General Instructions: The purpose of this exam is to assess your knowledge and ability to conceptualize theory and practice from a psychoanalytic perspective. The exam is open-ended and thus you may use the course material (texts, readings, lectures etc.) to assist you in developing your best response to each question. Completed exams should be uploaded in Microsoft Word (i.e. .docx) format to CANVAS by THURSDAY, MARCH 24 BY 3:00PM. Be sure to use your time wisely as there will be 10pts automatically deducted from exams submitted after the deadline.

Question 1: Effectiveness of Psychodynamic Therapy (10 points)

Summarize the research providing the evidence base for psychodynamic therapy. What do studies show about the efficacy of long-term and short-term psychodynamic therapy? What kinds of psychological disorders is psychodynamic therapy effective in treating? Do these clinical benefits last?

Question 2: Classical Freudian Psychodynamic Theory (10 points)

Describe some of the basic concepts presented in Sigmund Freud’s classical theoretical models (drive, topographic—preconscious, conscious, and unconscious, structural—id, ego, superego etc.). How did he conceptualize the role of unconscious impulses and wishes in the development of symptoms? Discuss how classic methodologies like free association, interpretation and defense analysis can be used to create therapeutic change.

Question 3: Conceptualizing Interpersonal Psychoanalysis & Self Psychology (20 points)

Compare and contrast Sullivan’s Interpersonal Psychoanalysis and Kohut’s Self Psychology. How does each theory conceptualize healthy development of the self? What is their perspective on the role of parents in healthy personality development? Describe the clinical methodology used in each approach especially with regard to the relationship between the therapist and client?

Question 4: Considering Relational Psychoanalysis & Intersubjective Theory (20 points)

Describe the focus of Relational Psychoanalysis including the ways in which Relational Psychoanalysis conceptualizes the therapeutic relationship, and how social and/or cultural factors influence the process of psychotherapy. Remember that this model was influenced by Interpersonal Psychoanalysis, Self-Psychology, and Object Relations Theories. How do intersubjective concepts like empathic introspection reinforce multiple ways of understanding psychological phenomena?

Question 5: Case Conceptualization (40 points)

Read the following case material. Then, describe how you would conceptualize the case using psychoanalytic theory. Consider various psychoanalytic perspectives (drive, object relations, self psychology, interpersonal psychoanalysis, relational psychoanalysis etrc.) in your formulation. Describe the client’s presenting concerns and central themes as well as sociocultural issues that provide insight regarding her subjective experience of her symptom presentation. Be sure to note the major goals of p

The Efficacy of Psychodynamic Psychotherapy

Jonathan Shedler University of Colorado Denver School of Medicine

Empirical evidence supports the efficacy of psychodynamic
therapy. Effect sizes for psychodynamic therapy are as
large as those reported for other therapies that have been
actively promoted as “empirically supported” and “evi-
dence based.” In addition, patients who receive psychody-
namic therapy maintain therapeutic gains and appear to
continue to improve after treatment ends. Finally, nonpsy-
chodynamic therapies may be effective in part because the
more skilled practitioners utilize techniques that have long
been central to psychodynamic theory and practice. The
perception that psychodynamic approaches lack empirical
support does not accord with available scientific evidence
and may reflect selective dissemination of research find-

Keywords: psychotherapy outcome, psychotherapy
process, psychoanalysis, psychodynamic therapy, meta-

There is a belief in some quarters that psychodynamicconcepts and treatments lack empirical support orthat scientific evidence shows that other forms of
treatment are more effective. The belief appears to have
taken on a life of its own. Academicians repeat it to one
another, as do health care administrators, as do health care
policymakers. With each repetition, its apparent credibility
grows. At some point, there seems little need to question or
revisit it because “everyone” knows it to be so.

The scientific evidence tells a different story: Consid-
erable research supports the efficacy and effectiveness of
psychodynamic therapy. The discrepancy between percep-
tions and evidence may be due, in part, to biases in the
dissemination of research findings. One potential source of
bias is a lingering distaste in the mental health professions
for past psychoanalytic arrogance and authority. In decades
past, American psychoanalysis was dominated by a hierar-
chical medical establishment that denied training to non-
MDs and adopted a dismissive stance toward research. This
stance did not win friends in academic circles. When em-
pirical findings emerged that supported nonpsychodynamic
treatments, many academicians greeted them enthusiasti-
cally and were eager to discuss and disseminate them.
When empirical evidence supported psychodynamic con-
cepts and treatments, it was often overlooked.

