analytic change: assessing ways of being in a psychoanalytic follow-up interview

Analytic change: Assessing ways of being in apsychoanalytic follow-up interview

Erik St€anicke, Hanne Strømme, Bjørn Killingmo and Siri ErikaGullestad

Department of Psychology, University of Oslo, P.O. Box 1094 Blindern,0317, Oslo, Norway – [email protected]

(Accepted for publication 24 July 2013)

The article argues that the concepts of relational scenario, structuralized affectand actualized affect are proposed candidates for observation of changes inrelational ways of being as it is expressed in transference. A psychoanalytic fol-low-up interview of a former analytic patient is presented in order to illustratehow change in relational ways of being may be registered and studied. By trian-gulating the patient’s verbal report of change with nonverbal information andtransference–countertransference dynamics, one may grasp qualitative changesin relational ways of being. The case presented illustrates a former patient’son-going process of working towards representing aggression in a more directmanner and how this process is made observable with the aid of the proposedconcepts in the interview situation. The proposed concepts of relationalscenario, structuralized and actualized affect discussed are compared to theconcept of transference used in studies of core conflictual relationship theme(CCRT).

Keywords: actualized affect, analytic change, CCRT, follow-up interview, relationalscenario, research, structuralized affect

IntroductionHistorically, the study of analytic change has focused on various aspects ofpersonality. In the beginning, the content of dynamic forces and id-deriva-tives, such as the ability to remember, or changes in dreams, was in the centre.With the developing focus on character and ego psychology, structuralaspects of the personality came to the fore. In 1935, Balint made a distinctionbetween a ‘classical’ and ‘romantic’ view on outcome of psychoanalysis(Balint, 1935; see also Sandler and Dreher, 1996). This distinction demarcatesstudies of change that focus on structural versus dynamic changes respec-tively. With the shift in psychoanalysis brought about by object relationtheory, the distinction between structural and dynamic changes still holds,but now in a different way. Object relation theory gives prominence to inter-action in relationships, and also deals with internalization of dialogues withsignificant others into established, inner relational configurations that areactualized in ongoing interaction.Central to the clinical study of object relations is the ‘total situation’

(Joseph, 1985) created in the treatment and the ‘ways-of-being with theanalyst’ (Stern, 2004) that actualize inner scenarios. Ways of being express

Int J Psychoanal (2014) doi: 10.1111/1745-8315.12145

Copyright © 2014 Institute of PsychoanalysisPublished by John Wiley & Sons Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK and350 Main Street, Malden, MA 02148, USA on behalf of the Institute of Psychoanalysis

�e International Journal of

relatively stable patterns of personality, such as self-representation, waysof speaking, regulation of affect as well as interpersonal styles implyingspecific relational messages and wished-for rejoinders. Such patterns arenot conveyed primarily through the content of the dialogue but throughits form, i.e. by bodily and psychological attitudes, via gestures and mimicsas well as through the use of language (Gullestad, 2005; Killingmo, 2007).It seems justified to say that the importance of focusing on form is sub-stantiated through recent neuro-cognitive research on memory systems,providing increased understanding of the procedural memory system: sig-nificant experiences underlying dominant object scenarios may occur beforethe formation of a memory system able to represent them as a narrative.Thus, the patient is not able to talk about them directly. Instead they areexpressed implicitly, for example, through relational procedures organizinghow the person deals with affects and other people – how he interpretsand reacts to emotional and relational situations and how he expressesfeelings (Clyman, 1991; Fonagy, 1999; Gullestad, 2005). Although there isan increasing focus in contemporary psychoanalysis on patients’ interper-sonal styles and ‘emotionality’, the corresponding criteria of analyticchange are still relatively neglected in outcome and follow-up studies.The purpose of the present article is to propose concepts that make it

possible to widen the scope of observations of post-analytic changes by cap-turing changes in relational ways of being. It is suggested that the conceptsof relational scenario, actualized affect and structuralized affect can be help-ful in understanding salient changes in relational ways of being. In the pres-ent article, change in relational ways of being will be illustrated throughmodification in the representation of aggression. A psychoanalytic interviewof ex-analysand Mr A is presented in order to illustrate how relationalchanges can not only be talked about but also observed in action. Theinterview is part of a conceptual case-based follow-up study of psychoanaly-sis (St€anicke, 2010, 2011; St€anicke and Killingmo, 2013). Seven participantswere interviewed, who were already part of the Oslo II study (Varvin, 1999)that consisted of data from their psychoanalysis. Excerpts from follow-upinterviews with Mr A are presented in this article. The empirical material isnot intended to demonstrate that changes are causally connected to the ana-lytic treatment, but rather to illustrate a widening scope of observation ofpost-analytic changes.In a time when psychoanalysis fares roughly in academic and health

institutions, we need research that demonstrates that analytic treatmentdoes work and how it works. More specifically, we need research that dis-tinctively shows the diversity of human development and maturation, aswell as studies of how analytic processes of change can take divergent path-ways, even after analysis. The more nuanced our models of change becomeand the better we get at developing procedures for registering analyticchange, the more precisely can we document our psychoanalytic work. Fur-thermore, studying post-analytic processes are not usually possible fromwithin a clinical position. We therefore need follow-up studies if we wantto know more about how patients make use of their analytic experienceafter analysis.

2 E. St€anicke et al.

Int J Psychoanal (2014) Copyright © 2014 Institute of Psychoanalysis

Relevant conceptsIn outcome and follow-up studies, it is critical to define relevant variablesof change (Hill and Lambert, 2004). Such definitions reflect the aspects ofpersonality that a particular treatment method aims to focus on. To manypsychoanalysts it seems relevant to focus on changes in inner object rela-tions, as work within the domain of the patient’s transference is at the heartof psychoanalytic treatment. Consequently, assessment of outcome shouldalso be centred on changes in transference. Such changes may be observedas changes in qualities of interpersonal action, which we term relationalways of being. They can be distinct and comprehensive, as when a patientwho has used schizoid withdrawal in every previous social situationbecomes capable of building long-lasting relationships. But often thechanges are subtle, as with former patient Mr A, presented later in this arti-cle, who is still in the process of working on representing aggression in amore direct way. Thus, changes in the transference are expressed throughchanges in the patient’s ways of being with the other. Clinically, concepts areneeded that can apprehend this relational information.We propose that the concept of relational scenario (Gullestad and Kill-

ingmo, 2005) may be a candidate for assessing qualities of change in trans-ference. The concept refers to the relationship between a representation of theself and a representation of the object having a relative stable pattern whichcan be identified in different situations (ibid., pp. 118–22). A relational sce-nario does not refer to a relationship that is directly observable, but to themental relationship pattern behind the observable behaviour, which mayoften be unconscious. It comprises an affective definition of the relation-ship, fantasies about the object as well as a definition of the self in relationto the other. The concept can help organize observations of interpersonalinteraction so that stable patterns of relational styles become salient.The concepts of structuralized and actualized affect (ibid., pp. 98–102) can

