The Effectiveness of Psychoanalysis in A Case Study Using Multi-Perspective Methodology: Conflict in Choosing A Partner Due To Transgenerational Mandate

Int J Psychoanal (2017) doi: 10.1111/1745-8315.
12643
The effectiveness of psychoanalysis in a case study

using multi-perspective methodology: Conflict in
choosing a partner due to transgenerational mandate
Alejandro Tamez
Calzada del Valle 400-1302 Ote., Colonia del Valle, Garza Garca, CP
xico alejandro@tamez.com.mx
66220, Me
(Accepted for publication 15 December 2015)
A case study is presented to evaluate the effectiveness of psychoanalysis and

the persistence of its benefits 20 years later in a young woman with severe
depression, professional inhibition, and difficulties in partner selection due to
transgenerational mandate (TGM). The investigation was carried out with
psychoanalytic interviews with the patient and analyst, which were evaluated
by both psychoanalytic and non-psychoanalytic judges following a methodol-
ogy based on one tested in Germany by Leuzinger-Bohleber et al. (2003). The
psychoanalytic treatment began in the early 1980s in Monterrey, Mexico.
The study concludes that the psychoanalysis was effective in assisting with
the patients character disorder and partner selection, mainly because of the
therapeutic alliance, the analysis of transference and character, and the
patients increased capacity for mentalization as a result of the interpreta-
tion of the TGMs.
Keywords: effectiveness, psychoanalytic treatment, psychoanalysis, partner

selection, transgenerational mandate, mentalization
Introduction
Problem
First, we must define the concepts of efficacy and effectiveness. The former
refers to the result of research designed with empirical, quantitative method-
ology in controlled clinical trials, which produces valid and reliable general-
izations by avoiding the biases that are common in evaluations of single
cases. Efficacy compares effective treatments to other treatments and to
studies with placebo (Sackett et al., 1994). It has also been useful for align-
ing psychoanalysis with evidence-based medicine, as shown in a number of
meta-analyses (De Maat et al., 2009; Shedler, 2010), although it overlooks
too many crucial qualitative elements (Kachele, 2002).
Effectiveness, in contrast which is the concept used in this study refers
to the overall beneficial effect of an intervention or treatment in clinical
practice (Feinstein, 1985). Such a methodology can be qualitative, quantita-
tive or mixed. Its validity is based on narratives that investigate process and
outcomes (Poch and Avila, 1998), and it entails in-depth field research,
describing what happens in treatment in its natural setting and carried out
with specific patients, such as in the present study.
Copyright 2017 Institute of Psychoanalysis

2 A. Tameza
The studies by Marianne Leuzinger-Bohleber et al. (2003), which began

in 1997 in Germany, and by Ramonet et al. (2005) in Mexico are some of
the reports in the literature that use a methodology related to the present
study.
Leuzinger-Bohleber et al. used interviews with the patient and the ana-
lyst, which were evaluated by psychoanalytic judges and academic psycholo-
gists (heterogeneous composition of judges), as well as surveys widely used
to evaluate improvement in psychotherapy at least one year after the end of
treatment. The authors conducted a qualitative and quantitative, naturalis-
tic, multi-perspective, and representative study in Germany with 401 cases.
They reported findings of 70% to 80% positive and stable psychological
changes (even after 7 years after the end of treatment). They made audio
recordings of interviews with the patient and analyst, which were then
supervised with another member of the research team. They then submitted
a report on these recordings to the heterogeneous team of judges and lis-
tened to 510 minutes of the recording, ultimately issuing an assessment of
the quality of the treatments.
Based on the methodology followed by Leuzinger-Bohleber et al. (2003),
the present investigation carried out semi-structured psychoanalytic inter-
views and made audio recordings of the patient and the analyst, reviewed
this material with third parties (multi-perspective methodology), and
ensured the heterogeneous composition of judges in order to avoid interpre-
tive biases, using the recordings to respond to the research questions until
arriving at a consensus. Unlike Leuzinger-Bohleber, in this study all of the
recorded interviews with the patient and analyst were listened to in their
entirety by the whole heterogeneous team of judges, and the judges recom-
mended aspects to be evaluated or changed in a second round of interviews
with the patient and analyst, which once again were listened to by the
judges in their entirety. All of the sessions with the judges were also
recorded. This study is a discourse analysis (units of meaning) of the eight
recordings of the patient, the analyst, and the judges. Another big difference
is that this study only addressed the first part of Leuzinger-Bohlebers
methodology (the qualitative part), focusing on only one case, while the
study in Germany repeated the experience in 401 cases, thereby allowing for
a quantitative evaluation, including patients in psychotherapy as well as in
psychoanalysis. Also in contrast to the Leuzinger-Bohleber study, the pre-
sent study did not use any questionnaires or tests.
This paper is based on a case study that follows the principles set out by
Reyes and Hern andez (2008) of seeking general knowledge that is contained
within the particular; as a result, the analysis of one case can lead to tran-
scendent conclusions by means of inductive and deductive inferences that
seek to discover the unexpected. The resource of intersubjectivity is used to
achieve objectivity. Its use in psychoanalysis has been studied extensively
(Gottdiener and Suh, 2012; Hopkins, 2012; K unstlicher, 2009: Midgley,
2006; Shepherd, 2004; Szecs ody and Stoker, 2004, Szecs ody, 2008).
At the same time, a large project was developed by the International Psy-
choanalytical Association in the second edition of the Open Door Review of
Outcomes Studies in Psychoanalysis (Fonagy, 2001) on the outcomes of
Int J Psychoanal (2017) Copyright 2017 Institute of Psychoanalysis
The effectiveness of psychoanalysis in partner choosing 3
psychoanalytic treatment both in Europe and America over the past several
decades. This study suggests that research on effectiveness faces a number
of difficulties: the inadequate specification of treatment procedures, the fail-
ure to follow up on cases in which treatment is abandoned, the lack of
homogeneity in the groups of patients under study, the lack of independent
assessment of outcomes, and the lack of standardization of outcome mea-
sures, among others.
The Open Door findings demonstrate not only that psychoanalysis has a
beneficial effect for patients with neurosis as well as some other groups of
patients (with personality disorders), but that completed analyses are associ-
ated with greater benefits, longer treatments have better outcomes, psycho-
analysis is associated with improved work capacity, and long-term effects
are associated with the development of resilience with respect to the
expected sequelae of early disorders. Notably, it was found that the thera-
peutic alliance at the start of treatment predicts outcomes and that the most
experienced analysts are not necessarily the most effective. Classical psycho-
analytic attitudes about technique, such as neutrality, abstinence, silence,
and interpretation of transference and resistance, do not predict the success
of psychoanalytic therapy, while a good therapeutic alliance between analyst
and patient is a key predictor of the outcome. The following findings were
identified: first, the psychoanalysts evaluations of the patients disorder
become richer over the course of the treatment; second, measures of psychi-
atric symptoms change more with psychoanalysis than do measures of per-
sonality or bonds; and third, psychoanalytic technique varies considerably
from one analyst to another, even when trained at the same institution.
These studies have led us to ask: what is happening in terms of treatment
and effectiveness in our context?
Documenting the effectiveness of psychoanalytic treatments with well-
designed research is necessary for the continuous renewal of theoretical con-
cepts and technical resources in psychoanalysis (L opez and Tamez, 2011;
Lopez, 2014).
Not documenting the effectiveness of treatments may have led to a
decline in the influence of psychoanalysis in psychological science, in psychi-
atric diagnosis, and in undergraduate and graduate teaching institutions
(Bornstein, 1995; Fonagy et al., 2002; Leuzinger-Bohleber et al., 2003).
Only 2% of the articles published in indexed psychology journals contain
the word psychoanalysis (Robins et al., 1999). This is in contrast to what
happened with psychoanalysis between the 1930s and the 1970s (Limentani,
2004), when numerous psychoanalytic societies were created in different
countries, including Mexico in the 1950s, and when psychoanalysis had sig-
nificant influence, especially in countries like France and Argentina, where
psychoanalysts occupy a dominant position in mental health, with 70% of
psychiatrists practising psychoanalysis or therapies inspired in psychoanaly-
sis (Meyer, 2007).
The scant importance psychoanalysts have given to the need to measure
and evaluate treatment outcomes (Rubistein et al., 2005) has led to what
many have called a supposed crisis of psychoanalysis (Rodriguez, 1997),
though we suggest that there is, instead, a crisis of psychoanalysts due to
Copyright 2017 Institute of Psychoanalysis Int J Psychoanal (2017)
4 A. Tameza
excessive competition and a lack of credibility, rather than a lack of psycho-

analytic theory and technique. The greatest impediments to contrasting the
effectiveness of psychoanalysis with other therapeutic techniques lie in the
lack of a specific methodology for studying a single clinical case, as pointed
out in the Open Door study (Fonagy, 2001).
Research verifying the effectiveness of psychoanalysis is thus relevant in
order to defend it from criticism and is crucial for developing psychoanaly-
sis in the current context (K
achele, 1999).
Objectives
The objectives of the study were to investigate the effectiveness of psycho-
analysis in the case of a young woman with severe depression, work failure
and marital conflict due to transgenerational mandate (TGM), as well as
the influence of the effect of transference and countertransference on men-
talization. Similarly, to explore a multi-perspective methodology for a case
study.
Research questions
1) Was psychoanalysis effective?
2) If so, what technical aspects of the treatment enabled the persistence of
effectiveness?
3) What components of psychoanalysis worked against its effectiveness?
4) Is the methodology in this research useful for evaluating the effectiveness
of psychoanalytic treatment?
5) Twenty years later, in the opinion of the patient, analyst and judges, can
we talk about persistent changes?
Case-specific research questions

1) Is psychoanalysis effective in this case of couple conflict?
2) Is treatment effective for preventing the repetition of transgenerational
conflict?
3) What is the role of mentalization in the effectiveness of psychoanalysis?
Study limitations
The case evaluated here has the following characteristics: a complete 6 year
analysis, with four sessions a week and with 20 years having passed since
the end of analysis.
Gold-standard definitions
For the work with the judges, a list of technical terms was used from the
book Fundamentos de la T ecnica Psicoanaltica [Foundations of Psychoana-
lytic Technique] by Dr Horacio Etchogeyen (2009, pp. 25-724), called gold
standards in this study. A summary of these terms was sent to each judge
to evaluate the psychoanalytic process and its effectiveness, as well as to
establish a shared language. These terms are: (1) indications and contraindi-
cations according to the diagnosis and other particularities; (2)

analysability; (3) therapeutic alliance; (4) transference; (5) countertransfer-

ence; (6) the psychoanalytic process; and (7) contract and setting.
Literature review
On the effectiveness of psychoanalysis
Recent studies based on meta-analyses of effectiveness with specific indica-
tions for personality disorders and chronic mental disorders demonstrate
that long-term psychodynamic treatment is superior to short-term treat-
ments (Leichsenring et al., 2013; Erle, 1979; Erle and Goldbert, 1979, 1984;
Keller et al., 1998; Kachele, 2008). Hartmann and Zepf (2003) indicate like-
wise, adding that effectiveness was 74%, higher than the 50% found in psy-
chodynamic therapy, the 42% in client-focused therapy, and the 29% in
cognitive behavioural therapy.
Introjective patients improve more in psychoanalysis, and anaclitic
patients in psychotherapy. Introjective patients are those with more conflicts
in their definition of self and their autonomy and who mainly use counter-
reactive defences. Anaclitic patients are those with conflicts principally
around interpersonal problems and who use avoidance defences (Blatt,
1992).
Kachele (2008) finds that a higher number of sessions per week is also
related to the greater effectiveness of treatment. In contrast, Leuzinger-Boh-
leber et al. (2003) find that there were no differences in effectiveness as a
function of frequency, measured as low frequency (12) and high frequency
(34) of visits per week. They also point out that it is important to indicate
a treatment correctly, whether analytical psychotherapy or psychoanalysis.
They further find that analysts were more critical about the outcomes of
treatment, but that in both cases the levels of satisfaction were high.
Improvement was assessed in terms of health status and personal growth,
as well as interpersonal relations, the capacity to face life situations, and
other factors.
Grande et al. (2003) demonstrates that there is less structural change in
psychotherapy than in psychoanalysis.
Transmission
Freud related this concept to the complementary series (191617). That is,
constitution predisposes, development disposes, and reality imposes, and in
addition, the transgenerational proposes (Tamez, 2008). From here, Freud
distinguished between historical and current neuroses (1895).
Freud first spoke of empathic transmission from the unconscious to the
unconscious (1913); that is, of mandates via identification, after the baby is
modified by neo-Lamarckian transmission (Freud, 1915, 1933). He also
mentioned the universality of the symbolism of language (Freud, 1913,
191617, 1933) and primitive phylogenetic transmission (Freud, 1985).
Psychoanalysis can be said to be both theory and a therapeutic technique,
mainly aimed at the history of the family of origin and its articulation with
current needs (Tamez, 2008). The current and historical reality that one

