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Tuttman, S. (1984). The Impact of Psychoanalytic Theories of Conflict Upon Treatment. J. Amer. Acad. Psychoanal., 12(4):491-509.

(1984). Journal of American Academy of Psychoanalysis, 12(4):491-509

The Impact of Psychoanalytic Theories of Conflict Upon Treatment

Saul Tuttman, M.D., Ph.D.

In 1981, I organized a conference in New York: Variations in Psychoanalytic Thought — The Impact of Theoretical Persuasion on Psychoanalytic Technique. Some months before this meeting, representatives of different psychoanalytic schools of thought were sent a detailed case report of a single psychoanalysis extending over a two-year period. For our purposes, I selected Paul Dewald's (1972) process notes and summary, which were published by Basic Books under the title, The Psychoanalytic Process. Each participant was asked to contribute, from his or her respective orientation, a summary and conceptualization of the patient's conflicts, an approach to treatment and a critique of the documented analysis. As might be expected, it was a provocative, though “Rashomon”-type experience!

The more classical Freudians on the panel felt that Dewald's work was effective and the outcome impressive and successful (although the more ego psychologically oriented Freudian felt that aspects of the developmental dyadic history might have been more productively emphasized and worked through in the course of the therapeutic interaction). Both the interpersonally oriented analyst and the Kleinian practitioner concluded that the treatment had been largely ineffective; that the essence of the patient's conflicts had not been engaged; indeed, that the interaction, in terms of transference-countertransference, repeated the original pathogenic history and so the patient's conflicts remained essentially unresolved.

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