Epilogue: Studying How Psychoanalytic Treatments Work and for Whom

Each of these articles captures and assesses an element of importance in psychoanalytic treatments: developing the capacity to reflect on motives and behaviors in oneself and others (Rudden), addressing the therapeutic alliance (Falkenström and Larsson) and defense mechanisms (Perry and Bond), and bringing into awareness dynamics and conflicts that contribute to symptoms (Ulberg et al.). The authors demonstrate how changes in these factors can lead to symptomatic and characterological change, and how each mechanism is clinically relevant. Luyten et al. call attention to the difficulties and importance of addressing the trait of self-critical perfectionism, and provide a series of ideas as to how psychotherapy works, as viewed through the two-polarities model. The capacity to measure these factors creates the opportunity to identify at which points and for which patients various interventions may be of most value.

In this regard, in addition to evaluating a specific mechanism of change, studies will ultimately need to address how the therapist chooses a particular pattern of interventions targeting particular moderators or mediators. For example, a therapist identifies that a patient becomes unassertive and anxious after feeling bullied by someone else, but denies being angry, believing he may have done something to provoke the response. The therapist may initially explore the defense mechanisms of denial of anger and reaction formation. After establishing that anger is, indeed, present, the therapist would help the patient gain insight into particular angry unconscious fantasies, such as vengeful wishes. At various points the therapist will need to attend to the therapeutic alliance, which may be strained by the process of addressing the patient’s denial. Helping the patient explore anger toward the therapist can aid in further improvement in symptoms (reduced anxiety) and functioning (assertiveness). Identifying the therapist’s basis for choosing amongst these vario