[Les demoiselles de Rochefort, or a clinical illustration of madness in pairs]. / Les demoiselles de Rochefort, ou une illustration clinique de folie à deux.

Although folie à deux is a confidential entity that has disappeared from psychiatric textbooks and is disguised in current international classifications of mental disorders, which tend to obscure the fundamental notion of the dyad, recent case reports highlight the topicality of the disorder. The richness of the clinical encounter with twin sisters, presenting a common delusion of parasitic infestation, may prompt us to question the disorder differently, guided in particular by ancient writings and the analytic compass.

Agreements and differences between psychoanalysts with regard to changes observed during a treatment. A quantitative exploration using the Three-Level Model (3-LM).

The aim of this paper is to report the partial results of an exploratory investigation into how twelve psychoanalysts of different theoretical-clinical orientations perceive and use hypotheses about the phenomena of change in connection with selected material from a psychoanalytic treatment. The Three-Level Model (3-LM) was used for the observation of patient transformations and for the collection of data. This was followed by the statistical analysis of the behaviour and relationship of a set of variables relating to the type and degree of change perceived in the patient's mental functioning during the course of her treatment. The results reported here show that there was significant agreement among the participants, irrespective of their theoretical-clinical orientation, as regards the following: 1) the positive impact of the application of psychoanalytic treatment in diverse areas of the patient's mental functioning; 2) the explanatory hypotheses of the changes observed in the patient under consideration; 3) the usefulness of the experience of group exchange using the 3-LM in observing and understanding the changes in the patient.

"No one can hate you more than I do": The perverse interplay of life and death drives in Roman Polanski's film Bitter Moon.

In this paper, the authors explore the depiction of perversion and the associated interplay of life and death drives in Roman Polanski's 1992 film Bitter Moon. To begin with, a theoretical discussion is presented regarding perverse organizations of mastery and sadomasochism. Perversion is viewed as an expression of the death drive under erotic disguise, in which the destructive fingerprint of the death drive is revealed at every stage, having as its ultimate purpose the destruction of the other. Based on these theoretical insights a dialogue is developed with Polanski's film, which brings to life the theory of sadomasochistic relations through the multidimensional aesthetic medium of cinema. It is shown how Polanski's cinematic oeuvre conveys the essence of the difficult and complex experience of perverse relations, where the life and death drives and their transformations are manifested. The portrayal of the sadomasochistic relations in this film contributes to the experiential knowledge with which the authors promote insight that would potentially enrich the clinical work with patients with perverse organizations.

Psychoanalytic Contributions to Psychodynamic Psychiatry and Psychotherapy: Freud's Structural Hypothesis.

Psychoanalysis has long lost its historical influence on U.S. academic psychiatry. Psychoanalytic theory, however, provides us with a rich and remarkably comprehensive knowledge of human development, both normative and pathologic. This article describes a psychoanalytic concept that enriches our understanding of the mind and its disorders: Freud's structural hypothesis. This core concept provides a theoretical foundation for understanding the clinical features of both neurotic and personality disorders. It also informs a psychodynamic psychotherapy.

A Psychoanalytic Approach to Internet Gaming Disorder.

BACKGROUND: Internet Gaming Disorder (IGD) is now an official diagnosis and significant public health challenges have been already identified regarding the provision of appropriate care to patients of all ages and the preparedness of mental health professionals to manage the disorder. Despite the existence of psychotherapeutic treatment modalities available for some time now, there is a paucity of any psychoanalytically driven treatments and the disorder is widely regarded and classified as being 'behavioral'. This has profound implications for patients with long-standing character pathology and psychiatric comorbidities, who are underserved by the provision of health services that could efficiently address their issues. METHODS: This study presents a psychoanalytic perspective on IGD, based on Kohut's Self Psychology as applied in the treatment of other addictions. An outline of the theory, assessment and treatment modalities is presented with two case reports that illustrate its application. RESULTS: The presentation outlines the challenges in treating IGD, expanding on the concept of guided imagery, resistance to treatment, selfobject transference and comorbidity with marijuana use and bipolar disorder. CONCLUSIONS: A psychoanalytically driven protocol can be effective in treating IGD, especially in cases with marked character pathology and low motive to engage in other treatment modalities.

