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Patients and Therapists Interviewed in the Midphase of Psychoanalytic Psychotherapy

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Patients and Therapists Interviewed in the Midphase of Psychoanalytic Psychotherapy University of Massachusetts Amherst ScholarWorks@UMass Amherst Doctoral Dissertations 1896 - February 2014 1-1-1997 Finding our way : patients and therapists interviewed in the midphase of psychoanalytic psychotherapy. Jennifer C. Nash University of Massachusetts Amherst Follow this and additional works at: https://scholarworks.umass.edu/dissertations_1 Recommended Citation Nash, Jennifer C., "Finding our way : patients and therapists interviewed in the midphase of psychoanalytic psychotherapy." (1997). Doctoral Dissertations 1896 - February 2014. 3270. https://scholarworks.umass.edu/dissertations_1/3270 This Open Access Dissertation is brought to you for free and open access by ScholarWorks@UMass Amherst. It has been accepted for inclusion in Doctoral Dissertations 1896 - February 2014 by an authorized administrator of ScholarWorks@UMass Amherst. For more information, please contact [email protected]. FINDING OUR WAY: PATIENTS AND THERAPISTS INTERVIEWED IN THE MIDPHASE OF PSYCHOANALYTIC PSYCHOTHERAPY A Dissertation Presented by JENNIFER C. NASH Submitted to the Graduate School of the University of Massachusetts Amherst in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY February 1997 Psychology (c)Copyright by Jennifer C. Nash 1997 All Rights Reserved FINDING OUR WAY: PATIENTS AND THERAPISTS INTERVIEWED IN THE MIDPHASE OF PSYCHOANALYTIC PSYCHOTHERAPY A Dissertation Presented by JENNIFER C. NASH Approved as to style and content by: ^ £ Edmund P. DeLaCour, Member \aJLl Melinda Novak, Department Head Department of Psychology ACKNOWLEDGMENTS First and foremost, I thank my family whose love and support made this work possible and who had the patience to watch it develop. My thanks to my dissertation committee and to my committee chair - and advisor, and supervisor - David Todd, for his friendship, his evenhanded curiosity, and his gentle example as a therapist. My affection to my close friends and colleagues with whom I shared our journey. Finally, my love, gratitude, and regret to my therapist who waded in with me in faith and love, who taught me how to swim, and with whom I swam deeply. IV ABSTRACT FINDING OUR WAY: PATIEN TS AND THERAPISTS INTERVIEWED IN THE MIDPHASE OF PSYCHOANALYTIC PSYCHOTHERAPY FEBRUARY 1997 JENNIFER C. NASH, B.S., UNIVERSITY OF PENNSYLVANIA M.S., UNIVERSITY OF MASSACHUSETTS AMHERST Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by Professor David M. Todd As relational theory (set out by Greenberg and Mitchell, 1983; Mitchell, 1988) challenges psychoanalytic psychotherapists to reconsider mutual influences in therapeutic interaction (Aron, 1996), this research explores those effects using methods consistent with new psychoanalytic technique. The midphase was studied from patient's and therapist's perspectives, emphasizing 1) the patient's perceptions of the therapist's contribution, 2) the patient's experience of technique and the therapist's authenticity, 3) the conditions in which the pair involve a third in the treatment, 4) attitudes of psychotherapists in private practice to the study, and 5) the effects of research intervention on treatments underway. Unstructured interviews were conducted with volunteer pairs from a psychoanalytically oriented mental health clinic and, following ethnographic interviews of therapists in private practice, with two therapists in private practice and five of their patients. Most psychotherapists who participated in interviews with patients identified themselves as Control-Mastery practitioners (viz., Weiss, Sampson, and the Mount Zion Psychotherapy Research Group, 1986), a phenomenon possibly related in part to (making theoretical emphasis on the patient's autonomy and the theory's empirical roots patients would therapists more likely than others to create an environment in which volunteer). v Patients at the t ransference threshold (briefly, when patients acknowledge emotional complication in the relationship) were anxious about upcoming problems in the therapy relationship and were relatively ignorant of the therapeutic utility of the transference. The patient who volunteered in a transference muddle feared his treatment had reached an impasse after much work in the transference. Most patients used interviews to evaluate the appropriateness of their and their therapist's emotions in the treatment, to compare their therapists with another therapist, and as an opportunity for trial disclosures. Many were much closer to termination than their therapists knew. Patients prefered authentic interaction with therapists and had much to say about them, leading the researcher to question the proportion of repression to discretion