Freedman Center for Psychoanalytical Research
Program of Empirical Research Studies
We take the letter “R” in IPTAR quite seriously and have developed a program that emphasizes hands-on empirical research studies to generate new findings about psychoanalytic treatment. The question of how to understand, let alone establish the validity of our analytic enterprise is a complex one. Starting at the surface, as Freud suggests, we first ask about our patients’ lives. Has treatment affected the quality of their lives, work, patterns of relationships, or self esteem? Next we ask: What has made such change possible? Here we seek to define the facilitating and mediating conditions in psychoanalytic psychotherapy and psychoanalysis. We are also interested in how persistent the changes are. In the spirit of these questions, five major research projects were completed, each seeking to define central psychoanalytic concepts.
- Effectiveness of Psychoanalytic Psychotherapy: This study of treatment effectiveness was based on observations at the IPTAR Clinical Center (ICC). Patients’ responses to the Effectiveness Questionnaire (EQ) adapted from the Consumer Reports Study (Seligman, 1995) were analyzed. Since the EQ is derived from the Consumer Reports survey, the authors compared the outcome of this treatment against a large national sample. The study allowed its authors to delineate effectiveness as mediated by treatment duration, session frequency, patients’ experience of the therapeutic relationship, and clinical syndromes.
- Therapy Remembered After Termination: In this study, former patients recalled their treatment experiences during extensive interviews several years later. The Retrospective Reconstruction of Therapy Remembered project was based on detailed, audio-recorded, semistructured interviews of patients who terminated their ICC treatment at least one year prior to the interview and conducted by an analyst. The Archive of Therapy Remembered contains 10 interviews. The focus was less on effectiveness and more on a consideration of the kinds of therapeutic processes, retrospectively reconstructed, which mediated effectiveness. The central question studied was how internalization is achieved in therapy remembered. This complex process needed to be looked at in more detailed and differentiated ways.
- Study of Recorded Psychoanalysis #1: The authors attended to the difference between working sessions and difficult sessions, thus studying the treatment process itself. This study of psychoanalytic process used recorded psychoanalyses and focused intensively on a series of single cases “inside the analytic hour.” The focus was on a single patient whose analysis was recorded. Several hundred sessions to date were recorded (but are no longer available) and analyzed to trace transformations from session to session and year to year. The primary question was whether psychoanalytic process can be defined empirically. A novel methodology was developed, which took as its starting point the analyst’s subjective experience of a session. This impression was corroborated using the time-honored method of the peer group by three senior consultants. These clinical evaluations were further corroborated through the objective study of recorded text. Target sessions with very different qualities, which were systematically defined as “A” and “Z” sessions, were then selected and scrutinized. In this manner, the authors identified transformation cycles within a given year of treatment, which were then compared with similar cycles in successive years.
- Study of Recorded Psychoanalysis #2: The authors studied the recorded psychotherapy of a patient who suffered severe trauma in Africa.
- Effectiveness of Psychotherapy with Children at the ICC: The relatively few empirical studies of child treatment (either psychotherapy or psychoanalysis) means that psychodynamic therapists’ ideas about the treatment efficacy do rests heavily on case reports that, however moving or dramatic, tend to resist objective assessment and controlled scrutiny. As the old quip goes, psychoanalytically oriented therapists can fail to realize that “data” is not the plural of “anecdote” (Fonagy, P., & Target, M. Mentalization and the Changing Aims of Child Psychoanalysis. Psychoanalytic Dialogues, 1998, p. 88). The goal of this study was to provide some objective assessment about how well children do when they are seen in psychoanalytically informed psychotherapy. This study was designed with an acute awareness of the limitations of a concept like “objective”; likewise, no single measure can give an accurate picture of how a patient has fared in psychotherapy. In the study conducted by the child research team at IPTAR (presented at the Academy of Science), the authors measured shifts in the parents’ perception of their children over time as well as shifts in the children’s sense of self, presenting empirical data that lend support to the idea that the conscious and unconscious thoughts and attitudes of parents have a profound impact on influencing the children’s perception of themselves. The data strongly suggested that when parents feel better about themselves in relation to their children, they see the child in a more positive light. This perception also seems to be reflected in the child’s enhanced feelings about themselves. The finding that parents’ perceptions of their children are influenced by how they are feeling about themselves as parents is not surprising. Parents’ constructions of the world are always subject to their emotional states. What was surprising is that when parents feel badly about themselves, there is little or no relationship between their subjective states and how they view their children. The authors view this situation as potentially chaotic for both parents and child. Children, for example, must learn via social cues that their parents’ emotional states have some predictive value for how the children are perceived. When children have a better, more consistent and coherent sense as to how they will be perceived, it seems reasonable to conclude that their world becomes less chaotic, and they have a higher probability of feeling good about themselves. For example, when does coherence become so rigid that parents’ perception of their child is so skewed toward the parents’ own internal state that any notion of relative objectivity becomes meaningless? This study highlighted some of the uncertainty about the notion of the identified patient in child therapy.
The empirical research of the Norbert Freedman Center for Psychoanalytic Research at IPTAR has led to publications in major psychoanalytic journals and presentations at national and international conferences (see below). In addition, the IPTAR Research Faculty has shared in sponsoring dissertation projects at various universities.
Freedman, N., Hoffenberg, J. D., Vorus, N., & Frosch, A. (1999). The effectiveness of psychoanalytic psychotherapy: The role of treatment duration, frequency of sessions, and the therapeutic relationship. Journal of the American Psychoanalytic Association, 47, 741-772.
