Bjørn Killingmo

A Widened Scope on Therapist Development: Designing a Research Interview Informed by Psychoanalysis

This article presents a qualitative research interview method informed by psychoanalysis, which can collect data beyond the subjective report of the participants. The method has been used to study acquisition of psychodynamic understanding and therapy technique among student therapists in psychology. Within the psychodynamic tradition, the subjective report of every person is viewed as potentially distorted by defense processes. Moreover, relational patterns in an interaction are viewed as significant data about the intrapsychic object relations of a person provided that the person is placed in a projective situation. Since common qualitative interview methods focus primarily on verbal data, such psychodynamic assumptions represent a methodological challenge. To collect a wider scope of data than merely the subjective report, a research interview has been developed based on a certain degree of projection, a psychoanalytic listening perspective, and the use of emotional expression in the interview relation as data. Subsequently, relational scenarios and incidences of defense processes in the research participants are inferred.

A plea for affirmation Relating to states of unmentalised affects

In some patients, among them the so-called psychosomatic patients, somatically-experienced affects are not transformed into words and symbols. Due to deficient mentalization, affective arousal is not linked to a meaningful and emotionally experienced self-representation. These patients do not experience affects as their own, and the analyst does not get through to their self-state by way of interpretation. The aim of this paper is to elaborate on the concept of “affirmation” and to argue in favour of affirmative interventions, supplementing classical interpretation, in the treatment of patients with deficient affect mentalisation. It is further argued that intonation and the sound quality of the analysts voice play a decisive part in conveying affirmative messages to the emotionally isolated patient.

The so-called rule of abstinence revisited

The paper discusses whether the rule of abstinence is still valid in the contemporary theoretical arena of psychoanalysis. Not only is this a debate on principle. It also raises the question of how gratifying the analyst should be in the analytic encounter, still remaining within the psychoanalytic paradigm. Current criticisms of the concept of abstinence are reviewed. The author replies to the objections. He argues that the so-called rule of abstinence is not a “rule” which describes the particular behaviour of the analyst, but a general principle describing the essence of the psychoanalytic cure. In the opinion of the author, abandoning this principle may have detrimental consequences both theoretically and technically. Finally, the author discusses the emotional presence of the analyst in the analytic setting and suggests an updated version of the idea of analytic abstinence.

Relational-oriented character analysis

Referring to the diversity of psychoanalysis of today, a position called relational-oriented character analysis is discussed. It is stated that relation and character as concepts refer to different and partly contradictory points of view in psychoanalysis, the first one emphasising mobile, dynamic aspects of personality, the second underlining stable, structural aspects. The principle aim of the article is to argue how the two perspectives can be theoretically combined in an overriding object-relational (two-person) conception and to discuss some implications for analytic technique. Finally, convergences and differences with other positions or schools in contemporary psychoanalysis are suggested.

HVA ER DYNAMISK PSYKOTERAPI

Artikkelen tar sikte pa a avgrense begrepet dynamisk psykoterapi. Med utgangspunkt i den psykoanalytiske tradisjon blir dynamisk psykoterapi beskrevet fra folgende synsvinkler: Relasjon, prosess, inngaenhet, varighet og autonomi. Det trekkes et skille mellom dynamisk psykoterapi og psykoterapi utfra dynamisk forstaelse. Til sist diskuteres hvordan egenarten av dynamisk psykoterapi og patologioppfattning far konsekvenser for psykoterapiforskning.

A psychoanalytic listening-perspective in a time of pluralism

This paper takes as its vantage point the idea that clinical observation is never free from preconceptions. An implicit listening-perspective organizing the analysts understanding is always present. However, due to contemporary theoretical pluralism, there is no longer consensus as to what are core concepts in psychoanalytic practice. The analyst of today has to model his own listening-perspective. The author describes a listening-perspective which gives priority to the following 5 aspects of clinical material: (1) affect; (2) object; (3) scenario; (4) self; (5) psycho-sexual stamp. A clinical vignette is presented to illustrate how these 5 aspects contribute, closely interacting, to the analysts understanding. Finally, issues of a principle kind, prompted by this listening-perspective are discussed.

Teoriutvikling innen klinisk dynamisk psykologi

Killingmo, B.: Theoretical developments in clinical dynamic psychology. Nordisk Psykologi, 1986, 38 (4), 243–252. Some conflicting trends in contemporary psychodynamic theory are reviewed. It is claimed that a main theoretical challenge today is to integrate the Freudian vision of the »threatened child« with the Kohutian vision of the »hurt child«. On the therapeutic level such an integration should appear as a systematic oscillation between interpretative and affirmative interventions. As to further development in psychodynamic theory, it is warned against emphasizing developmental deficit at the expense of the traditional psychoanalytic conception of conflict and regression.

Analytic change: Assessing ways of being in a psychoanalytic follow-up interview

The article argues that the concepts of relational scenario, structuralized affect and actualized affect are proposed candidates for observation of changes in relational ways of being as it is expressed in transference. A psychoanalytic follow‐up interview of a former analytic patient is presented in order to illustrate how change in relational ways of being may be registered and studied. By triangulating the patients verbal report of change with nonverbal information and transference–countertransference dynamics, one may grasp qualitative changes in relational ways of being. The case presented illustrates a former patients on‐going process of working towards representing aggression in a more direct manner and how this process is made observable with the aid of the proposed concepts in the interview situation. The proposed concepts of relational scenario, structuralized and actualized affect discussed are compared to the concept of transference used in studies of core conflictual relationship theme (CCRT).

What can we expect from trainee therapists? A study of acquisition of competence in dynamic psychotherapy

This study focuses on training in dynamic psychotherapy. Sessions deriving from the final phase of psychodynamic therapies (N = 21) performed by clinical trainees in an intensive psychodynamic psychotherapy training programme lasting 2 years were analysed for their level of psychotherapeutic competence. Research questions were: (i) To what extent do the trainees reflect strategic thinking in their clinical work? (ii) What characterises therapeutic attitude and interventions of therapists who have or have not achieved the capacity of strategic thinking? Three dimensions were analysed: strategic competence, attitudinal competence and technical competence. The concept “strategic competence” was developed in this study. It refers to the ability of the therapist to continuously reflect on therapeutic aims and on means designed to achieve these aims. Results: 53% of the therapists did not show operative clinical competence in terms of strategic thinking. Strategic competence was present, wholly or partially, in 47%. Only 2 therapists demonstrated high-level strategic competence. Most therapists demonstrated a lack of capability for strategic thinking and a lack of technical competence. Patients’ defence mechanisms and the therapists’ helplessness and lack of competence counteracted progress in the therapies. The study demonstrates that it is difficult to acquire dynamic understanding of the therapeutic process and that the novice therapist will need a longer period of time to acquire operative competence.

Mer om dynamisk psykoterapi

Artikkelen har to formal. For det fomte a kommentere synspunkter fremsatt av Ellen Hartmann og Terje Hartmann i et svar pa en tidligere artikkel av undertegnede, for det andre a utdype egne synspunkter, spesielt nar det gjelder sammenhengen mellom strukturvurdering og terapeutisk fremgangsmate. Nodvendigheten av a skjelne mellom terapeutisk teori, terapeutisk holdning og terapeutisk intervensjon blir understreket.