Analytic educators looking for new ways to help candidates and colleagues study the work of psychoanalysis might consider a carefully crafted and well-studied set of methodologies that have their origins in Europe. These can complement the more traditional methods used within our institutes of literature study, supervision and clinical case presentations commented on in a general way by experienced analysts. These approaches have the benefit of using experience-near language, rather than jargon, in their descriptions of psychoanalytic work and of elucidating how analysts from different theoretical schools think about and work with their patients.
In 2001, the European Psychoanalytic Federation began to fund an effort to study how psychoanalysts across different schools think and practice, in order to closely examine what they shared and how they differed. Gradually a number of discrete methodologies emerged, each based on the close examination of sessions from actual psychoanalytic cases, although with different areas of focus and manners of working. David Tuckett and numerous co-authors outlined the process of the Working Parties' development, in particular the Comparative Clinical Methods (CCM) project, in Psychoanalysis Comparable and Incomparable: The Evolution of a Method to Describe and Compare Psychoanalytic Approaches (2008), published by Routledge Press.
In 2008, Abbot Bronstein received an IPA grant to bring four of the central Working Party (WP) groups to North America. He became the chair of the Comparative Clinical Methods Working Party here, with Marie Rudden as co-chair. Current members of the North American CCM Working Party are Erik Gann, Phyllis Cath, Martin Gautier (Montreal), Gilda Sherwin and Robert White.
Moderators groups were trained for each of the WPs by experienced European moderators and consisted of analysts from the broad range of institutes affiliated with the North American Psychoanalytic Confederation (NAPsaC). A few years later, the IPA also funded the effort to bring these groups to Mexico and to Central and South America. Currently, the IPA is sponsoring a Committee on the Working Parties chaired by Ruggero Levy for the WPs among the different regions to share their observations and experiences via a series of papers and symposia, as well as to bring papers from the Working Parties to the different regional conferences.
The Comparative Clinical Methods system was based on three steps and the understanding that 1) each psychoanalyst presenting sessions from one of his/her ongoing treatments was to be regarded as practicing psychoanalysis, and 2) the aim of studying the work was not to supervise but to understand the analyst's particular way of working.
Step 1. Clinical groups consisting of trained CCM moderators and 8-15 IPA affiliated analysts would meet over the course of two days to examine each interpretation, prolonged silence or statement uttered by the presenting analyst during three or four analytic sessions with the same patient.
Each intervention would be looked at in terms of what the analyst seemed to be trying to accomplish: Was the analyst setting or maintaining the analytic frame, trying to elicit an unconscious response (for example, responding to a patient's utterance by mentioning one evocative aspect of it: “Teeth!”), consciously clarifying something the patient was speaking about, addressing an element of the unconscious relationship to the analyst expressed in the “here and now,” offering a complex interpretation that included genetic reconstructions, or doing something that was anomalous to the analyst's usual way of working— thus related to countertransference or an enactment?
Step 2. The pattern of the analyst's interventions was then studied as the group attempted to tease apart the following questions: What does this analyst think is wrong with his/her patient (theory of psychopathology), what does the analyst listen for in his/her patient's utterances (theory of analytic listening), how does the analyst seem to think analysis will help his patient (theory of therapeutic action), what does the analyst do to further this process (theory of technique), and how does the analyst seem to regard the situation between analyst and analysand (theory of transference)?
As these aspects of the analyst's work are considered, experience-near descriptions must be used (as opposed to analytic terminology, as many analytic terms refer to different phenomena across different schools) to defend the different ways of seeing the analyst's work. Sometimes group processes are observed that may be detracting from the study group's work. The moderator's job is to identify these and invite the group to understand what these processes may be about. For example, is something being responded to about the patient's difficulties or about the analyst's struggle with the patient that needs to be put into words to help the group work together better?
The clinical group members gradually assemble their views of the particular analyst's explicit and implicit ways of working and discuss their understandings with the presenter to develop a deeper understanding of his or her method of working.
Step 3. The Working Party—the group of trained moderators—meets to consider the same material in comparison with other cases they have examined. The Working Party uses the accumulated group of cases to look at various issues: When analysts see themselves as working in the “here and now,” what does that mean? Are there different methods analysts are using when they see themselves doing this? How do analysts conceive of the “working alliance or therapeutic relationship,” in relation to the transference? How do they conceive of themselves as particular kinds of objects for their analysands?
