When interventions make an impact: An empirical investigation of analyst's communications and patient's productivity

Psychoanalysis can be thought of as a scene that is created by the analyst, the patient and the "analytic work." The "work" comprises the interactional patterns of the dyad which evolve over time to create new possibilities for functioning of the patient. Taking this framework as a starting point, this study presents an empirically based investigation of the psychoanalytic process, paying close attention to the interplay between the analyst's interventions and the patient's linguistic productivity. The measures used assessed 2 dimensions: (a) variables coding the nature of the therapist's interventions (explorations, linking interventions, interpretations); and (b) variables assessing the patient's linguistic productivity as affected by her cognitive-affective states (use of repetition, level of symbolization and emotional engagement as measured by referential activity). Using a single-case design with a mixed quantitative/qualitative methodology, these measures were applied to psychoanalytically coherent segments of the sessions. Quantitative results showed significant differences between the type of intervention used by the analyst and patient's preceding or ensuing linguistic productivity. It was found that the analyst is significantly more likely to make interventions with exploratory functions, which have a greater disorganizing potential, when the patient is at a level of functioning where she can handle the inherent tension derived from the exploration of conflict-laden representations. Moreover, the analyst is significantly more likely to make a linking intervention-predicted to bring together different elements of the patient's representations in new ways that allow for a progressive reorganization of the patient's internal landscape-when the patient is adhering to the fundamental rule, a good working alliance, and the potential for symbolization and discovery is within reach. These results provide new insight into the way the psychoanalytic process operates bringing an empirical eye to the mix of controversy around questions of technique in psychoanalysis.