This article brings together findings from several em-
pirical literatures that bear on the efficacy of psychody-
namic treatment. I first outline the distinctive features of
psychodynamic therapy. I next review empirical evidence
for the efficacy of psychodynamic treatment, including
evidence that patients who receive psychodynamic therapy
not only maintain therapeutic gains but continue to improve

over time. Finally, I consider evidence that nonpsychody-
namic therapies may be effective in part because the more
skilled practitioners utilize interventions that have long
been central to psychodynamic the


Collected Papers

da9 – 2 Y 2 rn


With an Introduction by


Chapter XVIII

Transitional Objects and Transitional


IT IS W E L L K N O W N that infants as soon as they are born tend to use fist,
fingers, thumbs in stimulation of the oral erotogenic zone, in satisfaction of
the instincts a t that zone, and also in quiet union. I t is also well known that
after a few months infants of either sex become fond of playing with dolls, and
that most mothers allow their infants some special object and expect them t o
become, as it were, addicted to such objects.

There is a relationship between these two sets of phenomena that are
separated by a time interval, and a study of the development from the earlier
into the later can be profitable, and can make use of important clinical
material that has been some-vhat neglected.

B e First Possession
Those who happen to be in close touch with mothers’ interests and prob-

lems will be already aware of the very rich patterns ordinarily displayed by
babies in their use of the &st Not-Me possession. These patterns, being dis-
played, can be subjected todirect observation.

There is a wide variation t o be found.in a sequence of events which starts
with the new-born infant’s fist-in-mouth activities, and that leads eventually
on t o an attachment to a teddy, a doll o r soft toy, o r to a hard toy.

Based on a paper read before the British Psycho-Analytical Society on 30th May, 1951.
Int. I . Psycho-Awl., Vol. XXXIV, 1953.

i I t is ngzssaly to stress that the word used h m is ‘possession’ and not ‘object’. In the
typed version distributed to members I did in fact use the word ‘object’ (instead of ‘posses-
sion’) in one place by mistake, and this led to confusion in the discussion. It was pointed out

1 that the first Not-Me object is usually taken to be the breast. The reader’s attention is drawn
to the use of the word ‘transitional’ in many places by Fairbairn (1952, p. 35.).


It is clear that something is important here other than oral excitement and
satisfaction, although this may be the basis of everything else. Many other
important things can be studied, and they include:

The nature of the object.
The infant’s capacity to recognize the object as Not-Me.
The place of the object – outside, inside, a t the border.
The infant’s capacity to create, think up, devise, originate, produce an
The initiation of an affectionate type of object relationship.

I have introduced the terms ‘transitional object’ and ‘transitional pheno-
mena’ for designation of the intermediate area of experience, between the
thumb and the teddy bear, between the oral erotism and true object relation-
ship, between primary creative activity a

(1998). Psychoanal. Q., (67)(1):1-31

The Analyst’s Knowledge and Authority

Stephen Mitchell

Current controversies about the nature of the knowledge analysts offer their patients and the kinds of authority they can
legitimately claim are of central importance in the evolution of psychoanalytic ideas. These controversies reflect deep
differences regarding basic assumptions about both epistemology and the nature of mind. An approach to these issues is
offered which, it is argued, is closer to broad cultural shifts in thinking about knowledge in general than is the traditional
psychoanalytic stance. Implications for theory and clinical practice are explored.

There is no issue on the contemporary psychoanalytic scene, either in our literature or in our clinical conferences, more
important than recent, wide-ranging efforts to understand and redefine the nature of the analyst’s knowledge and
authority. In some sense this problem subsumes all other current issues and developments, for it raises questions about
the very claims psychoanalysis makes for itself as a discipline and about what we, as clinicians, think we are offering our
patients. It is also a key ingredient of any position on both the history of psychoanalysis and the important question of the
relationship between contemporary psychoanalysis and the classical tradition.

What kinds of expertise do psychoanalysts have? Is the kind of knowledge and authority we claim for ourselves today the
same as that claimed by Freud and his generation of clinicians? There are

An expanded version of this essay is to be found in the recently published book, Influence and Autonomy in Psychoanalysis (The Analytic Press, 1997).1

so many different facets to the problems of knowledge and authority in psychoanalysis that it would take a hefty volume
to even begin to do them justice.

What I intend to do in this paper is to outline the kind of knowledge and authority that I believe today’s analytic clinician
can justifiably claim: an expertise in meaning-making, self-reflection, and the organization and reorganization of
experience. However, the kind of authority and knowledge that I will highlight has often been hard to see clearly and hold
on to because it gets obscured by other, closely related problems concerning psychoanalytic politics and transformations
in philosophy of science. Our task here is to get to the heart of the problem for today’s clinicians, but to do that, we first
have to peel back other dimensions of the problem, to traverse some sweeping historical and philosophical terrain.

The Nature of Knowledge: Psychoanalytic and Otherwise

Outside of the seemingly self-contained community of matters psychoanalytic, we find pervasive changes in ideas about
ideas, in understandings of what it means to know anything. For almost three hundred and fifty years, from the beginnings
of the scientific revolution in the seventeenth century to the mid-twentieth century, Western culture moved more and more



Does Psychoanalysis Need a Psychology of the Self?

