Psychoanalytic research and the IPA: history, present status and future potential.

This paper traces the chequered history of formal psychoanalytic research within the century-long development of psychoanalysis as theory and practice. It describes the official involvement of the American Psychoanalytic Association in the support of psychoanalytic research since 1970, and of the International Psychoanalytical Association since the 1980s. In the IPA, this has consisted of the introduction at the 1987 Montreal Congress of two half-day panels on formal psychoanalytic research; in the creation in 1991 of an annual IPA Research Conference held in March at University College London; and then the creation in 1996 of an annual ten-day IPA Summer School for neophyte psychoanalytic researchers, also at UCL in London. The paper then details the inauguration by the IPA, at the 1997 IPA Congress in Barcelona, of a mechanism for funding psychoanalytic research the Research Advisory Board (RAB), and the overwhelming--and totally unanticipated--worldwide response to the initial call for proposals in the autumn of 1997. Implications of this for psychoanalysis as a discipline are sketched.

The IPA and the American Psychoanalytic Association: a perspective on the regional association agreement.

Ever since 1938 the American Psychoanalytic Association has had a special autonomous relationship within the IPA accorded to no other component organisation. This Regional Association status has had two main features: (1) total internal control over training standards and membership criteria, with no accountability to the IPA; and (2) an 'exclusive franchise', so that the IPA was barred from recognising any other component within the United States. This unique Regional Association status reflected the resolution at the time (1938) of the long-standing controversy between the IPA and the American over the issue of 'lay analysis', and remained unaltered for half a century until, with the resolution of the 3 1/2-year long law-suit against the American (and secondarily against the IPA) in 1988, the Regional Association agreement was modified (but not totally abrogated) by the American's giving up the 'exclusive franchise' aspect (thus permitting IPA recognition of psychoanalytic groups in the US organised outside the American), but still retaining its internal full control over training and membership. The meanings and consequences for psychoanalysis of this special status of the American are explored.

Erikson's concept of ego identity reconsidered.

This paper explores and attempts to explain the paradox that Erik Erikson--after Freud, undoubtedly the psychoanalyst best known, most deeply esteemed, and most widely influential in the sociohistorical surround of world culture--has at the same time never been properly integrated into the psychoanalytic mainstream, but has instead been marginalized, consigned to a persisting psychoanalytic limbo. Two successive contexts within the historical unfolding of psychoanalysis in America, the milieu in which Erikson worked, would seem to account for this neglect. First, Erikson's monumental contributions to our understanding of the psychosocial developmental process, of the epigenesis of the ego, of the phase-specific developmental tasks across the eight postulated stages of the life cycle, and of the intergenerational cogwheeling of the life cycles were made during the 1950s and 1960s and could not easily be integrated into the ego psychology metapsychological paradigm then monolithically regnant within American psychoanalysis. And, second, as a major paradigm shift took place in America, beginning in the 1970s, toward a more relational, interpersonal, and intersubjective framework, Erikson's contributions, couched as they were in the structural language of the ego psychology of his time, were overlooked and went unremarked as seminal precursors of the newly emerging emphases. The clear relationship of Erikson's concepts of (ego) identity to emerging conceptions of self in relation to objects was simply not noticed, and his work continues to this day to be neglected and unintegrated within psychoanalysis.

The identity of psychoanalysis: the question of lay analysis.

This article, besides being a general historical account of the nature and meaning of the almost century-long controversy over "the question of lay analysis," also had a specific context and purpose. The author was invited to give the plenary keynote address to the winter meeting of the American Academy of Psychoanalysis in Santa Barbara, California, on December 9, 1994. After the passage of the Gaskill Committee proposals by the American Psychoanalytic Association in 1986, the alteration of the Regional Association agreement between the American and the International Psychoanalytical Association in 1987, and the settlement of the class-action lawsuit by clinical psychologists against the American and the International in 1988, this controversy over lay analysis had finally been resolved within the International and all its component organizations, including the American. The American Academy of Psychoanalysis, however, is one organization (with some overlap of membership with the American Psychoanalytic Association) that continues to maintain a bar against any members except medically qualified psychoanalysts. The author agreed to give the plenary address with the stipulation, which was accepted, that he could use the occasion to review this long history of the struggle over lay analysis, and to ask the Academy to reconsider its long-standing policies that now make it a lonely holdout against the evolution and resolution that has taken place in the overwhelming balance of organized institutional psychoanalysis worldwide.