The scientific character of psychoanalysis: Freud in the current discussion / El carácter científico del psicoanálisis: Freud en la discusión actual.

The discussion on the scientific character of psychoanalysis is continuous and multifaceted. Nowadays the extent and variety of the implied aspects in it is even increased. In this context this article presents for its analysis and assessment a reconsideration of Freud's line of argument regarding the scientific character of psychoanalysis. Against a quite spread view that conceives Freud's scientific perspective as a reflex of general traits of his time such as positivism, sustained by recent research on Freud this article proposes the reconsideration of Freud's perspective in a more exhaustive and nuanced way and holds that it is based on a composed by integrated parts, unified and consistent line of argument maintained through all his work. The reconsideration of the design of Freud's argument allows to hold that his own formulation is still fruitful and suitable for the present, particularly as it possibilitates, justifies and requires the connection of psychoanalysis to the development of knowledge.

La discusión respecto del carácter científico del psicoanálisis es continuada y multifacética. En la actualidad la extensión y variedad de aspectos implicados en ella sigue aun incrementándose. En este contexto el presente trabajo plantea para su análisis y evaluación una reconsideración de la argumentación de Freud respecto del carácter científico del psicoanálisis. Frente a una difundida visión que concibe la perspectiva científica de Freud como un reflejo de caracterizaciones generales de época, por ejemplo, positivismo, el presente trabajo apoyándose en líneas de investigación sobre Freud recientes, propone la reconsideración de su perspectiva de modo más específico y matizado. Sostiene que ella se basa en una argumentación basada en una concepción flexible de la metodología ciencia y en una concepción de la ciencia como forma cultural en desarrollo; argumentación compuesta de partes integradas, unificada y consistente, mantenida a través de toda la obra de Freud. La reconsideración del diseño de la argumentación de Freud permite sostener entonces que su propia formulación es fructífera aún para el presente en tanto posibilita, justifica y requiere la conexión del psicoanálisis con el desarrollo del conocimiento.

Developing psychoanalytic case conceptualization skills through didactic teaching: A randomized controlled trial.

OBJECTIVE: Time-limited didactic interventions have been shown to be effective in developing "generic" case conceptualization skills. The objective of this study is to test whether similar interventions can be used to develop case conceptualization skills that are "specific" to a treatment modality. METHOD: University psychology students were randomized to a target (n = 62) or a control group (n = 62). The target group received a training on psychoanalytic case conceptualization skills based on the newly-developed operators model. The control group received a training on generic case conceptualization skills based on the well-established 5 Ps model. RESULTS: The students' self-efficacy for case conceptualization significantly increased in both groups. However, students in the target group reported a significantly greater increase in psychoanalytic case conceptualization skills and in their ability to make clinical inferences. The teaching method, as well as the case conceptualization models, were acceptable to students. However, the 5 Ps model was significantly more acceptable to students than the operators model. CONCLUSIONS: This is the first RCT to provide evidence that psychoanalytic case conceptualization skills can be developed through didactic teaching and that they constitute a specific set of skills that are not developed by learning generic case conceptualization skills.

A Letter from Winnicott to Bion: An Imaginative Conjecture to Illustrate a Paradigm Transformation.

