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The psychoanalytic societies in Germany as in many other countries are concerned by a decline in the number of candidates for full psychoanalytic training. While this situation is partly attributable to changes both in society and in educational and healthcare systems, it is questionable whether psychoanalytic training institutions have yet found adequate responses to it. Under the banner of 'evidence-based treatment', behaviour therapy has come to be widely disseminated, with major implications for the teaching of different psychotherapy paradigms at universities. To investigate the determinants of this trend in the specific German situation, a large-scale, multi-method exploratory study supported by 's programme was undertaken, focusing on the reasons given by a population (N = 679) of German psychology, medical, and education students for embarking on training in psychoanalysis or behaviour therapy. The results suggest that behaviour therapy is more compatible with the prevailing scientific understanding and with current societal and cultural trends, owing in part to inadequacies or bias in university teaching of the various paradigms of psychotherapy. While most of the psychology students expressed a preference for behavioural training, the psychotherapy option proved less attractive for their counterparts in the fields of medicine and education. Semi-standardized qualitative interviews were used to gain a deeper understanding of the students' decisions for or against training in a specific paradigm, and led to the identification of seven decision-making prototypes. Possible reasons for the students' decisions are discussed, and concrete proposals and recommendations are presented.

The psychoanalytic societies in Germany as in many other countries are concerned by a decline in the number of candidates for full psychoanalytic training. While this situation is partly attributable to changes both in society and in educational and healthcare systems, it is questionable whether psychoanalytic training institutions have yet found adequate responses to it. Under the banner of 'evidence-based treatment', behaviour therapy has come to be widely disseminated, with major implications for the teaching of different psychotherapy paradigms at universities. To investigate the determinants of this trend in the specific German situation, a large-scale, multi-method exploratory study supported by IPA's DPPT programme was undertaken, focusing on the reasons given by a population (N = 679) of German psychology, medical, and education students for embarking on training in psychoanalysis or behaviour therapy. The results suggest that behaviour therapy is more compatible with the prevailing scientific understanding and with current societal and cultural trends, owing in part to inadequacies or bias in university teaching of the various paradigms of psychotherapy. While most of the psychology students expressed a preference for behavioural training, the psychotherapy option proved less attractive for their counterparts in the fields of medicine and education. Semi-standardized qualitative interviews were used to gain a deeper understanding of the students' decisions for or against training in a specific paradigm, and led to the identification of seven decision-making prototypes. Possible reasons for the students' decisions are discussed, and concrete proposals and recommendations are presented.

Objective: To determine the effectiveness of manualized panic-focused psychodynamic psychotherapy (PFPP) in routine care in Germany. Method: German psychoanalysts were trained according to the PFPP manual. Fifty-four consecutive outpatients with panic disorder (with or without agoraphobia) were randomly assigned in a 2:1 ratio to PFPP or cognitive-behavioural therapy (CBT) plus exposure therapy. Subjects (female 57.4%; mean age 36.2 years) had high rates of psychiatric (68.5%) and somatic (64.8%) comorbidity, and previous psychiatric treatments (57.4%). Assessments were performed pre- and posttreatment and at 6-month follow-up. The primary outcome measure was the Panic Disorder Severity Scale. Results: Both treatments were highly effective. In patients randomized to PFPP, remission was achieved in 44.4% at termination and by 50% at follow-up (CBT 61.1 % and 55.6%, respectively). No significant differences were found. Emotional awareness, a posited moderator of good outcome in psychotherapies, was significantly higher in the CBT group at baseline. It was found to be a strong moderator of treatment effectiveness in both treatments. After adjusting for initial Levels of Emotional Awareness Scale (LEAS) scores, effect sizes (ESs) for the primary outcome were Cohen d = 1.28, from pre- to posttreatment, and d = 1.03, from pretreatment to follow-up, for PFPP, and d = 1.81 and 1.28 for CBT, respectively. Conclusions: PFPP was implemented effectively into clinical practice by psychoanalysts in the community in a sample with severe mental illness with large ESs. Assessment of LEAS may facilitate the identification of patients suitable for short-term psychotherapy. (Clinical Trial Registration Number: German Clinical Trials Register, DRKS00000245; Universal Trial Number, U1111-1112-4245)

Psychoanalytic training in the French Societies belonging to the International Psychoanalytic Association does not grant any place to the observation of babies as it exists in certain societies of other countries. Infant observation is even the object of sharp critiques by eminent French theoreticians. The reasons given for condemning infant observation and refusing to give it any place in the training programme lie in theoretical positions concerning the very nature of the Freudian discovery and its interpretation, which is more idealistic than empirical. The author discusses these reasons while drawing attention to the frequent confusion between a reference to empiricism and a reference to the experimental. The fear of a psychologizing deviation of metapsychology and of a denial of psychic reality leads, in the French model, to placing the emphasis on personal analytic experience during the candidate's psychoanalysis, prolonged by supervisions. It excludes any academic teaching of metapsychology or of related disciplines. The confusion between the empiricism of Esther Bick's method and the recourse to experimental procedures in developmental research stands in the way of making a place for infant observation and of recognizing its training value, not so much for the acquisition of new knowledge or the validation of metapsychological models, as for its usefulness in developing a mode of psychoanalytic observation and an increase in the candidates' containing capacities.

