Helmut Thomä

The German specimen case, amalia x: Empirical studies

The authors provide a perspective on how psychoanalytic process research can be implemented. This is based on a process research model described elsewhere and summarizes the kinds of studies that can be situated on the four levels of the model. The authors summarize multiple empirical studies that were performed in a completely tape-recorded psychoanalytic therapy and have been published. These studies demonstrate the many modalities empirical process research has available to objectively study psychoanalytic process phenomena and their implication for outcome.

Audio-Recordings of the Psychoanalytic Dialogue: Scientific, Clinical and Ethical Problems

The tape-recording of psychoanalytic sessions should by now be standard procedure for those who are prepared to undertake serious empirical research on the psychoanalytic process. However, the number of those who expose themselves to this procedure is still small, nearly as small as the number of those willing to engage in the careful scrutinizing of what they do when practicing psychoanalysis. Glover’s 1936 (1955) questionnaire investigation into the prevailing techniques among British psychoanalysts has to be looked upon more as an opinion poll than as actual empirical research.

A Session of Psychoanalysis as Analyzed by the Psychotherapy Process Q-Set: Amalia X, Session 152

Freud initiated the study of speciman reports of psychoanalytic work with the so-called Irma-dream [1]. This material has been re-analyzed a number of times (for example [2]). In the same vein, the Dora-case [3] has retained a prestigious pivotal position in availing itself to continuous re-elaboration and re-interpretation [4]. However, few detailed examples are available to extended scrutiny where “primary data” [5] are at hand. We leave utilized primary verbation data in our process analysis of a session of the psychoanalysis at process.

Zum Verhältnis von Theorie und Praxis der Psychoanalyse

Abstract According to psychoanalysis there is a relationship between gaining insight and therapeutic success. To clarify this relationship it is necessary to differentiate regions of psychoanalytic theory. On the one hand there are foundational theories - personality and aetiological theory - on the other hand there are technological theories: they explain the therapeutic process and generate rules for therapeutic intervention. The latter are supported by the former, but cannot be logically derived from them. The link between the mediation of self-knowledge and the improvement of the state of the patient is a theoretical and practical issue of psychoanalysis: theoretically it is a hypothesis that has to be proved by empirical investigation. Practically it is an aim to be fulfilled. A therapeutic theory should list the conditions that are necessary for this.

Single-Case Research: The German Specimen Case Amalia X

In a pivotal review of the problem of psychoanalytic treatment research some 40 years ago, Wallerstein and Sampson [1] enthusiastically recommended performing systematic single-case studies to enhance the field. Three decades later, Wallerstein [2] concluded: “that we are without warrant… to claim the greater heuristic usefulness or validity of anyone of our general theories over the others, other than by the indoctrination and allegiances built into us by the happenstance of our individual trainings, our differing personal dispositions and the explanatory predilections then carried over into our consulting rooms” (p. 1,251). In the same vein, Gabbard and Westen [3] urge that “we attempt to move from arguing about the therapeutic action of psychoanalysis to demonstrating and refining it” (p. 338). The best possibility for resolving these differences and for developing some consensus about the fundamental tenets of psychoanalysis rests on empirical research generating relevant data that can provide a basis for consensual agreement about fundamental psychoanalytic principles [4].

Relationship Between Theory and Practice

Sixty years ago Ferenczi and Rank (1924) attempted to clarify “the relationship between analytic technique and analytic theory” and to investigate “the extent to which the technique has influenced theory and the extent to which each currently assists or obstructs the other” — Freud’s prize question (1922 d, pp. 267–270). It is now time to compare today’s problems with those of that time. A few general observations have survived the passage of time. For example, Ferenczi and Rank pleaded the case for both an inductive empirical procedure and a deductive procedure to test hypotheses when they wrote: It is perhaps not an exaggeration to assert that this mutual control of cognition by experience (given facts, induction) and of experience by previous knowledge (systematization, deduction) is the only kind which can keep a science from erring. A discipline which utilized only one or the other of these paths of research or which prematurely attempted to forgo control by a countercheck would be condemned to lose the solid ground under its feet: pure facts because they lack the fructifying idea, pure theory because its premature omniscience would cause it to lose the motivation for further research. (Ferenczi and Rank 1924, p.47)