On the evening of October 5, 1955, Bion presented the paper Differentiation between the psychotic and non-psychotic personalities to the British Society of Psychoanalysis. Two days later, on October seventh, Winnicott commented on Bion's paper in a letter and in particular, discussed its clinical material. The author makes use of this exchange to examine how the transformations that took place in Bion's thought and Winnicott's contributions helped bring about a quantum revolution of the psychoanalytic paradigm. These may have facilitated the transition from an epistemological psychoanalysis (where what matters is what the analyst knows and what the patient comes to know about himself) to an ontological psychoanalysis (where the presence of the analyst becomes crucial-everything that the analyst is and the way in which he manages to become the patient's emotional experience). And what we witness in ontological psychoanalysis is a significant clinical transformation in which a theory of technique that focuses on interpretation can coexist with a theory of technique enriched, in the author's perspective, with new tools that make it possible to treat the most severely ill patients.

I Can't Forget What You Couldn't Tell Me: A Psychoanalyst Listens to Asylum Seekers.

This paper details my psychoanalytic process evaluating refugees as part of their application for asylum. It focuses on the emergence of unrepresented content and abject states within the intersubjective matrix that lead to collaborative creation of a story of trauma. Such intra- and inter-personal encounters are structured by the larger social, political, and cultural contexts that support, limit, structure, erase, and determine what can be known and told. Knowledge of traumatic inscription necessitates attunement to nonverbal affective states in both survivor and witness as well a receptive society that is able to tolerate grief, acknowledge the degradation and depravity unleashed in victim and victimizer during violence, and absorb survivors' mournful morality tales.

An Epistolary Conversation.

This written exchange is between a senior and a younger Jungian analyst on issues relevant to the development of analytical psychology throughout the world today. The younger analyst, Stefano Carpani, considers himself a neo-Jungian. He explains to John Beebe, known for post-Jungian contributions to the study of typology, integrity, and gender, how important it is to include sociological perspectives alongside those that stem from the Jungian practice of relational psychoanalysis. The degree to which analysis has become an extended meditation on the relation of individual self-exploration to supra-personal Self-realization is emphasized by both authors, who envision this introspection leading to an expanded inner openness that Carpani has called "absolute freedom." The authors conclude that absolute freedom is a space of engaged reflection that can permit an informed but individualized approach to the complexities of the world soul today.

Il s'agit d'un échange par écrit entre deux analystes jungiens - l'un plus agé, l'autre plus jeune - sur des questions concernant le développement actuel de la psychologie analytique à travers le monde. L'analyste plus jeune, Stefano Carpani, se considère comme un néo-jungien. Il explique à John Beebe - qui est connu pour ses contributions post- jungiennes à l'étude de la typologie, de l'intégrité et du genre - à quel point il est important d'inclure des perspectives sociologiques aux côtés de celles qui découlent de la pratique jungienne de la psychanalyse relationnelle. Les deux auteurs insistent sur le degré auquel l'analyse est devenue une méditation prolongée concernant la relation entre l'exploration individuelle de soi et une réalisation supra-personnelle du Soi. Ils envisagent que cette introspection mène à une ouverture intérieure élargie que Carpani a appelée « liberté absolue ¼. Les auteurs concluent que la liberté absolue est un espace de réflexion engagée qui peut permettre une approche éclairée mais individualisée des complexités de l'âme du monde aujourd'hui.

Este intercambio escrito es entre un analista junguiano senior y otro más joven sobre temas relevantes para el desarrollo de la psicología analítica en el mundo actual. El analista más joven, Stefano Carpani, se considera neo-jungiano. Explica a John Beebe, conocido por sus contribuciones postjungianas al estudio de la tipología, la integridad y el género, lo importante que es incluir perspectivas sociológicas junto a las que se derivan de la práctica junguiana del psicoanálisis relacional. Ambos autores enfatizan el grado en que el análisis devino en una prolongada meditación en la relación entre la exploración individual del self y la realización suprapersonal del Self, y visualizan como esta introspección conduce a una expansiva apertura interior que Carpani ha llamado "libertad absoluta". Los autores concluyen que la libertad absoluta es un espacio de reflexión comprometida que puede permitir una aproximación fundamentada y singular a las complejidades del alma del mundo actual.