On Scientific Objectivity

In the preceding chapter I presented clinical material in support of the thesis that we may consider an
analysis completed when by achieving success in the area of compensatory structures it has established
a functioning self—a psychological sector in which ambitions, skills, and ideals form an unbroken
continuum that permits joyful creative activity. The definition of psychoanalytic cure implied by the
foregoing statement must now be evaluated against the background of the definitions that have been
traditionally accepted by psychoanalysts.

Before going into details, let me emphasize that I am focusing here on a principle: I am not
concerned with issues evoked by such terms as analytic wisdom, reasoned expediency, and the like,
even though I fully recognize their clinical relevance and that I would probably avoid a number of
difficulties if I addressed myself primarily to them, inasmuch as no analyst will make the unrealistic
claim that he has ever analyzed a person completely in all sectors of his personality or that he should
even attempt to achieve such perfection. I concerned here with the problem raised by the fact that Iam
am speaking of a valid termination of an analysis that has—in terms of structures— dealt with all thenot
layers of the essential pathology of the analysand, that has—in terms of cognition— led to thenot
undoing of all infantile amnesias, to the expansion of knowledge concerning all those events of
childhood that are genetically and dynamically related to the psychopathology from which the patient

Freud was, of course, convinced of the fact that psychoanalysis had a wholesome effect on the
analysand, that it constituted a process whose momentum should be maintained, and that it should be
carried forward as far as possible. But while he provided us with the outline of the essentials of this
process, which, put briefly, can be defined either, in terms of cognition, as making the unconscious
conscious, or, in terms of structures, as extending the domain of the ego, he never elaborated—at least
not in scientific seriousness, i.e., in theoretical terms—his conviction of the wholesome effect of
analysis in the form of the claim that psychoanalysis cures psychological illnesses, that it establishes
mental health. Freud’s values were not primarily health values. He believed in the intrinsic desirability
of knowing as much as possible: he was—through the convergence and mutual reinforcement of the
dominant world view of his time and some personal preferences (no doubt determined by experiences
in early life) which transformed that scientific world view into his personal categorical imperative, his
personal religion—intransigently committed to the task of knowing the truth, facing the truth, seeing
reality clearly.

One of the most moving anecdotes about Freud’s life concerns this deeply anchored aspect of his



Reflections on the Nature of Evidence in Psychoanalysis

One cannot approach the problem of proper termination and cure in analysis unless one first
circumscribes the nature of the disturbance that is being treated. And one cannot convince anyone about
the accuracy of the definitions of certain psychic disorders to be ameliorated or cured through analysis
unless one has first succeeded in demonstrating that the framework into which these definitions are
placed—in the present context, the framework of a psychology of the self—is both valid and relevant.
The claim that a psychology of the self does indeed fulfill these criteria cannot be satisfactorily
supported, however, through logical argument alone. Without empirical data, one can hardly do more
than demonstrate the internal consistency of one’s views.

Before I undertake arguing the case, on the basis of the examination of empirical data, that
psychoanalysis does indeed need a psychology of the self, I would ask anyone wishing to make the
serious attempt of evaluating the explanatory power of this new step in theory first to set aside his
established convictions that all psychological illnesses can be adequately explained within the
framework of mental-apparatus psychology in general, and of modern structural-model psychology
(ego psychology) in particular—or even on the maturational level of the Oedipus complex. In other
words, the explanatory power and the heuristic value of a new theory, of a new way of viewing the
empirical data in the field of complex mental states, can be gauged only if the evaluator can accept the
difficult task of temporarily suspending his convictions to the contrary in order to expose himself to
new configurations. (I am omitting here the issue of specific emotional resistances and am addressing
myself only to the reluctance to give up the security provided by habitual modes of cognitive mastery.)
The evaluator must be able to put aside the traditional way of seeing the data frequently enough and for
sufficiently prolonged periods so that he can become familiar with the new theory.

Any beginner could of course tell me , for example, that Mr. M. broke off his analysis atex cathedra
the point when it really should have started, i.e., at the point when the yearning for the merger with the
idealized father would have turned into oedipal competitiveness accompanied by castration fear.
Clearly, I cannot deny with complete certainty that oedipal pathology was hiding behind Mr. M.’s
narcissistic disturbance. I can only state that, while I remain open to considering such a possibility, it
does not, on the basis of extensive clinical experience seem likely—although occasionally one is indeed
surprised to discover that a centrally located oedipal pathology has been covered over by what seemed
at first to be a primary disturbance of the self.

