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

ABSTRACT

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.

Accords et différences entre les psychanalystes au sujet des changements observés au cours d'un traitement. Une exploration quantitative au moyen du Modèle à trois niveaux (3 LM)

L'objectif de cet article est de rendre compte des résultats partiels d'une recherche exploratoire sur la façon dont douze psychanalystes aux orientations théorico-cliniques différentes perçoivent et utilisent les hypothèses relatives aux phénomènes de changement, qui seront reliées à un matériel extrait d'un traitement analytique. Le Modèle à trois niveaux (3-LM) a été utilisé pour observer les transformations chez une patiente, ainsi que pour collecter des données, et a été suivi d'une analyse statistique du comportement et de la relation d'une série de variables en lien avec le type et le degré de changement perçu au niveau du fonctionnement mental de la patiente dans le cours de l'analyse. Les résultats rapportés ici montrent qu'il y avait un accord significatif parmi les participants, indépendamment de leur orientation théorico-clinique, par rapport à : 1) l'impact positif de l'application du traitement psychanalytique à différentes parties du fonctionnement mental ; 2) les hypothèses explicatives des changements observés chez la patiente en question ; 3) l'utilité de l'expérience des échanges dans le groupe relatifs au 3-LM pour observer et comprendre les changements chez la patiente.

Übereinstimmungen und Unterschiede zwischen Psychoanalytikern in Bezug auf die während einer Behandlung beobachteten Veränderungen. Eine quantitative Untersuchung anhand des Drei-Ebenen-Modells (3-LM)

Ziel dieses Beitrags ist es, die Teilergebnisse einer explorativen Studie darzustellen, in der untersucht wurde, wie zwölf Psychoanalytiker unterschiedlicher theoretisch-klinischer Ausrichtung Hypothesen über Veränderungsphänomene im Zusammenhang mit ausgewähltem Material aus einer psychoanalytischen Behandlung wahrnehmen und verwenden. Das Drei-Ebenen-Modell (3-LM) wurde für die Beobachtung von Patientenveränderungen und für die Datenerhebung verwendet. Darauf folgte die statistische Analyse des Verhaltens und der Beziehung einer Reihe von Variablen, die sich auf die Art und den Grad der wahrgenommenen Veränderung der psychischen Funktionsfähigkeit der Patienten im Laufe ihrer Behandlung beziehen. Die hier berichteten Ergebnisse zeigen, dass unter den Teilnehmern, unabhängig von ihrer theoretisch-klinischen Ausrichtung, eine signifikante Übereinstimmung in Bezug auf Folgendes bestand: 1) die positiven Auswirkungen der Anwendung der psychoanalytischen Behandlung auf verschiedene Bereiche der psychischen Funktionsfähigkeit der Patientin; 2) die Erklärungshypothesen für die bei den Patienten beobachteten Veränderungen; 3) die Nützlichkeit der Erfahrung des Gruppenaustauschs unter Anwendung der 3-LM bei der Beobachtung und dem Verständnis der Veränderungen beim Patienten.

Accordi e divergenze tra psicoanalisti rispetto ai cambiamenti osservati nel corso di un trattamento. Un'esplorazione quantitativa condotta con il Modello a Tre Livelli (3-LM)

Il presente articolo si propone di riferire i risultati, ancora parziali, di un'indagine esplorativa circa il modo in cui dodici psicoanalisti di diverso orientamento teorico-clinico sentono e utilizzano ipotesi relative ai fenomeni di cambiamento presenti nel materiale clinico di un trattamento psicoanalitico. Il Modello a Tre Livelli (3-LM) è stato usato per l'osservazione delle trasformazioni dei pazienti e per la raccolta dei dati. A queste fasi ha fatto seguito l'analisi statistica del comportamento e delle relazioni di un insieme di variabili concernenti il tipo e il grado di cambiamento percepito nel funzionamento mentale del paziente durante il trattamento.