Transmission of moral values between generations of families in conditions of social and economic vulnerability / Transmissão de valores morais entre as gerações de famílias em condições de vulnerabilidade social e econômica

Introduction: the study sought to determine how the passage of values between generations is processed, in view of the exposure to conditions of deprivation to which these people are subjected, while they carry the obligation to ensure the minimum for their children but do not have the necessary resources. This raises the question of how it is possible to affirm a notion of right and wrong within this social framework. this study analysed the transmission of values between generations in groups of people in unfavourable economic and social conditions. Methods: this is a qualitative descriptive study, interviews were conducted through group meetings to discuss issues related to morals. It was carried out with grandparents, their children, and their grandchildren who are residents of a peripheral neighbourhood of the capital of São Paulo and live in restricted economic conditions and under the daily impact of violence. These discussions involved the three generational components of three families. Different arrangements were made that involved the same generational group in an initial meeting and, in another meeting, the mixture of different generations and different families responding to pre-established themes that involved moral dilemmas focused on the daily cultural and social life of these families. The theoretical basis of this study was psychoanalysis, using the concepts of Identification, Ego Ideal, Ideal Ego, Oedipus, and the dynamics underlying the insertion of the father in the Oedipal triad.Results: the grandfathers were ambiguous because they have a reference to a law of morals transcending space and time. Parents, realising the ambiguity of these grandparents in relation to reality, reformulate these moral questions, basing their convictions on a law that is established within the contingencies of everyday life and, therefore, changeable. The adolescent grandchildren perceive this ambiguity in the parents and in their speech. Conclusion: there is greater identification of moral standards among grandchildren and grandparents than between children and parents. The interviewed parents were ambiguous in the way they act and speak, with the transgenerational reproduction model being more guided between grandchildren and grandparents than in the sequential temporal generational sequence.

Introdução: o estudo procurou averiguar como se processa a passagem de valores entre gerações, face à exposição a condições de privação a que são submetidas estas pessoas, enquanto carregam a obrigação de assegurar o mínimo aos filhos mas não dispõem dos recursos necessários. Isso levanta a questão de como é possível afirmar uma noção de certo e errado dentro dessa estrutura social. este estudo analisou a transmissão de valores entre gerações em grupos de pessoas em condições econômicas e sociais desfavoráveis. Métodos: trata-se de um estudo qualitativo descritivo, foram realizadas entrevistas por meio de encontros grupais para discussão de questões relacionadas à moral. Foi realizado com avós, filhos e netos moradores de um bairro periférico da capital paulista e que vivem em condições econômicas restritas e sob o impacto cotidiano da violência. Essas discussões envolveram os três componentes geracionais de três famílias. Diferentes arranjos foram feitos envolvendo o mesmo grupo geracional em um encontro inicial e, em outro encontro, a mistura de diferentes gerações e diferentes famílias respondendo a temas pré-estabelecidos que envolviam dilemas morais centrados no cotidiano cultural e social dessas famílias. A base teórica deste estudo foi a psicanálise, utilizando os conceitos de Identificação, Ideal do Ego. Resultados: os avôs se mostraram ambíguos pois possuem uma referência de Lei, de moral, deslocada no espaço e no tempo; os pais percebendo a ambiguidade destes avôs em relação à realidade reformulam estas questões morais pautando suas convicções em uma Lei que se estabelece dentro das contingências do cotidiano e, portanto, mutável; os netos adolescentes percebem esta ambiguidade nos pais e nos seus discursos. Conclusão: há maior identificação de padrões morais entre netos e avôs do que entre filhos e pais. Os pais entrevistados se mostraram ambíguos na forma de agir e de discursar, sendo o modelo de reprodução transgeracional mais pautado entre netos e avôs do que na sequência geracional temporal sequencial.

Pragmatism or idealism: a systematic review and visual analysis of Winnicott's psychoanalytical treatment views.