be helpful in identifying what kind of relational scenario is activated in thetransference. Structuralized affect refers to affect that the patient can talkabout. The affect is already structured in language and narrative. Even ifthe affect is experienced it is experienced in a familiar way, characterized bythe person with having an observational stance towards his/her own affectand narrative which it is part of. Actualized affect, on the other hand, isidentified as it unfolds in interpersonal interaction. It refers to an affectiveexperience that dominates the patient’s way of relating to the object. It isnot understood but lived – and the patient does not have an observationalstance towards it. Actualized affect is part of the transference signallingwhat is at stake for the patient. The distinction between structuralized andactualized affect may be helpful in detecting relational scenarios operatingin the here-and-now, even when these differ from the structuralized narra-tive of the patient. Thus, with these concepts, it may be possible to ‘hear’the unconscious relational message in the transference.It is important to stress that we understand transference as a phenome-

non that unfolds in a relational situation. As argued later, we need todevelop methods of assessing inner structural change as expressed in the

Analytic change 3

Copyright © 2014 Institute of Psychoanalysis Int J Psychoanal (2014)

transference, as opposed to methods that assess transference via patterns intranscribed text of therapy sessions only. If we hold on to two of the dimen-sions Freud sees in transference – actualization of the past and displacementon to the analyst (see Laplanche and Pontalis, 1973) – it seems fair todemand of an assessment of transference that it is studied as it unfolds in arelational interaction, and not just in a transcribed text of a patient’s verbalreport of relationships.

Registering changes in relational ways of beingIn a recent study of post-analytic change (St€anicke, 2010, 2011; St€anickeand Killingmo, 2013), one aim was to test and refine a method that couldassess changes in relational ways of being. The material consisted of psy-choanalytic follow-up interviews with seven participants, all ex-analysands.Our interest was not only change as expressed at one specific moment aftertreatment, but also how patients are able to make use of the experience ofanalysis for continued development. More specifically, the aim was to see ifwe could interview the participants in a way that captured their ongoingprocess of transformation.In order to best evaluate process it is optimal to have at least three points

of observation. Consequently, it was decided to do three interviews witheach participant. All the participants were interviewed at least one year aftertermination of treatment. The first two interviews were conducted twoweeks apart, the third and final interview after a one-year interval. By thisdesign we intended to extend the time of contact and at the same timeensure adequate intensity of the two first meetings to activate a transferencereaction. The interview was semi-structured, with an overall aim of register-ing how the participants experienced the therapeutic results of the treatmentand how they experienced that possible change has continued, ceased orturned in new directions. After a short explanation of the research project,the participants were invited to talk about his/her experiences as freely aspossible. In the following interview, the interviewer’s attitude of listeningwas as open, non-directive and unstructured as possible, allowing for trans-ference material to emerge. Thus the interviewer approached an analyticattitude. Each interview was videotaped and then transcribed into text.The units of observation in the interviews were transference and counter-

transference constellations. The interview has affinities with the way Pfeffer(1959, 1961, 1963) and the Deutschen Psychoanalytischen Vereinigung study(DPV) (Leuzinger-Bohleber, 2002; Leuzinger-Bohleber et al., 2003) madeuse of follow-up interview methodology with emphasis on capturing actual-ized transference patterns. However, it was also decided to use countertrans-ference as information about the patient’s ways of being as a source of datafor defining actualized scenarios. In the present study, countertransferenceis defined as emotional reactions of the interviewer that are a response toaffective communication of the patient, to be distinguished from the transfer-ence reactions of the interviewer. The systematic use of countertransferenceas a source of information may be seen to represent a refinement of thePfeffer method.



The interviewer received clinical supervision as part of the research pro-ject between each interview. This supervision played a significant role inhelping the interviewer to understand the transference and countertransfer-ence in the situation. Since this is a highly complex process, and the goalwas to use only three sessions to assess changes in object relations, supervi-sion was an important aid in making the interviewer’s task possible.The assessment procedure follows three steps. The first step consists of

the participants’ verbal expression of having changed. This part begins withthe interviewer instructing the participants to talk as freely as possibleabout how changes have continued, ceased or turned in new directions afteranalysis. Participants in the follow-up study usually begin by describingexamples of how they use their therapy experience to handle different situa-tions in their current lives, relationships and work. These are stories abouthow they react, think and handle difficult situations, which usually includeversions of how they dealt with similar situations before their treatment.The second step of assessment in the interview involves understanding

what kind of relational scenario is actualized in the relationship between theex-analysand and the interviewer. This step is the most challenging as it ishard to grasp and explicate a person’s way of being with others. By havingan analytic attitude and a psychoanalytic listening perspective the inter-viewer tries to take hold of the actualized affect, as illustrated by thefollowing excerpts of interviews with Mr A. First and foremost the inter-viewer tries to listen to the affect present in the here-and-now interactionwith the interviewer. Formal and nonverbal aspects of behaviour –psychological attitudes, gestures and use of language – represent clues toactualized affect. These may be difficult to grasp, as one is less inclined toconsciously pick up on nonverbal information as compared with verbalinformation.The third step in the assessment implies that the interviewer is seeking to

communicate with the participant about the actualized affects, as will alsobe illustrated in the following presentation. This part has similarities to atransference interpretation. The participant gets an opportunity to confirm,elaborate, challenge or invalidate the interviewer’s understanding and inter-pretation of him.The interview process described above makes possible an inquiry into the

coherence between three aspects: firstly, the participant’s literary and struc-turalized version of change; secondly, the transference and countertransfer-ence constellation, consisting of a relational scenario that is actualized in theaffective way of relating during the interview; and thirdly, the extent to whichthe interviewer and participant are capable of communicating about what ishappening on these two levels. To put it simply, the more the participant’sversion of change is coherent with what unfolds in the interaction with theinterviewer, and the two of them are capable of speaking about the transfer-ence aspect of the interaction, the more ‘convincing’, ‘genuine’, ‘trustworthy’and ‘authentic’ the subjective report about change is considered to be. Assess-ing the authenticity of the verbal material becomes possible because transfer-ence and countertransference are regarded as research data in themselves.Whereby we have the possibility to triangulate the participant’s verbal report

