:
Betan, Ephi; Conklin, Carolyn Zittel; Heim, AmyKegley; and Westen, Drew

Abstract:
OBJECTIVE: This studyprovides initial data on the reliability and factor structure of a measure of countertransference processes in clinical practice and examines the relation between these processes and patients’ personality pathology.

METHOD: A national random sample of 181 psychiatrists and clinical psychologists in North America each completed a battery of instruments on a randomly selected patient in their care, including measures of axis II symptoms and the Counter transference Questionnaire, an instrument designed to assess clinicians’cognitive, affective, and behavioral responses in interacting with a particular patient.

RESULTS: Factor analysis of the Counter transference Questionnaire yielded eight clinically and conceptually coherent factors that were independent of clinicians’ theoretical orientation: 1)overwhelmed/disorganized, 2) helpless/inadequate, 3) positive, 4) special/over involved, 5) sexualized, 6) disengaged, 7) parental/protective, and 8)criticized/mistreated. The eight factors were associated in predictable ways with axis II pathology. An aggregated portrait of countertransference responses with narcissistic personality disorder patients provided a clinically rich,empirically based description that strongly resembled theoretical and clinical accounts.

CONCLUSIONS: Countertransference phenomena can be measured in clinically sophisticated and psychometrically sound ways that tap the complexity of clinicians’ reactions toward their patients. Countertransference patterns are systematically related to patients’ personality pathology across therapeutic approaches, suggesting that clinicians, regardless of therapeutic orientation,can make diagnostic and therapeutic use of their own responses to the patient.

Title:
Anxiety, Attributional Thinking, and the Primary Process

Author:
Brakel, Linda A.W. and Shevrin, Howard

Abstract:
In earlier publications, experimental evidence was provided for the existence of the primary vs. secondary process mental organization posited by Freud. A well-established cognitive categorization test based on attributional and relational similarity was found to map on to primary and secondary principles of mental organization respectively, thus offering the opportunity to test hypotheses drawn from psychoanalytic theory independent of the clinical situation. In prior work, primary process shifts occurred under three different conditions—all predicted by psychoanalytic theory: (1) when stimuli were (subliminal) unconscious; (2) when participants were 3-5 years of age; and (3) when tasks were implicit. In the current study, a fourth condition is examined dealing with the relationship of conscious anxiety to primary and secondary processes. In a naturalistic study, 120 patients waiting in medical center waiting rooms rated how anxious they felt on a 10-point scale and then completed a version of the categorization test alluded to above. Those who reported any anxiety at all showed a significant shift toward primary process categorization over those participants who rated themselves as calm. The implications of this fourth finding are discussed with respect to signal anxiety and symptom formation.

Title:
The Relationship of Patient Defensive Functioning and Alliance with Therapist Technique during Short-Term Psychodynamic Psychotherapy

Author:
Ackerman,Steven J.; Blagys, Matthew D.; Hilsenroth,Mark J.; Siefert, Caleb J.; and Weinberger, Joel

Source:
Clinical Psychology and Psychotherapy, 13, 20–33, 2006

Title:
Fact and Fantasy in Freudian Theory

Author:
Kline, P.

Source:
London, Methuen& Co., 1972

Title:
Interface of Psychoanalysis and Psychology

Author:
Barron, J.W.; Eagle,M.N.; and Wolitzky, D.L. (Eds.)

Source:
Washington, D.C.,American Psychological Association, 1992

Title:
The Scientific Credibility of Freud's Theories andTherapy

Author:
Fisher, S. and Greenberg, R. P.

Source:
New York, Basic Books, 1977

Title:
The Foundations of Psychoanalysis

Author:
Grunbaum, A.

Source:
Berkeley,California, University of California Press, 1984

Title:
Subliminally Activated Symbiotic Fantasies: Facts and Artifacts

Author:
Hardaway, Richard A.

Source:
Psychol Bull; 107(2):177-95, 1990

Title:
Separating Science from Myth in Subliminal Psychodynamic Activation

Author:
Hardaway, Richard A. and Weinberger, Joel

Source:
PsycINFO Database Record (c) 2006 APA, all rights reserved

Abstract:
Reviews subliminal psychodynamic activation(SPA). Eight common criticisms are described and evaluated: (1) SPA data analysis is too liberal; (2) there are enough nonsignificant unpublished SPA studies to offset those showing effects; (3) SPA studies are difficult to replicate; (4) the claims of SPA proponents rely on unpublished studies; (5) SPA stimuli are not really subliminal; (6) experimenter expectancy effects and/or demand characteristics can account for SPA effects; (7) the mediating events said to underlay SPA effects have never been evinced; and (8) alternative explanations for SPA effects are superior to the psychoanalytic ones typically offered. The SPA stimulus for which the most support was found was “Mommy and I Are One.” Oedipal sanction stimuli were also found to yield reliable effects whereas Oedipal prohibition stimuli did not.