Winnicott is an outstanding representative of the School of Object Relations, and his unique psychoanalytic treatment views have been greatly influential to the psychoanalytical community. Winnicott emphasizes the impact of facilitating environment and the key role of the maternal-child relationship in the early psychological growth of individuals. He puts forward the ideas of the development mechanism of the true self and the false self, which builds a bridge between the characteristics of adult psychopathology and the characteristics of early maternal-child relationships, providing a new perspective for research on individual self-development and psychoanalysis. Winnicott creatively introduces the concepts of the transitional object and the transitional phenomena into the theories of Object Relations. He relates the transitional experience to the field of mental health, and extends it from the relationship between the mother and the child to adult life, which not only has had a revolutionary impact on modern psychoanalysis but also literature, aesthetics, and other fields. Winnicott highlights the importance of the patient's emotional development in the treatment. He advocates holding the patients' sentiments and meeting their emotional needs. He also approves of the emotional reparenting of the patients, to make them gain the ability to establish a relationship with the real world. His treatment views formed through a large number of clinical practices are very practical and full of humanistic care. This review summarizes Winnicott's psychoanalytical treatment views as well as his marvelous original concepts, and analyzes the hot topics of academic research on his theories based on a visualization analysis by using the software CiteSpace, which includes data in the Web of Science Core Collection published from 1978 to 2023 with 365 papers involved. The study provides a macroscopic and panoramic review of Winnicott's theories, and it clearly shows Winnicott's significant influence on the field of psychoanalysis and related fields.

The polyfactorial model of autism and the question of causality.

After recalling the different pediatric, psychopathological and child psychiatric models of mental disorders in children and adolescents, the author presents in detail the so-called polyfactorial model, which includes primary, secondary, and mixed factors. This model is the epistemological heir of the Freudian concept of "complementary series." The example of autism is then explored as a paradigm of the usefulness of this polyfactorial model. Finally, we reflect on the notion of causality, from Aristotelian causality to epigenetic causality, which could 1 day re-legitimize psychoanalysis and the impact of the relationship on genome expression.

Reflections on the reception of attachment theory by psychoanalysts. A review of publications.

This article explores the reception and response of the psychoanalytic community to attachment theory by reviewing articles, with 'attachment' as a keyword, published up until December 2020 in the top seven (according to impact factor) English-language psychoanalysis journals in the ISI Web of Knowledge. A category system was designed and applied to classify the articles which met the inclusion criteria.Since 1996, there has been a significant increase in publications that compare attachment theory and psychoanalysis, explore avenues of integration, analyse different theoretical and technical aspects, or make eclectic use of concepts from both models. Overall, however, few articles referring to attachment (246, representing 1.8% of the sample) have been published in the analysed journals, and of those, many hardly make any mention of psychoanalysis.Contributions by the attachment theory pioneer, John Bowlby, emerged from psychoanalytic practice, with attachment theory reinforcing the more relational approaches of psychoanalysis. Nonetheless, a main conclusion of our study is that attachment and psychoanalysis follow parallel or divergent paths.

Understanding psychoanalytic work online and back to the couch in the wake of the COVID-19 pandemic: an investigation among Italian psychoanalysts.