6 A. Tameza
does not want to recognize is transmitted. Freud called the latter denial
(1925).
Freud proposes that we look for our progenitors in our partner choice
(1914). Hence, nobody marries a stranger; as Freud put it (1905a), the
object-finding is really a re-finding.
Melanie Klein offered the concept of projective identification (PI)
(1946) as the attempt to control the other through what is projected in a
split form (transmission), in order to then identify with what is projected.
Kernberg (1976) distinguishes between three concepts related to what is
transmitted from parents to children: early introjects (lacking self-object dif-
ferentiation); identification (differentiation); and internalization (mental
structures defined).
Grotstein (1990, 1994) has studied transgenerational transmission through
reintrojections of projective identifications, drawing on Bion (1962). This
leads one to seek in ones partner what one does not have or rejects in one-
self yet desires, to then unconsciously reject it in the partner.
Lacan (1936) proposes circular thought in the first oedipal period with
the mirror stage. The baby is constituted in that which the mother desires,
and she wishes to be complete through her child. Lacan suggests that these
are the early introjects mentioned by Kernberg, though not of the figure of
the mother, but rather of her desires (19578, p. 8).
The second period is an imaginary relationship of penis envy (Tamez,
1992) and the deification of a cannibalistic and aggressive totem figure.
In the third period, identification is with the symbols given by the par-
ents, which represent the symbolic phallus. They typify the child as belong-
ing to a class, referring to masculinity and femininity, which allows a
gender role (Tamez, 2010). The parents participate with Oedipal and histori-
cal forces that they transmit actively.
Mandate refers to an unconscious transmission that may be intergenera-
tional or transgenerational. In the intergenerational mandate, children
resolve something of their parents conflict. Freud, and then Lacan, put it
like this: we are born inscribed in our parents Oedipus to resolve their con-
flict and to compensate, symbolically, for the lost penis.
Kaes et al. (1996) suggest that psychological transmission is a new model
for understanding the development of the psychological apparatus and its
articulation with the unconscious. This makes it possible to think of the
subject as constituted not by forged identifications, but by ongoing acts of
imposition by the other, with whom mutual inductions occur, a multiple
subject who participates in unconscious alliances (Kaes et al., 1996; Chait,
2009).
Lebovici and Wiel-Halpern (1989) discuss transgenerational transmission
in children as the conscious and unconscious expectations and demands that
originate with the grandparents. These are transmitted first to the children
(parents of the baby), who in turn transmit them to the baby in the form of
preconscious expectations and demands that they imagine the baby fulfils
(imaginary baby), or through unconscious expectations and demands (phan-
tasmic baby), which makes the baby start to constitute itself as a function
of these mandates (Fonagy et al., 1993; Lebovici, 1983; Lebovici and
Wiel-Halpern, 1989; Mazet and Stoleru, 1990; Tamez, 1999). This also leads
to a choice of partner aimed at fulfilling the grandparents mandates, trans-
mitted through the parents.
The concept of transgenerational transmission has proven very useful for
understanding the mechanism through which healthy couples produce sick
children (Tamez, 1999, 2002; De Litvan and Manzano, 2005). The grand-
parents conflicts, which are inadequately managed and not resolved by the
parents, become embedded in the unconscious and transmitted via projec-
tive identifications to the children, who end up being the recipients of these
projections (Tamez, 1999).
This phenomenon has been studied exhaustively in the grandchildren of
both victims and Nazi perpetrators of the Holocaust (Eickhoff, 1986, 1989;
Tamez, 1996): the victims had post-traumatic stress disorder that their chil-
dren did not have, but that reappeared in the grandchildren. With respect
to the perpetrators, the grandchildren carry the neurotic guilt of their
grandparents, bypassing the parents.
Lebovici (1983; Lebovici and Wiel-Halpern, 1989) suggests that to pre-
vent pernicious transgenerational transmissions in the future, parent-baby
relations should be explored in the therapeutic interview (Winnicott 1941,
1960, 1968).
Bowen (1961) points out that it is important to study the transmission of
family conflicts in at least three generations, put into practice by McGol-
drick and Gerson (1985) in family genograms.
Paraphrasing Jorge Santayana (1906), I have suggested that, Those who
do not acknowledge their past in their present are condemned to repeat it
in themselves and/or in their descendants (Tamez, 1998). If the past is not
acknowledged, it will tend to be passed on to the children without repeating
it themselves, in the form of mandates. I propose the concept of mandate,
which unlike transmission, has the connotation of obligation, in the sense
defined by Kernberg for Projective Identification (1987) in that an attempt
is made to control and induce the object to take on the projection and enact
the repetition of what is transmitted. One example of the transgenerational
mandate is couples prohibited from getting pregnant, translating into inex-
plicable infertility (Tamez, 1994).
Fonagy et al. (1993) has shown how patterns of attachment and mental-
ization can be transmitted from one generation to another. He suggests that
understanding future parents capacity for mentalization helps us in the dif-
ficult task of predicting parenting (Tamez, 1998).
The concept of mentalization in transgenerational transmission

The philosopher Daniel Dennett (1987) wrote that humans try to under-
stand each other in terms of mental states thoughts and feelings, beliefs
and desires in order to grant meaning and, even more importantly, antici-
pate the actions of others. It is a key determinant of self-organization
(Fonagy and Target, 2006).
Fonagy (1999a) also called this reflective function and mentions (2000,
2003, Fonagy et al., 2011, 1993) that a caregivers capacity to mentalize

8 A. Tameza
enhances secure attachment in the baby and also fosters the development of
an optimum capacity to mentalize, allowing the proper development of a
sense of Self (Fonagy, 1998; Fonagy et al., 2007). This even occurs in emo-
tionally deprived mothers (Fonagy et al., 1994). This makes it possible to
have an awareness of external reality (Fonagy and Target, 2007), preventing
violence at school (Fonagy and Target, 1997; Fonagy, 1998; Twemlow
et al., 2005) and later in life (Fonagy, 2004), regulating states of aversive
excitation (Carlsson and Sroufe, 1995; Cassidy, 1994; Sroufe, 1996) to ulti-
mately allow impulses and affects to be adequately contained (Bion, 1962).
In addition, it helps predict what the other is capable of doing (Fonagy,
1999b).
Parental Mentalization (PM), then, reduces the possibility of generating
psychopathology in children (Sharp and Fonagy, 2008). In other words, a
childs perception that his or her parents behaviour is based on what is
happening to him or her internally makes the child feel understood and pro-
tects the child from psychological problems such as anxiety and depression.
By working with transgenerational mandates via transference, especially
transference resistance, a sense of the mental origin of the actions is created
in the patient and in others. Analysing TGMs allows the capacity for men-
talization to develop, which helps the patient to understand his or her self-
concept and the motivation of others, generating self-control. The latter is
especially relevant when working with patients with primitive personalities
with poor self-control and little empathy.
Methodology
Design type
This is a descriptive, retrospective clinical investigation (Laverde, 2008) of a
single case with semi-structured interviews. It uses an inter/subject/object
methodology to study one particular case, inscribed in a comprehensive
explanatory framework, and it is observational, situational, biographic, and
based on idiographic sciences. It is an in-depth study based on narration-
meaning-resignification. Its validity is sought by corroborating its transfer-
ability, comparing the data by triangulating with informants who work as
expert judges (Daz et al., 2011), using a perspective triangulation methodol-
ogy (Alvarez, 2008, 2011; Bolvar et al., 2005; Souza, 2014).
The case study is addressed from the perspective of the psychoanalyst
and the patient; the criterion for including the case was that treatment had
ended for at least one year following agreement about its termination.
Four specific periods of the analytic process were studied retrospectively:
(a) start of treatment (demand, indications, opening phase, setting, initial
alliance and transference resistance); (b) intermediate phase (establishment
of transference neurosis, therapeutic alliance, acting out, among others); (c)
final phase (resolution of transference, evolution of symptoms, grief); and
(d) post-analysis effects (self-analytic capacity, maintenance of positive
changes or new changes still emerging from the analysis, recurrence of the
original problem).

Subjects
Patient
The subject was required to sign a letter of informed consent to participate.
She was a 52-year-old woman who worked as a homemaker, with under-
graduate studies in basic sciences and of average socioeconomic status. She
was in psychoanalysis for 6 years, without having received treatment before
or since of any kind.
Psychoanalyst
The analyst was 59 years old, married, with 23 years of experience and
studies in medicine and psychiatry. He was a doctoral candidate at the
Mexican Psychoanalytic Associations Centre for Graduate Studies.
Materials
Audio-recording, transcription of interviews.
Procedure
The interviews with the patient and the analyst and the discussions with the
judges were audio-recorded and transcribed verbatim. The group of judges
(8) were sent a list of variables for the analytic process, which were used as
the gold standard, along with the research questions. At each meeting, the
judges had the transcribed interview that they could read while listening to
the audio-recording of the interview. This ensured no loss of meaning when
the audio-recording was not clear, and it also made it possible to study the
relational aspects of non-verbal communication (tone of voice, pauses,
exclamations and affections in the interview participants speech).
Stage 1
The patient was interviewed for 45 minutes following the methodology used
by Leuzinger-Bohleber et al. (2003). The patient was asked to talk about
the history of her treatment, focusing on its effectiveness. Transference and
counter-transference were noted, and she was guided by the research ques-
tions as well as the gold-standard variables.
The patients interview was discussed for 90 minutes in a meeting with
the judges, with the audio recording and the verbatim transcription. Half of
the judges (four) are not analysts, and the other half (four) are a group of
analysts who are doctoral students, plus one psychoanalytic candidate. The
missing aspects in the interview in terms of the initial research questions
were discussed, attempting to arrive at a consensus (Delphi Method; Lin-
stone and Turoff, 1975). At this first meeting with the judges, case-specific
questions were generated.
A first interview was carried out with the patients analyst.
The first interview with the analyst was presented to the group of judges,
and it was decided if any information was lacking with respect to the initial
research questions. Case-specific questions were identified.

10 A. Tameza
Stage 2
Second interviews were conducted with the patient and the analyst, guided
by the judges suggestions and questions. These were discussed again with
the judges and it was decided if a third interview with the patient was neces-
sary or if a saturation point had been reached (Glaser and Strauss, 1967).
Results and discussion

A selection of data is presented below as units of meaning (exact words)
that respond to each research question and related discussion, for each of
the three study participants: patient, analyst and judges.
Is psychoanalytic treatment effective?