Analytic change 5


with nonverbal, transference and countertransference phenomena. Withinsuch triangulation of perspectives, individually unique processes of changecan be described.The presented interview method is different from that used in other

follow-up studies, such as the Menninger study (Wallerstein, 2000), the Bos-ton study (Kantrowitz et al., 1990a, 1990b, 1990c) and the STOPP study(Falkenstr€om et al., 2007). These studies have all used interview methodsthat are often called ‘phenomenological’: a way of interviewing in which theinterviewer tries to facilitate participants’ talk about the research topic andthen analyses the content of their self-reported experience of change. It isinteresting to note, however, that the question of how ‘convincing’ subjec-tive reports of change may be considered also came to the fore in theSTOPP study, applying phenomenological interviews. In a subsequent dis-cussion of one of the participants, the STOPP project further discerns whatis ‘convincing’ and what seems, from a clinical point of view, to be a ‘genu-ine progression’ as opposed to what seemed to be reports characterized bydefensiveness (Falkenstr€om et al., 2007). When considered with regard tothe concepts of relational scenario, structuralized affects and actualizedaffects, it may be argued that the discussion about ‘genuine progression’came about because the researchers questioned whether the reports ofchange comprised mainly structuralized affects. In the STOPP study, how-ever, whether or not the participants’ reports of change are convincing andgenuine was only assessed following completion of the interviews. In con-trast, in the present study, assessment of the authenticity and genuinenessof the subjective report of change was part of the dialogue process in theinterviews. Thus, one can assess not only what the participant says aboutchange but also how he is ‘doing it’.

A case illustrationFollowing are excerpts from a follow-up interview with participant A.1 Theaim is to illustrate how the concepts introduced in the first section can help tofocus attention on changes in relational ways of being. Mr A is a participantin the Oslo II study (St€anicke, 2010; Varvin, 1999).2 The Oslo II study is asmall-scale process–outcome and follow-up study of psychoanalytic treat-ment within the Norwegian Psychoanalytic Society, comprising seven patientsin four sessions weekly psychoanalysis with Norwegian/ IPA psychoanalysts.Patients were interviewed twice a year about their experience of being inanalysis, as well as at the end of treatment and in a follow-up study. This lat-ter study is the focus of the present paper.The follow-up interviews were conducted at least one year after termina-

tion of treatment but the time since termination date differed – from one tofour years. All participants had agreed to the research design and consentedto the follow-up interviews. The first follow-up interview with Mr A was

1Mr A has read and approved the analysis of the case illustration.2The Oslo II study has been approved by the Data Inspectorate in Norway and received recommenda-tion by the Regional Committee for medical Research Ethics.



done four years after his analysis. The first author conducted the follow-upinterviews and he was not involved as a treating analyst in the study.To date, all the seven participants have been interviewed as part of a

follow-up study. Mr A was chosen for this article because his interviewsclearly illustrate the concepts that have been discussed, as well as demonstrat-ing all three steps involved in assessing the authenticity of an experience ofhaving changed. The three steps involved in the assessment process were fol-lowed with all participants. The aim of each step – to identify the structural-ized and actualized affect and communicate about them – was the same forevery interview. However, participants were to different degrees able to reflecton their own material, especially as concerned relational issues and conflictsthat were activated in the follow-up interviews (see St€anicke, 2011; St€anickeand Killingmo, 2013). Mr A was one of three participants that showed a quitehigh degree of reflection on his relationship with the interviewer.The following analysis of the interview with Mr A is not meant as a com-

prehensive analysis of his process of change. The findings are tentative sincethere is no control for whether Mr A’s expression of change is causally con-nected to his analytic treatment. The excerpts are not intended to give acomprehensive understanding of him. Rather they are presented in order toillustrate our argument. Thus, only excerpts from the first and the thirdinterviews are discussed. The second interview does not demonstrate newperspectives that contribute to our aim with this article.The interview takes Mr A’s experience of having changed as its starting

point and compares this with what actually unfolds during the interactionwith the interviewer. The main focus of the analysis is to illustrate how theinterview taps one dimension of analytic progress in Mr A and how thisprocess is still unfolding. The excerpts are selected to demonstrate how MrA handles aggression and how he is still working with this important rela-tional mode. Out of a sample of seven follow-up interviews, Mr A was theonly case in which an overtly negative transference reaction was observed.Accordingly, this was one of the sampled cases that presented both Mr Aand the interviewer with significant emotional challenges. Through thecourse of the interviews, even when Mr A expresses a negative transference,we can see how he struggles with it in the interview.

First interviewMr A was contacted by means of a letter stating the aims and frame of theinterviews. When contacted by phone about making an appointment Mr Asaid that he found it unpleasant to think that the interview would berecorded on video. Asked on the phone to elaborate these feelings, he dis-missed the question and said he could talk about it in the interviews.Because of this phone conversation, the interviewer did not start the videorecorder at the beginning of the first interview. When Mr A was invited totalk about the recording, he emphasized that it was the interviewer who setthe premise for the interview. He went on describing a fantasy in which thevideo is studied by a large group of students at the university. It is unpleas-ant to think that they would scrutinize every little movement of his face.

Analytic change 7


Then, abruptly, Mr A stated that he could accept the recording now that hehad talked about it. The interviewer once more invited him to elaborate onthe topic, but once more the invitation was dismissed. The rest of the inter-view was videotaped.This initial exchange between Mr A and the interviewer is important in

understanding the subsequent material. The following material is takenfrom the middle of the first interview. In this context Mr A has been talkingabout how he now, after analysis, experiences and handles a conflict ofinterests among his colleagues at work:

A: It’s, it’s a sort of power-thing that this is about. It’s um … it’s um … thoughts –it’s like … we’re men in the um … fifties, right, who um … if I were to – well, what

it is doesn’t actually matter very much, but what it takes – I experience this aspower-related … I become a bit like, a bit like um … someone wants to controlmore than what is necessary – unrightfully so, in a way by sheer power … urge for

power which I react very strongly to. I don’t want anyone to um … dictate to me.

Interviewer: What would a work conflict like that be like um … in earlier days?

A: [Clears his throat] … I think I would have just backed out, quickly from it. Um… I would probably have become quite aggressive, without showing it at the time

… to them. … be a bit nice, like.

Interviewer: So would you just have followed them and made out that it was allright?

A: Yeah, be, be a bit more nice, like, and “I’ll let you decide this” or something likethat. [A bit louder] Been a lot more like defensive, perhaps, compared to um … thatsituation and, like in the head been flying off the handle and … and probably … I

had a lot of those, those violent fantasies I mean like um … specific violence, likeknocking people down and hit them in the face, throw them up into the air and….