Psychotherapy research and its implications for a theory of therapeutic change. A forty-year overview.

The Psychotherapy Research Project of The Menninger Foundation was started in the early 1950s, with the goal of learning more about what changes occur in psychoanalytic therapies (outcome) and how those changes come about (process). The principal findings were that psychoanalyses and psychoanalytic psychotherapies alike consistently were modified in a supportive direction, that more of the achieved changes were based on the operation of supportive mechanisms than was anticipated, and that, in many instances, the kinds of change achieved on the basis of these supportive mechanisms were indistinguishable from those that came about through the interpretive resolution of intrapsychic conflict. The final clinical accounting of PRP, Forty-Two Lives in Treatment, was published in 1986 and included follow-ups for up to thirty years. A successor project, PRP-II, was started at the Langley Porter Institute in the mid-1980s and is ongoing. It is an effort to pursue the findings and conclusions of PRP by defining in more precise operational terms the concepts of psychic structure and structural change and then linking attained structural changes to the mechanisms, supportive or interpretive-expressive, by which they have come about. Scales of Psychological Capacities is a research instrument devised to reflect underlying structure and structural change.

Between chaos and petrification: a summary of the Fifth IPA Conference of Training Analysts.

The Fifth IPA Conference of Training Analysts was devoted to the problems in the integration of different theoretical and clinical perspectives in the formation of psychoanalysts, the dialectical tensions between rigidity and stultification on the one hand, and a chaotic 'anything goes' on the other. Seven presentations, from the three major geographical regions and representing a range of theoretical perspectives, though drawing upon common and shared clinical and training experiences, were widely divergent in both their descriptions and their prescriptions. The presentations by Janice de Saussure of Geneva, by Charles Kligerman of Chicago, by Marcio de Freitas Giovanetti of São Paulo, Raquel Zak de Goldstein of Buenos Aires, André Green of Paris, José Infante of Chile and André Lussier of Montreal, are arrayed along a spectrum from the most conservative to the most sweepingly radical critique of our organisations and our practices; what is shared by these seven quite disparate presentations from so many ideologically and geographically diverse quarters is a widespread dissatisfaction with so many aspects of, and so many consequences of, the operation or our extant tripartite training structure bequeathed to us by Eitingon and his colleagues almost 75 years ago and hardly changed at all ever since.

Followup in psychoanalysis: what happens to treatment gains?

A recent panel (1989) discussed the feasibility and the desirability of systematic post-treatment followup study of psychoanalytic patients. In this paper, I compare the data bearing on these issues from the Menninger Foundation Psychotherapy Research Project, headed by me, and the Boston Institute Project, headed by Kantrowitz, and I indicate why their data are neither comparable nor adequate enough to warrant the conclusion that their apparent discrepant findings--that in the Menninger project outcome at termination tended to be predictive of the subsequent followup course, while in the Boston project this was not so--are more than chance events. I then present detailed case descriptions of two patients from the Menninger project who were quite similar in character and in illness structure, had seemingly comparable analytic courses, and similar good therapeutic results, but had quite different followup courses, one with further consolidation, and the other with regression. I present some of the determinants of this difference.

The future of psychotherapy.

Psychotherapy, once the dominant vehicle of psychiatric care, and still the most distinctive aspect of the psychiatric therapeutic armamentarium, is rapidly becoming an endangered species within psychiatry. The author reviews the decline in psychotherapy training since World War II. In the immediate decades following the war, as many as 3,000 hours (50%) of the 3-year residency training program were devoted to the learning and practice of psychoanalytic psychotherapy, under close supervision. The current situation is totally transformed from that earlier period, as psychiatry has grown and diversified with the explosive rise of neurobiology (especially in the areas of molecular biology and molecular genetics), clinical psychopharmacology, competing psychological paradigms (behavioral, family, and social systems) and their therapeutic applications, and community psychiatry, with its preventive, crisis-oriented, and epidemiological approaches. Today, various authoritative bodies recommend as little as 200 hours (2 1/2%) of psychotherapy training out of the 8,000 hours of the current 4-year residency program. The author explores the implications of this significant reduction in psychotherapy training.

Psychoanalysis: the common ground.