Data from the patient
[Initial demand] . . . it was a terrible depression . . . I felt like dying and my
little boy . . . we started to analyse why I was like that . . . economic
problems, emotional problems, problems of loneliness, of insatisfaction . . .
I couldnt study well, I wasnt sleeping, I wasnt eating well.
[Results] . . . out of 100 . . . I can say, well 90% . . . I mean I was feeling
very good . . . I managed to know myself . . . to be more responsible for my
actions . . . it saved my life . . . it saved me from all my depression . . . it
helped me to be stronger to be able to control my mom and be able to help
her . . . it changed my life . . . and now I can identify that there are a lot of
us that go through this . . . eight1 . . .
[Couple relationship] . . . I had the opportunity to be in a couple, but to
choose it myself . . . to strengthen that self-esteem . . .
[Personal growth] . . . to start to know myself and start to understand . . .
I had caused a lot of things and I could avoid them . . . I became indepen-
dent . . . made myself responsible for my life . . . I tried to give my son more
independence.
Data from the analyst

[Symptoms] . . . I was very satisfied, with the suicide avoidance part, the
improvement in the social phobia situation, in the depressive situation of
course, her son developed . . . she was enjoying life, the sexual part, eco-
nomic, social . . . primary anorgasmia that she had . . .
[Work] . . . she bought an apartment . . . to put a dance studio . . . she
became independent.
[Couple relationship] . . . it was a success of the analysis that she divorced
her first husband . . . when [her new husband developed a relationship] with
my patient, it stimulated both of them and they grew a lot as people.
Data from the judges

[Initial demand] . . . the relationship with her son, should have improved in
many ways . . .
1
Referring to the years of analysis.

[Results] . . . improved 90% . . . she grew . . . If there is self-analysis . . .

analyst points out the psychodynamic changes a lot . . . that quality of treat-
ment meets its objectives . . .
[Internal and affective changes] . . . shows intrapsychic changes . . . she is
able to laugh at herself . . . observant of herself, much less projective . . .
She feels abandoned, not alone . . . self-analysis, its the improvement in the
symptoms, the structural change, change of character, her change in her
social life that was very clear . . .
[Romantic relationship] . . . the capacity to understand and comprehend
the other . . . her sexuality improved, her romantic relationship improved.
[Confidence in post-treatment analysis] . . . she came back . . . she was
grateful and finished paying . . . she sent a similar patient . . . the therapeutic
objectives were met . . . the life goals she has right now are not the same as
when she came for treatment . . .
Discussion
The outcome of the analysis was that the depression disappeared and the
patient felt well and thankful. She rates her improvement in her problems
as 90%. In terms of her interpersonal relationships with her parents and
her partner, her behaviour is more responsible. She feels free and with self-
esteem. Her suicidal ideation disappeared, and both her sex life and her
relationship with her son improved. The patient took tricyclic antidepres-
sants for the first year due to her severe depression, but she did not need
them during the rest of the analysis. She considers analysis to be something
positive and she has recommended it.
The analyst also sees the patients analytic process as having had good
results, unlike other reports (Leuzinger-Bohleber et al., 2003; Jimenez, 2009).
In synthesis, the analysis was effective in terms of improving her severe
depressive symptoms, romantic relationships, and work capacity.
If so, what technical aspects of the treatment enabled the

persistence of effectiveness?
[Projections] . . . I wasnt actually the victim that I thought I was . . . I was
causing all that . . . all the failures . . . I brought them about, I was boy-
cotting myself.
[Resistance] . . . I got so angry that I didnt go any more . . . I was angry
and I didnt want to see him . . . I didnt want to say a lot of things . . . I
decided to screw myself . . . the doctor was warm and everything, but some-
times I think the treatment required it, it put me up against a wall, one
always tries to be the victim . . . I had to realize that I had obligations in
the analysis too, that I wasnt a victim . . .
[Transference] . . . I really adore him, because for me he was my saviour
. . . when I turned 50 . . . I spoke to him, I said Dr . . . I am very content
and very happy and I owe it to you.2
2
Her eyes get teary and she is moved.

12 A. Tameza
[Mini-analysis] . . . you were talking to me as t u [informal you], I

would like us to talk to each other as tu . . . always Dr X and Dr X, I
could never say his name . . . thank you and it is a pleasure to meet you . . .
back to usted [formal you].3
[Transference resolution] . . . when I was able to find a partner, then I
was able to separate myself4
[Termination] . . . I was feeling very good by then . . . so, by mutual
agreement.

[Initial transference] . . . I helped her to guide her son in his education, she
was very worried that he didnt have a father figure.
[Initial countertransference] . . . very nice, she stood out because she has a
very warm tone of voice, and it resonated pleasantly on the couch.
[Negative transference and characterological resistance] . . . aggressive
component of her masochistic depressive situation . . . more openly aggres-
sive with me, saying, damn Doctor, you seem to be an ally of my husband,
you dont support me . . . a very reflexive woman . . . I was supervising the
case for a bit . . . . . . first Im going to have surgery . . . you should
change on the inside, not on the outside . . . narcissization of her body
image . . . she gets in trouble with women.
[Countertransference] . . . to rescue or support a helpless person . . . I saw
myself as an interdictor there, like getting her out of that . . . a kind of
saviour, I got desperate at times . . . she progressed so much that she lives
better than I do.5
[Transference and countertransference love] . . . she had a real situation
of sexual desire with me . . . she was always very respectful of my personal
situation . . . I shared in a countertransference way, I mean, I felt some-
how stimulated by these fantasies of hers, which never led to any type of
approach . . . a smooth, discreet process . . . like an analytic partner in
order to have a certain fatherly role with the son . . . she had never had
an orgasm . . . tied to the transference love neurosis, she was able to have
an orgasm, and her sex life became pretty functional . . . sometimes it had
an erotizing effect and I had a certain degree of discreet erection and
thats it, just for a little while, it surprised me, because I wasnt actually
attracted to her . . . she had sexual dreams, about love about being a cou-
ple . . . extratransference displacement or positive acting in, lets say,
towards the relationship with the doctor, and they became very good part-
ners, friends . . .
[Termination] . . . it was mutually agreed upon . . . it coincided more or
less, the situation of the analysis with her life situation.
3
Referring to her relationship with the investigator.
4
Referring to separating herself from the analyst.
5
Researcher and subject laugh.


[Technique] . . . technical aspects were respected . . . there was insight . . .
character analysis . . . a transference situation was created . . . there was a
therapeutic alliance, which sustained the treatment . . .
[Transference-countertransference] . . . defensive, projective mechanisms
. . . she was internalising, through the analytic relationship . . .
[Countertransference] . . . the analysts capacity to observe himself . . .
when a patient brings about so many transference issues . . . I think these
are the cases that need to be supervised.
[Self-analysis] . . . capacity for introspection . . . she brought us the whole
story . . .
[Choice of clinical case] . . . These are basically what made us become psy-
choanalysts . . . the therapist was in supervision . . . in analysis and . . . in
training . . . gratitude of the therapist and of the patient . . .
Discussion
The rescue countertransference was typical of masochistic patients, he liked
welcoming the patient at her visits.
In the intermediate phase she had a negative transference, in which she
offended and reproached the analyst for his lack of loyalty for supporting
her partner more, he was an evil and false man, she devalued the process
and missed her sessions. Despite this severe transference resistance, there
was always a good therapeutic alliance and the patients reflexive capacity
protected the analysis from a potential rupture.
Shortly after in the intermediate phase of the analysis, there was a
romantic and erotic but not erotized transference. This transference
caused an erotic countertransference, which was pleasant for the analyst.
This relationship allowed the patients problem of anorgasmia to be
resolved (Tamez, 1989). Professional distance was not compromised.
The termination of the analysis was handled well, and the improvement
occurred at the same time as the end of the analytic process.It was relevant
for the judges that the analyst supervised the case and analysed his counter-
transference reactions. Self-observation led him to have an appropriate ana-
lytic process.
There was agreement that characterological features were worked on, that
the analyst contained the intense negative transference, and that there was
resistance to the intense transference love without losing the analytic posi-
tion, along with good handling of the termination of analysis. The analytic
process developed with insight and therapeutic alliance. These were impor-
tant elements for the effectiveness of the analysis, with a satisfactory post-
analysis period.
At the end, the analyst joked that the patient was doing better than he
was, indicating that didactic analyses are more complex than those with
symptomatic patients, as the analyst was also in analysis and supervision
during this period.
This led the analyst to identify with the patient and the supervisor to
identify with the analyst, and now the investigator and judges to also
identify with the analyst, thus we see a chain reaction of transference

14 A. Tameza
(R. Tamez, 1960). The choice of this case is related to the fact that the
patient helped the colleague to become a psychoanalyst.
What components of psychoanalysis worked against its

effectiveness?
[Acting out] . . . during the treatment . . . buy an apartment, although it was
very hard financially . . .
[Self-esteem] . . . you cant get rid of everything . . . I am . . . alone.
[Characterological resistance] . . . I am the good one, I am the perfect
one, I mean, they are abusing me . . .
[Superego] . . . my self-esteem hasnt changed much . . . I feel really fat . . .
I used to drink, quite a lot . . .

[Self-destructive thinking] . . . plan to kill herself when she turned 50, she
was about 36 . . .
[Setting] . . . financial difficulties . . . I had to set up a system to give her
credit . . .
[Life difficulties] . . . mother was very sick and . . . died.
[Characterological difficulties] . . . social relationship with women.

[Characterological resistance] . . . she manages a lot of idealizations and
devaluations . . . she overrides and completely gets rid of her sons wife . . .
[Acting out] . . . the first time that she left the sessions . . . . . . that is
where the resistance is . . .
Discussion
The plan to commit suicide at 50, when her maternal work would be over
as her son would reach the age of majority, and the patients economic cri-
sis were serious obstacles.
The patient showed severe resistance, which the analyst had to overcome.
She is currently aware that there are remnants of her character problems,
such as her tendency to react with projections, yet now she recovers and
resolves. Some of her couple conflicts have recurred, but she manages them
differently; her son has become independent of her and she feels lonely
again, but without depression and with the capacity to manage and tolerate
it.
Another resistance occurred when they were managing the ending of
analysis. The patient acted out by going into debt and buying an apartment,
which accelerated the ending, as she could not tolerate her grief about it.
She also has sadistic demands of the superego that continue to create
problems for her. Her self-esteem drops sometimes, and she tirelessly pur-
sues a perfect body by going to gyms and undergoing aesthetic surgery. She
also had a 6 month episode of alcoholism, which she was able to end and
become sober by herself.

Seventeen years later, the patient returned to her analyst facing the loss
of her mother and conflicts with her husband. She went once a week for
irregular periods and did not reinitiate formal psychoanalysis, as both the
patient and the analyst considered it to be over. Treatment does not protect
patients from all future problems (Freud, 1937), although it creates tools
that enable them to better face these problems. The judges concluded that
the current problems were of a very different nature than those 20 years
earlier.
Is the methodology in this research useful for evaluating the

effectiveness of psychoanalytic treatment?
The patient was not asked this question.

There are no data for this question.

[Interview quality] . . . there was an order to the interview . . .
[Satisfaction of the judges] . . . intersubjective agreement . . . framing me
as well in the study objective . . . the interview itself transmits it . . . (8-32).
[Methodological requirements of the judges] . . . all of the questions were
answered and . . . the issues were expanded upon . . . it seems that we all
agree that we arrived . . . at a saturation point . . . we consider the interven-
tion of the judges to have concluded . . .
Discussion
There was agreement that the data obtained were sufficient and showed that
the method used was relevant for observing the quality of the psychoanaly-
sis. Arriving at a saturation point.
Twenty years later, in the opinion of the patient, analyst and judges,
can we talk about persistent changes?
. . . the relationship was very good, for a long time, over those 15 years.
. . . I talked to him, I said Dr . . . um . . . I am turning 50 now and I am
very content and very happy and I owe it to you.

. . . the suicidal ideas have not returned . . . she was enjoying life, the sexual
part, economic, social, etc., the productivity part . . .

[Symptom improvement] . . . for 17 years she functioned . . . without symp-
toms and she was happy . . . she didnt sound like she was in a depressive
state . . . the person is not becoming undone . . .