Background: Worldwide, psychotherapists' clinical experience went through rapid developments with transition to teletherapy during the COVID-19 pandemic. Literature on the use of remote psychoanalysis was not conclusive, leaving the issue of the consequences of the necessary setting alternation open. This study aimed to investigate the psychoanalysts' experiences of shifting to remote work and then returning to in-person setting, considering the effect of the patients' attachment styles and personality configurations. Method: Seventy-one analysts of the Italian Psychoanalytic Society were asked to fill out an online survey about patients who found the transition easier and patients who found it more difficult. General questions on therapeutic work, ISTS (Interpretive and Supportive Technique Scale) for interpretive and supportive aspects of technique, WAI-S-TR (Working Alliance Inventory-Short Revised-Therapist) for therapeutic alliance, RQ (Relationship Questionnaire) for attachment style, and PMAI (Prototype Matching of Anaclitic-Introjective Personality Configuration) for personality configurations were administered. Results: All of the analysts chose to continue the treatment using audio-visual tools. Patients with difficult transitions had a significantly higher frequency of insecure attachment and a higher score on RQ Dismissing scale than patients with easy transitions. No significant differences were found between the two groups in personality configurations, psychotherapeutic alliance, and psychotherapeutic technique. Moreover, a higher level of therapeutic alliance was positively correlated to RQ Secure scale and was negatively correlated to RQ Dismissing scale. Patients with easy transition both to remote work and back to in-person setting had higher scores of therapeutic alliances than those with difficult transition both to remote work and back to in-person setting. Conclusion: Online psychoanalytic therapy was widely used during the COVID-19 pandemic. Patients with insecure attachment styles had greater difficulties in adapting to setting alternations, thus confirming that insecure attachment is a vulnerability factor not only for psychopathological problems but also for a well-functioning therapeutic collaboration. Patient's personality configuration did not influence their adaptation to the setting alternation. The supportive and interpretive styles did not undergo significant changes in the transition from in-person setting to remote setting and vice versa, thus suggesting a continuity in the analysts' "internal setting."

Intricacies of Relational Intimacy: Approaching the Invasive Edge with a Schizoid Patient.

In hopes of contributing to the developing self-critique of relational analysis, I offer a case that illustrates a modified approach, one informed by current dialogue. The patient described had considerable unmet selfobject needs and a schizoid sensitivity to intrusion, engendering the question explored: How do two minds meet if one is largely relationally dissociated and acutely vulnerable when integrated? A premature emphasis on intersubjectivity would have obscured the patient's narcissistic needs and reinforced her tendency to retreat. Suspending the goal of intersubjectivity allowed for a regressive process to occur, and for contact to become safe before analyst and patient paved the way for future mutual relatedness.

El carácter científico del psicoanálisis: una reconsideración de la argumentación de Freud / The scientific character of psychoanalysis: a reconsideration of Freud's line of argument

La discusión respecto al carácter científico del psicoanálisis es continuada y multifacética. En la actualidad, la extensión y variedad de aspectos implicados es aún mayor. En este contexto el presente trabajo plantea una reconsideración de la línea de argumentación de Freud respecto al carácter científico del psicoanálisis. Frente a una visión bastante difundida que concibe la perspectiva científica de Freud como un reflejo del positivismo, el presente trabajo, apoyándose en líneas de investigación recientes, propone la reconsideración de dicha perspectiva de modo más matizado y sostiene que se basa en una argumentación mantenida a través de toda su obra. (AU)

The discussion on the scientific character of psychoanalysis is continuous and multifaceted. Currently the extent and variety of the implied aspects in it has even increased. In this context this article presents a reconsideration of Freud's line of argument regarding the scientific character of psychoanalysis. Against a quite spread view that conceives Freud's scientific perspective as a reflex of positivism, this article, sustained by recent research on Freud, proposes the reconsideration of Freud's perspective in a more exhaustive way and holds that it is based on a line of argument maintained through all his work. (AU)

Grupos de atención a padres y bebés: observación e intervención psicoanalítica en microscopía clínica como facilitador de las relaciones iniciales / Parent and infant care groups: observation and psychoanalytic intervention in clinical microscopy as a facilitator of early relationships

Este trabajo discute la microscopía de las intervenciones interpretativas yde la continencia ofrecida por los abordajes vinculares con padres, bebés y niños de corta edad, utilizando, como material ilustrativo e investigativo, viñetas de un Grupo de Atención a padres y a sus hijos de 0 a 3 años y once meses, realizado en ambiente ambulatorio en el Departamento de Pediatría (UNIFESP). A partir de la transcripción y comentarios del material originalmente filmado, buscaremos amplificar la comprensión de las interacciones lúdicas y verbales entre padres, niños y terapeutas en el contexto de grupo, reflexionando sobre detalles sutiles de las interacciones hilvanadas desde una visión psicoanalítica relacional.

