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CHAPTER THREE: The RTD Coding System and its clinical application: a new approach to studying patients' representations of the Therapeutic Dialogue

Freedman, Norbert; Geller, Jesse D.; Hoffenberg, Joan; Hurvich, Marvin; Ward, Rhonda Karnac Books ePub

Jesse D. Geller, Donna S. Bender, Norbert Freedman, Joan Hoffenberg, Denise Kagan, Carrie Schaffer, and Neal Vorus

The Schedule of Therapy Remembered (STR) produced a rich narrative of people's recollections of their therapy experiences. How to use this information to get a measure of patients’ judgments about what was and what was not accomplished during a course of therapy now became the question to be answered.

The primary aim of Chapters Three and Four is to demonstrate the potential of the Representation of the Therapeutic Dialogue Coding System (RTDCS), as well as its operational definitions, scoring principles, and instructions. This will be followed by a presentation of the ways in which RTD scores can be analysed to be specifically responsive to the need for normative information about patients’ retrospective reconstructions of the verbal and nonverbal aspects of the therapeutic dialogue. Included are the first steps in analyses of RTDCS data sets used on a case by case basis to arrive at highly particularized outcome criteria and to try to test the hypothesis that the likelihood of benefiting from a course of treatment is increased if a patient avails himself/herself of the opportunity to construct, remember, use, and identify with benignly influential representations of the therapeutic dialogue in the physical absence of the therapist.

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CHAPTER FIVE: Reminiscing and recollecting

Freedman, Norbert; Geller, Jesse D.; Hoffenberg, Joan; Hurvich, Marvin; Ward, Rhonda Karnac Books ePub

Jamieson Webster and Norbert Freedman

Let us revisit the Effectiveness Study where we encountered ten patients who elected to speak to Dr V, an analyst, about their earlier experience in treatment. The group had been divided in half with respect to their scores on the Effectiveness Questionnaire: five patients experienced the treatment as satisfactory and the other half reported a sense of dissatisfaction. Once more, we ask the question: what is meant by effective treatment?

In further studies of these patients and their recall narratives with Dr V, the division five and five holds over a number of telling categories with satisfaction correlating with measures of reflective functioning (Fonagy, 1995), secure attachment (Roy, 2007), absence of annihilation anxiety (Hurvich, 2002), and high referential activity, as measured by the referential process (Bucci &Maskit, 2007). One might conclude that satisfaction with therapy is a good quantitative indicator of the success of a treatment with all the concomitant benefits: more secure attachment to the therapist, decrease in anxiety, a widening of one's self-reflective capacities, and so on and so forth.

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CHAPTER TEN: Transformations in long-term psychoanalytic psychotherapy: the case of Ms K

Freedman, Norbert; Geller, Jesse D.; Hoffenberg, Joan; Hurvich, Marvin; Ward, Rhonda Karnac Books ePub

Rhonda Ward, Norbert Freedman, and Marvin Hurvich

In the two preceding chapters, it has been shown how a patient's psychic functioning can reorganize dramatically in diverse directions with the presence of Annihilation Anxiety. It was noted in Chapter Eight how, within the first four weeks of psychotherapy, Mohamed, a severely traumatized patient, revealed such a transformation. His telling of extreme torture, at first desymbolized and concretized, appeared within a new context during active transference engagement. This was a transformation arising through a symbolized transference.

In Chapter Nine, a clinical regression was described and an alteration in the opposite direction was noted. During the “eye of the storm”, the panic attack proper, there arose an accentuation of Annihilation Anxiety, a regressive transformation, creating experiences of psychic blankness. Under these conditions of helplessness, thinking came to a halt. As an epilogue to this second pathway, a fleeting moment of recovery appeared in conjunction with a coun-tertransference enactment, thus depicting the nonlinearity inherent in psychic transformation.

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CHAPTER FOURTEEN: The induction of transference regression during the symbolizing phase: sessions 232 to 243

Freedman, Norbert; Geller, Jesse D.; Hoffenberg, Joan; Hurvich, Marvin; Ward, Rhonda Karnac Books ePub

Norbert Freedman and Rhonda Ward

In 1950, Macalpine published a memorable paper on the nature of transference, in which she asserted that a regressive transference is not only inevitable, but is evoked and actually induced by forces inherent in the frame of the psychoanalytic process. For us, the regressive transference is a paradoxical situation in which the patient may feel received, even supported, yet at the same time confronted by an enigmatic force that pulls in a downward direction. This precise situation was encountered by Ms Y during the symbolizing phase of this transformation cycle.

Macalpine's statement, based on an extensive review of the cumulative psychoanalytic knowledge up to 1950, raises for us two fundamental issues deserving separate consideration. The first concerns what we might call the induction hypothesis, the other we will call the reverberation hypothesis. Regarding the induction hypothesis, Macalpine spells out a series of specific transference forces, mobilized by the explicit and implicit analytic frame, which activate a pull towards a lower level of mental organization. This implies a paradoxical situation: the patient experiences an enigmatic force, pulling in the direction of lesser differentiation, and occurring at the very point of feeling heard and received. In the reverberation hypothesis, what we call regression is not only experienced by the patient, but is also communicated to and experienced by the person of the analyst, lending depth to analytic work.

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CHAPTER SEVEN: Meet Mohamed and the method implemented

Freedman, Norbert; Geller, Jesse D.; Hoffenberg, Joan; Hurvich, Marvin; Ward, Rhonda Karnac Books ePub

Marvin Hurvich and Norbert Freedman

The recorded psychoanalytic therapy of Mohamed, a refugee from torture in Somalia, treated in Oslo, Norway is the subject matter of this chapter. We begin with a brief portrait of Mohamed, sketch out our method of analysis of the transcripts of sessions,2 present an account of the major variables of concern, Annihilation Anxiety (AA), and the symbolizing process (Symbolization and Desymbolization), and then return to the theme of our Propo-sitional Method with the question: how to infer clinical change or a process of transformation?

Mohamed was a political refugee from an African country. He was in his early forties and was an active Muslim. He had a wife and six children at the time of his arrest in the mid-Eighties for his association with groups opposing the dictator of his country. He was in prison for nine years, where he experienced severe torture, maltreatment, and under-nourishment, and was also sentenced to death. He was forced to watch the torture of his wife and one of his daughters, as well as to witness torture and other inhumane acts being inflicted on fellow prisoners, including children. A recurrent theme in therapy was his agony about what he had seen the soldiers and prison guards doing to others. This tormented him as did the physical suffering he himself had experienced. He managed, in spite of this, to find some comfort in his religious beliefs all through his time in prison. However, it was a hard blow for him when the authorities circulated a rumour that he had betrayed his comrades during torture.

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