Estudios de proceso

A specimen session of psychoanalytic therapy under the lens of the Psychotherapy Process Q-set
Raymond A. Levy, Stuart Ablon, Julie A. Ackerman, Carolina Seybert, Horst Kächele

In many instances the clinical arena of psychoanalysis has been shaped by model examples starting with Freud famous specimen dream about Irma that has become the repeated object of secondary analyses (f.e.Erikson 1954). In the same vein the Dora-case (Freud 1905) has retained a prestigious pivotal position in availing itself to continous re-elaboration and re-interpretation (Sachs 2005). However few detailed examples are available to extended scrutiny where ‘primary data’ (Luborsky & Spence 1971) are at hand. The Ulm study group on psychoanalytic process research in many details has analyzed atape-recorded psychoanalytic treatment, the case of Amalia X (Kächele et al. 2006). The treating analyst himself considered the session 152 as a specimen example of modern psychoanalytic technique when he presented this session to the participants of the International Psychoanalytic Congress in 2004 (Thomä & Kächele 2007). This session was debated by a fair number of experienced psychoanalysts (Wilson2004). Among those the clinical evaluation by Akhtar (2007) was especially strong in pointing out the key features of the analyst´s technique in this session:
„Dr. Thomä’s technique shows flexibility, resilience, and broad-mindness. It is centered upon helping the patient achieve ego freedom though interpretation and transference resolution. However, it incorporates a variety of listening attitudesand a broad range of interventions that can be seen as preparatory for, as well as in lieu of, the interpretive enterprise“ (Akhtar 2007, p. 691).
This session – available for further scrutiny to all researchers in the field[1] - provided a good opportunity to test the sensitivty of the Psychotherapy Q-Set developed by E. Jones (2000).
Rating a psychotherapy session utilizing thePsychotherapy Process Q-set (PQS) provides an empirical description of the process of that individual session that is suitable for quantitative analysis and offer process ratings as determined by the PQS. We first present an introduction to the PQS and a brief description of the prescribed approach for rating an hour. We then review our ratings of Session 152 of the aforementioned case, and provide amore detailed narrative of our impression of the hour in the context of our rating with the PQS.

Empirical Study of Psychoanalysis
A central difficulty for psychoanalytic research lies in designing quantitative methods that preserve the depth and complexity of clinical material while conforming to the requirements of empirical science. In order to use empirical data to testpsychoanalytic constructs, clinical phenomena must be intersubjectively observable, which means that different judges can independently agree about their characteristics and whether or not they occur. Disagreements about the interpretation or meaning of the same case material are commonplace in clinical work and constitute important grounds for criticism of the scientific status of psychoanalytic methodsfor acquiring knowledge. A particular problem is that clinical observers may vary a great deal in the concepts they use and in their descriptive language. Observers of the same case material may not arrive at the same conclusions; indeed, they may not even consider the same dimensions of the psychotherapeutic process. The issue of handling differences in inference or judgment among clinicalexperts is particularly important since there are alternate theoretical models within psychoanalysis itself.

The Psychotherapy Process Q-set
One solution to the consensus problem is to attempt to refine ordinary clinical judgment. An approach that does this in a sophisticated manner is Q-methodology (Stephenson, 1953; Block, 1978). The Q-technique is a method of measurement with a broad...