Working online due to the COVID-19 pandemic: a research and literature review.

Given the contemporary situation of many analysts in the world now being forced to work online due to the effects of the COVID-19 pandemic, it is important to review the working online issue. Substantial debate over previous years has questioned whether a genuine analytic process can unfold through online work. This debate is reviewed with the conclusion that such a process is not necessarily precluded. Research outcomes are then reviewed to highlight those things that can facilitate positive outcomes when working online. These cover the 'online disinhibition effect', the therapeutic alliance, particular ways of using the screen, focussing on trauma, the importance of self-awareness, knowing the predictors of mental health, certain potential positives of isolation/quarantine and psychotherapy interventions that may be currently needed. Final recommendations and suggestions are then presented as in the diagnosis issue, professional development and guidelines to do with practical and ethical considerations.

Etant donnée la situation actuelle dans laquelle beaucoup d'analystes dans le monde sont maintenant obligés de travailler en ligne du fait des effets de la pandémie de COVID-19, il est important de revisiter le sujet du travail en ligne. Dans les dernières années, il y a eu un débat important sur la question de savoir si un authentique travail analytique pouvait se déployer dans le cadre d'un travail en ligne. Ce débat est revisité ici avec la conclusion qu'un tel processus n'est pas nécessairement rendu impossible. Les résultats de recherches sont alors étudiés afin de souligner les éléments qui peuvent faciliter des effets positifs quand on travaille en ligne. Cela recouvre 'l'effet de désinhibition du travail en ligne', l'alliance thérapeutique, les manières particulières d'utiliser l'écran, se concentrer sur le traumatisme, l'importance de la conscience de soi, la connaissance des indicateurs de santé mentale, certains aspects potentiellement positifs de l'isolation/la quarantaine et les interventions psychothérapeutiques qui peuvent alors être avisées. Des recommandations et des suggestions sont enfin présentées au sujet du diagnostic, de la formation continue et des consignes sur les considérations pratiques et éthiques.

Dada la situación contemporánea de muchos analistas en el mundo forzados en la actualidad a trabajar en línea debido a los efectos de la pandemia COVID-19, es importante revisar el tema del trabajo online. Durante los años previos, un debate sustancial ha cuestionado si un genuino proceso analítico puede llevarse a cabo a través del trabajo online. Este debate es revisado con la conclusión de que semejante proceso no está necesariamente impedido. Los resultados de la investigación son luego revisados para destacar aquellos elementos que pueden facilitar resultados positivos al trabajar online. Los mismos abarcan, 'el efecto online de desinhibición', la alianza terapéutica, los modos particulares de usar la pantalla, el focalizarse en el trauma, la importancia del autoconocimiento, el conocer los predictores en salud mental, ciertos potenciales positivos del aislamiento/cuarentena e intervenciones en psicoterapia que pueden ser necesarias en la actualidad. Se presentan recomendaciones finales y sugerencias, en el tema diagnóstico, desarrollo profesional y guías con consideraciones prácticas y éticas.

The Development and Psychometric Evaluation of the Group Schema Therapy Rating Scale - Revised.

BACKGROUND: Recent research has supported the efficacy of schema therapy as a treatment for personality disorders. A group format has been developed (group schema therapy; GST), which has been suggested to improve both the clinical and cost-effectiveness of the treatment. AIMS: Efficacy studies of GST need to assess treatment fidelity. The aims of the present study were to improve, describe and evaluate a fidelity measure for GST, the Group Schema Therapy Rating Scale - Revised (GSTRS-R). METHOD: Following a pilot study on an initial version of the scale (GSTRS), items were revised and guidelines were modified in order to improve the reliability of the scale. Students highly experienced with the scale rated recorded GST therapy sessions using the GSTRS-R in addition to a group cohesion measure, the Harvard Community Health Plan Group Cohesiveness Scale - II (GCS-II). The scores were used to assess internal consistency and inter-rater reliability. Discriminant validity was assessed by comparing the scores on the GSTRS-R with the GCS-II. RESULTS: The GSTRS-R displayed substantial internal consistency and inter-rater reliability, and adequate discriminate validity, evidenced by a weak positive correlation with the GCS-II. CONCLUSIONS: Overall, the GSTRS-R is a reliable tool that may be useful for evaluating therapist fidelity to GST model, and assisting GST training and supervision. Initial validity was supported by a weak association with GCS-II, indicating that although associated with cohesiveness, the instrument also assesses factors specific to GST. Limitations are discussed.

