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Chair: Robert White
Presenters: Siri Erika Gullestad, Luisa Pérez Suquilvide, Robert White
Discussant: Margaret Ann Fitzpatrick Hanly
The IPA Clinical Observation Committee has pioneered a method to track transformations in patients along analysis, called the Three-Level Model (3-LM). In a group of peers, a psychoanalyst presents clinical hours from the beginning of an analysis, a middle section, and a later section, typically over 4-6 years of work. The group develops themes from the beginning sections, called anchor points, and follows those themes in the later material, observing the presence of negative change, no change and positive change. The work of the group is always bottom-up, starting with the phenomenological description and avoiding school terminology. In level two, the themes are sorted into categories of psychological functioning, allowing the group to understand in what functional areas there has been change or not.
After 10 years of work with this model, for this panel the focus chosen was level three, “Explanatory hypotheses of change”. Looking at the analyst’s interventions and the patients’ responses, the aim was, through microanalysis of the therapeutic dialogue, to explore mechanisms of change - although, as Siri Gullestad addresses, one cannot abstract mechanisms of change by looking solely at the analyst’s interventions.
The work remains bottom-up, taking as a unit a theme of the patient, how the analyst intervened, and how the patient then heard the intervention. Examples of questions are: What is the intent of the analyst? To what psychic space was the intervention addressed? To what level of consciousness? To wish or defence? Conflict or deficit? And finally, how was the intervention heard by the patient and did it produce change? Not all these questions were addressed in this panel.
In this panel three different clinical materials were presented. Ana, David and Kim’s cases belong to three main regions of the IPA: Latin America, North America a