Beyond dualism: psychoanalysis and medication in the 21st century.

Dualistic thinking continues to pervade psychoanalytic views of psychopathology. The author points out the shortcomings of this perspective as represented in Mark Swoiskin's article, "Psychoanalysis and Medication: Is Real Integration Possible?" She contends instead that the latest scientific evidence does not support a dichotomy between organic (biological) and psychodynamic (nonbiological) factors in psychopathology. She presents two cases to illustrate both the challenge and the importance of reformulating psychoanalytic views in an integrated, holistic way.

The Columbia Supervision Project: data from the dyad.

Anonymous questionnaires were sent to all candidates and supervisors at the Columbia University Center for Psychoanalytic Training and Research (hereafter "Columbia"). Questions focused on the four domains most emphasized in the literature on supervision: logistical issues; the "teach or treat" question; the evaluatory function of the supervisor; and the affective experience of supervision. By coding the questionnaires, anonymity of respondents was maintained while allowing for a matched pair of analyses of supervisors and supervisees. Return rate was over 85 percent. In general, rates of satisfaction with supervision were high, and candidates and supervisors agreed on such issues as the "teach or treat" question, as well as the technical and theoretical frame of reference of the supervisor. However, there were striking disagreements between candidates and supervisors as to the role of the supervisor, what candidates find useful in supervision, the evaluatory function, and the relation between supervision and progression to graduation. Although 50 percent of candidates reported anxiety about receiving credit for cases, this was not routinely discussed in supervision, and the supervisory relationship itself was not discussed in over 50 percent of dyads. Despite high overall satisfaction ratings, 25 percent of candidates said they wished they had a different supervisor for the case, and 75 percent believed that a candidate who asked to switch supervisors would be labeled problematic. In contrast, over 75 percent of supervisors reported that switching supervisors carries no stigma. In a follow-up study conducted one year later, many candidates reported that they feared reprisals for switching, and some reported that their training analysts advised against "rocking the boat." Candidates felt that participating in the study emboldened them to think more openly about supervision and in some cases to make changes.

The control case: a unique analytic situation.

Control cases conducted by candidates as part of their training are different in many ways from other analyses. The most important difference is that candidates must receive credit for cases in order to graduate. To study how training requirements influence candidates' analytic technique, a survey was conducted of all candidates at Columbia who were treating at least one control case. Sixty percent of respondents reported that the need to obtain credit had influenced their technique in at least one of their cases in one or more of the following areas: interpretation, fee setting, charging for missed sessions, scheduling of sessions, writing up the case, and presenting in supervision. Thus, training requirements. specifically the need to obtain credit for cases, affected the analytic technique of a majority of candidates surveyed. This effect is better conceptualized as a shared common experience of training than as a specific countertransference reaction in individual candidates.

The impact of psychoanalytic values on transference and countertransference: a study in transcultural psychotherapy.

In transcultural psychoanalytically oriented treatments, the therapist must consider differences between the cultures of origin of both patient and therapist. The therapist also must be aware of a third relevant culture that affects the patient-therapist dyad: the psychoanalytic culture. The effect of the psychoanalytic culture and its values on the development of transference and countertransference is illustrated in three clinical vignettes from transcultural treatments. The authors offer suggestions for dealing with problems that arise because of discrepancies between the psychoanalytic cultural values and the patient's cultural values.