Promoting Behavioral Change in Psychoanalytic Treatments.

One of the shibboleths of psychoanalysis is that treatment should not target behavioral change, focusing instead on gaining insight and the therapeutic relationship (Freud, 1917; 1923; Gabbard, 2014; Greenson, 1967). Such an approach is believed to be accompanied by disruptions of exploration or problematic distortions of the transference (Freud, 1917; 1923; Gabbard, 2014; Greenson, 1967). However, ignoring behavioral change can put patients at increased risk for stalemates in treatment and persistent problematic behaviors that interfere with improvement and impair relationships. This article suggests that rather than being at odds or disruptive, efforts at behavioral change can be part of the development and employment of a psychodynamic formulation, and can be used to enhance self-understanding and exploration of the transference. Psychoanalytic approaches provide strategies for behavioral change not included in other psychotherapeutic treatments. This article describes a variety of ways in which efforts at behavioral change can be integrated with and enhanced by psychodynamic exploration.

Silicon in 'pure gold'? Theoretical contributions and observations on teleanalysis by videoconference.

Ideas about psychoanalysis via videoconference-videoconference teleanalysis (VT)-are presented with the general understanding that these settings produce a twofold split between various degrees of recognition/negativisation of the absence of the other, on one hand, and the expectation of physical co-presence, on the other. This split has been put forward as dismantling the here, now, with me pre-reflexive unity of the analytic experience. This article suggests that both members of the analytic dyad will seek to reappropriate the experience through a forced ego integration that interferes with accessing states of unintegration in the analytic treatment and produces subtle alterations to symbolisation work. The effort to overcome this condition is illustrated with clinical vignettes and therapists' comments about feelings of inauthenticity and discontent when trying to sustain evenly-suspended attention, as well as in the perception of a form of flattening of the alive nature of speech. However, this is not a constant for all VT, and mutual understanding can be an important mitigating feature. The focus of the discussion should be on the capacity of the analytic dyad to overcome such a split and not on a direct extrapolation of the perceptual limitations of VT to possible effects on transference / countertransference.

[Therapy for elderly family members and couples: concerning the viability of relationships in later life, the role reversal and 'finishing' amicably]. / Familie- en paartherapie bij ouderen: over leefbaarheid, rolomkering en finishing well.

BACKGROUND: Research shows that in most countries the number of elderly persons is increasing and that close relationships in late life are playing a more important role. Therefore, it is surprising that there have been so few publications about family therapy for the elderly. AIM: To formulate some guidelines for psychotherapy for family members in their later years and to make suggestions regarding further research. METHOD: We summarise the existing literature and focus on important themes about working with the elderly, supplementing major issues with our own clinical experience. RESULTS: Family therapy with the elderly differs from therapy for younger adults in some respects; for instance, the emphasis in the case of the elderly is more on strengthening the viability of a long/standing relationship. The reversal of roles that often accompanies the ageing process and leads to increasing dependency is another factor that affects the elderly more than the younger adults. If the last stage of life is to finish calmly and amicably, therapists need to tackle any tensions or injustices that patients have experienced in the course of their relationships. CONCLUSION: Psychotherapy for the elderly needs to provide clients with constant opportunities for reflection and should initiate discussions about partners' experiences of tensions and injustices in their earlier relationship. However, the increasing number of elderly persons means that more empirical research needs to be done into systematic psychotherapy.

The analyst's authenticity: "if you see something, say something".

The history of authenticity in psychoanalysis is as old as analysis itself, but the analyst's authenticity in particular has become an increasingly important area of focus in recent decades. This article traces the development of conceptions of analytic authenticity and proposes that the analyst's spontaneous verbalization of his or her unformulated experience in session can be a potent force in the course of an analysis. We acknowledge that although analytic authenticity can be a challenging ideal for the analyst to strive for, it contains the power to transform the experience of the patient and the analyst, as well as the meaning of their work together. Whether it comes in the form of an insight-oriented comment or a simple acknowledgment of things as they seem to be, a therapist's willingness to speak aloud something that has lost its language is a powerful clinical phenomenon that transcends theoretical orientation and modality.

"Spinning one's wheels": Nonimproved patients view their psychotherapy.