16 A. Tameza
[Reconstruction of the subject] . . . many resources as a person . . . she con-

tinues to have new conflicts . . . she had insight . . . they end up building . . .
[Self-analysis and current conflict] . . . she integrated the analysis . . . she
has a clear awareness of herself, of her limitations . . . it is not the same con-
text as the one she arrived in . . . she is adapting to a specific age or moment
with the resources that analysis gave her . . . post-analysis elaboration . . . it
may last her whole life . . .
[Awareness of the scope of the analysis] . . . she clearly understands that it
is not a panacea and that it is not absolute happiness . . . The idea is not
exactly that people completely get rid of conflict, but rather that they actu-
ally learn how to face conflict . . .
[Goals of analysis] . . . the therapeutic goals were met . . .
Discussion
There was agreement that the patient continued to be psychologically stable
and remained in her marital relationship for more than 17 years after hav-
ing finished her analysis. Her new crisis is due to circumstances that are out
of her and her husbands hands. The patient expressed her gratitude.
Her relationship with her mother improved. Her symptoms did not
return, which allowed her to improve her communication with her partner,
her friends, and her colleagues.
Is psychoanalysis effective in this case of couple conflict?

[First marriage] . . . I didnt want to marry him, but my mother . . . didnt
want me to be a spinster.
[Divorce from first husband] . . . I was going to go from being
my mothers domain to his domain . . . he started by cheating on me
(laughter) . . .
[Second marriage] I depend on my husband . . . thanks to the treatment, I
had the opportunity to be able to open myself up to having a romantic rela-
tionship, but choosing it myself . . . I got married during the treatment.
[State of mind in the face of marital conflict] . . . when we die we are
going to be incinerated . . . he says that he is going to put me in a little
clock . . . in the kitchen, to see if that way Ill be in the kitchen, thats what
he says, to see me work in the kitchen someday (both laugh).

[Termination of marriage] . . . in the process she legally divorced her hus-
band.
[New marital relationship] . . . somewhat warm relationship . . . she helps
him or rescues him . . . he went from the bad guy . . . a womanizer, problem-
atic, to a good man.

[Insight on couple conflict] . . . I see her trying to build something with her
husband . . .

Discussion
The patient realized that her first husband needed her economically in order
to sustain her in-laws, in addition to being unfaithful to her. Analysis
helped the patient to go from being passive to being someone active in the
legal dissolution of her first marriage.
Her couple conflicts were worked on, and as part of their resolution via
transference, she married a second time and has kept the marriage stable
for more than 18 years. It is interesting that her current husband also comes
from a relationship in which his partner was unfaithful to him. There was a
kind of mutual rescuing, in which both came from failures and were
deceived by their partners, which permitted mutual identification and soli-
darity that made them grow both emotionally and in their work.
Her second husband became unemployed, which has created difficulties for
the patient, leading her to seek her analyst again in order to face this crisis.
The data indicate that the patient had insight into her participation in the
marital conflicts and that she is now attempting to build a different mar-
riage with her husband. She enjoys sexual relations more, as well as her
capacity to understand the other.
Is treatment effective for preventing the repetition of

transgenerational conflict?
[Parental influence] My mother was a very dominant, very strict person . . .
her marriage was very dysfunctional . . . not even emotional support from
loving parents, I felt alone.
[Suicide mandate] . . . I started with the idea that as soon as my son was
21 and could take care of himself I was going to commit suicide . . . it was
affecting my son too.
[Maternal transmission] . . . spare the rod spoil the child . . . my mother
was always very rebellious . . . she never felt loved by either her father or
her mother . . . my mother always felt like the ugliest, the least loved, the
most unprotected.
[Paternal transmission] . . . my fathers family . . . was very different . . . a
very good economic situation . . . he was the crazy kid . . . my grandfather was
not satisfied with him . . . he didnt want to study . . . my father was the loser.
[Marital mandate] . . . of being the rejected ones6 . . . I studied . . . because
my mother would say to me, that profession because it is a very good
career . . . not because I wanted to be that.
[First husbands mandate] . . . 11 siblings, a very irresponsible father . . .
he grew up in an orphanage . . . very intelligent . . . he wanted to adopt . . .
his siblings . . . he also cheated on me . . .
[Parentified daughter] . . . when I realized that I contributed to all of these
conflict situations, that I was reliving the conflicts from my house . . . I
attacked my father a lot, to protect my mother and I did a lot of my
fathers duties . . .
6
Both the mother and the father.

18 A. Tameza

[Maternal transmission] . . . her mother also came from a situation of deval-
uation by her sisters . . .
[Parental disloyalty] . . . her mother . . . got pregnant and so her grandfa-
ther said to him look, I already covered you once,7 Im not going to do it
this time, so he forced him . . . to marry her mother . . . it turned out that
she wasnt pregnant, it seems that it was a little lie.8
[Repetition in men] . . . trapped, with other women, dominated, castrated
... 9
[Repetition in first husband] . . . he didnt want it10 . . . sad cases where
they take shelter in their family of origin.
[Initial rejection of first analyst] . . . she was referred by another analyst
who saw her for a few sessions.
[Parental rejection] . . . very tough mother . . . she calls her the spider . . .
the father . . . missing from the family.
[Repetition with the second husband] . . . second husband weak with his
ex . . . just like the father . . .
[Prevention with her offspring] . . . her son developed well . . . he got mar-
ried, he has two children, she is a grandmother . . . he is a very capable kid
. . . jealous about me, a paternal-like situation . . . the son does not have
any symptoms, he doesnt drink . . . hes stable, but the patient thinks he is
also subordinated, according to her, I think that he became a part of her
family.11 . . .

[Transgenerational couple repetition] . . . there you interpreted for her that
you are seeing your relationship with your husband like with your mater-
nal grandfather . . . listen, your two husbands have been unfaithful to
you, both are tied to another family, you divorce your first husband
because he is tied to his family of origin, and now your second husband is
tied to his first wife . . .
[Perverse choice of partner] . . . the partner was wanted in order to catch
someone . . . these are perverse reasons . . . romantic relationships are based
on something else . . .
[Repetition of dominant-dominated couple] . . . the transgenerational, the
husbands, the men, all dominated, by phallocentric women . . . if another
women gets him from me, like the exma . . . the ex-wife, I was going to say
ex-marida, analysts slip, I was going to say la ex-marido,12 when I wanted
to say the second husbands ex-wife, she ends up as the loser, and she tries
to dominate him by maxing out the credit cards . . . the son repeats the
7
The patients father had gotten a previous girlfriend pregnant.
8
The patients mother was disloyal to the father by lying about the pregnancy.
9
Referring to the father, the two husbands and the son.
10
Referring to the father of the patients son.
11
The patients daughter-in-laws family.
12
Translators note: Marida is a non-existent term made by feminizing the Spanish word for husband.
Similarly, la exmarido uses the feminine article [the] for the masculine term ex-husband.

pattern transgenerationally, suppressed husband, a man oppressed by his

wife, by the family on the other side who takes him away, like the ex-hus-
bands family . . . so the game is the eternal competition with that dominant
mother . . .
Discussion
The dysfunctional parents needed each other and could not distance them-
selves from one another, with respect to the father being fooled by the
mother faking a pregnancy. The relationship with her mother was very
aggressive: she did not encourage or tolerate the patients independence.
During the mothers childhood, she never felt loved either by her father
or by her mother,13 she always felt rejected. The intergenerational repeti-
tion between her mother and her and the TGM from her maternal grand-
mother as the ugly, rejected and unloved ones was very clear to her.
Analysis changed this mandate, she recognizes the influence of her parents
on her current situation and the risk of influencing her son.
This parental failure was closely related to her depression, as she did not
consider relying on her parents with her divorce, even though she felt alone.
She sees her parents marriage as for her mothers economic benefit,
which is repeated in the patient: the mother forces her to study and to
marry the person she chooses for her economic benefit. The patient
makes it clear that her husband married her out of financial interest,
they did to her what her mother wanted her to do. With her first hus-
band it was important: (1) to be apparently a good provider (conscious
mandate, Tamez, 2008), (2) to be trapped, dominated and castrated by
his mother, and (3) to betray and be unfaithful. The second and third
are transgenerational mandates, which the patient was not conscious of
obeying.
The first husband repeated his own story transgenerationally after the
divorce by not seeing his son again, as he had been abandoned in an
orphanage. The patient unconsciously detected this mandate of her husband
in order to repeat her own mandates.
With analysis, with respect to her second husband, she understood the
tendency to repeat these transgenerational mandates (Freud, 1914). He is
not a cheater or deceptive, nor does he have the intention to be unfaithful,
but he does form a part of the group of those trapped, deceived, and cas-
trated by other women.
The patient played the role of parentified daughter, replacing her father
in order to defend her mother. Analysis helped her to get out of this posi-
tion and allowed her to improve her relationships with her parents and
other adults.
The rebellious position of her parents, which was repeated in her with her
parents, husbands, and society, was also replicated in her son, who rebelled
against her by not wanting to study.
The transgenerational conflict was understood by the patient and is char-
acterized by the tendency to devalue the feminine, to value men only for
13
Maternal grandparents.

20 A. Tameza
their capacity to be good providers, with unfaithfulness and subordination

in romantic relationships, which has had the effect of low self-esteem, high
levels of aggressiveness, and depressive tendencies.
What is the role of mentalization in the effectiveness of

psychoanalysis?
. . . I came to analysis thinking that I was everyones victim and I realized
that I had contributed a lot myself to these situations . . . there is a distanc-
ing . . . between my husband and me . . . but I have a lot of responsibility
for that . . . because of his age, hes 74 years old, so it isnt easy for someone
that age to have a job . . .

No data found for this question.

[Mentalization as an outcome of analysis] . . . the capacity to understand
and comprehend the other . . . she is more aware of herself, more aware of
others . . .
Discussion
We can observe the fundamental role played by mentalization in the thera-
peutic process through the analysis of characterological resistance, which
helped her to reduce her projections and stop blaming others for her suffer-
ing. This allowed her to realize others intentions and to not mix them up
with her projections.
The best example of how the patients capacity to mentalize has improved
with analysis is in how she is managing her current suffering around her sec-
ond husbands work situation. Before, in similar conflicts, the patient would
get angry and tend toward disruption. Now she gets angry, she recognizes her
mistake, she apologizes, and she even laughs with her husband about it.
I think that the analysis of transgenerational mandates has enabled her to
enhance her mentalization in order to understand the motivations of others,
such as her son and her current husband, and not place herself in the role of vic-
tim, which was her traditional role at the beginning of analysis. She improved
her capacity to understand herself and others in terms of mental states.
Conclusions
The data from the study allow us to answer the research questions, pre-
sented below.
Is psychoanalytic treatment effective?

It was effective in the case of the patient studied here, as the three partici-
pating elements perceived that there was an improvement due to the psy-
choanalytic process that the patient underwent.