Zur Stellung der Krankengeschichte in der klinisch-psychoanalytischen Forschung

Die Diskussion uber die Psychoanalyse als wissenschaft liche Disziplin hat in den letzten Jahren in der ganzen Welt eine grose Intensivierung erfahren. Je deutlicher im Allgemeinen Bewusstsein die Tatsache wird, dass die Psychoanalyse als psychologisches System einen grosen Einfluss auf die psychosoziale Profession wie auch auf die zeitgenossische Kultur ausgeubt hat und noch weiter ausuben wird, desto mehr fallt der Umstand auf, dass auch nach uber 100 Jahren seit der Entstehung dieses theoretischen und praktischen Systems fundamentale Konzepte noch kontrovers beurteilt werden (Grunbaum 1998). Es durft e jedoch nicht ubertrieben sein, Freuds Versuch, die neurotischen Symptome prinzipiell anders zu erklaren als seine Zeitgenossen, als wissenschaft liche Revolution zu bezeichnen. Vor Freuds Versuchen betrachtete die Psychiatrie hysterische Symptome als Ergebnis einer degenerierten Konstitution, als Folge einer somatischen Anlage. Freuds entscheidender Beitrag zur Entwicklung der psychologischen Forschung bestand in der Ausarbeitung zweier Annahmen: Hysterische Symptome seien primar als psychische Phanomene unter besonderer Berucksichtung unbewusster Prozesse, und als sinnvolle seelische Gebilde zu betrachten.

Amalie X — ein deutscher Musterfall (Ebene I und Ebene II)

Beginnen wir mit der simplen Frage: warum brauchen wir Musterfalle? Psychoanalytiker erinnern sich unmittelbar, dass Freud vom Traummuster der Psychoanalyse gesprochen hat (1900) und Erikson (1954) diesen Irma-Traum als Beispiel gebendes Exemplar erneut durchgearbeitet hat.

The Specimen Hour

This is the verbatim transcript of the fifth hour of the tape-recorded psychoanalysis of a 28-year old married woman. The transcript was carefully prepared and punctuated to reflect the disfluencies and fragmentation that are characteristic of much of spoken language. In this session the analysand spoke 5244 words and the analyst 247. Substitute proper names have been used, e.g. David is the woman’s husband.

Zum Verhältnis von Theorie und Praxis

Rund 70 Jahre nach dem Versuch von Ferenczi u. Rank (1924), „das Verhaltnis der analytischen Technik zur analytischen Theorie“ zu klaren und hierbei zu untersuchen, „inwiefern die Technik die Theorie beeinflust hat und inwieweit die beiden einander gegenwartig fordern oder behindern“ — so lautet die von Freud (1922 d) formulierte Preisfrage -, ist es angebracht, die heutigen mit den damals ungelost gebliebenen Problemen zu vergleichen. Einige allgemeine Feststellungen haben die Zeit uberdauert. So pladierten bereits Ferenczi u. Rank fur ein empirisch-induktives und fur ein hypothesenprufendes deduktives Vorgehen, wenn sie sagen: „Es ist vielleicht nicht ubertrieben zu behaupten, das diese Art gegenseitiger Kontrolle der Erkenntnis durch die Erfahrung (Empirie, Induktion) und der Erfahrung durch vorhergehende Erkenntnis (Systemisierung, Deduktion) die einzige ist, die eine Wissenschaft davor behuten kann, in die Irre zu gehen. Eine Disziplin, die sich mit dem einen oder dem anderen Forschungswege allein begnugen oder auf die Kontrolle durch eine Gegenprobe zu fruh verzichten wollte, ware dazu verurteilt, den sicheren Boden unter den Fusen zu verlieren; die reine Empirie, weil ihr der befruchtende Gedanke fehlte, die reine Theorie, weil sie in voreiligem Allwissen die Motive zu weiterer Forschung verstummen lieβe“ (Ferenczi u. Rank 1924, S.47).