Assessing outcome in psychoanalysis and long-term dynamic psychotherapy.

The efficacy of psychoanalysis and long-term psychotherapy remains a fundamentally unresolved issue for lack of methodologically sound studies. This article reviews the shortcomings of prior long-term treatment research, and presents a rationale and justification of the importance of more rigorous outcome studies. An emphasis on process research is premature when efficacy remains uncertain. The modern reconceptualization of psychotherapy in terms of hermeneutic theory is discussed in relation to the empirical model. Although historically the hermeneutic perspective has served to repudiate positivism, the hermeneutic and empirical (but not positivistic) approaches to understanding information actually share common priorities. The clearest of these is that the process is ultimately evaluated and validated by the produced effect. It is argued that the recasting of psychoanalytic technique and theory according to aesthetic and pragmatic principles is not inconsistent with contemporary outcome research paradigms so long as the professed treatment objective is clearly specified in verifiable terms. The specific methodologic problems involved in extending the successful short-term psychotherapy research model to psychoanalysis are discussed. An overview of the major components of the Columbia feasibility study currently underway is presented. Finally, a number of assessment domains-for which reliable and validated instruments exist-that are thought to be relevant to outcome are reviewed.

Countertransference in court interpreters.

Transference and countertransference are important concepts in the therapist-patient relationship in psychiatry. They are also important elements of the courtroom setting and the court interpreter's verbalizations. Transference and countertransference are defined and illustrated in both the psychotherapeutic setting and the courtroom setting with interpreters. The role of the forensic psychiatrist as consultant in interpreter countertransference is discussed in this article.

A "new" drug for treating agitation and psychosis in the general hospital: chlorpromazine.

Psychiatric residents on a consultation-liaison service consistently avoid chlorpromazine in favor of haloperidol for the treatment of psychotic, agitated patients. The residents' fears of chlorpromazine as a dangerous medication are presented and the literature about chlorpromazine's side effects is reviewed. Evidence was not found to support the contention that chlorpromazine is too dangerous to use in the medical setting. Case material illustrating the benefits of chlorpromazine is presented. A theoretical explanation for the observed prescribing practices is suggested.

Successful treatment of obsessive-compulsive disorder with ECT.

A man with obsessive-compulsive disorder without evidence of depression responded to ECT but not to drug treatments. Further investigation of the utility of ECT in treating drug-refractory obsessive-compulsive disorder is indicated.