Siri Erika Gullestad

Nondisclosure in psychotherapy group supervision: The supervisee perspective

The aim of this study was to investigate aspects of nondisclosure in a sample of 55 student therapists, working within a group format of supervision. The study constituted one part of a larger study, with the other, parallel part addressing nondisclosure in supervisors. The participants were recruited from seven university-based training clinics in Norway and Denmark. The supervisees answered a questionnaire comprising 11 items about nondisclosure in supervision. The items were answered in a yes/no format, and the respondents were invited to provide examples and justifications for their answers to each item. The examples and justifications provided were analysed in accordance with Hill’s guidelines for consensual qualitative research. The study confirmed significant nondisclosure by supervisees in a number of important areas. A high percentage found it difficult to talk about topics related to the supervisory relationship, fearing that they would hurt their supervisor or be met with criticism or interpretation. They were also reluctant to talk to their supervisors about professional matters, particularly related to the perceived incompetence of their supervisors and their expectancy of non-constructive criticism. They felt that their supervisors withheld feedback on their work, as well as advise on what to do, and would like more of this. Several of them thought of the lack of feedback as a conscious strategy helping the students to find out for themselves. A rather striking finding was that a high number of students experienced that the groups became more closed throughout the supervision, and blamed their supervisors for inadequate handling of the group process. This is an issue that needs further exploration.Supervisee non-disclosure in psychotherapy group supervision: The supervisee perspective

The Adult Attachment Interview and psychoanalytic outcome studies

During the last two decades, the Adult Attachment Interview (AAI) has attracted growing interest from psychoanalysts concerned with empirical research. The paper discusses the application of Crittendens Dynamic‐Maturational AAI method for assessing the outcome of psychoanalysis. The aim is to demonstrate, through a case presentation, how therapeutic change can be expressed in the AAI. The pre‐ and post‐treatment interviews of one patient, having completed a four‐times‐a‐week psychoanalysis, are presented. It is demonstrated that the detailed discourse analysis of the AAI, based on transcribed tape‐recorded interviews, focuses subtle formal elements of language and speech reflecting dominant patterns of affect regulation and object relating. The AAI text analysis provides possibility for coding procedural memory as conveyed by the handling of the relationship to the interviewer, incorporating the dynamic relationship between researcher and subject and thus complying with a methodological prerequisite regarded by many psychoanalysts as necessary for capturing data that are relevant to psychoanalysis. On this background, the method emerges as promising for psychoanalytic outcome studies.

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.

Attachment theory and psychoanalysis: controversial issues

On the present theoretical arena of psychoanalysis, attachment theory has obtained increasing attention, especially from psychoanalysts interested in empirical research. This paper presents the controversies raised by Bowlbys theory, and discusses the relationship between attachment theory and psychoanalysis. Although Freud and Bowlby differ in their image of Man, ideas developed within attachment theory have parallels in those of psychoanalytic object relation theories, both with regard to the conceptualisation of motivation and the understanding of the origins of psychological disturbances. As regards therapy, the emphasis on the “emotional availability” of the analyst is highlighted. It is concluded that Bowlbys theory does not, however, contribute specifically to analytic technique. Bowlbys main concern is the interpersonal and traumatic origins of psychological disturbances, rather than the patients fantasies and constructions of narratives.

Who is 'who' in dissociation? : A plea for psychodynamics in a time of trauma'

Contemporary theories of dissociation and trauma for the most part have evolved outside of psychoanalysis. Psychoanalytic writings have also been regarded as being in opposition to trauma‐based notions of human psychopathology. The specific psychoanalytic contribution—the emphasis on unconscious conflict and meaning—is for the most part excluded from the discourse on dissociation, often resulting in a mechanic conceptualisation of trauma. In this paper, based on clinical material, the author argues in favour of including conflict, unconscious intention and personal meaning in understanding the kind of dissociation we see in cases of multiple personality pathology. Textual analysis of letters written to the analyst illustrates how events of abuse are defensively elaborated. The author demonstrates that patterns of affect regulation and dominant object–relational strategies can be captured through analysis of the discourse structure. She focuses on how an organised character pattern, revealed mainly through narrative style and the analysts countertransference, serves protective purposes as well as wishfulfillment. She argues that dissociation in the form of multiple personalities may imply an active, strategic agent.

In the beginning was the affect

The paper argues that affect represents an immediate evaluation of the environment, informing us about our experience of ourselves in the world and providing a basis for action. The perception of other peoples emotions is a process occurring rapidly, automatically and subliminally—it comes first. Between analyst and patient, an automatic emotional scanning takes place. Affect also represents a non-verbal “language “functioning as an unconscious communication. In a clinical vignette, a distinction between verbalised affect and immediate transference affect is highlighted. It is argued that affect may be present as implicit, emotional procedures and ways-of-being that actualise qualities of internalised object relations that are not easily expressed semantically or symbolically. The status of affect within contemporary psychoanalytic theory is summed up in five points. (1) Affect represents an immediate evaluation of the environment. (2) Affect is disconnected from drives. (3) Affect is communication. (4) Affect guarantees the continuity of the self. (5) Affect is incorporated into self-other relations and representations.

One depression or many

This article takes as its starting point a paper by Hugo Bleichmar presented at the 2003 Joseph Sandler Research Conference on Depression. The author argues in favour of viewing depression in a broad perspective. The Freudian prototype of “guilty depression” represents only one of many pathways leading to depressive states. Psychoanalytic understanding of depression should represent a multidimensional approach, characterised by interacting determinants, both internal and external. In clinical practice, this would imply an attitude of greater freedom and flexibility in the analyst. The paper compares the psychoanalytic account of depression with that given by the cognitive approach. It is argued that within a diverse research field, where depression is studied from different angles—as a disorder of the brain and in terms of cognitive deficits—the contribution of psychoanalysis is that depression is most usefully studied at the level of psychological causation. The psychoanalytic understanding of depressive states in terms of unconscious interpretation and meaning of experience represents a distinct contribution. Implications of viewing depression as an “illness” are discussed.

Evaluating psychoanalytic therapy

The article discusses problems pertinent to the evaluation of psychoanalytic therapy. Psychoanalytic therapy aims at changes that are unique, and that are difficult to capture objectively. Traditional outcome research has not yet managed to capture these changes in a systematic way. Therefore, comparative research has not done justice to the distinctive character of psychoanalytic therapy. The author argues that the transference, expressing structures of internalized object-relations, occupies a privileged position as an observational basis for therapeutic change. Countertransference represents a royal road to capturing affective qualities of old, repetitive dialogues, and thereby attains status as a tool of research, specifically aimed at registering changes in interactional patterns, that are particular to psychoanalytic therapy. As long as satisfactory solutions to the complex methodological problems connected with evaluating psychoanalytic therapy, have not been found, the time has not yet come for co...

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).

Disclosure or non-disclosure?

Contemporary supervision discussions often imply that non-disclosure may hinder the learning process of a supervisee. However, is disclosure always a benefit? What are the consequences of non-disclosure—or disclosure—for a student therapists training? These questions are discussed through an in-depth analysis of longitudinal data from a single-case study of a student therapist conducting his first psychodynamic therapy. The perspectives of the student therapist, the supervisor, the patient and the research interviewer, are included as data, as well as an independent competence evaluation. The student therapists non-disclosure of negative feelings towards the supervisor—and the supervisors neglect of the students inner drama—did not seem to affect his learning process, which progressed in a very constructive manner. Perhaps remaining silent was an expression of self-respect? With regards to the supervisor, it is assumed that recognition and acceptance of the student therapists anxiety could have diminished the unfolding inner drama.