Changes in symptoms and interpersonal problems during the first 2 years of long-term psychoanalytic psychotherapy and psychoanalysis.

OBJECTIVES: Longitudinal measurements can provide important information regarding variations in developmental trajectories of patients in long-term treatment. The present study investigated changes in general symptoms, depression, anxiety, and interpersonal problems during the first 2 years of long-term psychoanalytic psychotherapy (PP) and psychoanalysis (PA). It was expected that interpersonal problems would diminish more slowly compared to symptomatic dysfunction. DESIGN: An accelerated longitudinal design with five consecutive measurement points across two cohorts of patients was used. METHODS: Changes on the Symptom Checklist-90-R (SCL-90-R), Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory (STAI), and Inventory of Interpersonal Problems-64 (IIP-64) were investigated during the first 2 years of long-term PP (n = 73) and PA (n = 40). Linear regression analysis was performed to model the different courses of improvement. RESULTS: After 2 years of treatment, patients in both groups still presented moderate to high levels of symptoms and interpersonal problems compared to non-clinical populations. As expected, interpersonal problems changed less rapidly. PP patients changed both with regard to symptomatic and interpersonal problems, whereas the only significant change in the PA group was on one of the symptomatic subscales. Slopes in the PA group and in PP group did not differ significantly from each other, except for the IIP-64 scale intrusive, with PP patients showing significantly more improvement than PA patients. The height of intake values of the outcome variables appeared to predict the speed of symptomatic recovery. CONCLUSIONS: Symptoms and interpersonal problems did not decrease notably within the first 2 years of psychoanalytic treatment. This is consistent with the idea that significant change takes time for patients with chronic mental disorders and personality pathology. In regular practice, it is advisable to monitor changes routinely in order to identify slow responders more quickly and change the treatment plan, if necessary.

Psychology's dilemma: an institutional neurosis?

The term psychology refers both to an institutional discipline and to a subject matter. Henriques, in his article "Psychology Defined" (this issue) , emphasizes the second reference, and its focus can be sharpened by taking into account the first reference. On the one hand, epistemic progress in science is a dynamic process, which, as often as not, cuts across institutional divisions. However, on the other hand there are some problems of disunity that solely concern the institution. That the latter falls within the scope of the Tree of Knowledge is illustrated in how Henriques' "Justification Hypothesis" sheds light on the nature of institutional disunity.

Unity versus multiplicity: a conceptual analysis of the term "self" and its use in personality theories.

There is no single answer to the unity-multiplicity problem regarding the self for the simple reason that the term "self" is used by too many different theorists in too many different ways. In fact, there are several important substantive topic areas that need to be distinguished and studied scientifically. The topic areas I examine in this article are reflexivity, unit coherence, agency, and subjectivity. Each of these areas will be evaluated in terms of what it contributes to, and can be interpreted in terms of, the unity-multiplicity issue. It is proposed that we need a more differentiated technical vocabulary if we are to better understand the phenomena we are examining. Matching our technical vocabulary to this empirical detail sharpens the questions being asked and places the empirical facts in better focus. A more elaborate framework of conceptual differentiation provides a better basis for developing an integrated theory.

The rhetoric of psychological research and the problem of unification in psychology.

There has been in the field of psychology a long and well-documented discontent with an apparent disorganization in its literature, most often interpreted as reflecting the absence of a unifying theory. This article examines some alternative ways in which some of the disorganization is being actively created by forms of argumentation used in reporting and discussing psychological research. One institutionalized form of argumentation used in reporting data actually generates the proliferation of theoretical terms in the literature. A second form of argumentation reifies theories into social groups, incorporating values that discourage theoretical integration. Some of the discontent arises from the incompatibility between the values latent in such social organizations and the values that motivate scientific inquiry at a personal level.