Change across a completed analysis assessed using a modified Three-Level Model

Abstract

The authors present their design for a clinical teaching exercise to study transformation in psychoanalysis. They chose a completed analysis from which to select the sessions retrospectively so that the clinical review exercise would not influence ongoing analytic process. The co-authors selected three tranches of clinical material, a few years apart, to be presented by the analyst. They studied the material with colleagues in the impressionistic manner of traditional clinical review, and then subjected it to more systematic examination, using a modified application of the Three-Level Model (3-LM) for assessing change. Their prediction was that the use of the 3-LM model could amplify the clinical impressions of the individual analyst and provide a way of being more specific about the changes, if any, that had occurred, and arrive at which theories best explained those changes.

Key words:

• transformation
• analytic process
• clinical teaching

Acknowledgements

The authors gratefully acknowledge the participation of colleagues who engaged in the exercise, the generosity of Paul Koehler, MSW, Charles Ashbach, PhD, and David Scharff, MD, who shared their responses to the three tranches of case material, and the analysand who gave permission for the use of her clinical material.

Additional information

Notes on contributors

Jill Savege Scharff

Authors

Jill Savege Scharff, MD, FABP, is co-founder, former chair, and supervising analyst at the International Institute for Psychoanalytic Training at the International Psychotherapy Institute (IPI), and a teaching analyst at the Washington-Baltimore Center for Psychoanalysis. She is also in private practice in child and adult psychoanalysis in Chevy Chase, MD, USA.

Pat Hedegard

Pat Hedegard, LMHC, is a supervising analyst at the International Institute for Psychoanalytic Training at the International Psychotherapy Institute (IPI), and is in private practice in adult psychoanalysis in Indianapolis, USA.