Biomedical subjects

Lawrence Josephs

Publications and source records attributed to Lawrence Josephs.

3 recordsLinked to original sources

PubMed2004

Assessing progress in analysis interminable.

A case study is provided of a schizoid patient in her mid-sixties who in a lengthy analysis had made significant clinical improvement. The treating analyst's impression of clinical improvement was independently verified through systematic analysis of transcripts of audiotapes of thirty-six sessions over a four-year period of treatment. The patient showed significant improvement on measures of character pathology, object relations, mentalization, and superego anxiety. The results suggest that some patients with entrenched character pathology who seem to be in analysis interminable may still make clinically significant improvement. It is suggested that the scientific status of psychoanalysis would be greatly enhanced if the anecdotal evidence generated in private practice were supported by independent verification. The current study illustrates one methodology, "case study plus," for providing independent verification while retaining the richness of the traditional case study.

Female↗

PubMed2003

The observing ego as voyeur.

A resistance to self-observation and self-reflection is discussed in which there is a perversion of the observing ego. The observing ego has been unconsciously recruited in the service of enacting an unconscious fantasy: the fantasy of being an excited observer of a primal scene who is punished for making forbidden observations. This voyeuristic observing ego is pathologically enmeshed in a love triangle with the patient's seductive superego (i.e. identification with the desired but unfaithful parent) and with the patient's punitive superego (i.e. identification with the rivalrous parent). This unconscious scenario is played out in the clinical situation as the patient unreflectively cycles through phases of denial (i.e. self-seduction) and moral masochism (i.e. self-betrayal). A case study illustrates how humor may be employed to free the observing ego from being enthralled by a perverse superego. Humor may unconsciously enable a rebellious attitude toward the omnipotent sadism of a perversely oppressive superego and thus enable the observing ego to break free from its pathological enmeshment.

Denial, Psychological↗

PubMed2002

Where's the text? The problem of validation in psychoanalysis.

Whatever their differences, the various schools of psychoanalysis all subscribe to the case study, based on clinical vignette and anecdote, as the "text" of psychoanalysis. Because the typical case study presents not the actual analytic dialogue but a reconstruction based on the analyst's selective memory, the use of such a text renders problematic the validation of an analyst's case formulation, and has traditionally diminished the epistemological status of psychoanalysis. Pristine clinical data, as would be provided by verbatim transcripts of audio-recorded analytic sessions, are rarely created and even more rarely made public. Study of the psychoanalytic process is thereby made impossible, whether by clinical exegesis, qualitative analysis, or quantitative statistical analysis. Yet the analytic community, highly resistant to this public documentation, continues to marshal five common arguments against it. These arguments are reviewed and responded to in the belief that such documentation would enhance the field's intellectual status by allowing the problem of clinical validation to be addressed in ways that move beyond appeals to the authority of private clinical experience.

Confidentiality↗