Psychoanalytic Psychology

Summers, Frank

doi: 10.1037/0736-9735.25.3.413pmid: N/A

It is argued that the tendency of psychoanalysis toward sectarianism, the inclination to isolate theoretical viewpoints from each other, rather than pluralism, the active engagement of differences, is a significant factor in the loss of influence psychoanalysis has suffered. A brief history is given of the fate of theoretical differences in the field to show the historical sectarianism of psychoanalytic thought. The contention is that the resulting inability of psychoanalysis to define itself, even as a pluralistic discipline, renders it vulnerable to the criticism that the field has little claim to be a branch of knowledge, or to achieve scientific status, even under the most liberal definition of that term. The contention is that the failure to engage differences openly bears a closer kinship to religion than human science. A plea is made for dialogue in the Heideggerean sense of openness to difference so that psychoanalysis can establish itself as a human science characterized by the pluralism of intellectual dialogue rather than the insularity of sectarianism.

Holinger, Paul C.

doi: 10.1037/0736-9735.25.3.425pmid: N/A

Affect has always occupied a place of central importance in psychoanalysis, from Freud's early writings and revisions, to more recent contributions of many others, and into the current era of theoretical pluralism. Following Darwin and Freud, Silvan Tomkins (1911–1991) explored clinical and theoretical aspects of affect and motivation for over four decades; however, Tomkins' work is often misunderstood and rarely discussed comprehensively, particularly his more recent and posthumous elaborations. Tomkins is best viewed as presenting a developmental psychology of affect, and the theoretical and clinical aspects of Tomkins' work relevant to psychoanalysis are examined here with particular emphasis on his more recent revisions and additions. Tomkins and his colleagues described in detail the nature of affects and their triggering mechanisms; the development and transformations of the affect system; the potential for virtually unlimited ideo-affective structures resulting from this system; the relationships between affects, motivation, and other mental functions (e.g., drives and cognition); and various clinical implications.

Arizmendi, Thomas G.

doi: 10.1037/0736-9735.25.3.443pmid: N/A

Nonverbal communication, at both conscious and unconscious levels, can be portrayed as a type of “body language,” a communication between the psychic bodies of patient and therapist. In this article, the author provides several examples of this communication process in the context of a psychoanalytic treatment with a patient who has a history of trauma resulting in frequent dissociative states. Motoric actions (drawing), somatosensory symptoms, and intense affect states represent the media through which she “informs” the analyst of her painful experiences. The analyst's surrender to countertransference states, such as deadness, constitutes the beginning of attunement to the patient's body communications. In one particularly unusual symptom of dissociation, the patient exhibits physical abilities that she is incapable of in more integrated states. An attempt is made to understand this event from a phenomenological and neurobiological perspective. Using an information-processing model, the author illustrates one instance of how the patient's subsymbolic information may be converted to the verbal symbolic via the analyst's use of evoked images.

Gottdiener, William H.

doi: 10.1037/0736-9735.25.3.458pmid: N/A

The subject of substance use disorders has been of interest to the field of psychoanalysis since its inception, and theoretical discussions and clinical case reports continue to regularly appear in the psychoanalytic literature. In addition, there is an ongoing upsurge in systematic research to test psychoanalytic theories and treatments, some of which addresses the topic of substance use disorders. The purpose of this symposium is to present original systematic research that has tested psychoanalytic theories and treatments for substance use disorders. It is hoped that these studies will provide models for investigating substance use disorders from a psychoanalytic perspective and will serve as a catalyst for further research.

Barber, Jacques P.; Gallop, Robert; Crits-Christoph, Paul; Barrett, Marna S.; Klostermann, Susan; McCarthy, Kevin S.; Sharpless, Brian A.

doi: 10.1037/0736-9735.25.3.461pmid: N/A

We examine the complex relations amongtherapeutic alliance, adherence to Supportive-ExpressiveTherapy (SET), therapist competence, and their interactionsin predicting change in drug use. Experts rated earlytherapy sessions of cocaine dependent patients(n = 108) randomized to SET as part of theCollaborative Cocaine Treatment Study. Moderate adherence toSET and competent delivery of SET were separately associatedwith poorer outcome. Further, strong alliance combined withlow levels of SET adherence was associated with a betteroutcome than moderate or high levels. Moreover, the usage ofnonprescribed techniques (i.e., Individual Drug Counseling[IDC]) by SET therapists predicted better outcome in asubsample (n = 36), and SET patientsreceiving high levels of IDC adherence had less predicteddrug use compared with those with high levels of SETtechniques. Overall results may suggest that decreasingcocaine use through straightforward drug counselingtechniques instead of trying to help patients understand thereasons for their use is a better initial road torecovery.