In this dialogue, Mr A describes how his ways of handling conflicts andexpressing aggression have changed during treatment. Before his psychoanal-ysis he used to repress his anger and represent himself socially as easy to geton with. He also tells how this pattern took its toll on the inside. His socialrepresentation as easy-going contrasted distinctly with his fantasies of actingout against his conflict partners – he wanted to “knock(ing) people downand hit them in the face, throw them up in the air”. Thus, as he himself seesit, before treatment he backed off from expressing his interests directly.Instead anger and aggression were expressed through violent fantasies.So far the content of the subjective report about change has been exam-

ined. Looking at the structure of the language, it should be noticed that MrA, describing a conflict at his workplace, begins with a categorization: “It’sa sort of power-thing”. Instead of speaking directly about his feelings ofbeing in conflict with colleagues, he seems to take the position of an outsideobserver, looking at and describing a power struggle between “men in theirfifties”. “Someone wants to control…”comes forward as a non-specific, gen-eral statement. It would seem that the concrete conflict at work herebecomes an expression of Mr A’s general view on power struggles. This



way of talking, in a non-personal, general way and from an observer’s per-spective, would seem to indicate a dismissive3 style.However, by the end Mr A suddenly speaks more directly: “I don’t want

anyone to um … dictate to me”. This sentence is experienced as though MrA is speaking about the present situation, as if conveying a message to theinterviewer. It seems that what he is saying has relevance in the here-and-now, between participant and interviewer. Thus, in this statement one cansee a movement from a more distanced description of a conflict to an acti-vation of affect in the here-and-now. Obviously, Mr A at the moment seemsable to express aggressive affect more directly – he would seem to havetaken a step on the way to integrating anger and aggression as emotionsthat can be experienced as part of the self. However, on a conscious level,he is only speaking about the conflict at work.In the excerpt presented above the interviewer, immediately after Mr A

says: “I don’t want anyone to dictate to me”, responds with a questionregarding how Mr A experienced such conflicts before beginning treatment.Through the interviewer’s question, Mr A is invited into an intellectualcomparison of experiences that can be categorized as before and after,along a time dimension. As a consequence, focus is turned away from thesituation here-and-now.How can this piece of dialogue be understood? When Mr A describes sit-

uations of being dictated to as especially provoking, it seems that it isexactly a relational scenario of being provoked that is activated in the pres-ent situation. Probably, the interview situation has activated protest and acritical attitude in Mr A. He does not want to – he protests. However, thisprotest cannot be expressed directly to the interviewer. His initial “No” tothe video recording was replaced by an abrupt “Yes”. From the intense“No” to dictation expressed in the dialogue the impression is, however, thatthis “Yes” was not an authentic one. Rather, it would seem that Mr Abacked off from a conflict with the interviewer.Already from the very beginning, i.e. from the telephone conversation

where Mr A questioned the use of video, the interviewer unconsciouslyreacted to the feeling of aggression on Mr A’s part. Immediately, an atmo-sphere of conflict was created between the two of them. The interviewer gotthe impression that the interview was of interest only to him, and not toMr A. Mr A’s reaction to the interview invitation gave the interviewer theimpression that Mr A felt being dictated to and controlled. Indeed, the firstinterview was experienced by the interviewer as a kind of fight. Also, forthe interviewer being in conflict feels threatening – a feeling that was rein-forced by Mr A’s physical appearance: Mr A is a handsome, masculine andquite elegant man, older and taller than the interviewer. When the inter-viewer asks Mr A about how he experienced interpersonal conflicts beforehis psychoanalytic treatment, thus turning focus away from the present

3This way of analysing discourse data was inspired by the Adult Attachment Interview (AAI). Accordingto the discourse analysis applied in the coding of the Adult Attachment Interview this kind of observa-tional perspective characterized by e.g. distancing pronouns is typical of an attachment pattern charac-terized by dismissal of affect, serving to protect the self from directly experiencing own intolerableemotions (Crittenden, 1999–2001; Gullestad, 2003).

Analytic change 9


situation, it seems likely that he was trying to ward off the affective inten-sity in the dialogue.To summarize, Mr A’s affective expression, his discourse as well as the

interviewer’s feeling of being in a fight, indicate the activation of a rela-tional scenario of control and protest. In the beginning, protest was articu-lated rather directly, through questioning of the video recording. However,Mr A soon backed off, apparently accepting the frame, while neverthelessindirectly continuing to hold a critical attitude towards it and to the inter-viewer. Yet, protest was not articulated in a direct and straightforwardmanner, but instead expressed in a displaced form.In the first interview we cannot observe what Mr A has proclaimed – that

he has changed with regard to handling situations of conflict. In describinghow he has changed as a result of treatment, Mr A declares that psycho-analysis has helped him with responding to situations of interpersonal con-flict. Now he “handles it better” and “is more offensive in the situation”.His story about more direct expression of aggression represents structural-ized affect. But the transference – and the actualized affects – told anotherstory: During conflict, protest and aggression were expressed in an implicitor displaced form.As concerns the interviewer, he felt threatened by Mr A’s intense affec-

tive expression in the first interview, trying to handle the situation by shift-ing to an intellectual question. This illustrates, firstly, that conducting anopen-ended interview of this kind may be hard. Containing the patient’saffects and maintaining one’s openness are not easy tasks. From a theoreti-cal viewpoint, the interviewer’s fear of aggression may be regarded ascountertransference, i.e. as a response to the patient’s confrontationalstance. In the present interview, this fear was not contained but wasenacted – by detracting attention from the affective centre of the dialoguethrough intellectual questioning. Secondly, the interview excerpt illustratesthat what kind of relational scenario is activated is not only dependent onthe patient. The interviewer’s personality will also play a part. Here,aggressive feelings from the patient evoked counter-aggression in the inter-viewer, which he tried to avoid. The interviewer felt a strong inner conflictbetween anger at participant A’s difficult way of being and his ownresearch interest in conducting the interviews in a way that would elicit‘good’ data. This conflict activated at first anxiety, resulting in the angerbeing warded off. Well into the first and second interviews the interviewerbecame more assertive in his communication. Bodily, this was experiencedin the countertransference as becoming more alert and tense. Indeed, theinterviewer’s way of reacting seems to be parallel to that of the patient.Both were avoiding the experience of direct conflict but were also probablytense and ready for a mental fight.

Third interviewAt the end of the third interview Mr A talked about how, earlier in his life,he was inhibited about expressing thoughts that could offend and hurt oth-ers. The following excerpt is from a longer section where he has been



recounting how today he goes about confronting significant others aboutparticularly unpleasant facts:

A: Yes, I did [He confirms here that he hesitated in a specific situation before heconfronted another person.] and then it turned out to be less threatening than Ihad anticipated, it’s like the fear of that which is awful – or it’s the thought of it

that generates fear, but it’s not that dangerous in reality. That’s the case with a lotof things, really [Clears his throat], when I was coming here today I was goingthrough this: I didn’t want to have this meeting really, for instance … I wasn’t

motivated to come here at all … that’s, that’s related to the fact that a few otherthings are a bit turbulent um these days, but um….

Interviewer: Yes, and that made your motivation for coming low.