The indication of psychoanalysis and the analysts clear objectives were

appropriate given the depressive symptoms, personality disorder, and inter-
personal difficulties. This is consistent with the indications given by several
authors (Freud, 1905b; Etchegoyen, 2009; Weber et al., 1985a; Bachrach
et al., 1985; Bachrach and McNutt, 1992; Rudolf, 1991; Rudolf and Manz,
1993; Rudolf et al., 1994; Sashin et al., 1975) and is in line with findings of
greater effectiveness (Rad et al., 1998; Heuft et al., 1996; Teufel and Volk,
1988; Huber et al., 2002). Symptoms improved overall both over the med-
ium and long terms (Rudolf, 1991; Rudolf and Manz, 1993; Rudolf et al.,
1994; Sandell et al., 1997, 2000).
Another element to consider: the patient was intelligent, educated, and
with a good psychological disposition (Appelbaum, 1973; Werman, 1979;
Beitel et al., 2005; Hua et al., 2007), and this allowed the capacity for
insight and enabled a decrease in projections, corresponding to intrapsychic
changes due to analysis (Katz, 2000; Meadow, 2000; Bass, 2001; Raphling,
2002; Romanowski et al., 2003; Hanly, 2005; Blessing, 2005; Zack, 2005;
Fisch, 2011). This was all based on the ongoing process of analysing trans-
ference and countertransference.
The improvement in the patients sex life was clear, going from a pre-
oedipal sexuality to one that is oedipal and satisfying. She was no longer
anorgasmic, and she enjoyed sexual relations with her partner.
As a result of her analysis, the patient improved her work-related intellec-
tual capacity (D uhrssen, 1962; Rudolf, 1991; Rudolf and Manz, 1993;
Rudolf et al., 1994; Keller, 1998; Teufel and Volk, 1988).
The analyst and patient were both satisfied with the analysis, as has been
reported by Sashin et al. (1975), yet is unlike findings by others (Leuzinger-
Bohleber et al., 2003; Keller, 1998).
The patient and analyst disagreed on the duration of the analysis. The
patient thought that it lasted 8 years, while her analyst reported only 6 years.
This difference is reported in the studies by Leuzinger-Bohleber et al. (2003)
and may be due to the enormous effort patients make in analysis.
The fact that she now has new difficulties in her current life and responds
to them with new resources demonstrates the effectiveness of the analysis.
If so, what technical aspects of the treatment enabled the

persistence of effectiveness?
In terms of analysability (Zetzel, 1968), the patient seemed to be difficult
due to her severe characterological reactions. Her ego strengths were impor-
tant for her to be able to understand and analyse her character and reac-
tions with the analyst.
She was suffering from depression and was thinking, as already reported
here, about a future suicide at 50 years of age, when her responsibility as a
mother had finished. However, she did not present any suicidal ideation or
attempts, there was no planning, and she had no signs of risk.
Effectiveness as a result of a treatment intensity of four sessions on the
couch a week is consistent with other studies (Weber et al., 1985a; Bachrach
et al., 1985; Bachrach and McNutt, 1992; Rudolf et al., 1994; Fonagy et al.,

22 A. Tameza
2002; Heinicke and Ramsey-Klee, 1986), as is the ongoing interpretation of

resistance and characterological defences such as projections.
With respect to transference resistance, she expressed feeling rejected and
betrayed, just as she felt from her loved ones and her husband. At first she
missed a lot of sessions, which made the analyst use her time slot on one
occasion (after 2 weeks without notice, as suggested by the analyst in estab-
lishing the setting, which is a common tactic in our psychoanalytic commu-
nity), when she then showed up and felt betrayed by the analysts use of her
time with another patient. These were love tests; that is, if you love me,
you wont abandon me or betray me, even if I abandon and betray you.
He used these reactions so she would understand her character pathology,
her tendency to place herself in the position of being rejected and betrayed,
and she understood her participation in others reacting by abandoning her.
Faced with the patients attempts to control, as if she was saying I aban-
don you in order to demonstrate that you are going to abandon me, the
analyst corroborated again and again the patients unconscious fantasy, but
offering her space to rethink her actions.
In the intermediate phase, there was a tender and affectionate transfer-
ence relationship, she developed transference love, though it was not intense
as it was able to be analysed and resolved. She did not act out and had a
classical period of analytic resistance as she thought of her analyst as a pos-
sible partner. She was able to resolve her relationship with her previous
partner and established a stable romantic relationship and got married.
The analyst reacted appropriately to the transference love, which permit-
ted positive growth in the patient.
The construction of a therapeutic alliance (Zetzel, 1956) allowed a good
response to the analysis, corroborating that found by Rudolf (1993). Inter-
preting transference and complementary countertransference (Racker, 1957,
1960; Tamez, 1989, 1993) made the patient put her early relationships with
her parents in the here and now and with the analyst; the concordance of these
transferences in her libidinal objects operated in the same way, where the ana-
lyst initially functioned as interdictor (Lacan, 19578) to then analyse the
negative transference and the romantic relationship, which led to the effective-
ness of psychoanalysis via insight (R. Tamez, 1960; Tamez, 1989). In the
judges view, not losing the analytic position in the face of the onslaughts of
negative transference allowed him to maintain the therapeutic alliance.
The termination of analysis by mutual agreement shows that the therapeu-
tic and analytic objectives had been met, in line with other studies (Weber
et al., 1985b; Bachrach et al., 1985; Bachrach and McNutt, 1992; Rudolf,
1991; Rudolf and Manz, 1993; Rudolf et al., 1994; Sashin et al., 1975).
What components of psychoanalysis worked against its

effectiveness?
Intense acting out by missing sessions and a deeply rooted suicide plan,
which threatened the continuity of the analysis, were handled by analysing
the patients projective characterological defences of placing the analyst as
an abandoner.

Another difficulty: the analyst had to give her credit for one year, which
modified the natural process of analysis, as it created a commitment of grat-
itude that disturbed the transference.
Her position as victim in situations of conflict is overcome as a result of
her capacity for insight. For example, new situations appeared recently that
had nothing to do with the previous analysis (Freud, 1932, 1937), such as
her mother getting sick and her taking on her mothers care, which led her
to return to treatment to analyse how to face the new situation.
Another variable was the inexperience of the analyst, who was in training
when he took the case, which influenced the management of the counter-
transference (Erle, 1979; Erle and Goldberg, 1979, 1984).
Is this research methodology useful for evaluating the effectiveness

of psychoanalytic treatment?
The methodological approach made it possible to continue as each of the
points indicated in the research questions were met, thereby allowing bias
to be detected (Leuzinger-Bohleber et al., 2003; Fonagy, 2001; Tamez, 2012,
2013).
It was possible to organize the necessary interviews with the patient and
analyst in order to have enough data to respond to the research questions.
Comparing the information from the two, the judges agreed that the infor-
mation they provided could be cross-checked.
The selection of the case for the research, following the criteria that anal-
ysis had to have taken place four times a week for several years and that
the analysis had to have been completed, and, especially, that both the ana-
lyst and the patient were willing to participate in the research, had a posi-
tive effect on meeting the research objectives.
Investigating a case in which the patient was not a patient of the investi-
gator protected against a first bias of analyst over-involvement in their own
clinical case. Interviewing the patient and not only the analyst allowed us to
avoid a second bias of converting the outcome of a clinical case into a
solipsistic or narcissist report by the analyst.
Having a group of judges listen to the recordings of the interviews with
the patient and with the analyst, without the opinion of the investigator,
helped avoid a third bias, preventing not only a biased analysts report, but
also the possibilities of a biased patients report, biased by remnants of
romantic or idealized transference, and a biased investigators report, seek-
ing to prove his or her hypotheses.
The heterogeneous composition of the judges provided protection from a
fourth bias, that of self-justifying reports among analysts, which would run
the risk of an interpretive endogamy. The non-analyst methodologists, in
addition to being people with experience in qualitative research, were
mainly from the area of health care (three academic psychologists, including
two doctorates in social psychology and one behavioural psychologist with
a doctorate in educational psychology, and one writer with a doctorate in
literature, all of whom are university professors). This allowed them to have
an even more objective perspective on the methodological approach. The

24 A. Tameza
inclusion of non-analysts was also used in the study by Leuzinger-Bohleber

et al. (2003), who used academic psychologists with excellent results.
A fifth bias was avoided by using the Delphi group work scheme (Adler
and Ziglio, 1996), in which the group of judges discussed the material until
arriving at a reasonable consensus.
A sixth bias was avoided by arranging meetings with the judges until a
saturation point was reached (Glaser and Strauss, 1967).
Using a case that was supervised avoided a seventh bias, as there was tri-
angulation on the initial perspective of the analysis.
Finally, having all of the material presented with the investigators main
advisor and doctoral thesis supervisor avoided an eighth bias by ensuring
there were no methodological omissions.
The methodological approach used permitted a more objective evaluation
of the effectiveness of psychoanalysis in this case, given the controls and the
protection, which may shield it from the classical critiques of presenting
clinical cases in psychoanalysis, given the degree of subjectivity and intro-
spection that they entail. It also created the freedom to develop research
questions that were specific to the unique case under study and did not limit
the investigation to the research groups overall questions.
Twenty years later, in the opinion of the patient, analyst and judges,
can we talk about persistent changes?
The three subjects suggest that 20 years later, the treatment continues to
prove itself effective. This is in agreement with the findings of other authors
who suggest that psychoanalysis has better outcomes than psychotherapy
when evaluated years after its successful completion (Weber et al., 1985b;
Bachrach et al., 1985; Bachrach and McNutt, 1992; Sandell et al., 1997,
2000), which also applies to studies carried out with children in analysis
(Fonagy and Target, 1998; Target and Fonagy, 1998).
Considering the cost/benefit ratio of psychoanalysis, the psychological
well-being achieved can be considered a very positive outcome (Weber
et al., 1985b; Bachrach et al., 1985; Bachrach and McNutt, 1992).
Twenty years later, there is clear resilience; as a result of analysis, the
patient is strong in the face of conflict (Fonagy and Target, 1998; Target
and Fonagy, 1998). The improvement gave the patient tools to face new
conflicts in her life more effectively.
The patient integrated the analysis and continues to apply a strong self-
analytic capacity in her life to understand herself, her romantic relation-
ships, and her overall setting. This has protected her from relapsing to her
initial depressive and suicidal symptoms. Psychoanalysis is seen by the
patient not as a panacea, but as something that she built along with her
analyst (Freud, 1937).
Is psychoanalysis effective in this case of couple conflict?

The patient understood that her first husband represented a castrating
mother who possessed and manipulated her, and she also victimized herself.
During the process she managed to separate from him.

Through insight from the analysis of transference, she understood that in

romantic relationships, her choice was not her own but rather her mothers.
This created intrapsychic changes in her pre-oedipal, sadistic, and punitive
superego that demanded that she victimize herself, and she was able to
make changes toward a new, healthier, pleasant oedipal relationship.
This helped her to be sexually active and to resolve her anorgasmia in
her romantic relationships, and it allowed her to choose her libidinal object
instead of it being imposed by her transgenerational mandates.
This case demonstrates that careful analysis of the nature of the romantic
relationship helps the individual to improve said relationships by under-
standing TGMs and developing mentalization.
Is treatment effective for preventing the repetition of

transgenerational conflict?
The relevant transgenerational mandates came from a dominant mother
who did not permit independence, and the patients analysis helped prevent
them from being repeated in her second marriage and helped her not to
impose them on her son.
The suicidal mandate that came from a primitive, sadistic superego that
made her see herself as a failure and lacking any reasons to live other than
that her son be able to take care of himself was resolved.
The structure of the TGM coming from the paternal grandfather, who
ordered a marriage to preserve honour, along with the image of the
deceived father and deceiving mother who faked a pregnancy, repeated itself
in the patient as a woman ordered to marry for money in order to deceive
and in turn is cheated on and exploited, leading to the end of her first mar-
riage. This mechanism was described by Grotstein (1990, 1994) as the retro-
jection of projective identification. She chose her first husband as a model
of her mother. In analysis, she noted that her work relationships and her
friendships always ended in the role of rejected and exploited, because she
was unconsciously seeking to identify herself not with her mother, but with
her devalued and exploited father. Analysis helped her to not repeat this
phenomenon with her second husband and with her son.
She analysed the TGM of considering herself to be the ugly, rejected, and
unloved one, like her mother was to her sisters and maternal grandmother
and which she repeated in her choice of her first husband, who like her first
father-in-law, was rejected by the family as irresponsible. Feeling devalued
as a woman was meant to compensate her mother for the rejection she had
suffered in her past by identifying with her rejected mother and making her
feel victorious by seeing her daughter worse off than her in her romantic
relationships, soothing her envy. She was also identifying with her deceived
father through unfaithful romantic relationships.
Analysis allowed her to free herself from previous TGMs, which helped
her to form a healthier romantic relationship. Although her second husband
has not cheated on or betrayed her, the image of being controlled and cas-
trated by his wife is now repeated in him. She does not accept, however,
her role of being rejected, and she fights for equal circumstances. This has

