Time for Change

How can we, analysts, evaluate whether analysis is generating transformations in our patients? The IPA Project Committee on Clinical Observation and Testing offers a tool: The Three-Level Model for Observing Patient Transformations (3-LM); a guide for refining, conceptualizing, and systematizing clinical observations about patient transformations. It seeks to enhance clinical observations, making them more accurate and more useful for theory testing and theory building through a systematic analysis of clinical material.Time for Change: Tracking Transformations in Psychoanalysis - The Three-Level Model focuses on the question of how to observe changes in psychoanalysis. It presents the model and the outcome of having worked with the 3-LM tool, which has been applied to adult patients, adolescents and children, as well as in analytic training. The 3-LM goes from clinic to theory, from implicit to explicit theory, from unquestioned hypotheses to reviewed hypotheses enriched by the work on the clinical material after its discussion by several participants with different perspectives. Firstly, the 3-LM seeks to make a careful characterization of the patient and his/her problems and capacities when (s)he enters analysis. Then, it observes later moments of his/her treatment and the positive or negative changes that have occurred during treatment, what has not changed, the relevance of changes, and how changes are explained. Reports are elaborated in each group which state the convergences and divergences that emerged during the group discussion. Approximately 700 analysts from different parts of the world have participated in these clinical observation groups. They have found that this tool has proved useful and friendly for analysts, for it rescues and re-values the richness of the clinical experience between analyst and patient. It also allows us analysts to exercise our abilities and clinical sharpness as well as acquiring precision when communicating our work. It provides us with one way to monitor our work in a more subtle and meticulous way, offering a second look at the material for the benefit of both analyst and patient.

Marina Altmann de Litvan, PhD, is a child and adolescent psychoanalyst, a full member and training analyst of the Uruguayan Psychoanalytic Association, and a member of the Clinical Research Subcommittee of the International Psychoanalytical Association (IPA). She has been a member of the Education Committee and Co-Chair of the Education-Research Subcommittee of FEPAL, as well as Research Fellow and Visiting Professor at University College of London, Research Training Programme. She was also awarded the Biannual Exceptional Contribution Award from the Research Committee of the IPA for her research into verbal and nonverbal interactions in mother-baby psychotherapeutic process. She has published chapters of books and papers both in Spanish and English.