in patients' conduct in treatment. It was felt that research interviewing of this kind could be very productive empirically and clinically when including open exploration among all participants regarding the potential and function of the encounters. vi PREFACE This study was designed to begin to explore the patient’s experience of the therapist; in particular, what the patient sees of the therapist's contribution to the therapeutic puzzle and the role of the therapist's "realness" or authenticity to the patient. I began from my experience as patient and therapist, having found my own therapist's immediacy profoundly helpful in my treatment and having observed crucial moments in my work as a therapist in which I offered the patient, either purposely or inadvertently, something spontaneous, something real. I believe these moments affirmed to all of us the authenticity of the relationship and the efficacy of growth in evoking healthy responses from the other. My questions arose primarily from my own efforts to find a way of interacting in my personal therapy that would address some of my needs, among them, to understand my impact and to reconcile what I was seeing with what was being said. As many others probably have, I was seeking new technique until I discovered the wealth of new work in psychoanalysis emphasizing the mutuality of the relationship and the technical changes consistent with it. To this extent, then, the study is theory-driven. I wanted to see how other dyads worked with the relationship, whether other patients sought what I had sought, whether other therapists had changed their technique as I had in my work as a therapist, and how their patients may have been responding. When an impasse seemed inevitable in my therapy, I had more questions concerning how and when consultation could be helpful and what the effects of intervention might be. Anguish at the looming impasse of my own treatment motivated the research, a motivation tempered by my commitment to the necessary illusions of the treatment, the - the belief that patient potential space. I come to this - clinical work and the research with analyzed and and therapist devise a realm together which is a mix of each of their histories, product of their unanalyzed, their characteristic responses to each other, and the new about what transpires. Among the relationship. I also believe that much is not knowable vii biggest challenges to me here has been in finding a balance between what Christopher BoHas calls, dreaming up the patient" (1987) and the need to recognize the patient's perspective on the therapy relationship which includes her* perceptions and understanding of that relationship and of the therapist, a view all the more important if the therapy is foundering. I recognize that there are times when I may speak strongly, may range farther from the data than some readers might prefer into speculation motivated and informed by my own sense as patient and as therapist. I chose to keep this material that arises out of my own passionate experience rather than eliminate what the reader may need to know in order to understand and evaluate this enterprise which is so preliminary and exploratory in method and aim. At the outset, then, I acknowledge the following biases based on an indescriminable mix of assumption and observation: People begin life sensing what is best for themselves which years of life- training and fear may obscure; Patients are fundamentally interested in getting better and will work hard to facilitate their treatments and repair damage; Psychotherapists, despite and because of their professional training, can be blind to the limitations that theory itself places on the ways in which they listen to and understand their patients, and can underestimate patients' capacities to be theorists with something to offer to the understanding of the particulars and generalities of the therapeutic process in which they are involved; Psychotherapists may misjudge the degree to which the conditions and the techniques of the therapies limit what patients are able to do with them; The inherent group dynamics of a dyadic situation influence the therapy more than we know given the ever-changing admixture of preoedipal and oedipal concerns of both patient and therapist. The unspoken third may be represented * to refer to the patient and male personal 1 have chosen to use female personal pronouns people are cited. The choice makes pronouns to refer to the therapist except in cases in which particular between (and relating to the discrimination between referents easier while reflecting the historical differences discussed here in an essentially genders of) the participants in power and authority, a difference relationship (Aron, 1996). feminist/relational critique of classical conceptions of the therapy last names, for example, Dr. B, and patients
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