26 A. Tameza
prevented symptoms of depression from reappearing and, in contrast,

makes her happier. This format of the happy dominated husband and dom-
inant wife has been repeated with her son.
What role does mentalization play in the effectiveness of

psychoanalysis?
The patient identified the projections of her characterological defences and
made them conscious, which helped her to distinguish her perception of her-
self from others perceptions, creating a new capacity for reflection. The
patient no longer follows her first reaction to her couple conflicts, but
rather understands them in function of the context and the personal history
of the participants. This is synthesized in the phrase I no longer blame
others (Szecs ody et al., 1997, 1999).
Analysis has allowed the patient to understand her behaviour as a result
of her history and to perceive the motivations of others without projections.
This means that she can even laugh at herself with her husband about their
current problems and her own reactions to their conflicts.
In synthesis, the three members of the investigation were in agreement on
affirming that analysis helped the patient to understand her marital conflicts
and their roots in transgenerational mandates. They determined that men-
talization in the patient had improved as a result of the ongoing analysis of
the TGMs, which protected her from repeating conflicts and making
intrapsychic changes. It was concluded that the indication was correct for
an analysable patient. The proper management of the technique, especially
the therapeutic alliance, and the case being supervised, allow us to see that
this articulation of factors prevented the analysis from deviating and led to
effective outcomes. As a result, the changes in the person occur not only
over the short and medium term, but also, as we have seen, the positive
effects can last decades.
Translations of summary
Lefficacite de la psychanalyse dans une e tude de cas base e sur une me thodologie a perspecti-
ves multiples. Lauteur de cet article presente une etude de cas afin devaluer lefficacite de la psychana-
lyse et la persistance de ces bienfaits vingt ans apres chez une jeune femme en proie a une grave
depression, une inhibition professionnelle et des difficultes dans le choix dun compagnon en raison dun
mandat transgenerationnel (TGM). Ce travail de recherche a ete realise a partir dentretiens psychanaly-
tiques avec le patient et lanalyste, entretiens qui ont ete evalues par des experts analystes et non-ana-
lystes selon une methodologie inspiree de celle deja utilisee en Allemagne par Leuzinger-Bohleber et al.,
(2003). Le traitement psychanalytique en question a commence a Monterrey, au Mexique, au debut des
annees quatre-vingt. Letude conclut que le traitement analytique a ete efficace et pour les troubles du
caractere de la patiente et pour le choix dun compagnon, gr^ace a lalliance therapeutique, lanalyse du
transfert et du caractere, et au developpement de la capacite de mentalisation resultant de linterpretation
des TGM.
t der Psychoanalyse in einer Fallstudie mit einer multiperspektivischen Methode.

Effektivita
Konflikt bei der Partnerwahl infolge eines transgenerationellen Mandats. Der Autor stellt einen
Behandlungsfall vor, um die Effektivitat der Psychoanalyse und ihre nach 20 Jahren gemessene Langzeit-
wirkung am Beispiel einer jungen Frau zu untersuchen, die unter einer schweren Depression und berufli-
chen Hemmungen litt; infolge eines transgenerationellen Mandats (TGM) hatte sie zudem
Schwierigkeiten bei der Partnerwahl. Die Untersuchung erfolgte durch psychoanalytische Interviews mit

der Patientin und dem Analytiker, die mit Hilfe einer Methode, die in Deutschland bereits von Leuzin-
ger-Bohleber et al. (2003) getestet wurde, von psychoanalytischen und nicht-psychoanalytischen Ratern
ausgewertet wurden. Die psychoanalytische Behandlung begann Anfang der 1980er Jahre in Monterrey,
Mexiko. Die Untersuchung ergab, dass die Psychoanalyse die Charakterst orung und die Partnerwahl der
Patientin positiv beeinflusste, und zwar vor allem durch das therapeutische Bundnis, die Analyse der
Ubertragung und des Charakters sowie durch die Verbesserung der Mentalisierungsfahigkeit, die durch
die Deutung des TGM erzielt werden konnte.
Lefficacia della psicoanalisi in un case study osservato attraverso il metodo della prospettiva
multipla. Il conflitto nella scelta del partner dovuto a un Mandato Transgenerazionale. Larticolo
presenta un case study in cui vengono valutate lefficacia della psicoanalisi e la persistenza a distanza di
20 anni dei benefici da essa apportati in una giovane donna gravemente depressa, inibita in ambito pro-
fessionale e con difficolta nella scelta del partner dovute a un mandato di tipo transgenerazionale
(TGM). La ricerca e stata realizzata facendo valutare una serie di colloqui psicoanalitici tra la paziente e
lanalista da giudici sia psicoanalisti sia non analisti, seguendo una metodologia derivate da quella gia
testata in Germania da Leuzinger-Bohleber et al., (2003). Il trattamento psicoanalitico ha avuto inizio
nei primi Anni 80 a Monterrey, in Messico. La conclusione dello studio e che la psicoanalisi si e rivelata
efficace tanto rispetto ai disturbi di tipo caratteriale quanto rispetto alla scelta del partner da parte della
paziente, e che il successo del trattamento sia dovuto principalmente allalleanza terapeutica, allanalisi
del transfert e del carattere, e inoltre allaccresciuta capacita di mentalizzazione risultante dallinterpre-
tazione del TGM.
Eficacia del psicoana lisis en un estudio de caso con una metodologa de perspectivas mu lti-
ples: Conflicto en la seleccio n de pareja por mandato transgeneracional. Se presenta un estudio
de caso para evaluar la eficacia del psicoanalisis y la persistencia de sus beneficios 20 a~
nos mas tarde en
una mujer joven con depresi on severa, inhibicion profesional y dificultades en la selecci
on de pareja
debido a mandato transgeneracional (TGM, por sus siglas en ingles). La investigaci on se llev
o a cabo
mediante entrevistas psicoanalticas con la paciente y el analista, quienes fueron evaluados por jurados
psicoanalticos y no psicoanalticos, siguiendo una metodologa derivada de aquella ya puesta a prueba
por Leuzinger-Bohleber et al. (2003), en Alemania. El tratamiento psicoanaltico comenz o a principios
de los a~ nos 80 en Monterrey, Mexico. El estudio concluye que el psicoanalisis fue eficaz en relaci on al
trastorno del caracter y la selecci
on de pareja de la paciente debido, sobre todo, a la alianza terapeutica,
al analisis de la transferencia y del caracter, como tambien al incremento de capacidad de mentalizaci on
como resultado de la interpretaci on del TGM.
References
Adler M, Ziglio E, editors. (1996). Gazing into the oracle: The Delphi Method and its application to
social policy and public health. London: Kingsley.
Alvarez C (2008). La etnografa como modelo de investigacio n en educacio
n. Gazeta de Antropologa
24(1), article 10:115.
Alvarez C (2011). El intere s de la etnografa escolar en la investigacio n educativa. Estudios
Pedago gicos XXXVII(2):26779.
Appelbaum SA (1973). Psychological-mindedness: Word, concept and essence. Int J Psychoanal
54:3546.
Bachrach HM, Weber JJ, Murray S (1985). Factors associated with the outcome of psychoanalysis.
Report of the Columbia Psychoanalytic Research Center (IV). Int Rev Psychoanal 12:37989.
Bachrach HM, McNutt ER (1992). Psychoanalysis and psychoanalytic psychotherapysimilarities
and differences: Indications, contraindications, and initiation. J Amer Psychoanal Assoc 40:223
31.
Bass A (2001). Mental structure, psychic process, and analytic relations how people change in
analysis. Psychoanal Dial 11:71725.
Beitel M, Blauvelt KS, Barry DT, Cecero JJ (2005). Abstracts of the 2005 Poster Session of the
American Psychoanalytic Association Winter Meeting. J Amer Psychoanal Assoc 53:13015.
Bion WR (1962). Learning from experience. London: Tavistock.
Blatt SJ (1992). The differential effect of psychotherapy and psychoanalysis with anaclitic and
introjective patients: The Menninger psychotherapy research project revisited. J Amer Psychoanal
Assoc 40(3):691724.
Blessing D (2005). Review of In pursuit of psychic change the Betty Joseph Workshop, edited by
Edith Hargreaves and Arturo Varchevker. Psychoanal Psychother 19:1779.

28 A. Tameza
Bolvar A, Ferna ndez M, Molina E (2005). Investigar la identidad profesional del profesorado: Una
triangulacion secuencial. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research 6
(1), Art. 12.
Bornstein RF (1995). Psychoanalysis in the Undergraduate Curriculum: An agenda for the
psychoanalytic researcher. Bull Psychoanal Res Soc 4:34.
Carlsson E, Sroufe LA (1995). Contribution of attachment theory to developmental psychopathology.
In: Cicchetti D, Cohen DJ, editors. Developmental psychopathology. Vol 1: Theory and methods,
581617. New York: Wiley.
Cassidy J (1994). Emotion regulation: Influences of attachment research. Monogr Soc Res Child Dev
(Serial No 240) 59:22883.
Bowen M (1961). Del individuo a la Familia. Mexico: Ed. Paidos, 1979.
Chait AR (2009). A forca da transmissa ~o psquica entre geraco ~es: Intergeracionalidade e
transgeracionalidade. In: Kleiman S, editor. Familias y Parejas, Psicoanalistas en Ame rica Latina.
Buenos Aires: FEPAL.
De Litvan MA, Manzano J (2005). Intergenerational transmission of psychopathology. Int J
Psychoanal 86:51720.
De Maat S, De Jonghe F, Schoevers R, Dekker J (2009). The effectiveness of long-term
psychoanalytic therapy: A systematic review of empirical studies. Harv Rev Psychiatry 17(1):1
23.
Dennett D (1987). The intentional stance. Cambridge, MA: MIT Press. Available at:http://www.scribd.c
om/doc/8609524/Daniel-C-Dennett-The-Intentional-Stance-1987.
Daz S, Mendoza V, Porras C (2011). Una gua para la elaboracio n de estudios de caso. Razo n y
Palabra 75(FebApr). Retrieved from www.razonypalabra.org.mx on 26 February 2014.
Du hrssen A (1962). Katamnestische Ergebnissebei 1004 Patientennach Analytischer Psychotherapie.
Psychosom Med 8:94113.
Eickhoff FW (1986). Identification and its vicissitudes in the context of the Nazi phenomenon. Int J
Psychoanal 67:33.
Eickhoff FW (1989). On the borrowed unconscious sense of guilt and the palimpsestic structure of a
symptom: Afterthoughts on the Hamburg Congress of the IPA. Int R Psychoanal 16:323.
Erle J (1979). An approach to the study of analyzability and the analysis: The course of forty
consecutive cases selected for supervised analysis. Psychoanal Q 48:198228.
Erle J, Goldberg D (1979). Problems in the assessment of analyzability. Psychoanal Q 48:4884.
Erle J, Goldberg D (1984). Observations on assessment of analyzability by experienced analysts. J
Amer Psychoanal Assoc 32:71537.
Etchegoyen H (2009). Los fundamentos de la te cnica psicoanaltica. Buenos Aires: Amorrortu, 2010
(3rd edn).
Feinstein AR (1985). Clinical epidemiology: The architecture of clinical research. Philadelphia:
Saunders.
Fisch J (2011). The essence of therapy: What is essential for a therapeutic. Int J Psychoanal Self
Psychol 6:37794.
Fonagy P (1998). Prevention, the appropriate target of infant psychotherapy. Infant Ment Health J 19
(2):12450.
Fonagy P (1999a). Persistencias transgeneracionales del apego: una nueva teora. Aperturas
Psicoanalticas 3 (Online journal: http://www.aperturas.org/3fonagy.html).
Fonagy P (1999b). Points of contact and divergence between psychoanalytic and attachment theories:
Is psychoanalytic theory truly different? Psychoanal Inq 19:44881.
Fonagy P (2000). Apegos patolo gicos y accion terape utica. Aperturas Psicoanalticas 4 (Online
journal: www.aperturas.org).
Fonagy P, editor. (2001). An open door review of outcomes studies in psychoanalysis, 2nd edition.
London: International Psychoanalytic Association.
Fonagy P (2003). The development of psychopathology from infancy to adulthood: The mysterious
unfolding of disturbance in time. Infant Ment Health J 24(3):21239.
Fonagy P (2004). Early-life trauma and the psychogenesis and prevention of violence. Ann NY Acad
Sci 1036:181200.
Fonagy P, Bateman A, Bateman A (2011). The widening scope of mentalizing: A discussion. Psychol
Psychother Theor Res Prac 84(1):98110.
Fonagy P, Gerber A, Higgitt A, Bateman A (2002). Anna Freud Center Study 4: The comparison of
intensive (5 times weekly) and non-intensive (once weekly) treatment of young adults (AFC4). In:
Fonagy P, editor. An open door review of outcomes studies in psychoanalysis (2nd edn), 967.
London: International Psychoanalytic Association.
Fonagy P, Gergely G, Target M (2007). The parentinfant dyad and the construction of the subjective
self. J Child Psychol Psychiatry 48:288328.