A: YES, that made my motivation for coming low, but also because it’s, it’s noth-

ing, well I don’t know, my mood it, it swings sometimes, but uhm … what do Icome here for, like to sit here and look at the camera – it’s my whole story on tape,sort of on video and I don’t know you. Do we really um … like each other? Is

there any [Laughs briefly] is there any…

Interviewer: Any what?.

A: Is there any good chemistry here [Laughs briefly]. I sort of thought on my way

here, must I sit here, then um … well, but um … that was fine, you know, it’s a loteasier than what I had feared and it’s probably that experience I draw on, that …that there are things you don’t want to do or which you even fear a little. It’s usu-ally always easier when you get down to it, and it is an all right experience.

Interviewer: Yes, it was easier than you imagined, and the chemistry is fair enough,

but um … but um … yes, I suppose it’s one side of what you are saying that youhaven’t asked to come here, I was the one who…

A: No, it’s an agreement, a contract, it is.

Interviewer: Yes.

A: Which I intend to keep.

Interviewer: So it’s more like you perhaps deliver something that you feel you havepromised to deliver, then?

A: Yes, I have no interest in sitting here and telling you about … you, yes, it’s …that’s how it is.

Interviewer: No, I can see that.

A: So by sheer duty [Laughs], not urge [Laughs], and that’s quite all right.

Interviewer: No, you tell me this directly. Um… I’d say it’s quite understandable.

A: Yes, you’re not getting hurt, either, that’s not an issue.

Analytic change 11


At the beginning of this section Mr A said: “I didn’t want to have thismeeting, really … I wasn’t motivated to come here at all … that’s related tothe fact that a few other things are a bit turbulent um these days…” Statingthat the reason for his lack of motivation lies in other things in his life itseems at first that he does not want to criticize the interviewer. Even if helacks any motivation, this is not personal but rather due to external life cir-cumstances, to his turbulent life. It should be noticed that the interviewerseemed to confirm Mr A’s externalization: “Yes, and that made your moti-vation for coming low.” Again, direct confrontation is avoided.However, in Mr A’s next move there was a change: “What do I come here

for […] I don’t know you. Do we really um like each other?” represents amuch more openly expressed critical attitude. This is all the more noteworthyas Mr A here went against the interviewer’s attribution of lack of motivationto external life circumstances. Obviously, this was not easy to take for theinterviewer. When the interviewer asked: “Any what?”, he felt irritationabout Mr A’s dissatisfaction with the interviews and wanted to challenge MrA to elaborate on his experience. At the same time the interviewer becameencouraged by what he experienced as Mr A’s relief, expressed throughlaughter, when Mr A said something about the conflict he experienced in theinterview situation. Certainly, Mr A’s laughter functions to ward off theintensity of his criticism of the interviewer and the interviews. It is interestingto notice, however, that this time Mr A did not withdraw his critique. On thecontrary, when he stated that: “I have no interest in sitting here and tellingyou about…”, he is quite direct in expressing his negative feelings. Here, MrA comes across as a man able to assert his own interests in a straightforwardmanner in a conflict situation. Yet, at the same time, he did not blame theinterviewer in a one-sided manner. On the contrary, when the interviewerconveyed that he understands Mr A’s reluctance to come to the researchinterviews (“You haven’t asked to come here, I was the one who…”), Mr Areferred to the contract which he intends to keep. Essentially, Mr A is in asituation of conflict where he wants to keep his part of the deal, which is toparticipate in the follow-up study, but lacks motivation to do so. By referringto his “duty” and by stating that this is “quite all right”, Mr A demonstratesthat he was capable of maintaining a stance of self-observation and also ofmaintaining his share of responsibility in the situation. Obviously, this is anexpression of a reflective functioning or mentalizing stance (Fonagy et al.,2002), taking into account the mental state of the other person. Thus, itseems that Mr A is now able to represent his interests and at the same timeto be reflective in a situation where aggressive feelings were evoked.Several times in the interview, Mr A reflected on his anxiety about hurt-

ing or offending others when he is frank and honest. He also linked thissensitivity to his relational history where there were few significant otherswho would tolerate a confrontation. Both in psychoanalysis and after termi-nation, he told the interviewer, he has proceeded tentatively towards beingmore self-assertive. All along, he has been keenly aware of the reactions ofother people to his self-assertion. He has experienced that going againstsomeone is usually more frightening in fantasy than in reality: “It’s thethought of it that generates fear, but it’s not that dangerous in reality”. At



the end of the last excerpt this topic comes to the fore in the here-and-nowsituation. It becomes clear that, all along, Mr A has been occupied withnoticing the interviewer’s reaction to his frank assertion about the inter-views. In this last section the interviewer, stating that Mr A’s lack of moti-vation is “quite understandable”, meets Mr A’s protest with an affirmativecomment. Mr A responded by saying that: “You’re not getting hurt …that’s not an issue”. In the interview, Mr A seems to have feared a confron-tation in which he expresses his dissatisfaction with the interviewer and theinterviews. However, during the interview he seems to recognize that it wasnot the interviewer’s vulnerability that it all hinges on. It is as if he under-stands that it depends upon his own courage.Mr A’s internal ‘work’ on being direct and frank towards the interviewer

may have been challenged by the interviewer’s work with his anxiety andaggression in the countertransference. The interviewer’s statement about MrA’s lack of motivation being “understandable” came after a struggle withinthe interviewer that was probably unconsciously registered by Mr A. Thus,the fact that there was a conflict between the two in the interview situationsupports, in our opinion, the interpretation that Mr A – in line with hisown self-report of change – is now able to handle conflicts and also repre-sent his aggression in a more constructive way in action. His greater free-dom is not only a question of saying, but of doing.The interviews with Mr A demonstrate self-assertion on two different lev-

els. Firstly, Mr A gives a report about change involving increased capacityfor active self-assertion. However, contrary to the subjective report ofchange, the first interview demonstrated that, although obviously on hisway to becoming more direct in expressing his feelings, Mr A could notarticulate his protest straightforwardly. The last interview, however, demon-strates active self-assertion as unfolding in the here-and-now. The dialogueillustrates how Mr A now is able to speak directly about his reluctance andnegative feelings about the interviews as well as the interviewer. Thus, inthe follow-up interviews with Mr A self-assertion is present both as a reportand as lived. The distinction between the two is well captured through theconcepts of structuralized and actualized affect: Mr A’s subjective report ofhow he feels he has changed represent a structuralized narrative about self-assertion, in contrast to actively expressed self-assertion in the here-and-now situation. More specifically, the interviews illustrate a movement froma passive protest – that is probably activated by his experience of the inter-views as a dictation – to an active protest. Throughout the three interviews,Mr A struggles with being more direct and frank about his negative affects,working with his relationship to the interviewer to become increasinglymore open and expressive. This process occurring across the interviews maysignify an authentic expression of being in change.As to the assessment of change, this interview method not only provides

subjective reports about change, but observations of behaviour as well. MrA’s capacity to express protest in a straightforward manner stands in sharpcontrast to his earlier relational style which, by his own words, involved asocial representation of being easy-going but at the same time being trappedin intrapsychic violent fantasies. Certainly, this altered way of being would

