Program of Empirical Research Studies
We take the letter “R” in IPTAR quite seriously and have developed a program that emphasizes hands-on empirical research studies to generate new findings about psychoanalytic treatment. The question of how to understand, let alone establish the validity of our analytic enterprise is a complex one. Starting at the surface, as Freud suggests, we first ask about our patients’ lives. Has treatment affected the quality of their lives, work, patterns of relationships, or self esteem? Next we ask: What has made such change possible? Here we seek to define the facilitating and mediating conditions in psychoanalytic psychotherapy and psychoanalysis. We are interested in how persistent the changes are. Along these lines, we are pursuing four major research projects, seeking with each to define central psychoanalytic concepts. They are:
- Effectiveness of Psychoanalytic Psychotherapy: This study of treatment effectiveness is based on observations at the IPTAR Clinical Center (ICC). Patients’ responses to the Effectiveness Questionnaire (EQ) adapted from the Consumer Reports Study (Seligman, 1995) were analyzed. Since the EQ is derived from the Consumer Reports survey, we are in a position to compare the outcome of our treatment against a large national sample. It has allowed us to delineate effectiveness as mediated by treatment duration, session frequency, patients’ experience of the therapeutic relationship, as well as clinical syndromes. (For published study results, please see: Freedman, N., Hoffenberg, J.D., Vorus, N., Frosch, A.(1999). The Effectiveness Of Psychoanalytic Psychotherapy: The Role Of Treatment Duration, Frequency Of Sessions, And The Therapeutic Relationship, (Journal of the American Psychoanalytic Association), 47:741-772. The article can be found at PEPWeb.
- Therapy Remembered After Termination: In this study, former patients recall their treatment experiences during extensive interviews several years later. The Retrospective Reconstruction of Therapy Remembered project is based on detailed audio-recorded interviews of patients who terminated their ICC treatment at least one year prior to the interview. It is a sensitive clinical semi-structured interview conducted by an analyst. To date, our projected “Archive of Therapy Remembered” contains 10 interviews. The focus here is less on effectiveness than on a consideration of the kinds of therapeutic processes, retrospectively reconstructed, which may have mediated effectiveness. The process we have centered on is how internalization is achieved in therapy remembered. This general process is complex and needs to be looked at in more detailed and differentiated ways.
- Study of Recorded Psychoanalysis #1: Here we attend to the difference between working sessions and difficult sessions, thus studying the treatment process itself. The study of psychoanalytic process uses recorded psychoanalyses and focuses intensively on a series of single cases “inside the analytic hour.” Our focus is on a single patient whose analysis is being recorded. Several hundred sessions to date are available to trace transformations from session to session and year to year. Our major question here is: Can psychoanalytic process be defined empirically? A somewhat novel methodology has been developed, which takes as its starting point the analyst’s subjective experience of a session. This impression is corroborated using the time-honored method of the peer group by three senior consultants. These clinical evaluations are further corroborated through the objective study of recorded text. Target sessions with very different qualities, which we systematically define as “A” and “Z” sessions, are then selected and scrutinized. In this manner, we hope to identify transformation cycles within a given year of treatment, which can then to be compared with similar cycles in successive years.
- Study of Recorded Psychoanalysis #2: Here we are studying the recorded psychotherapy of a patient who suffered severe trauma in Africa.
The empirical research of the IPTAR Research Group has led to publications in major psychoanalytic journals and presentations at national and international conferences. In addition, the IPTAR Research Faculty has shared in sponsoring dissertation projects at various universities.
Effectiveness of Psychotherapy with Children at the ICC
The relatively few empirical studies of child treatment (either psychotherapy or psychoanalysis) means that our ideas about the efficacy of what we do rests “heavily” on case reports that, however moving or dramatic, tend to resist objective assessment and controlled scrutiny. As the old quip goes, psychoanalytically oriented therapists can fail to realize that data is not the plural of anecdote (Fonagy, P. and Target, M. Mentalization and the Changing Aims of Child Psychoanalysis. Psychoanalytic Dialogues, 1998, p.88). The goal of the present study was to provide some objective assessment about how well children do when they are seen in psychoanalytically informed psychotherapy. We are not unaware of the limitations of a concept like “objective,” and we would argue that no single measure can give an accurate picture of how a patient has fared in psychotherapy. In the study conducted by the child research team at IPTAR (presented at the Academy of Science), we measured shifts in the parents’ perception of their children over time as well as shifts in the children’s sense of self, presenting empirical data that lends support to the idea that the conscious and unconscious thoughts and attitudes of parents have a profound impact on influencing the children’s perception of themselves. Our data strongly suggest that when parents feel better about themselves in relation to their children, they see the child in a more positive light. And this seems to be reflected in children also feeling better about themselves. The finding that parents’ perceptions of their children are influenced by how they are feeling about themselves as parents is not surprising. Our constructions of the world are always subject to our emotional states. What is surprising is that when parents feel badly about themselves, there is little or no relationship between their subjective states and how they view their children. We see this as a potentially chaotic situation for both parent and child. Children, for example, must learn via social cues that their parents’ emotional state has some predictive value as to how they, the children, are seen. When children have a better, i.e., more consistent/coherent sense as to how they will be perceived, we speculate that their world becomes less chaotic, and they have a higher probability of feeling good about themselves. For example, when does “coherence” become so rigid that parents’ perception of their child is so skewed toward the parents’ own internal state that any notion of relative objectivity becomes meaningless? We certainly believe that this study has highlighted some of the uncertainty about the notion of the identified patient in child therapy.
The Annual Program of the the Investigative Section
This program offers a forum in which clinical psychoanalytic concepts are examined in a multifaceted, systematic, and critical way. Our aim is to bring together into a single arena information about these concepts gathered from various sources. The more familiar path of exploring the foundations or evolution of a concept through clinical observations and conceptual scholarship is augmented by assessment yielding systematic empirical findings. The empirical research includes reports of the findings of IPTAR’s own programs as well as the work of other investigators, who we invite in to widen our perspective. Past themes that were explored included: the concept of internalization of the psychoanalytic experience; the ordinary and extraordinary counter-transference; and the effectiveness of psychotherapy with children.