Fonagy P, Steele M, Moran G, Steele H, Higgitt A (1993). Measuring the ghost in the nursery: An
empirical study of the relation between parents mental representations of childhood experiences
and their infants security of attachment. J Amer Psychoanal Assoc 41:957.
Fonagy P, Steele M, Steele H, Higgitt A, Target M (1994). The Emmanuel Miller Memorial Lecture
1992: The theory and practice of resilience. J Child Psychol Psychiatry 35:23157.
Fonagy P, Target M (1997). Attachment and reflective function: Their role in self-organization. Dev
Psychopathol 9:679700.
Fonagy P, Target M (1998). The outcome of psychodynamic therapy: The work of the Anna Freud
Centre. Invited Public Lecture, London, September.
Fonagy P, Target M (2006). The mentalization-focused approach to self pathology. J Pers Disord 20
(6):54476.
Fonagy P, Target M (2007). Playing with reality: IV. A theory of external reality root. Int J Psychoanal
88:91737.
Freud S (1895). Estudios sobre la hysteria. Complete works, Vol. 2, AE: 265 ff. Buenos Aires: 1978.
Freud S (1905a). Tres ensayos de teora sexual. Complete works, Vol. 7, AE.
Freud S (1905b). Sobre psicoterapia. Complete works, Vol. 7, AE, p. 243.
Freud S (1913). Totem y tabu . Complete works, Vol. 13. AE.
Freud S (1914). Introduccio n del narcisismo. Complete works, Vol. 14. AE.
Freud S (1915). El inconsciente. Complete works, Vol. 14. AE.
Freud S (1916-7). 22nd and 23rd Conferencias de Introduccio n. Complete works, Vol. 16. AE, p. 316
and 330.
Freud S (1925). La negacio n. Complete works, Vol. 19. AE.
Freud S (1932). 34th Conferencia. Esclarecimientos, aplicaciones, orientaciones. Complete works,
Vol. 22. AE.
Freud S (1933). Suen ~os y ocultismo [1932]. Complete works, Vol. 22. AE.
Freud S (1937). Ana lisis terminable e interminable. Complete works, Vol. 23. AE.
Freud S (1985). A phylogenetic fantasy. Grubrich-Simitis I, editor. Cambridge: Harvard UP, 1987.
Glaser B, Strauss A (1967). The discovery of grounded theory: Strategies for qualitative research.
New York: Aldine Publishing Company. Ch. 3: El muestreo teo rico, p. 45-77.
Gottdiener WH, Suh JJ (2012). Expanding the single-case study: A proposed psychoanalytic research
program. Psychoanal Rev 99:81102.
Grande T, Rudolf G, Oberbracht C, Jakobsen T, Keller W (2003). Investigating structural change in
the process and outcome of psychoanalytic treatment: The Heidelberg-Berlin Study. In: Richardson
P, Ka chele H, Renlund C, editors. Research on psychoanalytic psychotherapy with adults, 3562.
London: Karnac.
Grotstein JS (1990). Nothingness, meaninglessness, chaos, and the black hole: The importance of
nothingness, meaninglessness, and chaos in psychoanalysis. Contemp Psychoanal 26:257.
Grotstein JS (1994). Projective identification reappraisedPart I: Projective identification,
introjective identification, the transference/countertransference neurosis/psychosis, and their
consumpartner expression in the crucifixion, the pieta, and therapeutic exorcism. Contemp
Psychoanal 30:708.
Hanly MA (2005). Submission, inhibition and sexuality. Int J Psychoanal 86:483501.
Hartmann S, Zepf S (2003). Effectiveness of psychotherapy: a replication of the Consumer-Reports-
Study. Psychother Res 13:23542.
Heinicke CM, Ramsey-Klee DM (1986). Outcome of child psychotherapy as a function of frequency of
sessions. J Amer Acad Child Psychiatry 25:24753.
Heuft G, Seibuechler-Engec H, Taschke M, Senf W (1996). Langzeit-Outcome ambulanter
psychoanalytischer Psychotherapien und Psychoanalysen: ein textinhaltsanalytische Untersuchung
von 53 Katamneseinterviews. Forum der Psychoanalyse: Zeitschriftfuer Klinische Theorie und
Praxis 12:34255.
Hopkins J (2012). Fifty years ago: John Bowlby recommends the use of a single case study to
understand a childs detached relationships. Att: New Dir in Psychother Relat Psychoanal J 6:173
89.
Hua W, Beitel M, Schuman-Olivier Z, Barry D (2007). III. Dimensions and new measures relevant to
psychoanalysis. J Amer Psychoanal Assoc 55:3005.
Huber D, Klug G, vonRad M (2002). The Munich Psychotherapy Study: A process-outcome
comparison between psychoanalyses and psychodynamic psychotherapies. In: Leuzinger-Bohleber
M, Target M, editors. Outcomes of psychoanalytic treatment, 22339. New York, NY: Brunner
Routledge.
Jime nez JP (2009). Aprehender la pra ctica de los psicoanalistas en sus propios me ritos. Psicoana
lisis
APdeBA 31(1):5175.
Kachele H (1999). Validacio n del psicoana lisis, presented at Half Day on research at API conference
in Santiago, Chile.

30 A. Tameza
Kachele H (2002). Fases de investigacio n en psicoterapia. Intersubjetivo. Revista de Psicoterapia
Psicoanaltica y Salud 4(1):512.
Kachele H (2008). Short or long term psychoanalytic therapies. Presentation viewed on 14 December
2013 at: www.psychoanalysis-mps.ru/events/03.ppt
Kae s R, Faimberg H, Enriquez M, Baranes JJ (1996). Transmisio n de la vida psquica entre
generaciones. Madrid: Amorrortu, 2006.
Katz AW (2000). Psychic reality and psychic change: A therapeutic journey. Psychoanal Rev 87:81100.
Keller W, Westhoff G, Dilg R, Rohner HH (1998). Study and the Study Group on Empirical
Psychotherapy Research in Analytical Psychology. Berlin: Department of Psychosomatics and
Psychotherapy, University Medical Center Benjamin Franklin, Free University of Berlin. In: Fonagy
P, editor (2001). An open door review of outcomes studies in psychoanalysis (2nd edn). London:
International Psychoanalytic Association.
Kernberg O (1976). Object relations theory and clinical psychoanalysis. New York: Aronson.
Kernberg O (1987). Projection and projective identification: Developmental and clinical aspects. J
Klein M (1946). Obras completas. Buenos Aires: Paidos, 1980.
Kunstlicher R (2009). The conflicting forces of Freuds clinical situation. Scand Psychoanal Rev
32:11624.
Lacan J (1936). El estadio del espejo. In Escritos I:1118. Mexico: Siglo XXI, 1971.
Lacan J (19578). Las Formaciones Del Inconsciente. In Seminario 5:84107. Mexico: Paidos.
Laverde E (2008). Metodologa de la Investigacio n: Psicoterapia Analtica y Psicoana lisis. Rev colomb
psiquiatr 37(1).
Lebovici S (1983). El Lactante, Su Madre Y El Psicoanalista. Buenos Aires: Amorrortu Editores, 1988.
Lebovici S, Wiel-Halpern F (1989). Por que la psicopatologa del bebe ? p 11-16. El bebe en su
familia, p. 61-64. Los vnculos intergeneracionales (transmisio n y conflictos) las interacciones
fantasma ticas. In: La Psicopatologa Del Bebe , 11220. Mexico: Siglo XXI.
Leichsenring L, Abbass A, Luyten P, Mark Hilsenroth M, Rabung S (2013). The emerging evidence for
long-term psychodynamic therapy. Psychodyn Psychiatry 41(3):36184.
Leuzinger-Bohleber M, Stuhr U, Ru ger B, Beutel M (2003). How to study the quality of psychoanalytic
treatments and their long-term effects on patients well-being: A representative, multi-perspective
follow-up study. Int J Psychoanal 84:26390.
Limentani A (2004). El movimiento psicoanaltico durante la guerra (19391945) segu n archivos de la
Asociacio n Psicoanaltica Internacional. Psicoana lisis APdeBA 26(3).
Linstone HA, Turoff M (1975). The Delphi Method: Techniques and applications. Reading, MA:
Addison Wesley.
Lopez D (2014). El psicoanalisis en el siglo XXI. En: Obras Completas Freud por Freud. Indices
tema ticos de sus obras completas en espan ~ ol. Ed. Jacobo Numhauser. Madrid: Editorial Biblioteca
Nueva S.L.
pez D, Tamez A (2011). Project presented at Half Day on Research, International IPA Conference
Lo
on Psychoanalysis, Mexico City.
Mazet P, Stoleru S (1990). Psicopatologa de la Primera Infancia. Barcelona: Masson Editores.
McGoldrick M, Gerson R (1985). Genogramas en la Evaluacio n Familiar. Barcelona: Ed. Gedisa.
Meadow PW (2000). Creating psychic change in analysis. Mod Psychoanal 25:322.
Meyer C (2007). El Libro Negro del Psicoana lisis. Buenos Aires: Sudamericana.
Midgley N (2006). The inseparable bond between cure and research: Clinical case study as a
method of psychoanalytic inquiry. J Child Psychother 32:12247.
Poch J, Avila A (1998). Investigacio n en Psicoterapia. Barcelona: Paidos.
Racker H (1957). The meanings and uses of countertransference. Psychoanal Q 26:30357.
Racker H (1960). Estudios sobre te cnica psicoanaltica. Buenos Aires: Paidos.
von Rad M, Senf W, Bra utigam W (1998). Psychotherapie und Psychoanalyse in der
Krankenversorgung: Ergebnisse des Heidelberger Katamnesenprojektes. Psychother. Psychosom.
medPsychol 48:88100.
Raphling DL (2002). Psychic change in analysis. J Amer Psychoanal Assoc 50:76577.
Ramonet RS, Corona PC, Lartigue T, Rios JM, Garza DL (2005). A successful trial utilizing the
Leuzinger-Bohleber methodology for evaluation of psychoanalytic treatment: Preliminary report. Int J
Psychoanal 86:142540.
Reyes P, Hernandez A (2008). El Estudio de Caso en el contexto de la Crisis de la Modernidad.
Cinta Moebio 32:7089.
Robins RW, Gosling SD, Craik KH (1999). An empirical analysis of trends in psychology. Am Psychol
54:11728.
Rodrguez D (1997). El psicoana lisis y la investigacio n. Psicoanalisis APdeBA 29(12).
Romanowski R, Escobar JR, Sordi RE (2003). An application of bi-logical theory to the study of
psychic change and mourning. Int J Psychoanal 84:53345.