Further investigations of the various relations existing between self pathology and structural
pathology must, of



The Psychology of the Self and the Psychoanalytic Situation

The theoretical framework that defines our understanding of psychopathology and normal psychology
will influence not only our specific technical activities (especially with regard to the content of our
interpretations), but also, via subtle innuendos and gross moves, our general attitude vis-à-vis analytic
process and patient. The point of view, for example, taken with regard to such seemingly esoteric
questions as whether it is correct to say that man is born helpless because he is not born with a
significantly functioning ego apparatus—rather than that he is born powerful because a milieu of
empathic self-objects indeed his self—or whether man’s untamed drives are the primary units in theis
world of complex mental states with which introspective-empathic depth psychology deals—rather than
that the primary units are the complex experiences and action patterns of a self/self-objectab initio
unit—is closely connected with the attitude (manifested in concrete behavior) that the
depth-psychologist chooses to adopt as the most appropriate one for the therapeutic setting.

All psychoanalysts subscribe in principle to the tenet that the structure of the patient’s personality
(particularly his nuclear psychopathology and the genetically decisive experiences of his early life) will
emerge optimally in a neutral analytic atmosphere. I fully agree with this tenet—indeed, I believe that it
was only by a strict adherence to it that I was able to discern the specific form of psychopathology of
the narcissistic personality disorders and that I could recognize the dynamic essence of this disturbance
and delineate its genetic determinants. When I try to conduct myself in accordance with the principle of
analytic neutrality, however, i.e., of being the neutral screen upon which the personality of the
analysand, with its needs, wishes, and desires, can delineate itself, I do not attempt to approach a
zero-line of activity.

I have wondered how psychoanalysts who in general are endowed with far-above-average ability to
be empathic, could ever commit the error, as I think they sometimes do, of equating neutrality with
minimal response. Could the analyst’s training in the nonpsychological sciences be responsible for this
misinterpretation of a sound psychological principle? Someone who was first trained in the physical
sciences might well be inclined to compare the analytic situation with an experiment in chemistry or
physics or with a surgical operation. And he might define the analyst’s attempt to create a neutral
psychoanalytic atmosphere in analogy to, let us say, the attempt to keep a sensitive scale insulated from
any vibrations produced by noise or other uncontrolled sources. But appealing as such an analogy might
be on first sight, it is misleading.

During the analytic process the analyst’s psyche is engaged in depth. The essence of his evenly
hovering attention is not to be d



Professor Treniece Lewis Harris, PhD

Spring 2022

Week 3

On Beginning Treatment
● These were Freud’s recommendations for psychoanalysis not rules
● Treatment is Not recommended when

○ you have a previous social connection
○ the client wants to delay beginning

● Suggest a preliminary period of two weeks
● Be up front that this treatment is long-term and without a predefined ending
● Set a specific day and time to meet and hold the client accountable for it
● Charge a fee. Be clear about your fee and collect it on a regular basis
● Maintain the established frequency of appointments
● Maintain the treatment “position” and boundaries

On Beginning Treatment
● Allow the client to end treatment at any time

○ be clear about the risk of continued illness if ended prematurely
● Encourage the client to say whatever comes to mind. Say especially those

things that come to mind that you are reluctant to say for whatever reason.
● Allow the client to do most of the talking
● Say only enough to support them in talking further
● Do not grant requests to tell them what to talk about
● Reassure and question resistance if they “don’t have anything on their mind”
● Discourage client from preparing something to say or creating a narrative
● Discourage talking to others about the therapy, the therapist etc.

Guiding Principles & Values
● Capacity for survival or the continuation of a meaningful or purposeful state
● Acknowledgment of life’s complexity, depth, nuance
● Essential stance of humility, curiosity and patience
● Essential honesty about self and motives
● Exploration of motivational forces outside of our awareness (i.e. the


● Understanding the role of fantasy life

○ fulfillment of libidinal or aggressive wishes through one’s imagination

○ regulating self esteem, affect etc.

○ managing trauma or creating an experience of safety

● Balancing universal concepts with the client’s subjectivity and phenomenology

Guiding Principles & Values
● The Therapist’s Stance

Maintaining a Degree of Anonymity & Neutrality
■ keeping the focus on the patient’s desires, needs, conflicts etc.
■ respecting the client’s autonomy and decision-making
■ goal to facilitate the working alliance
■ understanding the impact on intimacy and power in the therapeutic


Use of Reflection-in-action
■ ongoing assessment
■ evolving situation with new information
■ modification of understanding

The Therapeutic Alliance
● Ongoing process of negotiating a collaborative relationship between the

therapist and the client to achieve a benefit from therapy
● The Three Parts of the Working Alliance

○ The Bond
■ Trust and attachment between therapist & client; degree of feeling

understood by the therapist
○ The Goals

■ Alignment on the aims or objectives the client and therapist are working

○ The Tasks
■ Agreement on methods used to reach therapeutic goals

● Invol

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