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This panel was organized by the Clinical Observational Committee of the IPA (ipa.world), which has developed the Three-Level Model (3-LM) methodology for observing patient transformations (Bernardi 2015; Bernardi and Eidlin 2024, 2025). This method allows for in-depth clinical reflection on change and non-change in long psychoanalytic processes. It has been used as a powerful tool both for research (Rodríguez Quiroga et al. 2023) and for psychoanalytic training (Altmann de Litvan 2014; Hanly, de Litvan, and Bernardi 2021).
At an initial meeting, held online in February 2025, members of the IPA Clinical Observational Committee – including the panel presenters – discussed a clinical case (appropriately modified to guarantee confidentiality), applying the 3-LM methodology. The reflections, clinical discussions and conclusions presented by the speakers in this panel were “inspired” by the work of this group.
Mónica Eidlin, from Uruguay, presented the first panel paper, with the title “From Psychotherapy to Psychoanalysis”. She introduced an impressive clinical case of a young woman who, from the beginning, gave the impression that a “tornado had entered the office”: confusing, very distressed, pressuring and challenging the analyst. The carefully prepared clinical material referred to different phases of the treatment, highlighting mental functioning, the organization of the transference–countertransference relationship and the main transformative movements.
At the start, the patient’s emotional instability, agitation, intense anxiety, profound depression and risky, self-destructive behaviours (drug abuse, acting out) led the analyst to begin with transference-focused psychotherapy. Feeling somewhat powerless, the analyst witnessed the patient “playing with her own life”, condensed in her own expression as “trampling and not being trampled”, and also enacted in the transference.
Mónica highlighted c