The Penn Psychoanalytic Treatment Collection: a set of complete and recorded psychoanalyses as a research resource.

From a set of seventeen complete and tape-recorded psychoanalyses, a sample of findings is presented: (a) the level of agreement of two clinical judges on the psychological health of these patients is adequate for the late sessions, but not for the early sessions; (b) the amount of change during psychoanalysis appears to be similar to that in the Menninger Foundation Psychotherapy Research Project; (c) psychiatric severity measures from the early sessions can yield a significant level of prediction of the later benefits from psychoanalysis. Finally, further research uses of this collection of psychoanalyses are suggested.

Linking verbal and non-verbal representations: computer analysis of referential activity.

The objective of this study was to develop a computer assisted procedure to model the Referencial Activity scales as scored by raters. Referential Activity is defined as the function of connecting non-verbal experience with language. Using a large text corpus that had been rated by experienced and reliable judges, extreme samples from both ends of the Referential Activity Scales were selected. The Characteristic Vocabularies for each of these corpora, words that were significantly more frequent in each corpus as compared to the other, were then identified. A small set of 181 frequent words was derived that accounted for half of all words in the text corpora. These words were used as dictionaries for a Computerized Referential Activity measure based on computer assisted content analysis techniques. The new measure showed a correlation with judge-scored Referential Activity of around .50 across both the development and test corpora.

Object relations and referential activity in physically abused adolescents.

This study compared the object relations and language functions of 15 physically abused and 15 nonabused adolescents. The adolescents provided a 5-minute narrative about their mothers, which was scored for referential activity and object relations. As predicted, the abused adolescents tended to have lower levels of affect tone, indicating more malevolent relationship paradigms. Contrary to what was predicted, however, there were no significant differences between groups on overall measures of referential activity and object relations. Further, the abused adolescents tended to have higher levels of two elements of referential activity (concreteness, imagery), indicating increased verbal ability to express emotional experience. While predicted correlations were found between object relations and referential activity for the nonabused group, the abused group showed higher symbolizing and verbalizing capacity, associated with more malevolent representations of relationships. The findings do not support the view that physically abused adolescents experience developmental lags, instead suggesting that they organize and use emotional and symbolizing processes differently from nonabused adolescents. The implications for treatment are discussed.

Private psychotherapy patients of psychiatrist psychoanalysts.

OBJECTIVE: The characteristics of private psychotherapy patients of medical psychoanalysts are described. METHOD: A structured interview was administered to 51 medical psychoanalysts. Patients' demographic characteristics, historical features, and other clinically relevant aspects of behavior were assessed. RESULTS: Of 575 patients, 88% had at least one axis I disorder and 46% had at least one axis I and one axis II disorder. Treatment duration varied from less than 6 months to more than 6 years. Forty-three percent of the patients were also treated with psychotropic drugs. CONCLUSIONS: The patients in this cohort met the criteria for DSM-IV psychiatric disorders, had lifetime histories of major psychiatric disturbances, and were not the "worried well."

Discourse patterns in "good" and troubled hours: a multiple code interpretation.

Multiple code theory is a theory of psychological organization, which is rooted in current research in the areas of cognitive psychology, emotion, and development; it accounts for adaptive functions as well as pathology. The theory incorporates Freud's seminal discovery of modes of thought outside the conscious, rational mode, but recognizes three rather than two forms: subsymbolic nonverbal, symbolic nonverbal, and symbolic verbal. Computer-assisted procedures assessing these three forms are applied to verbatim transcripts of a long-term, fully recorded psychoanalysis. The measures point to the patient's central themes, allow evaluation of the analyst's interventions as facilitating or impeding the patient's explorations, and facilitate more rigorous comparison of differing clinical views. The discourse pattern in an early session was found to anticipate that in the treatment as a whole; the pattern in a later session indicates how this treatment may have become disrupted. The measures point to affiliative themes in the patient material that were not emphasized by previous researchers studying this case.

Topics and signs: defensive control of emotional expression.

This single-case study examined frank disclosure of important topics in a brief exploratory psychotherapy, including topics closely related to a recent, unintegrated stressor life event. Quantitative measures of emotion and control variables showed heightened levels of both emotionally and defensive control during discourse on the topic of the stressor event. In future studies, such measures of verbal and nonverbal signs of emotional expression and defensive control might be used to identify topics in an unresolved state.

Cyclical changes in emotional information processing in sleep and dreams.