OBJECTIVE: To explore psychotherapy experiences among nonimproved young adults in psychoanalytic psychotherapy. METHOD: A two-stage, mixed-method design was used. Twenty patients in the clinical range at pretreatment were identified as either with reliable deterioration or with no reliable change at termination. Interviews at termination and 3-year follow-up were analyzed with grounded theory methodology. RESULTS: "Spinning One's Wheels" emerged as a core category. The patients described the therapeutic relationship as distanced and artificial. While they saw active components in therapy and their own activities in life as beneficial, therapy itself was experienced as overly focused on problem insight and past history. CONCLUSIONS: When the therapist does not contribute to the achievement of the patient's treatment goals--even when the patient gains some benefit--the patient does not fully profit from the therapy.

The twilight of the training analysis system.

This paper briefly reviews challenges to psychoanalysis at this time, including those derived from both external, societal origins and internal psychoanalytic problems. It focuses attention on serious conflicts around psychoanalytic education, and refers to the training analysis system as a central problem determining fundamental constraints on present-day psychoanalytic education. These constraints are examined in some detail, and the general advantages and disadvantages of the training analysis system are outlined. The effects of all these dynamics on the administrative organization of the American Psychoanalytic Association are explored, and a proposal for a fundamental reorganization of our educational system to resolve the correspondent problems is outlined.

Neuroscience in the residency curriculum: the psychoanalytic psychotherapy perspective.

Educators of future psychiatrists tend to teach an array of approaches to the mind and brain, including among them the neurobiologic perspective and the psychoanalytic perspective. These may be considered at opposite ends of many spectra, including the fact that psychoanalysis takes a large-scale and treatment-oriented perspective and has helped countless patients over the years, while neuroscience has tended to be reductionistic, focused on understanding, and has helped very few people. A tension, therefore, exists for the educator in teaching neuroscience: is it wise to spend valuable time and energy teaching this interesting but, thus far, impractical field to future practitioners? Here, we argue that neuroscience is re-orienting itself towards more psychoanalytically relevant questions and is likely, in future years, to give new insights into the nature of basic drives and social relations. We additionally argue for balance on the part of providers in both acknowledging biologic underpinnings for clinical phenomena and yet continuing to take a stance oriented towards appropriate change. Given the burgeoning new focus within neuroscience on topics directly relating to the human internal experience and the novel challenges in both understanding those advances and appropriately using them, we encourage educators to continue to give future psychiatrists the educational foundation they need to follow neuroscientific discoveries into the future.

Implementing an aim-based outcome measure in a psychoanalytic child psychotherapy service: insights, experiences and evidence.

In this paper, we describe the use of an aim-based outcome measure used in routine outcome monitoring of child and adolescent psychotherapy within a child and adolescent mental health service. We aim to explore the clinical feasibility and implications of the routine use of this measure. We argue that use of the measure provides a simple and useful way of clarifying the focus of the clinical work and reflecting its progress, while also having the potential to illuminate the clinical picture by contributing an additional source of clinical information from a collaborative process with the patient, parents or both. We argue that while there are some cases where use of the measure may be impossible, or even perverse, in general it enhances rather than detracts from clinical work.

A tripartite model of the therapeutic relationship: theory, research, and practice.

The development and empirical examination of a tripartite model of the therapeutic relationship over nearly three decades are described. The model asserts that all therapeutic relationships, to varying degrees, consist of a real relationship, a working alliance, and a transference-countertransference configuration. Research testing propositions about how each of these components is related to treatment process and outcome, and to each other, is presented. Many propositions have been supported, but some have been disconfirmed. Although the tripartite, or perhaps a quadripartite, model appears to be empirically and theoretically viable, continued research and theoretical development will serve to refine the model further. The development and testing of additional models that unpack the global concept of the therapeutic relationship would also be useful.

On the impact of words: interpretation, empathy and affect regulation.

This paper offers a contribution towards furthering our understanding of a theme more usually associated with the Freudian tradition, namely the role and function of words as action, particularly in relation to the representational process and its somatic roots. Some reference to neuroscience research will be offered in this respect. It also considers the value of differentiating Empathy from Empathism, as defined by the Italian psychoanalyst Stefano Bolognini who distinguishes informing complementary countertransference from states of over-concordance. Two analytic sessions taken from the intensive analysis of a deeply deprived late-latency child showing violent behaviour are provided with the aim of illustrating the application of these concepts. It is argued that, given the same elaboration of the countertransference and the adequate empathic position on the part of the analyst, the difference in the outcome of the interpretation was made by the specific use of words-in this case the use or not of the personal pronoun-in the two sessions. As the case material is taken from the clinical work of a supervisee, some elements regarding the supervisory situation are also discussed in the paper.