We test the hypotheses that (a) cognitive therapy is of comparable efficacy to psychodynamic psychotherapy, (b) 8-10 sessions of therapy is as effective as 16-20 sessions, and (c) brief therapist training is as effective as intensive training. Of 178 out-patients referred to a clinical trial of psychological treatment for generalised anxiety, 110 patients met DSM-III-R criteria for generalised anxiety disorder and were randomly assigned to three different forms of psychotherapy. The main comparison was between cognitive therapy and analytic psychotherapy, delivered by experienced therapists at weekly or fortnightly intervals over six months. A third treatment, anxiety management training, was delivered at fortnightly intervals by registrars in psychiatry after a brief period of training. Eighty patients completed treatment and were assessed before treatment, after treatment, and at six-month follow-up. Cognitive therapy was significantly more effective than analytic psychotherapy, with about 50% of patients considerably better at follow-up. Analytic psychotherapy gave significant improvement but to a lesser degree than cognitive therapy. There was no significant effect for level of contact. Patients receiving anxiety management training showed similar improvements to cognitive therapy after treatment, with rather lower proportions showing clinically significant change. Cognitive therapy is likely to be more effective than psychodynamic psychotherapy with chronically anxious patients. Significant improvements in symptoms can be achieved by trainee psychiatrists after only brief instruction in behaviourally based anxiety management. However, the superiority of cognitive therapy at follow-up suggests that the greater investment of resources required for this approach is likely to pay off in terms of more sustained improvement. There is no evidence that 16-20 sessions of treatment is more effective, on average, than 8-10 sessions.

The need to establish the efficacy of psychoanalytic long-term treatments has promoted efforts to operationalize psychic structure and structural change as key elements of psychoanalytic treatments and their outcomes. Current, promising measures of structural change, however, require extensive interviews and rater training. The purpose of this paper is to present the theory and measurement of Levels of Emotional Awareness (LEA) and to illustrate its use based on clinical case vignettes. The LEA model lays out a developmental trajectory of affective processing, akin to Piaget's theory of sensory-cognitive development, from implicit to explicit processing. Unlike other current assessments of psychic structure (Scales of Psychological Capacities, Reflective Functioning, Operationalized Psychodynamic Diagnostics) requiring intensive rater and interviewer training, it is easily assessed based on a self-report performance test. The LEA model conceptualizes a basic psychological capacity, affect processing. As we will illustrate using two case vignettes, by operationalizing implicit and explicit modes of affect processing, it provides a clinical measure of emotional awareness that is highly pertinent to the ongoing psychoanalytic debate on the nature and mechanisms of structural change.

Manualisation of psychodynamic psychotherapy poses a formidable challenge, but may prove indispensable in the effort to disseminate short-term psychodynamic treatments to a wider patient community. In the case of childhood emotional disturbances, the need for widely available treatments is particularly pressing especially once we pay heed to the emotional turmoil also underpinning many behavioural problems. Short-term Psychoanalytic Child Therapy (PaCT) is an emotion-oriented, play-focused treatment that aims to help the child to relinquish rigidly held maladaptive defence mechanisms that give rise to symptoms and interfere with healthy development. PaCT comprises twenty to twenty-five psychotherapeutic sessions conducted in alternating settings (parent-child, child alone, parents alone), in which a relational theme is uncovered and worked through. Here, the authors have created a manual for PaCT, successfully retaining the complexity of each treatment whilst making the application accessible for a greater range of settings. This manual will be of use to trainees and practising therapists alike.

In spite of the efficacy of the psychodynamic psychotherapies, the number of young psychiatric residents interested in psychodynamic therapies is decreasing. Our psychoanalytical group, Genden (Genève—Denver), explored the possible reasons for psychiatric residents' hesitation to get psychoanalytic training. Five psychoanalytical psychotherapists met weekly for a year in order to debate that question, focusing on personal feedbacks from all of our 100 residents in psychiatry working with us for at least 4 years. Following the residents' responses, our focus group proposed ten commonsense feedbacks for psychoanalysts regarding stimulating young psychiatric residents' interest in psychoanalytic approaches.

Gilbert M. Foley Yeshiva University, New York Contact author: Elaine Geller, Department of Communication Sciences and Disorders, Long Island University/Brooklyn, One University Plaza, Brooklyn, NY 11201. E-mail: egeller{at}liu.edu . Purpose: To offer a framework for clinical supervision in speech-language pathology that embeds a mental health perspective within the study of communication sciences and disorders. Method: Key mental health constructs are examined as to how they are applied in traditional versus relational and reflective supervision models. Comparisons between traditional and relational and reflective approaches are outlined, with reference to each mental health construct and the developmental level of the supervisee. Three stages of supervisee development are proposed based on research from various disciplines, including nursing, psychology, speech-language pathology, social work, and education. Each developmental stage is characterized by shifts or changes in the supervisee's underlying assumptions, beliefs, and patterns of behavior. Conclusion: This article makes the case that both the cognitive and affective dimensions of the supervisor–supervisee relationship need to be addressed without minimizing the necessary development of discipline-specific expertise. The developmental stages outlined in this paradigm can be used to understand supervisees' patterns of change and growth over time, as well as to create optimal learning environments that match their developmental level and knowledge base. Key Words: mental health, supervision, adult cognitive development, relationship-based learning CiteULike     Connotea     Del.icio.us     Digg     Facebook     Reddit     Technorati     Twitter     What's this?