Analytic change 13


seem to indicate a restructuring of aggression, implying increased ability touse aggression in the service of self-representation.The illustration provided by patient A is in line with the reflections of

Pfeffer and others after him, that a successful psychoanalysis typically givesthe patient a better way of working with his dominant relational themes(Kantrowitz et al., 1990a, 1990b, 1990c; Leuzinger-Bohleber, 2002; Orem-land et al., 1975; Pfeffer, 1959, 1961, 1963; Schlessinger and Robbins, 1975,1983). In accordance with this, it is also argued to be a good sign – in termsof being in a process of change – that the patient is capable of regressing inthe interviews and of getting into a transference relationship with the inter-viewer such that he or she is then capable of re-examining and handling hisor her own transference (Norman et al., 1976).

DiscussionThis article aims to introduce concepts that can make analytic change sali-ent in relational ways of being. In order to illustrate these concepts we havepresented excerpts from a psychoanalytic follow-up interview with Mr A. Inthis case representation of aggression, on a procedural level, could be regis-tered and studied. The present study has no ambition to conclude whetheror not Mr A’s process of change is really causally connected to him havingundergone psychoanalysis. Neither is the aim to argue that a psychoanalyticfollow-up interview is the best way to study all kinds of personality changesafter analysis. However, the presented interview method can provide richmaterial with which to assess authenticity of changes in interpersonal style.It is also an interview method that can provide complex material for study-ing psychoanalytically relevant phenomena, such as how experiences ofchange are expressed in transference and countertransference. The situationof the interview allows the participant to show his/her ways of being andthen provides an opportunity to talk about these ways of being in a mannerthat can reveal how the participant experiences and thinks about it.Other studies on the phenomenon of transference in extra-analytic situa-

tions exist and are relevant to the present study. For example, there arestudies that demonstrate, within an experimental paradigm, that transfer-ence can be “activated without awareness of triggering cues“ (Andersen andBerk, 1998; Glassman and Andersen, 1999). These studies are interestingfrom a psychodynamic viewpoint since the rather complex phenomenon oftransference is shown under experimental conditions. However, the designsof these studies focus on a rather limited aspect of transference. For exam-ple, they study the degree to which subliminally triggering cues in partici-pants lead to more significant-other-derived inferences about a targetperson (Glassman and Andersen, 1999). The participants in the studybelieved that they were playing a computer game with an unknown partner.While playing the game, they were exposed to subliminal cues of differentqualities. The study showed that, when the participants where subliminallypresented descriptors of their own significant other while playing the game,they were more likely to infer their game partner as having significant-otherfeatures. Descriptors, trait words, of their significant other, acted as trigger-



ing cues that influenced how the participants ‘see’ the gaming partner. Inother words, in this experimental situation transference is demonstrated.This represents a social–cognitive perspective of transference with a focus on“significant-other-derived inferences about a new person” (ibid., p. 1158).Another, rather complex study was conducted by Krause and Merten

(1999). Briefly, the study arranged for two people, one taken from a group ofmental health patients and one from a healthy group, to collaborate on asocial task while they were measured on several interaction variables includ-ing facial expression, eye contact, listener–speaker conditions and verbal dis-course. In their discussion of the findings, the authors argue that transferencecan be understood as a choreographing of scenes containing three elements:“the author of the scene, an action partner and a sequence of interactionbetween them” (ibid., p. 111). This seems to have conceptual affinity with theconcept of ‘relational scenario’ used in the present article, as relational sce-nario refers to a relationship between a representation of the self and of anobject, with a pattern of interaction that is relatively stable in different situa-tions. As was experienced in the current study’s interviews, Krause and Mer-ten also argue that these scenes “nudge” others to “take over a part in a realobject relationship” (ibid., p. 112). They argue that it is the affective part ofscenes that gives them their “seductive power” (ibid., p. 111).In psychotherapy research there has also been a growing interest in mea-

suring transference. Some of the best-known methods that contributedirectly or indirectly to studying transference are the Missouri IdentifyingTransference Scale (Multon et al., 1996), the Plan Formulation Method(Curtis and Silberschatz, 1997), Ideographic Conflict Formulation Method(Perry et al., 1989), Configurational Analysis (Horowitz and M€oller, 2009)and Core Conflictual Relationship Theme Method (CCRT) (Luborsky,1977; Luborsky and Crits-Christoph, 1998). These are all methods that aimat systematic assessment of therapeutic process and outcome, where trans-ference is a variable that is measured. The methods have in common thatthey make use of systematic procedures in coding transcripts of sessionsand use independent and trained scorers. The methods thus make impor-tant, yet different contributions to the field of formal research on psycho-therapeutic and psychoanalytic process and outcome. This field is not thefocus, however, of the present study. The present study is focused, rather,on a more explorative and conceptual goal.Despite its unsuitability for the purposes of the present study, it is none-

theless interesting to compare the concept of transference used in the pres-ent article with that used in CCRT. We have argued that it is important tohave concepts of transference, and ways of registering it, that take intoaccount ways of being and relational style. We also claimed that qualities inrelational ways of being as expressed on a procedural level is somewhatneglected in the assessment of change. Is it really true to say, however, thatCCRT, as one of the systematic methods that most directly focuses ontransference, has neglected this aspect of analytic change?Dreher (2000) has critically examined the concept of transference, as

applied in the CCRT method, in a way that clearly depicts the differences inunderstanding of this concept. The definition of transference in CCRT seems

Analytic change 15


to be based primarily on that part of Freud’s writing where transference isunderstood as a “stereotype plate,” a “relatively invariant relationship”(ibid., p. 78). This is a well-known and meaningful definition of transference,and it fits with a method in which the aim is to find transference via patternsin transcribed text of therapy sessions. However, one may ask if this is theonly possible definition of transference, and whether, by holding on to thisperspective on transference alone, one is limiting the phenomenon. Dreherargues that transference is not a thing that is in the behaviour of a patientper se. On the contrary, the phenomenon that we refer to as ‘transference’ isa result of psychoanalytic interpretation, and is thus dependent on the rela-tional context and on the person making the interpretation. This implies thattransference involves the participation of at least two persons. Seen from thisviewpoint, observation of transference is optimal when done in a relationalsituation, i.e. not in transcribed text but in a real relationship.Interestingly, Dreher (ibid., p. 87) argues that it is in an active, real rela-

tionship that one can become aware of “the gestures that accompany words”.By referring to the importance of observing gestures and not just words, Dre-her is expressing a perspective on transference that is close to the onepresented here: a concept of transference that includes formal ways of beingand relational procedures. According to this perspective, a relational proce-dure is usually manifest in nonverbal gestures, intonation and bodily attitude.CCRT’s coding system fails to capture an important aspect of transferenceby not including any observation of the “scene” in which the relational inter-action between two persons unfolds (ibid.). This argument is in line with ours:that relational style can be registered only if one is sensitive to the total rela-tional situation. An interactional pattern can only be grasped by consideringthe ‘Gestalt’ of the scene, meaning that this pattern is difficult to detect whenone has to break down an interaction into codes (Lorenzer, 1976).