I risultati qui riportati mostrano una notevole convergenza di opinione tra i partecipanti, a prescindere dai rispettivi orientamenti teorico-clinici, relativamente ai seguenti aspetti: 1) l'impatto positivo dell'applicazione del trattamento psicoanalitico in diverse aree del funzionamento mentale del paziente; 2) le ipotesi esplicative rispetto ai cambiamenti osservati nei vari pazienti in esame; 3) l'utilità dell'esperienza dello scambio di gruppo quando si utilizza il 3-LM per osservare e comprendere i cambiamenti nel paziente.

Acuerdos y diferencias entre psicoanalistas sobre los cambios observados durante un tratamiento. Una exploración cuantitativa utilizando el 3-LM.

Se comunican resultados parciales de una investigación exploratoria sobre la manera en que doce psicoanalistas de distintas orientaciones teórico-clínicas perciben y utilizan conjeturas sobre los fenómenos de cambio en torno a material seleccionado de un tratamiento psicoanalítico. Se utilizó el Modelo de los tres niveles para la observación de las transformaciones del paciente (3-LM) para relevar datos, luego se analizó estadísticamente el comportamiento y relación de un conjunto de variables referidas al tipo y grado de cambios percibidos sobre el funcionamiento mental de la paciente durante el transcurso de su tratamiento. Los resultados que aquí comunicamos muestran que existió un acuerdo significativo de los participantes, independientemente del tipo de orientación teórico-clínica asumida, respecto de: 1) la incidencia positiva de la aplicación del tratamiento psicoanalítico en diversas áreas de funcionamiento mental de la paciente; 2) las conjeturas explicativas de los cambios observados en la paciente bajo consideración; 3) la utilidad de la experiencia de intercambio grupal con el 3-LM para observar y comprender los cambios en la paciente.

Palabras clave: psicoanálisis – investigación empírica – modelo de los tres niveles – terreno clínico común.

KEYWORDS:

• Psychoanalysis
• empirical research
• Three-Level Model
• clinical common ground

Acknowledgements

We would like to thank Dr Ricardo Bernardi (Co-Chair of the IPA Research Committee) for his support and encouragement in carrying out this research. We would also like to acknowledge the commitment of the analyst colleagues who participated in the group exchanges, and to thank the patient for consenting to the production of clinical material that her analyst provided for this purpose.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 “Bleichmarians” is a term that here refers to psychoanalysts who predominantly use the theoretical-clinical model developed by Silvia Bleichmar (cf. Viguera 2019). “Integrators” refers to those who do not identify exclusively with a single theoretical-clinical model, but who use tools deriving from different theoretical approaches. In Argentina, integrationism in psychotherapy is a growing movement that represents a very significant sector of professionals (Muller 2008; Muller and Palavezzatti 2015).

2 “Mutual resonance does not mean identical resonance. In physics, resonance occurs when one vibrating system causes another system to oscillate with greater amplitude within a certain frequency. In this sense, discussion groups act as a resonator, creating a multiplier effect between the different participants, but recognising that each of them reacts according to his or her own personal equation” (Bernardi 2017, 739).

3 For the form used, see Appendix IV in Altmann de Litvan (2015) and Appendix 15 (Hanly, Altmann) by Litvan and Bernardi (2021).

4 We can here assume a distinction between the term efficacy, commonly referring to the results that a treatment achieves in the framework of a research trial, and the term clinical effectiveness, which refers to the outcome of a therapy in everyday practice (Fonagy 2002, 36). As regards the value that the convergence found could have for analysing therapeutic efficacy, it should be noted that the diversity in theoretical orientation still exists within the field of psychoanalysis in which all participants are included. As this is a group of psychoanalysts evaluating psychoanalytic treatment, it is important to question the extent to which certain kinds of bias may have been at work here, for example as a result of “loyalty to a model” (Leichsenring et al. 2017; Leykin and DeRubeis 2009). We elaborate on this aspect below, in the section on the limitations of this study.