Rubistein A, Naparstek F, Bachmann R (2005). La perspectiva freudiana de la eficacia del ana lisis.
Faculty of Psychology, University of Buenos Aires, Research Department. Anuario De
Investigaciones 13.
Rudolf G (1991). Free University of Berlin: Berlin Psychotherapy Study. In: Beutler L, Crago M,
editors. Psychotherapy research: An international review of programmatic studies. Washington:
American Psychological Association.
Rudolf G, Manz R (1993). ZurprognostischenBedeutung der therapeutischen Arbeitsbeziehungaus der
Perspektive von Patienten und Therapeuten. PPmP, Psychother Psychosom med Psychol 43:193
9.
Rudolf G, Manz R, Ori C (1994). Ergebnisse der psychoanalytischen Therapien. ZschPsychosom Med
40:2540.
Sackett D, Haynes R, Guayat G, Tugwell P (1994). Epidemiologa Clnica. Mexico City: Editorial
Me dica Panamericana, 2004.
Sandell R, Blomberg J, Lazar A (1997). When reality doesnt fit the blueprint: Doing research on
psychoanalysis and long-term psychotherapy in a public health service program. Psychother Res
7:33344.
Sandell R, Blomberg J, Lazar A, Carlsson J, Broberg J, Rand H (2000). Varieties of longterm outcome
among patients in psychoanalysis and long-term psychotherapy: a review of findings in the
Stockholm outcome of psychoanalysis and psychotherapy project (STOPP). Int J Psychoanal
81(5):92143.
Santayana G (1906). The Life of Reason. Or, The Phases of Human Progress, 5 vols. Available free
online from Project Gutenberg. 1998. 1 vol. abridgement by Santayana, G and Cory, D. Amherst,
NY: Prometheus Books.
Sashin J, Eldred S, Van Amerowgen ST (1975). A search for predictive factors in institute supervised
cases: A retrospective study of 183 cases from 1959-1966 at the Boston Psychoanalytic Society
and Institute. Int J Psychoanal 56:34359.
Sharp C, Fonagy P (2008). The parents capacity to treat the child as a psychological agent:
Constructs, measures and implications for developmental psychopathology. Soc Dev 17:73754.
Shedler J (2010). The efficacy of psychodynamic psychotherapy. Am Psychol 65(2):98109.
Shepherd M (2004). Single-case-study methodology and the contact function. Mod Psychoanal
29:16370.
Souza J (2014). La triangulacio n metodolo gica como herramienta para construir conocimientos en
torno a la problema tica del uso de plaguicidas. Buenos Aires: ALAI, Ame rica Latina en Movimiento.
Sroufe L (1996). Emotional development: The organization of emotional life in the early years. New
York: Cambridge University Press.
Szecso dy I (2008). A single-case study on the process and outcome of psychoanalysis. Scand
Psychoanal Rev 31:10513.
Szecso dy I, Varvin S, Amadei G, Stoker J, Beenen F, Klockars L (1997). The European multisite
collaborative study of psychoanalysis (Sweden, Finland, Norway, Holland and Italy). Paper
presented at the Symposium on Outcomes Research (Chair Otto Kernberg). International
Psychoanalytic Association Congress, Barcelona.
Szecso dy I, Varvin S, Beenen F, Stoker J, Klockars L, Amadei G (1999). Multicenter collaboration of
research on process and outcome of psychoanalysis. Presentation of AHMOS. Paper presented at
the International Psychoanalytical Congress, Santiago, Chile.
Szecsody I, Stoker J (2004). A single-case study on the process and outcome of psychoanalysis. J
Tamez A (1989). Las Transferencias. Memorias del IV Congreso Psicoanaltico Regiomontano.
Monterrey, Mexico: Asociacio n Regiomontana de Psicoana lisis.
Tamez A (1992). La Envidia Fa lica. Memorias del VIII Congreso Psicoanaltico Regiomontano.
Monterrey, Mexico: Asociacio n Regiomontana de Psicoana lisis.
Tamez A (1993). The transferences. In: Lemlij M, editor. Psychoanalysis in Latinamerica, 21947.
Peru: FEPAL.
Tamez A (1994). La ilusio n de ser padres; experiencia con parejas infe rtiles. Memorias del X
Congreso Psicoanaltico Regiomontano. Monterrey, Mexico: Asociacio n Regiomontana de
Psicoana lisis.
Tamez A (1996). Panel Report: The Holocaust and Beyond. Int J Psychoanal 77:147.
Tamez A (1998). Parentalidad y adopcio n. Unpublished thesis, Diploma in Psychopathology of the
Baby and Early Interactions, Faculty of Medicine, University of Paris XIII (Bobigny).
Tamez A (1999). La consulta terape utica de bebe y lo transgeneracional. Monterrey, Mexico:
Asociacio n Regiomontana de Psicoana lisis.
Tamez A (2002). Pre diction de la Parentalite Adoptive. In: Sols Ponto
n, editor. La Parentalite
. Paris:
Ed. Presses Universitaires de France (Spanish version 2004, ch. 19, 30924).

32 A. Tameza
Tamez A (2008). Sobre la Transmisio n Psquica. Memorias del XXIV Congreso Anual Psicoanaltico
Regiomontano de ARPAC on Desarrollo y Psicopatologa del Nin ~ o y Adolescente in UNITEC,
Monterrey, Mexico.
Tamez A (2010). Identidad de Ge nero, Desarrollo, Transmisio n y Abordaje. Transiciones, Journal of
the Asociacio n Peruana de Psicoterapia Psicoanaltica de Nin ~ os y Adolescentes 149:6785.
Tamez A (2012). Eficacia y Calidad en Psicoterapia y Psicoana lisis. Memorias del XXVIII Congreso
Anual Psicoanaltico Regiomontano de ARPAC, on Problemas en la Pra ctica Psicoanaltica,
Monterrey, Mexico.
Tamez A (2013). Metodologa empleada para evitar sesgos. Memorias del XXIX Congreso Anual
Psicoanaltico Regiomontano de ARPAC, on La de-formacio n del Sujeto, Monterrey, Mexico.
Tamez R (1960). Reacciones transferenciales y contratransferenciales en cadena. In: Palacios A,
Ramrez S, Valner G, editors. Psicoana lisis la Te
cnica. Mexico: Pax, 1962.
Target M, Fonagy P (1998). The long-term follow-up of child psychoanalysis. Paper presented at the
Vulnerable Child Symposium at the American Psychoanalytic Association, Toronto, Canada, May.
Teufel R, Volk W (1988). Erfolg und Indikationstationa rer psychotherapeutischer Langzeittherapie. In:
Ehlers W, Traue HC, Czogalik D, editors. Bio-psycho-sozialeMedizin, 33146. Berlin: Springer-PSZ.
Drucke. Stuttgart Kolleg
Twemlow SW, Fonagy P, Sacco FC (2005). A developmental approach to mentalizing communities: I.
A model for social change. B Menninger Clin 69(4):26581.
Weber J, Bachrach H, Solomon M (1985a). Factors associated with the outcome of psychoanalysis:
Report of the Columbia Psychoanalytic Center Research Project (II). Int Rev Psychoanal 12:12741.
Weber J, Bachrach H, Solomon M (1985b). Factors associated with the outcome of psychoanalysis:
Report of the Columbia Psychoanalytic Center Research Project (III). Int Rev Psychoanal 12:251
62.
Werman DS (1979). Chance, ambiguity, and psychological mindedness. Psychoanal Q 48:10715.
Winnicott DW (1941). The observation of infants in a set situation. Int J Psychoanal 22:229.
Winnicott DW (1960). The theory of the parent-infant relationship. In: The maturational processes and
the facilitating environment. London: Karnac Books, 1990.
Winnicott DW (1968). Playing: Its theoretical status in the clinical situation. Int J Psychoanal 49:5919.
Zack D (2005). Projective identification, conflict, and psychic change. Can J Psychoanal 13:23041.
Zetzel ER (1956). Current concepts of transference. Int J Psychoanal 37:36975.
Zetzel ER (1968). The so called good hysteric. Int J Psychoanal 49:25660.

The Effectiveness of Psychoanalysis in A Case Study Using Multi-Perspective Methodology: Conflict in Choosing A Partner Due To Transgenerational Mandate

Enviado por

Dados do documento

Título original

Direitos autorais

Formatos disponíveis

Compartilhar este documento

Compartilhar ou incorporar documento

Opções de compartilhamento

Você considera este documento útil?

Este conteúdo é inapropriado?

Direitos autorais:

Formatos disponíveis

The Effectiveness of Psychoanalysis in A Case Study Using Multi-Perspective Methodology: Conflict in Choosing A Partner Due To Transgenerational Mandate

Enviado por

Direitos autorais:

Formatos disponíveis

Int J Psychoanal (2017) doi: 10.1111/1745-8315.

The effectiveness of psychoanalysis in a case study

(Accepted for publication 15 December 2015)

A case study is presented to evaluate the effectiveness of psychoanalysis and

Keywords: effectiveness, psychoanalytic treatment, psychoanalysis, partner

Copyright 2017 Institute of Psychoanalysis

The studies by Marianne Leuzinger-Bohleber et al. (2003), which began

excessive competition and a lack of credibility, rather than a lack of psycho-

Case-specific research questions

Int J Psychoanal (2017) Copyright 2017 Institute of Psychoanalysis

analysability; (3) therapeutic alliance; (4) transference; (5) countertransfer-

Copyright 2017 Institute of Psychoanalysis Int J Psychoanal (2017)

The concept of mentalization in transgenerational transmission

Copyright 2017 Institute of Psychoanalysis Int J Psychoanal (2017)

Int J Psychoanal (2017) Copyright 2017 Institute of Psychoanalysis

Copyright 2017 Institute of Psychoanalysis Int J Psychoanal (2017)

Results and discussion

Is psychoanalytic treatment effective?

Data from the analyst

Data from the judges

Int J Psychoanal (2017) Copyright 2017 Institute of Psychoanalysis

[Results] . . . improved 90% . . . she grew . . . If there is self-analysis . . .

If so, what technical aspects of the treatment enabled the

Copyright 2017 Institute of Psychoanalysis Int J Psychoanal (2017)

[Mini-analysis] . . . you were talking to me as t u [informal you], I

Data from the analyst

Int J Psychoanal (2017) Copyright 2017 Institute of Psychoanalysis

Data from the judges

Copyright 2017 Institute of Psychoanalysis Int J Psychoanal (2017)

What components of psychoanalysis worked against its

Data from the analyst

Data from the judges

Int J Psychoanal (2017) Copyright 2017 Institute of Psychoanalysis

Is the methodology in this research useful for evaluating the

Data from the analyst

Data from the judges

Data from the analyst

Data from the judges

Copyright 2017 Institute of Psychoanalysis Int J Psychoanal (2017)

[Reconstruction of the subject] . . . many resources as a person . . . she con-

Is psychoanalysis effective in this case of couple conflict?

Data from the analyst

Data from the judges

Int J Psychoanal (2017) Copyright 2017 Institute of Psychoanalysis

Is treatment effective for preventing the repetition of

Copyright 2017 Institute of Psychoanalysis Int J Psychoanal (2017)

Data from the analyst

Data from the judges

Int J Psychoanal (2017) Copyright 2017 Institute of Psychoanalysis

pattern transgenerationally, suppressed husband, a man oppressed by his

Copyright 2017 Institute of Psychoanalysis Int J Psychoanal (2017)

their capacity to be good providers, with unfaithfulness and subordination

What is the role of mentalization in the effectiveness of

Data from the analyst

Data from the judges

Is psychoanalytic treatment effective?

Int J Psychoanal (2017) Copyright 2017 Institute of Psychoanalysis

The indication of psychoanalysis and the analysts clear objectives were

If so, what technical aspects of the treatment enabled the

Copyright 2017 Institute of Psychoanalysis Int J Psychoanal (2017)

2002; Heinicke and Ramsey-Klee, 1986), as is the ongoing interpretation of

What components of psychoanalysis worked against its

Int J Psychoanal (2017) Copyright 2017 Institute of Psychoanalysis