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Chair: Margaret-Ann Fitzpatrick-Hanly
Panelists: Marina Altmann de Litvan and Steven H. Goldberg
Reporter: William Glover
The Panel continued a series of programmes on the work of the Clinical Observation Committee held at previous IPA Congresses in Mexico City, Prague and Boston. Transformations in the fear of intimacy were discussed using findings from a case studied by two different Clinical Observation Groups using the same clinical material and working with the 3-level model (3-LM) for observing patient transformations (Altman de Litvan, 2014).
Marina Altman began by introducing the panel and briefly describing the 3-Level Model and work of the Clinical Observation Committee. Cases are intensively studied by small groups using the 3-LM to track change at different points of an analysis on a spectrum of diagnostic dimensions derived from psychoanalytic nosology. In Level 1 Clinical Observation, groups discuss the material at the phenomenological level using only the language of the patient and analyst in the verbatim text. Key metaphors spontaneously emerge in the material and in the group's associations that capture in condensed form the patient's core issues. The patient's presenting problems appear in the associations, enactments, metaphors, and the analyst's initial countertransferences and become ‘anchor points’ that convey the patient's experience and psychic functioning in palpable ways that orient the group and from which change can be observed.
In the more systematic examination of Level 2, the observations of change and no change in these metaphors and the changes within them are correlated with conceptual language and diagnostic dimensions. Given the time constraints of this Panel, changes in metaphors expressing a single core issue of the patient, linked to ‘fear of intimacy’, were demonstrated and discussed. Fear of intimacy was related to several of the 3-LM dimensions of change: Patterns of Interpersonal Relationships, Perceptions of Self and Other, an