Freedman, N., Hurvich, M., & Ward, R. (2007, July). A propositional method for the study of psychoanalytic concepts: The transformation of annihilation anxiety and its symbolization in short term and long term psychoanalytic treatment. Paper presented at the 45th IPA Congress, Berlin, and published in the Proceedings of the IPA (translated into German in 2009).
Freedman, N., Hurvich, M., & Ward, R., with Hoffenberg, J., & Geller, J. (2011). Another kind of evidence: Studies on internalization, annihilation anxiety, and progressive symbolization in the psychoanalytic process. Karnac Books.
Freedman, N., Lasky, R., & Ward, R. (2009). The upward slope: A study of psychoanalytic transformations. Psychoanalytic Quarterly, 78, 201-231.
Freedman, N., Lasky, R. & Webster, J. (2009). The ordinary and the extraordinary countertransference. Journal of the American Psychoanalytic Association, 57, 203-331.
Freedman, N., & Ward, R. (2010, spring). Nodal moments and progressive symbolization. Paper presented at the IPTAR 50th Anniversary Scientific Meeting, New York.
Freedman, N., Ward, R., & Lasky, R. (2004, spring). From impasse to reintegration. Paper presented at the IPTAR Section of Investigative Psychoanalysis, New York.
Frosch, A., Cancelmo, J., Edmondson, D., Greenblatt, R., Mazzella, A., Kleinerman, L., Rourke, M., & Tingley, E. (2004, spring). A psychoanalytically informed child outcome study. Paper presented at IPTAR East by the IPTAR Section on Investigative Psychoanalysis, New York.
Frosch, A., Cancelmo, J., Edmondson, D., Greenblatt, R., Mazzella, A., Kleinerman, L., Rourke, M., & Tingley, E. (2006, March). WIll the real patient please stand up? A psychoanalytically informed child outcome study. Paper presented at the New York Academy of Sciences by the IPTAR Section on Investigative Psychoanalysis, New York.
Hurvich, M., Freedman, N., Ward, R. & Grunes, M. (2006, spring). Propositions defining psychoanalytic concepts. Paper presented at the IPTAR Section of Investigative Psychoanalysis, New York.
Hurvich, M., Ward, R., & Webster, J. (2012, fall). Another kind of evidence: Innovative perspectives on concepts familiar to the practicing analyst. Paper presented at the NYPSI Academic Research Seminar, New York.
New Research Projects (2015-present)
In 2015, Dr. Geoff Goodman became the Director of the Norbert Freedman Center for Psychoanalytic Research at IPTAR. Under his leadership, a new research project has been undertaken (see below). The Center is pleased to offer small grants to fund psychoanalytic research conducted by members of the IPTAR community. An application form can be obtained by contacting Geoff Goodman (firstname.lastname@example.org).
Testing the Therapeutic Effectiveness of Two Group Intervention Programs on Private Middle School Students
Drs. Geoff Goodman and Carla Rentrop are conducting a research study at the De La Salle Academy in Manhattan. The purpose of this research study is to test the effectiveness of two once weekly, 60-min group interventions (see below) taking place as part of the ongoing curriculum at De La Salle Academy, a private middle school in Manhattan. In September, 2015, approximately 64 12 to 13-year-old students (grade 8) decided whether they want to participate in a year-long curriculum-based group intervention program (eight members per group) led by group leaders who are supervised by Dr. Rentrop, Site Supervisor. Dr. Rentrop will supervise the group leaders throughout the school year (2 per group). After they have enrolled, Dr. Rentrop approached them individually about participating in an evaluation of the group intervention, which is the subject of this study. Students were randomly assigned to either 1) the Storytelling/Story-Acting (STSA) activity or 2) the Mentalization-Based Therapy group intervention (MBT-G) with adolescents. There are four groups of approximately eight students each (two of each treatment model).
Briefly, the STSA activity (Paley, 1990) consists of two phases: 1) students’ dictation of spontaneously generated stories (storytelling phase), and 2) students’ acting out these stories on a makeshift stage (story-acting phase). After the group leader has collected four or five stories, he or she assembles all the students around a large rectangle on the floor, instructing them to sit behind the lines. The group leader then calls up the first student author, who selects from the group those student actors who will be acting out the story characters. The group leader reads the story first to acquaint the students with it, and then reads it again with the student actors acting it out. Each student author’s story is read and acted out in the same fashion. This group intervention has been shown to improve literacy skills, narrative comprehension, and social competence.
Briefly, MBT-G with adolescents (Malberg, 2012) consists of sharing thoughts and feelings in the context of everyday social situations. Exchanges in the group allow for consideration of cultural understanding and relevant individual values (e.g., ethnic traditions, spiritual beliefs) and are respectful and attentive to the personal meaning of the experience. Furthermore, this approach does not follow a prepackaged set of exercises. Rather, it is meant to be a playground of ideas and an exchange of experiences guided by basic aims in the group leaders’ minds. Certain activities, however, have proven especially useful in promoting the aims of the group such as the use of popular television programs, which illustrate stressful interpersonal circumstances, as these allow the group (especially during the early stages) to explore difficult issues of displacement.
Two kinds of measures are being administered to assess the students’ progress: 1) baseline, midpoint, and termination measures, administered in September (prior to the first group session), January, and May, 2016 (after the final group session); and 2) group process measures, administered at the beginning or end of each group session, depending on the measure. The first set of measures will determine each group intervention’s therapeutic effectiveness; the second set of measures will determine the trajectory of the group process as well as the weekly progress made by the students throughout the school year. In addition, grade reports from the school as a supplemental outcome measure will be requested.