Some Afterthoughts – or Looking Back

The relationship of “psychoanalysis and language” was in the center of many theoretical and clinical discussions ever since Freud (1916/17) had declared:Nothing takes place in a psycho-analytic treatment but an interchange of words between the patient and the analyst. The patient talks, tells of his past experiences and presents impressions, complains, confesses his wishes and his emotional impulses. The doctor listens, tries to direct the patient’s processes of thought, exhorts, forces his attention in certain directions, gives him explanations and observes the reaction of understanding or rejection which he in this way provokes in him (p. 17)

Psychoanalytic single case studies of children and adolescents: characterisation with the 'inventory of basic information in single cases'

Right from its beginning single case studies on children and adolescents have been an highly esteemed means of communication in psychoanalysis; from the view of treatment research time and again critical arguments are brought forward. As single case studies may provide relevant answers for detailed process aspects, in this study we present a methodology for systematizing the reporting culture

Conversation Analysis – A Powerful Tool for Psychoanalytic Practice and Psychotherapy Research

Psychoanalysis does not have an easy stand in documenting what “clinical facts” are. This paper proposes to use an established research tool such as Conversation Analysis (CA) in order to analyze how psychoanalytic conversation is performed in the consulting room. The vicinity of CA-approaches and psychoanalytic intuitions is documented by selected examples. We provide an outline of CA-research in psychoanalysis. Finally we debate whether psychoanalysis be science or hermeneutics; these positions are seen as two sides of a coin. One side is always in the dark. Metaphorically speaking, the future will have the task to bring this coin to an upright stand which can be managed only when the coin is given a thrilling turn by acknowledging that both, hermeneutics and science, in far reaching dimensions ignored the (micro-)social dimension of the psychoanalytic endeavor: conversation, talk-in-interaction. This will help to more clearly get in view what “clinical facts” are.

From turn-by-turn to larger chunks of talk: An exploratory study in psychotherapeutic micro-processes using conversation analysis

Independent of theoretical orientation therapies of all kind are talk-in-interaction. Influential overall conceptualizations (as e.g. intervention) belong to a certain model of medicalizing the psychotherapeutic endeavor. Talk-in-interaction is the base for applying Conversation Analysis (CA) in psychotherapeutic process research. CA is a powerful tool originating from social science taking data, hypotheses and theories from careful observing in a similar way as infant observers did. The common discovery is that conversation precedes language. Some features of infantile proto-conversation survive in adult life. CA has directed careful attention to processes like turn-taking, repair, conditional relevances, etc. in observing the rules of interaction. However, in studying psychotherapy process turn-by-turn analysis alone does not suffice. It can be completed by a new model of common ground activities and package-by-package analysis turning attention to new objects of observation in therapeutic conversation (allusions, metaphorical framing activities). We propose a methodology for both kinds of analyses based on transcribed examples from the CEMPP-Project. This exploratory designed project (Conversation analysis of empathy in Psychotherapy Process; supported by the Khler Foundation, Germany) compared psychoanalytic, psychodynamic and cognitive-behavioral treatments in five dyads each taking transcribed sessions from the beginning, the middle phase and the end; our database includes 45 transcribed sessions

Wünsche und ihre Ver-Bindungen: eine Einzelfallstudie mit der Methode der Zentralen Beziehungsmuster

Anhand einer Einzelfallstudie (23-jähriger Klient) wird die Methode des Zentralen Beziehungs-Konflikt-Themas (ZBKT) von L. Luborsky veranschaulicht. Orientiert an klinischen Schlussbildungsprozessen werden bei der ZBKT-Methode die in Narrativen subjektiv organisierten Beziehungserfahrungen kategorisiert. Die komplexe internalisierte Erfahrung wird als subjektiv motivierter prototypischer Interaktionsalgorhythmus zwischen Subjekt und bedeutungsvollen Anderen gefasst und in drei Komponenten (häufigster Wunsch des Subjekts, häufigste Reaktion des Objekts auf diesen Wunsch, häufigste Reaktion des Subjekts darauf) zerlegt. Anhand der dargestellten Fallstudie wird die Analyse internalisierter Beziehungsstrukturen im Therapieverlauf demonstriert

The Building of Empathy: Conceptual “Pillars” and Conversational Practices in Psychotherapy

Empathy can be considered a special type of cooperation between therapist and patient. This exploratory study compares psychoanalytical, depth-psychological and behavioural therapy, in each case using transcriptions of audio recordings of initial, mid-term and late sessions. For each school of therapy, five treatments are included, creating a database of 45 sessions. We describe the project and the method of conversation analysis using examples of these transcripts and hypothesise that while all three schools of therapy are faced with common fundamental problems concerning the realisation of empathy, one can observe empathy profiles specific to each school. Here, we introduce theoretical groundwork and the terminology of conversation analysis. The topic may be of particular interest to clinicians, since everyday problems are examined through the prism of microanalysis

An fMRI Study

Individuals with borderline personality disorder (BPD) are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging (fMRI). Eleven female patients with BPD without posttraumatic stress disorder (PTSD) and 17 healthy female controls matched for age and education were telling stories in the scanner in response to the Adult Attachment Projective Picture System (AAP), an eight-picture set assessment of adult attachment. The picture set includes theoretically-derived attachment scenes, such as separation, death, threat and potential abuse. The picture presentation order is designed to gradually increase the activation of the attachment system. Each picture stimulus was presented for 2 min. Analyses examine group differences in attachment classifications and neural activation patterns over the course of the task. Unresolved attachment was associated with increasing amygdala activation over the course of the attachment task in patients as well as controls. Unresolved controls, but not patients, showed activation in the right dorsolateral prefrontal cortex (DLPFC) and the rostral cingulate zone (RCZ). We interpret this as a neural signature of BPD patients’ inability to exert top-down control under conditions of attachment distress. These findings point to possible neural mechanisms for underlying affective dysregulation in BPD in the context of attachment trauma and fear