Title:
Series on Empirical Studies of Psychoanalytical Theories

Author:
Bornstein, R.F. and Masling, J.M.. (1993,1994, 1996, 1998)

Title:
Is Psychoanalysis OneScience, Two Sciences, or No Science at All? A Discourse among Friendly Antagonists

Author:
Shevrin, H.

Source:
Journal of the American Psychoanalytic Association;43:963-986, 1995

Title:
Freud Scientifically Reappraised: Testing the Theories and Therapy

Author:
Fisher,S. and Greenberg, R. P.

Source:
New York, John Wiley &Sons, Inc., 1996

Title:
The Process of Therapeutic Change Involving Implicit Knowledge: Some Implications of Developmental Observations for Adult Psychotherapy

Author:
Stern, D. N.

Source:
Infant Mental Health Journal, 19(3), 300-308, 1998

Title:
The Scientific Legacy of Sigmund Freud: Toward a Psychodynamically Informed Psychological Science

Author:
Westen, Drew

Source:
PsycINFO Database Record (c) 2006 APA, all rights reserved

Abstract:
Although commentators periodically declare that Freud is dead, his repeated burials lie on shaky grounds. Critics typically attack an archaic version of psychodynamic theory that most clinicians similarly consider obsolete. Central to contemporary psychodynamic theory is a series of propositions about (a) unconscious cognitive, affective, and motivational processes; (b) ambivalence and the tendency for affective and motivational dynamics to operate in parallel and produce compromise solutions; (c) the origins of many personality and social dispositions in childhood; (d) mental representations of the self, others, and relationships; and (e) developmental dynamics. An enormous body of research in cognitive, social, developmental, and personality psychology now supports many of these propositions. Freud's scientific legacy has implications for a wide range of domains in psychology,such as integration of affective and motivational constraints into connectionist models in cognitive science.

Title:
Developments in Cognitive Neuroscience: I.Conflict, Compromise, and Connectionism

Author:
Gabbard, Glen O. and Westen, Drew

Abstract:
The strength of psychoanalysis has always been its understanding of affect and motivation. Contemporary developments in cognitive neuro-science offer possibilities of integrating sophisticated, experimentally informed models of thought and memory with an understanding of dynamically and clinically meaningful processes. Aspects of contemporary theory and research in cognitive neuroscience are integrated with psychoanalytic theory and technique, particularly theories of conflict and compromise. After a description of evolving models of the mind in cognitive neuroscience, several issues relevant to psychoanalytic theory and practice are addressed. These include the nature of representations, the interaction of cognition and affect, and the mechanisms by which the mind unconsciously forges compromise solutions that best fit multiple cognitive and affective-motivational constraints.

Title:
Developments in Cognitive Neuroscience: II. Implications for Theories of Transference

Author:
Gabbard, Glen O. and Westen, Drew

Abstract:
An integration of psychoanalytic theory with contemporary developments in cognitive neuroscience offers a useful perspective on longstanding controversies about the nature of transference, and a better understanding of the precise mechanisms by which transferential processes occur.Contemporary psychoanalytic views of transference are reviewed, and the many processes that constitute transference are described. Two issues that have emerged in different guises for several decades—the role of the analyst in eliciting transference, and the nature of “real” and “transferential” components of the therapeutic relationship—are reconsidered in the light of concepts such as connectionist networks. Although a useful analytic stance is one that allows the patient's enduring dynamics to dominate the analytic field, it is suggested,anonymity is neither a cognitive possibility nor the driving force behind most transference reactions, and the distinction between “real” and “transferential”perceptions is one of therapeutic interest, not of mechanism. Certain features of the analytic situation make some dynamics more likely than others to enter the treatment relationship, notably those related to authority, intimacy and attachment, and sexuality. Transference reactions are best understood as constructed from a combination of the patient's enduring dispositions to react in particular ways under particular conditions; features of the analytic situation and of the analyst; and interactions between patient and analyst.These reactions do not unfold ineluctably from the patient's mind in the consulting room, nor are they cognitive constructions of the patient-analyst dyad or co-constructions of relatively equal partners exerting their influence on the analytic field.

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