Crits-Christoph, Paul; Gibbons, Mary Beth Connolly; Gallop, Robert; Ring-Kurtz, Sarah; Barber, Jacques P.; Worley, Matthew; Present, Julie; Hearon, Bridget

doi: 10.1037/0736-9735.25.3.483pmid: 19960117

Using data from the National Institute on Drug Abuse Collaborative Cocaine Treatment Study, this article focuses on the outcomes of patients who received supportive-expressive (SE) psychodynamically oriented psychotherapy (plus group drug counseling; GDC). Short-term SE for cocaine dependent individuals, while not the most efficacious treatment examined in the study (individual drug counseling [IDC] plus GDC was), produced large improvements in cocaine use. In addition, there was evidence that SE was superior to IDC on change in family/social problems at the 12-month follow-up assessment, particularly for those patients with relatively more severe difficulties in this domain at baseline. For patients who achieved abstinence early in treatment, SE produced comparable drug use outcomes to IDC, with mean drug use scores numerically lower for SE at all of the follow-up assessments (9, 12, 15, and 18 months). SE patients who achieved initial abstinence decreased cocaine use from a mean 10.1 day per month at baseline to a mean of 1.3 days at 12 months.

Suchman, Nancy; DeCoste, Cindy; Castiglioni, Nicole; Legow, Nancy; Mayes, Linda

doi: 10.1037/0736-9735.25.3.499pmid: 20057923

The authors examined pilot data from an attachment-based parenting intervention for substance-abusing mothers of toddlers (ages 12–36 months). The Mothers and Toddlers Program (MTP) is a 20-week individual therapy intervention that aims to help mothers develop more balanced representations of their children and improve their capacity for reflective functioning (i.e., recognition of the intentional nature of children's behavior). The authors hypothesized that improvement in maternal representational balance and maternal capacity for reflective functioning would correspond with improvements in maternal behavior with toddlers (e.g., sensitivity to cues, responsiveness to distress, and social–emotional growth fostering) and reduction in maternal psychiatric distress and substance abuse. Eight mothers who completed MTP showed moderate improvements in representational balance and reflective functioning, and these changes corresponded with significant improvements in maternal behaviors with toddlers. The authors also compared MTP completers and noncompleters on sociodemographic and psychosocial indexes and examined the validity of the intervention's proposed mechanisms of change. Preliminary findings support the importance of attachment mechanisms and indicate that attachment-based interventions may strengthen substance-abusing mothers' capacities to foster their toddlers' socioemotional development.

Suh, Jesse J.; Ruffins, Stephen; Robins, C. Edward; Albanese, Mark J.; Khantzian, Edward J.

doi: 10.1037/0736-9735.25.3.518pmid: N/A

According to E. J. Khantzian's (2003) self-medication hypothesis (SMH), a psychoanalytically informed theory of substance addiction that considers emotional and psychological dimensions, substance addiction functions as a compensatory means to modulate affects and self-soothe from the distressful psychological states. To manage emotional pain, dysphoria, and anxiety, substance abusers use the drug actions, both physiological and psychological effects, to achieve emotional stability. The SMH was retrospectively tested using 6 Minnesota Multiphasic Personality Inventory–2 special scales with 402 non–drug users and drug users to capture the psychological elements relevant to the SMH. Three logistic regression models were formed to predict alcohol, cocaine, and heroin “drug-of-choice” groups. Predicting variables were the Repression, Overcontrolled Hostility, Psychomotor Acceleration, Depression, Posttraumatic Stress Disorder, and Cynicism scales. Repression and, inversely, Depression scales significantly predicted the alcohol group. Psychomotor Acceleration was the only significant predictor of the cocaine group. Cynicism significantly predicted heroin preference. The results are partially consistent with the SMH. Implications of these results for understanding the relationship between affect regulation and addiction and treatment interventions are discussed.

Gottdiener, William H.; Murawski, Philip; Kucharski, L. Thomas

doi: 10.1037/0736-9735.25.3.533pmid: N/A

A meta-analysis was conducted to test a core feature of the self-medication hypothesis of substance use disorders (SUDs) that posits that SUDs are associated with failures of ego control. This hypothesis was tested by quantitatively synthesizing studies that used the delay discounting task in individuals with SUDs compared with nonclinical controls. An additional aim of the study was to identify variables that might moderate the relationship between SUDs and delay discounting task performance. The results were based on 10 studies that consisted of 925 participants who used a variety of psychoactive substances, and all studies used matched-groups designs. Participants with SUDs showed significant failures in ego control compared with nonclinical controls (d = 0.587). Variance across studies was nil, and therefore no moderators were sought. The results of this study support the self-medication hypothesis and suggest that SUD treatment should focus on improving ego control. The results also show that the delay discounting task is an experimental method that can be used to operationalize a number of psychoanalytic constructs and thus opens the door to further psychoanalytic experimental research on failures of ego control.

Jacobs, Theodore J.

doi: 10.1037/0736-9735.25.3.550pmid: N/A

In this clinical vignette, the author describes an individual who, in his opinion, manifested unusual courage, both in making extremely difficult life decisions and in facing his own fatal illness.