ConclusionOutcome research in psychoanalysis is in need of criteria that do justice tothe specific changes sought by psychoanalysis. This article has argued for acriterion of change in patterns of dynamic ways of relating. When a patienthas gone through an intensive and time-consuming treatment such as psy-choanalysis, with its focus on insight and reflection, we can probably expectthe patient to show some practice in reflecting about himself. However, clin-ically we know that self-reflection does not always express a permeatingchange. Qualities of relational ways of being more authentic express innerobject relationships and should not be neglected in studies of change.

Translations of summaryAnalytic €Anderung: Beurteilung Wege des Seins in eine psychoanalytischen Follow-up-Inter-view. Der Autor vertritt die These, dass die Konzepte des Beziehungsszenariums, des strukturalisiertenAffekts und des aktualisierten Affekts Kandidaten f€ur die Beobachtung von Ver€anderungen relationaler,in der €Ubertragung Ausdruck findender Seinsweisen sind. Er illustriert anhand eines psychoanalytis-ches Follow-up-Interview mit einem ehemaligen Analysepatienten, wie Ver€anderung in relationalen



Seinsweisen identifiziert und untersucht werden kann. Durch Triangulierung der m€undlichen Schilderungder Ver€anderung durch den Patienten selbst mit nonverbaler Information und €Ubertragungs-Gegen€ubert-ragungsdynamik werden qualitative Ver€anderungen in relationalen Seinsweisen fassbar. Der vorgestellteFall illustriert den fortlaufenden Prozess des Hinarbeitens auf eine direktere Repr€asentation der Aggres-sion und zeigt, wie dieser Prozess mit Hilfe der vorgeschlagenen Konzepte in der Interviewsituation beo-bachtbar wird. Die erl€auterten Konzepte des Beziehungsszenariums, des strukturalisierten und desaktualisierten Affekts werden mit dem in Studien €uber das zentrale Beziehungskonflikt-Thema (CCRT)verwendete €Ubertragungskonzept verglichen.

Cambio anal�ıtico: evaluando los modos de ser en las entrevistas de seguimiento psicoanal�ıti-cas. El art�ıculo argumenta y propone que los conceptos de escenario relacional, afectos estructurados yafectos actualizados sean considerados a la hora de observar los cambios en los modos de ser relacio-nales que se expresan en la transferencia. Se presenta una entrevista psicoanal�ıtica de seguimiento de unex-paciente anal�ıtico para ilustrar c�omo el cambio en los modos de ser relacional pueden ser registradosy estudiados. Triangulando la informaci�on verbal del paciente sobre el cambio con la informaci�on noverbal y las din�amicas transferencia-contratransferencia, uno puede captar cambios cualitativos en losmodos de ser relacional. El caso presentado ilustra el continuo proceso de trabajo del ex-paciente pararepresentar la agresi�on de una manera m�as directa, y c�omo este proceso puede observarse con la ayudade los conceptos propuestos para la situaci�on de entrevista. Estos conceptos de escenario relacional, afec-tos estructurados y actualizados se comparan con el concepto de transferencia usado en los estudios so-bre el tema central del conflicto relacional (CCRT).

Le changement analytique : l’�evaluation des mani�eres d’etre dans les entretiens de suivi.L’auteur de cet article soutient que les concepts de sc�enario relationnel, d’affect structurel et d’affect ac-tualis�e sont propices �a l’observation des changements des mani�eres d’etre dans la relation aux autrestelles qu’elles s’expriment au sein de la relation transf�erentielle. L’auteur pr�esente l’entretien de suivid’un ancien analysant afin d’illustrer comment il est possible de recueillir et d’�etudier de tels change-ments. En triangulant le compte-rendu du patient sur les changements qu’il a observ�es avec des informa-tions non verbales et la dynamique transf�ero-contre-transf�erentielle, il est possible de saisir leschangements qualitatifs des mani�eres d’etre dans les relations �a autrui. Le cas pr�esent�e ici illustre �a lafois le processus en cours chez cet ancien patient dans le travail d’�elaboration et de repr�esentation plusdirecte de l’agressivit�e et la fac�on dont ce processus peut etre observ�e dans la situation d’entretien graceaux concepts mentionn�es pr�ec�edemment. Ces concepts – sc�enario relationnel, affect structurel et affectactualis�e, sont mis en regard avec le concept de transfert qui est utilis�e dans l’�etude du noyau conflictuelde la th�ematique relationnelle (CCRT).Il cambiamento in analisi: Valutazione delle modalit�a di esistenza in colloqui di follow-up. Inquesto lavoro si propongono i concetti di ‘scenario relazionale’, ‘affetto strutturato’ e ‘affetto realizzato’come criteri possibili per la valutazione dei cambiamenti delle modalit�a relazionali osservati nel transfert.Viene presentato un incontro analitico di follow-up con un ex-paziente al fine di illustrare come sia possi-bile registrare e esaminare i modi di rapportarsi di un soggetto. Le comunicazioni verbali del paziente,quelle extraverbali e l’insight ottenuta nel transfert-controtransfert formano una prospettiva triangolareche consente di individuare i cambiamenti qualitativi nelle modalit�a di rapporto del paziente. Nel caso difollow-up presentato, si illustra il processo ancora attivo del paziente, e il costante impegno di quest’ul-timo a rappresentare la sua aggressione in modo pi�u diretto; il caso dimostra inoltre come questo proces-so sia reso manifesto servendosi, nel corso dell’incontro, dei tre criteri sopracitati. I tre criteri propostivengono quindi comparati con il concetto di transfert usato negli studi di Core Conflictual RelationshipTheme (CCRT), basati sull’osservazione dei motivi centrali e ricorrenti nei conflitti relazionali del paz-iente.

ReferencesAndersen SM, Berk MS (1998). Transference in everyday experience: Implications of experimentalresearch for relevant clinical phenomena. Rev Gen Psychol 2:81–120.

Balint M (1935). The final goal of psychoanalytic treatment. Chapter 11 in: Primary love andpsychoanalytic technique. London: Hogarth, 1952.

Clyman RB (1991). The procedural organization of emotions: A contribution from cognitive science tothe psychoanalytic theory of therapeutic action. J Am Psychoanal Assoc 39:349–82.

