Psychoanalytic training in the Eitingon model and its controversies: A way forward.

Psychoanalytic training has been an object of controversy for many years. Arguments have been intense about the details, sometimes called "requirements", and particularly over whether or not training institutes should have routine external validation. We describe these arguments and present preliminary conclusions about the core challenges psychoanalytic trainings face using a unique set of detailed observations collected during structured "conversations" inside nine European institutes. We conclude that whether a psychoanalytic training is "working" is not a matter of compliance with requirements. Rather, it is an issue of how candidates, training analysts, supervisors and committee members, confront within and between each other the consequences of the unconscious dynamics that psychoanalytic training must inevitably create. Institutional psychoanalytic capacity is to take itself as the object. Consequentially, we propose that training committees that seek to claim that their psychoanalytic training is genuinely and safely producing psychoanalysts would be ones that institute routine procedures to show to themselves, transparently, how they attend to the dynamics just mentioned and how they take a neutral inquisitive stance towards them. Fear of oversight, we suggest, is a symptom of deeper anxieties. They can be faced by creating an appropriate setting. Properly conducted visits from outsiders are welcomed.

[Predictors of dropout during psychoanalytic treatments of patients with personality disorders]. / Prädiktoren des Therapieabbruchs in psycho-analytischen Behandlungen von Patienten mit Persönlichkeitsstörungen.

OBJECTIVES: Are there predictive factors which impair the progress in psychoanalytic treatments of patients with severe personality disorders? METHODS: In 38 psychoanalytic treatments, severity of symptoms (SCL-90-R), interpersonal problems (IIP), character traits and psychostructural functioning (SWAP-200) were investigated half-yearly. Predictors for drop-out were identified using stepwise binary logistic regression models and repeated ANOVA models. The statistical stability was controlled using a jackknife algorithm. RESULTS: For the first year denial of needs for closeness, conflicts around engagement and abandonment, as well as fears of an impulsive breakthrough of negative affects predicted dropout of therapy. During the second year externalizing defence, projection/projective identification, somatisation, hypochondria and dismissive interpersonal behaviour predicted break-ups. CONCLUSIONS: For psychoanalytic technique, it is necessary to perceive and catch paranoid anxieties, negative affects, externalizing mechanisms and projective identification from the very beginning as well as to interpret and work through these elements in transference thoroughly in order to prevent treatment dropout.

[Indication of psychoanalytic treatment for personality disorders]. / Zur Indikationsstellung von psychoanalytischen Behandlungen bei Persönlichkeitsstörungen.

AIM: The study investigates how a psychoanalytic institution reaches its aims by identifying different factors like diagnosis, sociodemographic characteristics of the patient, motivation of the psychoanalyst, and their impact on the indication-process. MATERIAL AND METHODS: 38 patients diagnosed as having severe personality disorders and treated in a psychoanalytic outpatient clinic were compared with 49 patients who were referred for psychoanalytic treatment to a private practice. RESULTS: Although the groups were similar regarding the severity of their problems, more comorbidity and a more stable professional life were found in the group referred to private practice. Patients who tend to distort their social life in order to maintain a fragile psychic balance are more likely to get institutional treatment. The psychoanalytic team-conference and discussion of unconscious object-relationship pattern had great impact on the process of giving correct indications. CONCLUSION: The indication for psychoanalytic treatment does not correlate with personality disorder diagnosis or with the motivation of the therapist. Nevertheless, more differentiated, in clinical routine practicable instruments measuring reflective functioning, or the quality of object relationship have to be developed in order to give an adequate indication for psychoanalytic treatment.