Wallerstein R S
University of California School of Medicine, San Francisco.
J Am Psychoanal Assoc. 1989;37(4):921-41. doi: 10.1177/000306518903700403.
Psychoanalysis has never developed a tradition of systematic followup study to evaluate outcome and to improve technique and theory for a variety of reasons, partly theoretical, stemming from the conception of the unfolding transference neurosis and its analytic resolution as the precondition for cure, and partly historical, having to do with the happenstance of its development as a private practice-based discipline and training outside of the academic setting. Freud, however, was never bound by such strictures and published whatever post-treatment data he acquired on all his best-known case histories. But following Freud most analysts, with some notable exceptions, eschewed followup activity as unanalytic. It is this tradition that more recent studies like those of Pfeffer in New York and the Psychotherapy Research Project of The Menninger Foundation in Topeka have squarely challenged. Data are presented from the Menninger project dealing specifically with the impact of routine planned followup on issues of treatment termination and resolution and on the nature of the post-treatment period. The degree and kind of patient cooperation with the followup inquiry, the impact of followup on treatment termination and resolution (both impeding and facilitating), and the role of followup intervention in relation to return to formal post-treatment therapy (or consolidating against it), are all discussed.
由于多种原因,精神分析从未形成系统的随访研究传统来评估治疗结果、改进技术和理论。部分原因是理论性的,源于将移情神经症的展开及其分析解决视为治愈前提的观念;部分原因是历史性的,与它作为一门基于私人执业的学科在学术环境之外发展的偶然情况有关。然而,弗洛伊德从未受这些限制的束缚,他公布了自己在所有最著名病例中所获得的治疗后数据。但在弗洛伊德之后,除了一些显著的例外,大多数分析师都回避随访活动,认为这不符合精神分析的做法。正是这种传统受到了最近一些研究的直接挑战,比如纽约的菲弗以及托皮卡的门宁格基金会心理治疗研究项目所进行的研究。文中呈现了门宁格项目的数据,这些数据专门涉及常规计划随访对治疗终止与解决问题以及治疗后阶段性质的影响。文中还讨论了患者对随访询问的合作程度和类型、随访对治疗终止与解决的影响(包括阻碍和促进),以及随访干预在患者回归正式治疗后治疗(或防止回归)方面所起的作用。