19 Chapters
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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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CHAPTER TWO: Patients' representations of the therapeutic dialogue: a pathway towards the evaluation of psychotherapy process and outcome

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 next three chapters explore the hypothesis that the operationalizing and measurement of the construct “representations of the therapeutic dialogue” can serve as a valid source of evidence about the outcomes of psychoanalytic therapy and the internalization processes whereby psychoanalytic therapy becomes and remains an adaptive resource in patients’ lives after termination.

The research strategy we have adopted to explore this central idea is based on our shared commitment to three basic operating premises:

1. We conceive of representations of the therapeutic dialogue as the intrapsychic equivalents or analogues of the types of verbal and nonverbal exchanges patients have with their therapists. As early as 1926, Freud came to the view that the very essence of psychoanalysis is that it is a conversation in which “… nothing takes place between [the patient and the analyst] except that they talk to each other” (1926b, p. 187).

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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 TWELVE: A very broad concept seen through a very narrow lens

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

Norbert Freedman and Rhonda Ward

What we are about to explore is a very broad concept seen through a very narrow lens. The concept is working through and the lens is a specimen from a recorded psychoanalysis. The concept has evolved over decades of psychoanalytic experience and clinically can cover years of analytic work. The lens comprises 25 sessions from the third year of a four-times-a-week psychoanalysis. The concept gets at the very heart of the efficacy of psychoanalytic work, but the lens, hopefully, pinpoints those ingredients that matter. One of those ingredients we have discovered and believe is essential to working through is termed the nodal moment.

In the course of this specimen, the repeated theme of torture can be heard. Torture is desired, feared, dreaded, confronted, imagined, reflected upon, and resolved through contrition. For Ms Y, the patient, torture appears within the context of an anticipated inner storm, a theme running like a red thread throughout the specimen, representing an effort towards transformation.

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CHAPTER THIRTEEN: Method and findings: the case of Ms Y: the patient and her analyst within the context of a recorded psychoanalysis

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

Norbert Freedman, Richard Lasky, and Rhonda Ward

At the time of this research, Ms Y was a professional woman in her thirties, and a mother of a three-year-old boy and a newly adopted infant daughter. She and her husband were residing in a suburban community in the US Midwest, enjoying a secure income. About six years prior to this study, she began a twice weekly psychotherapy and in her second year of treatment converted to a four-times-a-week psychoanalysis.

According to the analyst, the tone of the treatment shifted dramatically during the first two years of the analysis. The initial transference, one of non-engagement and affective withdrawal, developed into a sadomasochistic transference and then into one that was explicitly erotic. This intensity, one of over-engagement, seemed to have been a defence against the initial schizoid-like position, though, as the treatment progressed, acute neurotic conflicts also surfaced. It was at this stage that we entered the study of the treatment process.

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