This paper discusses the microscopy of interpretative interventions and the continence offe-red by bonding approaches with parents, babies and young children, using, as illustrative and investigative material, vignettes of a Care Group for parents and their children from 0 to 3 years and eleven months, carried out in an outpatient setting in the Department of Paediatrics (UNIFESP). From the transcription and commentaries of the originally filmed material, we will seek to amplify the understanding of the playful and verbal interactions between parents, children and therapists in the group context, reflecting on subtle details of the interactions threaded from a relational psychoanalytic vision.(AU)

Aquest treball discuteix la microscòpia de les intervencions interpretatives i de la continènciaoferta pels abordatges vinculars amb pares, nadons i nens petits, utilitzant, com a material il·lustratiu i d’investigació, vinyetes d’un grup d’atenció a pares i als seus fills de 0 a 3 anys i onze mesos, realitzat en ambient ambulatori al Departament de Pediatria (UNIFESP). A partir de la transcripció i els comentaris del material originalment filmat, buscarem amplificar la comprensió de les interaccions lúdiques i verbals entre pares, nens i terapeutes en el context de grup, reflexionant sobre detalls subtils de les interaccions embastades des d’una visió psicoanalítica relacional.(AU)

Uncanny Teletherapy: Working with Extimacy.

Responses to the question of teletherapy have multiplied over the past decades, yet many therapists are grappling with the challenges and opportunities of teletherapy for the first time in the wake of the Covid-19 pandemic. For many clinicians, teletherapy was, at least initially, unfamiliar and unsettling. Much of the literature construes teletherapy as a degradation of an original-incapable of providing the intimacy achieved and maintained in two-bodies-in-a-room therapy-or as a good enough simulation. Both positions risk enshrining the consulting room as offering an unmediated scene of therapy. An alternative approach to the strangeness, distance, and mediations so prominent in the transition to teletherapy takes up a qualified sense of Freud's concept of the uncanny: the "minimal uncanny" and its reformulation in Lacanian theory as extimacy, a lens through which to explore intimacy and bodily proximity in the transition to teletherapy. Through the logic of extimacy, a theoretical view emerges that approaches teletherapy not as a poor substitute for real therapy, or a good enough substitute, but as an exemplary case of the therapeutic encounter.

Free-Association Session Scale: factor structure and preliminary validity test.

One of the main concepts of the psychoanalytic method postulated by Freud in 1912 is the fundamental rule, which involves asking the patient to say whatever comes to mind as the analyst follows the patient's speech with fluctuating attention. Despite different theoretical models, this concept has remained an invariant element that characterizes the psychoanalytic method. For this reason, the purpose of the current study is to present a new instrument that measures this process based on the clinician's assessment. The Free-Association Session Scale (FASS) has been designed according to the psychoanalytic framework. Study 1 presented the preliminary validation of the FASS factor structure. Experienced Italian psychoanalysts (N = 281; 196 women) completed the FASS and sociodemographic questionnaire. The following two factors were identified using exploratory factor analysis: (1) Perturbing, and (2) Associativity. Study 2 cross-validated the two factors using an independent sample (N = 259; 187 women) of experienced psychoanalysts and confirmatory factor analysis (CFA). The FASS has been tested for concurrent validity using the Session Evaluation Questionnaire (SEQ) and Linguistic measures of the Referential process. The two-factor model achieved a close-fit test, and the FASS items were found to measure the corresponding factors with good reliability. The Perturbing factor is negatively associated with three SEQ factors (Depth, Smoothness, and Positivity) and negatively correlated with symbolization (IWRAD and IWRAD_IWRRL), confirming a more complex and unexpected session. The Associativity factor is positively associated with all four SEQ factors (Depth, Smoothness, Positivity, and Arousal). In conclusion, the FASS is a promising new questionnaire for assessing psychoanalytic session quality processes with satisfactory validity and reliability.