After working with patients at the Chicago Institute for Psychoanalysis for many years, I have become more and more convinced that psychodynamic psychotherapy can lead to change that is both effective and lasting. In fact, we’ve got solid data that back up this contention.
In follow-up studies at the institute, my colleagues and I looked at 40 patients 2 or more years after they had completed psychoanalysis by mutual agreement with the treating psychoanalyst.
By Dr. Phil S. Lebovitz
We were very careful to use safety and consent procedures aimed at avoiding disruptive effects on the patients. For example, the interviewing analysts reviewed process notes of the original analysts so that they would not inadvertently inquire into traumatic areas. This goal was balanced against the concern about the analyst having too much information about resultant biases.
Our findings should be particularly rewarding to those of us who have dedicated our lives doing this work: The change that our patients experienced proved enduring. Furthermore, we found two key elements that correlated with that enduring change.
The first, which occurred as the treatment reached its concluding phase, is characterized by a capacity to self-analyze and recognize the disruptive patterns that led the patients to treatment and to modify those patterns using the self-analytic capacity. An essential component of this is a process of cycling between a character style that early in life had been adaptive and later became dysfunctional and the painful tensions of needs that had led to the character style.
The second element involved a period of mourning the loss of the psychoanalysis and the psychoanalyst. This optimally began during the concluding phase of the treatment and continued to resolve during the 2 years post treatment.
Patients were rated based on several dimensions having to do with the therapeutic alliance related to a feeling that the analyst is helping, dreams, Oedipal issues, defense transference, and the analytic alliance related to an identification with the analytic function. As we know, the defense transference is an adaptive characterological feature that operates automatically and unconsciously in all relationships to regulate feelings of tension and to manage anxiety. It develops early in life and allows the child to preserve a relationship with the primary caregiver.
Specific dimensions tied to the therapeutic alliance included basic trust; object constancy; self-constancy; dyadic object relationship; dyadic reality testing; tolerance of frustration, anxiety, and depression; and triadic object relations among others.
These studies affirm that change can be assessed in this manner, transferences quickly disappear, and patients develop self-analyzing capacities to a greater or lesser degree.
In addition, patients are able to work with the defense transference that was the crucial factor in this development.
These studies are ongoing. Future studies are needed to determine whether a similar process can occur in psychoanalytic psychotherapy.
Dr. Phil S. Lebovitz is clinical associate professor in the department of psychiatry at the Rosalind Franklin University of Medicine and Science/the Chicago Medical School, and faculty and training and supervising analyst at the Chicago Institute for Psychoanalysis.