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This study examines how reflective functioning (RF) can be assessed in analytic sessions and throughout psychoanalytic psychotherapy. The goals are to replicate in part a study by Josephs and colleagues (2004) by applying the RF Scale to analytic sessions and to study fluctuations of RF within each session. Additionally, RF based on sessions was compared with the RF ratings based on the Adult Attachment Interview (AAI) during the course of two psychoanalytic psychotherapies with a duration of 240 hours. RF changes based on 10 sessions per patient, assessed at baseline and after 80, 160, and 240 hours of therapy, and RF changes based on AAI ratings measured at baseline and after 240 hours of therapy, and in one case at follow-up, were related to changes of symptoms and attachment classifications over time. Results showed that in both cases RF fluctuated within sessions. The average RF rating per session
Susanne Hörz-Sagstetter, Member, German Society for Psychoanalysis, Psychotherapy, Psychosomatics, and Depth Psychology (DGPT); Professor of Psychotherapy, Psychologische Hochschule, Berlin; Research Associate, Department of Psychology, Clinical Psychology, Psychoanalysis, and Psychodynamic Research section, Ludwig-Maximilians-Universität, Munich. Wolfgang Mertens, Professor Emeritus, Department of Psychology, Clinical Psychology, Psychoanalysis and Psychodynamic Research section, Ludwig-Maximilians-Universität, Munich; Training and Supervising Analyst (DGPT). Sybille Isphording, psychoanalytic candidate; private practice, Munich. Anna Buchheim, Member, IPA and DGPT; Professor and Chair for Clinical Psychology, Department of Psychology, Leopold-Franzens-Universität, Innsbruck. Svenja Taubner, Member, German Psychoanalytic Society; Chair for Clinical Psychology and Psychotherapy, Alpen-Adria-Universität, Klagenfurt, Austria.
This work was supported by the Köhler-Stiftung / Stifterverband für die Deutsche Wissenschaft, Baumgart-Stiftung, and the Bayerische Gleichstellungsförderung (BGF). The authors thank Susanne Stegmaier for contributing to the data analysis. Parts of this article were presented in a poster presentation at the Winter Meeting of the American Psychoanalytic Association, New York, January 13-17.
Submitted for publication March 11, 2014.
increased over the course of treatment, while the AAI-based RF rating needed longer to increase. Rather good correspondence was found between session-based RF ratings and independent AAI-based RF ratings. In both cases, changes in RF over time were compared to changes in attachment classification based on the AAI and to symptomatic change. Better correspondence between symptomatic and attachment changes was found with the AAI-based RF rating. It was tentatively interpreted that session-based RF ratings may represent a state of RF that is strongly influenced by the therapist-patient interaction, whereas AAI-based RF can be considered to have more trait characteristics.