Understanding Transference: The Core Conflictual Relationship Theme Method

This study developed a measure of the accuracy of therapists' interpretations based on the core contliclual relationship theme method and examined the relation of accuracy to the outcome of dynamic psychotherapy. Accuracy was assessed on therapists' interpretations from two early-intreatment sessions of 43 patients receiving moderate-length dynamic therapy. The results indicated that accuracy about the main wishes and responses from others that were expressed in the relationship themes was significantly related to outcome, even after the effects of general errors in treatment techniques and the quality of the helping alliance had been controlled for. Our hypothesis that accurate interpretations would have their greatest impact in the context of a positive helping alliance was not confirmed.

The accuracy of therapists' interpretations and the outcome of dynamic psychotherapy.

Repression has become an empirical fact that is at once obvious and problematic. Fragmented clinical and laboratory traditions and disputed terminology have resulted in a Babel of misunderstandings in which false distinctions are imposed (e.g., between repression and suppression) and necessary distinctions not drawn (e.g., between the mechanism and the use to which it is put, defense being just one). "Repression" was introduced by Herbart to designate the (nondefensive) inhibition of ideas by other ideas in their struggle for consciousness. Freud adapted repression to the defensive inhibition of "unbearable" mental contents. Substantial experimental literatures on attentional biases, thought avoidance, interference, and intentional forgetting exist, the oldest prototype being the work of Ebbinghaus, who showed that intentional avoidance of memories results in their progressive forgetting over time. It has now become clear, as clinicians had claimed, that the inaccessible materials are often available and emerge indirectly (e.g., procedurally, implicitly). It is also now established that the Ebbinghaus retention function can be partly reversed, with resulting increases of conscious memory over time (hypermnesia). Freud's clinical experience revealed early on that exclusion from consciousness was effected not just by simple repression (inhibition) but also by a variety of distorting techniques, some deployed to degrade latent contents (denial), all eventually subsumed under the rubric of defense mechanisms ("repression in the widest sense"). Freudian and Bartlettian distortions are essentially the same, even in name, except for motive (cognitive vs. emotional), and experimentally induced false memories and other "memory illusions" are laboratory analogs of self-induced distortions.

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The unified theory of repression.

As with all systematic models of therapy, cognitive therapy distills a theory to the understanding of particular cases through the case formulation method. This article sets out criteria to evaluate whether cognitive case formulation follows the process of scientific inquiry, and it questions whether the formulation method meets these criteria. In terms of the evidence base for the cognitive theory that underpins cognitive case formulation, the research suggests that although the descriptive elements of cognitive theory are substantiated, the explanatory elements have received less support. In terms of the scientific status of the cognitive case formulation process, current evidence for the reliability of the cognitive case formulation method is modest, at best. There is a striking paucity of research examining the validity of cognitive case formulations or the impact of cognitive case formulation on therapy outcome. Implications for the clinical use of cognitive case formulation within a scientist-practitioner model are discussed, and potential programs of research to evaluate the case formulation method are described.

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Is Cognitive Case Formulation Science or Science Fiction

I. Towards the Objective Analysis of Psychodynamic Structures.- Problem-Treatment-Outcome Congruence: A Principle Whose Time Has Come.- The Specimen Hour.- Converging Evidence for Emotional Structures: Theory and Method.- Frames of Mind.- A Scheme for Coding the Patient's Experience of the Relationship with the Therapist (PERT): Some Applications, Extensions, and Comparisons.- The Assessment of Transference by the CCRT Method.- A Comparison of Three Transference Related Measures Applied to the Specimen Hour.- Application of the CCRT: A Measure of Adequacy of Therapist's Interpretation and a Measure of Patient's Self-Understanding.- Testing Hypotheses of Psychotherapeutic Change Processes.- Developing an Instrument for Characterizing Psychotherapy Techniques in Studies of the Psychotherapy of Borderline Patients.- Artificial Intelligence as a Basic Science for Psychoanalytic Research.- II. The Evolution of Single Case Study Methods.- Audio-Recordings of the Psychoanalytic Dialogue: Scientific, Clinical and Ethical Problems.- The Ulm Textbank Management System: A Tool for Psychotherapy Research.- Time-Series Analysis of Psychoanalytic Treatment Processes: Sampling Problems and First Findings in a Single Case.- Different Types of Suffering during a Psychoanalysis: A Single Case Study.- The Emotional Insight Rating Scale.- Facial Indicators of Transference Processes within Psychoanalytic Treatment.- What Makes Psychoanalysts Tick? A Model and the Method of Audio-Recorded Retroreports.- From Calvin to Freud: Using an Artificial Intelligence Model to Investigate Cognitive Changes during Psychoanalysis.- References.- Name Index.

Keith J. Alexander

Papers

A verification of Freud's grandest clinical hypothesis: The transference

Repressive style and relationship patterns—three samples inspected