Our scientific tools have rapidly advanced in recent decades. Urine tests and hormone assays allow us to know exactly where a woman is in her menstrual cycle and to document precisely her hormonal rhythms. Sleep-laboratory techniques allow us to know exactly when someone is dreaming so that we can obtain that communication that Freud prized so highly. Furthermore, we now have quantifiable means to measure accessibility to nonverbal mental representations, which derive from important advances in theory and method in cognitive psychology in the last several decades. None of the studies we surveyed combined these tools. The sleep-laboratory studies did not document menstrual-cycle phase with either temperature or hormone levels. Moreover, the relationship between their findings and daily functioning is still unclear. The psychoanalytic study by Benedek and Rubenstein carefully documented cycle phase, but statements about fantasy and conflict were large and sweeping and the focus was on drive-related rather than information processing effects. Careful work must be done by modern investigators before the field of medical psychoanalysis can address the basic questions of mind-body functioning that are at issue here. We have presented one approach to entering the communication network of mind-brain functioning, that is, the application of the dual-code model to dreams, in the context of the influence of hormones across the menstrual cycle. Although prior research has demonstrated cyclical fluctuations of psychodynamic themes in dream content (Baron, 1977; Benedek & Rubenstein, 1939a, b; Hertz & Jensen, 1975; Lewis & Burns, 1975; Swanson & Foulkes, 1968), the existence of a cyclical cognitive pattern as regulated by gonadal function has not previously been explored. While the findings are preliminary and limited, this is the first study to provide evidence that there are psycholinguistic styles characteristic of different phases in the menstrual cycle, and that this variation in verbal expression reflects a correspondence between hormone production and the ability to access and communicate nonverbal representations. Although the relationship between referential activity and phases of the menstrual cycle represents a statistical relationship and is hardly conclusive, the article does demonstrate how the dual-code model permits us to translate our psychoanalytic observations into operational terms. This provides one means of access to the network of communication between neuropeptides and mental representation, or in more general terms, between body and mind.

Dual coding: a cognitive model for psychoanalytic research.

Four theories of mental representation derived from current experimental work in cognitive psychology have been discussed in relation to psychoanalytic theory. These are: verbal mediation theory, in which language determines or mediates thought; perceptual dominance theory, in which imagistic structures are dominant; common code or propositional models, in which all information, perceptual or linguistic, is represented in an abstract, amodal code; and dual coding, in which nonverbal and verbal information are each encoded, in symbolic form, in separate systems specialized for such representation, and connected by a complex system of referential relations. The weight of current empirical evidence supports the dual code theory. However, psychoanalysis has implicitly accepted a mixed model-perceptual dominance theory applying to unconscious representation, and verbal mediation characterizing mature conscious waking thought. The characterization of psychoanalysis, by Schafer, Spence, and others, as a domain in which reality is constructed rather than discovered, reflects the application of this incomplete mixed model. The representations of experience in the patient's mind are seen as without structure of their own, needing to be organized by words, thus vulnerable to distortion or dissolution by the language of the analyst or the patient himself. In these terms, hypothesis testing becomes a meaningless pursuit; the propositions of the theory are no longer falsifiable; the analyst is always more or less "right." This paper suggests that the integrated dual code formulation provides a more coherent theoretical framework for psychoanalysis than the mixed model, with important implications for theory and technique. In terms of dual coding, the problem is not that the nonverbal representations are vulnerable to distortion by words, but that the words that pass back and forth between analyst and patient will not affect the nonverbal schemata at all. Using the dual code formulation, and applying an investigative methodology derived from experimental cognitive psychology, a new approach to the verification of interpretations is possible. Some constructions of a patient's story may be seen as more accurate than others, by virtue of their linkage to stored perceptual representations in long-term memory. We can demonstrate that such linking has occurred in functional or operational terms--through evaluating the representation of imagistic content in the patient's speech.

The vocalization of painful affect.

The act of verbalizing painful emotion is a sign of positive adaptive functioning, related to improved clinical state in depressed patients, and to capacity for self-regulation in persons experiencing stressful life events. In this investigation, the quality of articulation of emotion is assessed using a technique of discourse analysis applied to five-minute speech samples produced by severely depressed psychiatric inpatients and elderly medical outpatients. The method yields affect articulation profiles that trace sequential patterns of affect expression in spontaneous speech. The positive impact of the verbalizing process is based on the operation of the referential activity function, which involves integration of speech with cognitive and motoric processes. A model is proposed in which a linguistic or cognitive drive associated with referential activity, a "need for names," operates as a positive force, in opposition to a potentially maladaptive mechanism of avoidance of negative affect by blocking the experience to symbol link.

Depression in a family practice elderly population.

This study addresses several major methodologic issues in the assessment of depressive illness among the elderly family practice living in the community. These include the selection of screening locale, the definition of depression in the elderly, and the evaluation of age trends within this group. The family physician's office is viewed as the optimal screening locale; this facility serves as the chief link between the elderly patient and the community health care system, for psychologic as well as physical complaints. In the definition of depression, a type of depressive illness particularly affecting the elderly may be distinguished from a syndrome more characteristic of depression in the population at large. Emphasis is laid on viewing aging as an evolving process rather than as a steady state. A pilot study of 166 chronically ill family practice patients living in the community was conducted. A large proportion of them, all without previously diagnosed psychiatric impairment, had elevated depression scores according to the Zung Depression Status Inventory. Distinct symptom clusters characteristic of depression in the aged were identified. The data also suggested a systematic age trend, with different peaks of depression for men and women within the elderly age range.

Studies in linguistic ambiguity and insecurity.

This article focuses on problems of cross-culture communication between patients and psychiatrists of varying socio-linguistic and foreign language backgrounds, in an in-patient psychiatric community facility. Issues of diagnosis, integration into the ward treatment program, and progress in the course of treatment can in some cases be traced to specific socio-linguistic problems, which have previously gone undiagnosed. The clinical impact of three types of communication breakdowns are evaluated: (1) overt language differences; (2) linguistic ambiguity; and (3) linguistic insecurity. A need exists for further research in identification and assessment of language insecurity, and for modification of therapeutic procedures to deal with inter-dialectic communication difficulties.