Research project Beginnings and endings in psychoanalytic psychotherapy
Beginnings and endings in psychoanalysis and psychoanalytic psychotherapy: A multi-center case-control study within the anaclitic-introjective personality continuum – Swedish arm.
The aim is to develop, test, and evaluate a systematic way of preparing patients for starting and ending long-term open-ended psychotherapy, in order to strengthen the working alliance, involve the patient as an active agent of change, and enhance the patient’s ability to apply what is learned in therapy to everyday life.
The battery of instruments includes patient and therapist interviews, assessment of personality configuration, ratings of working alliance, and well-established outcome measures. Qualitative and quantitative data are analyzed with the focus on the initial phase, the termination phase, and the post-treatment phase, exploring similarities and differences between patients with predominantly anaclitic or introjective personality orientation (focus on relatedness or autonomy and performance).
Project description
Objectives
There is a need to prepare the patient for goals and tasks of psychoanalytically oriented treatment and for ending long-term therapy. This includes working through of incongruities between the patient’s and the therapist’s private theories of cure, and adjusting the work to the patient’s predominant personality orientation (anaclitic focusing on relatedness and intimacy or introjective focusing on autonomy and performance).
This project is a part of a multi-center study, aggregating cases and data from Sweden and Italy. The general aim is to develop, test, and evaluate a systematic way of preparing the patient for starting and for ending long-term open-ended psychoanalytically oriented treatment. Being a long-term project, the study is divided into several stages, including implementation of the guidelines “What Should I Expect in Psychoanalysis/Psychotherapy” in the pre-treatment assessment phase, follow-up in the initial phase, implementation of the guidelines “What Should I Expect when Ending Psychoanalysis/Psychotherapy” in the termination phase, and a long-term follow-up.
Current State of Knowledge
Patient initial difficulties in understanding the psychoanalytically oriented treatment method have often been reported. Early in therapy patients frequently test to ascertain what they can safely work on with a particular therapist. There is a need to prepare the patient for the goals and tasks of psychoanalytic psychotherapy and to actively involve the patient for the joint exploration.
Therapeutic collaboration is not there a priori but presupposes assisting the patient “to become a therapy patient”. Likewise, the therapist needs to learn to be the unique patient’s therapist.
Previous research has demonstrated that patient preparation for psychotherapy, negotiating treatment expectations and maximizing perspective convergence yields beneficial effects for treatment attendance, treatment process, and outcome. Furthermore, there is a need to prepare the patient for ending long-term psychoanalytic treatment, enhancing the patient’s ability to apply what was learned and experienced in therapy to everyday life post-termination. The post-termination phase is a time of both increased vulnerability and new opportunities, and its quality shapes the patient’s capacity to cope with new challenges in life.
Taken together, pre- and post-therapeutic work can be expected to increase the patient’s potential for taking responsibility for the treatment and for the post-treatment phase. We assume that both the initial and and the termination phase of long-term open-ended psychoanalytically oriented treatment can be, in some way, “manualized”.
The development of guidelines for pre- and post-therapeutic work has to take into consideration the unavoidable incongruities between the patient’s and the analyst’s private theories of cure, as well as the patient’s predominant personality orientation.
Theoretical Starting Point
Previous studies suggested that both beginnings and endings of psychoanalytically oriented treatment might profit from working through of incongruities between the patient’s and the therapist’s perspectives, and adjusting the work to the patient’s predominant personality configuration. The anaclitic configuration is connected with difficulties in close relationships, whereas the introjective configuration is connected with excessive demands for autonomy, achievement, prestige and perfectionism (Blatt, 2008). We have today extensive evidence that different personality-related difficulties might lead to similar symptoms, but require different treatments, tailored to the patient’s personality features.
Method
The project has a “quasi-experimental” design for exploration of effects of use vs non-use of interventions at pre-treatment and termination, i.e. providing the patients (and the therapists) with “guidelines” focusing on specific issues when starting and ending long-term psychoanalytically oriented treatment. The treatments include open-ended psychoanalysis (3–5 sessions per week) and psychoanalytic psychotherapy (2–3 sessions per week), conducted by therapists in private practice. The pre-therapy guidelines “What Should I Expect in Psychoanalysis/Psychotherapy” are given by the therapist to the patient during the initial consultations. The post-treatment guidelines “What Should I Expect when Ending Psychoanalysis/Psychotherapy” have been developed to be given the patient when the issue of ending treatment arises.
Data are collected at pre-treatment assessment, at 3 and 12 months in treatment, with one-year intervals in the course of treatment, at termination and 18-month follow-up, and aggregated across sites. Data collection comprises repeated Private Theories Interviews with patients and their therapists, patient self-ratings, and therapist assessments. The core battery of instruments includes measures of personality configuration, outcome, working alliance, and changes in personalty organization. A Computer-Assisted Qualitative Data Analysis Software (CAQDAS) and adequate statistical methods are applied for studying between-groups differences and changes across time.
The Swedish arm of this project has been approved on September 28, 2016, by the Regional Institutional Review Board in Stockholm (registration number 2016/1740-31/4).
Significance
The main contribution of this project to the field is the focus on facilitating and promoting effective therapeutic processes in the initial and the termination phase of long-term open-ended psychoanalytically oriented treatments. Furthermore, this project might enhance our knowledge of how negotiating incompatibilities between the patient’s and the therapist’s perspectives can contribute to effective psychotherapeutic processes. Last but not least, the issue of effective ways of working through specific difficulties in the initial and terminal phase of psychotherapy for patients with contrasting personality orientation is of high clinical relevance.
Project members
Project managers
Andrzej Werbart
Affiliated Professor
Members
Fredrik Falkenström
Professor
David Anders Forsström
Researcher
More about this project
Project Members
Additional Members in Sweden
Kristian Aleman, kristianaleman@me.com
Ragnhild Holmqvist, ragnhild.holmqvist@telia.com
Members in Italy
Anna Daniela Linciano, annadanielalinciano@gmail.com
Giulia Chichi, giuliachichi.gc@gmail.com
Licia Reatto, liciareatto@hotmail.com
Claudio Galvano, claudio.galvano.cg@gmail.com
Emilio Fava, emiliofava@yahoo.it
Benedetta Vai, vaibenedetta@gmail.com
Irene Cumia, cumia.irene@gmail.com
Publications
Up to now, the first stage of this research program resulted in one master theses at Stockholm University and two submitted papers, including the one below.
Werbart. A., & Lagerlöf, S. (2022). How much time does psychoanalysis take? The duration of psychoanalytic treatments from Freud’s cases to the Swedish clinical practice of today. International Journal of Psychoanalysis, 103(5), 786–805. doi:10.1080/00207578.2022.2050463 (Open access)