This paper carries further the theme I developed in my presidential address in Montreal, 'One psychoanalysis or many?' where I discussed the issue of what holds us together as psychoanalysts sharing a common discipline and science despite our increasing theoretical diversity. My response was that our common ground rested in our shared clinical enterprise in our consulting rooms where we relate comparably to the immediacy of the transference-countertransference interplay with our patients. In this paper I reconsider these perspectives in the light of the specific responses to them, including in the six pre-published statements for the Rome Congress which was dedicated to this theme of exploring our common ground; and I then apply these conceptions in my own comparative assessment of the three plenary clinical presentations of the Rome Congress, drawn from the three major world regions of psychoanalytic activity and presented by adherents of three of the major metapsychological perspectives in our field, the ego psychological, the Kleinian, and the object relational.

The future of psychoanalysis.

We have tried, in a necessarily kaleidoscopic and highly condensed manner, to highlight our perspectives on the foreseeable future of psychoanalysis, along a number of interrelated but clearly distinct dimensions. Our discussion has dealt with the nature of our field as a science and also as a discipline, the nature of the training for it, the nature of its research, and the nature and scope of its professional practice. In all of these areas, matters seem both more complex and less clear-cut than they were in the immediate post-World War II period when we entered the field, which is now forty years ago in the approximately one-hundred-year-old history of psychoanalysis. We did not discuss in any detail the International Psychoanalytical Association or the American, its component through which we have our international membership. We have, however, via the IPA Newsletter, given voice to the organizational struggles of the International: the April 1989 issue of the Newsletter carries our account of the organizational changes within the IPA during the last four years and what we think they mean in relation to some of the issues discussed in this article. The fuller story of how our changing psychoanalytic life and identities are reflected in our institutional structures, as well as a more detailed specification of the future directions we have tried to chart in our inquiry, all deserve separate extended treatment and more complete justification.

The Psychotherapy Research Project of the Menninger Foundation: an overview.

Studied processes and outcomes of psychoanalysis and psychoanalytic psychotherapy, both expressive and supportive. 42 Ss were followed via initial, termination, and follow-up studies over the entire natural course of treatment, with 100% follow-up 2-3 years posttermination. Some follow-ups extended over the 30-year life span of the study. Detailed case histories and life histories were obtained from all 42 Ss. Psychoanalyses achieved more limited outcomes than predicted; psychotherapies often achieved more than predicted. Supportive mechanisms infiltrated all therapies, psychoanalyses included, and accounted for more of the achieved outcomes (including structural changes) than anticipated. An expanded new categorization of supportive therapeutic mechanisms is proposed, along with an elaboration of expressive therapeutic mechanisms.

Psychoanalysis and psychotherapy: an historical perspective.

I have reviewed the historical unfolding of psychoanalytic (or dynamic) psychotherapy as a therapeutic application of psychoanalytic theory directed towards patients not considered appropriate for proper psychoanalysis. I have divided this history into three phases. The first phase that I call the prehistory of dynamic psychotherapy is the period of Freud's development of psychoanalysis as a distinctive therapy for mental illness and its clear differentiation from the varieties of suggestive therapies in vogue at the time. The second phase (from the 40s to the late 70s) is the period of the development of psychoanalytically-based expressive and supportive psychotherapies related to but clearly separate from proper psychoanalysis in terms of specific techniques, goals, and the portions of the psychopathological spectrum against which each is directed. I call it the period of psychoanalytic consensus. The third current phase, from the late 70s to date, I call the period of fragmented consensus. The leading protagonists in the forging of the second phase consensus, brought to its fullest expression in the landmark publications of 1954, have now diverged widely in their perspectives on these issues as expressed in a 1979 Symposium, 25 years after.

Followup in psychoanalysis: clinical and research values.

Psychoanalysis has never developed a tradition of systematic followup study to evaluate outcome and to improve technique and theory for a variety of reasons, partly theoretical, stemming from the conception of the unfolding transference neurosis and its analytic resolution as the precondition for cure, and partly historical, having to do with the happenstance of its development as a private practice-based discipline and training outside of the academic setting. Freud, however, was never bound by such strictures and published whatever post-treatment data he acquired on all his best-known case histories. But following Freud most analysts, with some notable exceptions, eschewed followup activity as unanalytic. It is this tradition that more recent studies like those of Pfeffer in New York and the Psychotherapy Research Project of The Menninger Foundation in Topeka have squarely challenged. Data are presented from the Menninger project dealing specifically with the impact of routine planned followup on issues of treatment termination and resolution and on the nature of the post-treatment period. The degree and kind of patient cooperation with the followup inquiry, the impact of followup on treatment termination and resolution (both impeding and facilitating), and the role of followup intervention in relation to return to formal post-treatment therapy (or consolidating against it), are all discussed.