A group of experienced analysts has developed scales and a coding manual illustrated with clinical examples to evaluate recorded analyses and psychodynamic therapies. The analytic process scales (APS) assesses three dimensions: (1) the contribution of the analyst: helping to develop a relationship in which the analyst can provide clarification and interpretation of transference and resistance; (2) the contribution of the patient: the communication of experience and the expression of feeling in ways which provide information about needs, wishes and conflicts, accompanied by self-reflection; and (3) interactional characteristics of the emerging relationship, explored by studying sessions divided into psychoanalytically coherent segments. A preliminary study of nine sessions has established that the variables assessed by the APS can be rated reliably. Study of the analysts' contributions illuminated their varied and complex structure. Important differences emerged among the three patient-analyst pairs studied, and changes in scores over time tracked developments in the analytic work which would imply different treatment outcomes. The APS appears to be a reliable tool facilitating the systematic study of psychoanalyses.
In this study we critically review the formal research literature pertinent to the outcomes of psychoanalysis and the factors influencing these outcomes. Our inquiry was conducted from a psychoanalytic perspective. We found the research yield consistent with the accumulated body of clinically derived psychoanalytic knowledge, e.g., patients suitable for psychoanalysis derive substantial therapeutic benefit; analyzability and therapeutic benefit are relatively separate dimensions and their extent is relatively unpredictable from the perspective of initial evaluation among seemingly suitable cases. The studies all contain clinical and methodological limitations which are no more substantial than in other forms of psychotherapy research, but they have not substantially advanced psychoanalytic knowledge. This raises challenges for the further development of formal research strategies native to psychoanalysis.
Skillful psychoanalytic technique presumably involves knowing what to say, and when and how to say it. Does skillful technique have a positive impact upon the patient? The study described in this article relied on ratings by experienced psychoanalysts using the Analytic Process Scales (APS), a research instrument for assessing recorded psychoanalyses, in order to examine analytic interventions and patient productivity (greater understanding, affective engagement in the analytic process, and so on). In three analytic cases, the authors found significant correlations between core analytic activities (e.g., interpretation of defenses, transference, and conflicts) and patient productivity immediately following the intervention, but only if it had been skillfully carried out. Findings were independently replicated by psychology interns.
The first aim of this article is to report a newly developed measure of therapeutic process, the Dynamic Interaction Scales. When combined with the Analytic Process Scales (Waldron, Scharf, Crouse, et al., 2004;, the two instruments permit a reliable and fine-grained assessment of technical and relational aspects of psychoanalytic and psychodynamic psychotherapeutic process. The Shedler-Westen Assessment Procedure and Psychological Health Index (Westen & Shedler, 1999a, 1999bWaldron et al., 2011) permit a reliable and fine-grained assessment of the changes during treatment. The second aim is to demonstrate how combining results from these instruments permits exploring the relationships between processes and outcomes of treatment. We illustrate the utility of this approach by a demonstration project, applying the instruments to two treatments started 21 years apart. The results show different relational and classical approaches of the analysts and different outcomes. Both patients had a similar level of psychological functioning at the outset of treatment, but one made a much more extensive recovery than the other. The difference in outcomes may reflect different patient pathology, in spite of their initial level of functioning, but it may also reflect the impact in the better outcome case of a more relational approach, combined with a more extensive use of classical analytic interventions judged to be of higher quality.
Psychoanalysts have long relied on the case study method to support the validity of their theoretical hypotheses and clinical techniques and the efficacy of their treatments. However, limitations of the case study method have become increasingly salient as the medical-scientific community and policymakers have increasingly emphasized the need for empirical data. This article describes the progression of an analysis from the perspective of both the treating analyst and an independent research team using empirical methods to study verbatim session transcripts. Empirical measures include the Shedler-Westen Assessment
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