Crittenden PM (1999–2001). Attachment in adulthood: Coding manual for the dynamic–maturationalapproach to the adult attachment interview. Unpublished manuscript, available from the author.

Curtis JT, Silberschatz G (1997). The plan formulation method. In: Eells TD, editor. Handbook ofpsychotherapy case formulation, 116–136. New York, NY: Guilford.

Dreher AU (2000). Foundations for conceptual research in psychoanalysis. London: Karnac.

Analytic change 17


Falkenstr€om F, Grant J, Broberg J, Sandell R (2007). Self-analysis and post-termination improvementafter psychoanalysis and long-term psychotherapy. J Am Psychoanal Assoc 55:629–74.

Fonagy P (1999). Memory and therapeutic action. Int J Psychoanal 80:215–23.Fonagy P, Gergely G, Jurist EL, Target M (2002). Affect regulation, mentalization and thedevelopment of the self. New York, NY: Other Press.

Glassman NS, Andersen SM (1999). Activating transference without consciousness: Using significant-other representations to go beyond what is subliminally given. J Personal Social Psychol 77:1146–62.

Gullestad SE (2003). The adult attachment interview and psychoanalytic outcome studies. Int JPsychoanal 84:651–68.

Gullestad SE (2005). Underteksten. Psykoanalytisk terapi i praksis. Oslo: Universitetetsforlaget.Gullestad SE, Killingmo B (2005). Underteksten. Psykoanalytisk terapi i praksis. Oslo: Univer-sitetsforlaget.

Hill CE, Lambert MJ (2004). Methodological issues in studying psychotherapy processes andoutcomes. In: Lambert MJ, editor. Bergin and Garfield’s handbook of psychotherapy and behaviourchange, 84–136. New York, NY: Wiley.

Horowitz MJ, M€oller B (2009). Formulating transference in cognitive and dynamic psychotherapy usingrole relationship models. J Psychiatr Pract 15:25–33.

Joseph B (1985). Transference: The total situation. Int J Psychoanal 66:447–54.Kantrowitz JL, Katz AL, Paolitto F (1990a). Follow-up of psychoanalysis five to ten years aftertermination: I. Stability of change. J Am Psychoanal Assoc 38:471–96.

Kantrowitz JL, Katz AL, Paolitto F (1990b). Follow-up of psychoanalysis five to ten years aftertermination: II. Development of the self-analytic function. J Am Psychoanal Assoc 38:637–54.

Kantrowitz JL, Katz AL, Paolitto F (1990c). Follow-up of psychoanalysis five to ten years aftertermination: III. The relation between the resolution of the transference and the patient–analystmatch. J Am Psychoanal Assoc 38:655–78.

Killingmo B (2007). Relational oriented character analysis: A position in contemporary psychoanalysis.Scand Psychoanal Rev 30:76–83.

Krause R, Merten J (1999). Affects, regulation of relationship, transference and countertransference.Int Forum Psychoanal 8:103–14.

Laplanche J, Pontalis J-B (1973). The language of psychoanalysis. London: Hogarth.Leuzinger-Bohleber M (2002). A follow-up study – critical inspiration for our clinical practice? In:Leuzinger-Bohleber M, Target M. Outcomes of psychoanalytic treatment: Perspectives for therapistsand researcher, 143–176. London: Whurr.

Leuzinger-Bohleber M, Stuhr U, R€uger B, Beutel M (2003). How to study the ‘quality of psychoanalytictreatments’ and their long-term effects on patients’ well-being: A representative, multi-perspectivefollow-up study. Int J Psychoanal 84:263–90.

Lorenzer A (1976). Sprachzerst€orung und Rekonstuktion. Vorarbeiten zu einer Metatheorie derPsychoanalyse. Frankfurt a/M: Suhrkamp.

Luborsky L (1977). Measuring a pervasive psychic structure in psychotherapy: The core conflictualrelationship theme. In: Freedman N, Grand S, editors. Communicative structures and psychicstructures, 367–395. New York, NY: Plenum.

Luborsky L, Crits-Christoph P (1998). Understanding transference. New York, NY: Basic Books.Multon KD, Patton MJ, Kivlighan Jr DM (1996). Development of the Missouri identifying transferencescale. J Counsel Psychol 43:243–52.

Norman HF, Blacker KH, Oremland JD, Barrett WG (1976). The fate of the transference neurosis aftertermination of a satisfactory analysis. J Am Psychoanal Assoc 24:417–98.

Oremland JD, Blacker KH, Norman HF (1975). Incompleteness in ‘successful’ psychoanalysis: Afollow-up study. J Am Psychoanal Assoc 23:819–44.

Perry JC, Augusto F, Cooper SH (1989). Assessing psychodynamic conflicts: I. Reliability of theideographic conflict formulation method. J Study Interpers Processes 52:289–301.

Pfeffer AZ (1959). A procedure for evaluating the results of psychoanalysis: A preliminary report. J AmPsychoanal Assoc 7:418–44.

Pfeffer AZ (1961). Follow-up study of a satisfactory analysis. J Am Psychoanal Assoc 9:698–718.Pfeffer AZ (1963). The meaning of the analyst after analysis: A contribution to the theory oftherapeutic results. J Am Psychoanal Assoc 11:229–44.

Sandler J, Dreher AU (1996). What do psychoanalysts want? The problem with aims inpsychoanalytic therapy. New York, NY: Routledge.

Schlessinger N, Robbins FP (1975). The psychoanalytic process: Recurrent patterns of conflict andchanges in ego functions. J Am Psychoanal Assoc 23:761–82.

Schlessinger N, Robbins F (1983). A developmental view of the psychoanalytic process: Follow-upstudies and their consequences. Madison, CT: International UP.

Stern DN (2004). The present moment in psychotherapy and every day life. New York, NY: Norton.



St€anicke E (2010). Analytic change after analysis. A conceptual case-based follow-up study. Doctoralthesis (PhD), Department of Psychology, Faculty of Social Sciences, University of Oslo.

St€anicke E (2011). Different ways of moving ahead after analysis: Changes in experientialdimensions. Psychoanal Psychol 28: 229–246.

St€anicke E, Killingmo B (2013). Object trust: A specific kind of analytic change. Psychoanal Psychol30: 423–437.

Varvin S (1999). The Oslo II study: A process–outcome study of psychoanalysis. In: Fonagy P, editor.An open door review of outcome studies in psychoanalysis. University College London.

Wallerstein RS (2000). 42 lives in treatment: A study of psychoanalysis and psychotherapy: Thereport of the psychotherapy research project of the Menninger Foundation, 1954–1982. New York,NY: Other Press.

Analytic change 19


analytic change: assessing ways of being in a psychoanalytic follow-up interview

Documents