In North America, about 35 study groups have met and studied the work of 35 psychoanalysts. We have also had access to summaries of the approximately 70 cases studied in Europe. In addition, the method has recently expanded to include studying child psychoanalytic cases, considering, for example, what constitutes interpretation in these analyses.
CCM moderators have often noted a good deal of enthusiasm from both candidate study group members and experienced analysts. Candidates find the method itself, delineating five different dimensions of theory and practice analysts bring to their work, to be instructive and thought-provoking. Senior analysts often comment that the method proves useful as they supervise candidates, helping them to identify with their trainees the kinds of interventions they tend to make and the ways in which they work along the different dimensions. In addition, listening carefully and systematically to presenting analysts who work from different schools of analytic thought can help study group members understand these approaches more deeply.
In examining our cases, the CCM clinical groups in Step Two and the moderators group in Step Three observe how each analyst's series of interventions embody aspects of their underlying, implicit theories.
We noted, for example, the ways in which some analysts, regardless of their very different theoretical backgrounds, focused their interpretations based on their assessments of their patients' underlying object relations. One analyst, for example, thought interventions addressing his patient's occasional, tentative attempts at connection did not make sense: He saw her as quite schizoid, with a fragmented sense of self and others. These utterances on her part were overlooked in favor of those that articulated, instead, her lack of conviction that her analyst maintained a coherent vision of who she was or that addressed her anxiety about her own internal fragmentation. Her analyst's interventions were couched in terms that were both sophisticated and richly metaphorical, while remaining impersonal. It seemed he felt acknowledging their relationship, rather than simply observing it, would threaten his analysand's schizoid defenses. In addition, he seemed to see his role in the therapeutic relationship as that of a removed commentator, even as he regularly formulated most interventions in terms of what he surmised the analysand was experiencing in the room with him. Thus, the meaning of transference, for this analyst who saw himself as regularly interpreting “in and around it” was quite particular. He did not think his patient had actual transference fantasies, but instead had “proto-fantasies,” which if addressed might eventually result in more coherence in his analysand's construction of self and others.
By contrast, another analyst formulated her interpretations in metaphors that arose from an ongoing dialogue with her patient about a particular art form in which they each shared an interest. The analysand often finished her analyst's sentences. They clearly had a lively working relationship. This analyst regularly made deep, elaborated interpretations of both sides of her patient's transferences, not only her longings to receive special “gifts” from the analyst, but also her intense envy and wishes to extract whatever she could from her.
The analyst did this despite the fact she saw the patient as having significant difficulty with acknowledging her very hostile dependent transference: The analyst felt the patient's central difficulties were based on affective storms connected to highly conflicted and ambivalent self and object representations, and each side required interpretation. Interestingly, this analyst, who regularly interpreted the transference, seemed to regard her patient's transferences as connected only to her parents as she experienced them (sometimes in fantasy), and as not truly involving the analyst herself. This, too, represented a very particular formulation of transference.
There is no research that suggests one theory or technique of psychoanalysis has superior results. Rather, the different approaches stress different ways of formulating psychopathology, technique, the analytic situation and therapeutic action. Listening respectfully to diverse treatments can lead to a clearer understanding of how psychoanalysis, in all its different forms, is actually practiced. It can also clarify the limitations and strengths of each approach.
We have found the CCM clinical workshops can clarify some misunderstandings about how analysts from different schools of thought actually think and work. Further, they challenge both presenters and participants to sharpen their thinking about five different dimensions of theory and practice. We have also found that insisting on plain, descriptive language rather than theoretical constructs in our clinical discussion has minimized the confusion over the vastly different ways in which different psychoanalytic schools use the same terminology. Each of these objectives offer something important to our participants' ongoing education in psychoanalysis.
From the Issues in Psychoanalytic Education Editor
The article by Abbot Bronstein and Marie Rudden describes the ongoing work of the Comparative Clinical Methodology Study first initiated by the IPA, now in its second decade. Converging with the present reformation of APsaA's educational structures, the inquiries into and fine-tuning of these developing methodologies add novel dimensions to the intradisciplinary integrations in modern psychoanalytic learning.
—Luba Kessler
The Comparative Clinical Methods Clinical groups meet for one and a half days just before the APsaA spring and winter meetings and are advertised in the meeting announcements. They offer CME credit for the 10.5 hours of
participation.
Editor's Note:
For further information on the research resources in this article, please contact the authors at and .