=66066$*D!7#2*D0!$*!2*2<46$6!(0%9$*23<0!
i)601#6_!A>![+,,,^>!Q0<:E7%$($7$69!2*&!(#0!1647#$7!6B%:270>! N">#+@B&"!&,-%&/$%#)?@+&'(A?-"@+@BA,)?&/(("?)@,)"+O& le _!+..E+b,> & >-001(3! The current study systematically assesses the progress of a single patient during a four-year treatment episode. As a case study it centers a schizoid patient in her mid-sixties who had made in a lengthy analysis – for much of her adult life – significant clinical improvement. The treating analyst’s impression of clinical improvement was independently verified through systematic analysis of transcripts of audiotapes of thirty-six sessions over a four-year period of treatment. The patient showed significant improvement in measures of character pathology, object relations, mentalization, and superego anxiety. The presented traditional case study offers a special attention to the impact of taping and the supplemented analysis of verbatim transcripts of the whole period of treatment. The transcripts have been rated by external judges with good levels of interrater reliability (> .70) on measures of character pathology, object relations, reflective functioning, and superego anxiety. Two types of measure were selected for the study. Measures of the first type were selected to assess personality variables such as character pathology and level of objects relations that are presumed to be fairly stable and resistant to change. The research question with these measures was whether long-term intensive treatment could significantly alleviate severe and entrenched character pathology. Measures of the second type were selected to assess more fluid and psychodynamically significant process variables such as reflective functioning and superego anxiety. The research question with these measures was whether the patient would become more reflective and develop a milder superego over the cours of treatment. If the patient did, future research could then examine how aspects of technique and the therapeutic interaction impact on variables that fluctuate quite a bit during sessions. The results suggest that some patients with entrenched character pathology who seem to be in analysis interminable may still make clinically significant improvement. In addition, the study demonstrates that the reflective functioning scale (Fonagy et al. 1998) can be fruitfully adapted for use with transcripts of psychoanalytic sessions and furthermore it offers that the SWAP (Shelder and Westen 1998) can generate a personality profile that is consistent with an established self-repot measure, the MCMIIII, so that it is a suitable measure for assessing change in character structure. G$#.1/.\!
JOSEPHS@ADELPHI.EDU
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