Open door review

Conceptual studies




The Conscious Id

Solms, M. (1997): What is consciousness? J Am Psychoanal Ass 45, 681-778.
Solms, M. & Panksepp, J. (2012): The id knows more than the ego admits. Brain Sci 2, 147-175.
Solms, M. (2013). Das bewusste Es. Psyche-Z Psychoanal 67, 991-1022.


Two aspects of the body are represented in the brain, and they are represented differently. The more important difference is that the brain regions for the two aspects of the body are associated with different aspects of consciousness. Very broadly speaking, the brainstem mechanisms derived from the automic body are associated with affective consciousness and the cortical mechanisms derived from the sensory motor body are associated with cognitive consciousness. Moreover, the upper brainstem is intrinsically conscious whereas the cortex is not; it derives its consciousness from the brainstem. These facts have substantial implications for psychoanalytic metapsychology because the upper brainstem (and associated limbic structures) performs the functions that Freud attributed to the id, while the cortex (and associated forebrain structures) performs the functions he attributed to the ego. This means that the id is the fount of consciousness, and the ego is unconscious in itself. The basis for these conclusions, and some of their implications, are discussed in several papers in different fashions.


Mark Solms


Towards a better use of psychoanalytic concepts: A model illustrated using the concept of enactment

Bohleber, W., Fonagy, P., Jiménez, J., Scarfone, D., Varvin, S., & Zysman, S. (2013). Towards a better use of psychoanalytic concepts: A model illustrated using the concept of enactment. International Journal of Psychoanalysis, 94, 501-530.
Canestri, J., Bohleber, W., Denis, P., & Fonagy, P. (2006). The map of private (implicit, preconscious) theories in clinical practice. In J. Canestri (Ed.), Psychoanalysis. From Practice to Theory (pp. 29-44). Chichester: Whurr Publishers.
Canestri, J. (Ed.). (2011). Putting Theory to Work. How Are Theories Actually Used in Practice. London: Karnac Books.


It is well known that there is a lack of consensus about how to decide between competing and sometimes mutually contradictory theories, and how to integrate divergent concepts and theories. In view of this situation the IPA Project Committee on Conceptual Integration developed a method that allows comparison between different versions of concepts, their underlying theories and basic assumptions. Only when placed in a frame of reference can similarities and differences be seen in a methodically comprehensible and reproducible way. We used “enactment” to study the problems of comparing concepts systematically. Almost all psychoanalytic schools have developed a conceptualization of it. We made a sort of provisional canon of relevant papers we have chosen from the different schools. The five steps of our method for analyzing the concept of enactment will be presented. The first step is the history of the concept; the second the phenomenology; the third a methodological analysis of the construction of the concept. In order to compare different conceptualizations we must know the main dimensions of the meaning space of the concept, this is the fourth step. Finally, in step five we discuss if and to what extent an integration of the different versions of enactment is possible.


Werner Bohleber

Am Ebelfeld 1 A, D-60488 Frankfurt a.M.


Unconscious phantasy and its conceptualizations: An attempt at conceptual integration

Bohleber, W., Fonagy, P., Jiménez, J., Scarfone, D., Varvin, S., & Zysman, S. (2013). Towards a better use of psychoanalytic concepts: A model illustrated using the concept of enactment. International Journal of Psychoanalysis, 94, 501-530.

Bohleber, W., Jiménez, J.P., Scarfone,D., Varvin, S., & Zysman, S. (2018) . Unconscious phantasy and its conceptualizations: An attempt at conceptual integration. International Journal of Psychoanalysis, 96.


That there is a lack of consensus as to how to decide between competing, at times even contradictory theories, and about how to integrate divergent concepts and theories is well known. In view of this situation, the IPA Committee on Conceptual Integration (2009–2013) developed a method for comparing the different versions of any given concept, together with the underlying theories and fundamental assumptions on which they are based. Only when situated in the same frame of reference do similarities and differences begin to appear in a methodically comprehensible and reproducible form. After having studied the concept of enactment followed by the publication of a paper in the International Journal of Psychoanalysis in 2013, we proceeded to analyze the concept of unconscious phantasy while at the same time continuing to improve our method. Unconscious phantasy counts among the central concepts in psychoanalysis. We identified a wide range of definitions along with their various theoretical backgrounds. Our primary concern in the present paper addresses the dimensional analysis of the semantic space occupied by the various conceptualizations. By way of deconstructing the concepts we endeavoured to establish the extent to which the integration of the different conceptualizations of unconscious phantasy might be achieved.


Werner Bohleber

Am Ebelfeld 1 A, D-60488 Frankfurt a.M.


What is conceptual research in psychoanalysis?

Leuzinger-Bohleber, M.; Dreher, A.U.; Canestri, J. (Eds.) (2003): Pluralism and Unity? Methods of Research in Psychoanalysis. (The International Psychoanalysis Library). London: International Psychoanalytical Association.

Leuzinger-Bohleber, M. (2006): Conclusion: future clinical, conceptual, empirical, and interdisciplinary research on sexuality in psychoanalysis. In: Fonagy, P.; Krause, R.;Leuzinger-Bohleber, M. (Eds.): Identity, Gender and Sexuality. 150 years after Freud.(Controversies in psychoanalysis series, 1) (pp. 181-192). London: International Psychoanalytical Association.

Leuzinger-Bohleber, M.; Fischmann, T. in cooperation with the Research Subcommittee for Conceptual Research of the IPA (2006): What is conceptual research in psychoanalysis? International Journal of Psychoanalysis, 87, 1355-1386.


The development of psychoanalysis as a science and clinical practice has always relied heavily on various forms of conceptual research.  Thus conceptual research has clarified, formulated and reformulated psychoanalytic concepts permitting to better shape the findings emerging in the clinical setting. By enhancing clarity and explicitness in concept usage it has facilitated the integration of  existing psychoanalytic thinking as well as the development of new ways of looking at clinical and extra-clinical data.  Moreover, it has offered conceptual bridges to neighbouring disciplines particularly interested in psychoanalysis e.g. philosophy, sociology, aesthetics, history of art and literature and more recently cognitive science/ neuroscience.

In the present phase of psychoanalytic pluralism, of worldwide scientific communication amongst psychoanalysts irrespective of language differences and furthermore of an intensifying dialogue with other disciplines the relevance of conceptual research is steadily increasing. Yet, it still often seems not clear enough how conceptual research can be characterized in contrast to clinical and empirical research in psychoanalysis. Therefore the Subcommittee for Conceptual Research of the IPA  presented some of its considerations on the similarities and the differences between various forms of clinical and extraclinical research, their specific aims,  quality criteria and thus their specific chances as well as their specific limitations in this paper. Examples taken from two volumes of the International Journal of Psychoanalysis 2002/2003 served as illustrations for eight different subtypes of conceptual research.


Prof. Dr. Marianne Leuzinger-Bohleber; PD Dr. Tamara Fischmann

Sigmund-Freud-Institut, Myliusstr. 20, D- 60323 Frankfurt



Conceptual and clinical research

Dreher, A. U. (2002). Psychoanalytische Konzeptforschung und psychoanalytische empirische Forschung: das Beispiel "psychisches Trauma". In: Giampieri-Deutsch, P. (Hrsg.) Psychoanalyse im Dialog der Wissenschaften. Europäische Perspektiven. Kohlhammer.

Dreher, A. U. (2005) Conceptual research. In: Textbook of Psychoanalysis (pp. 361-372). American Psychiatric Publishing. Edited by ES Person, AM Cooper, and GO Gabbard. Arlington, VA, American Psychiatric Publishing, Inc.

Dreher, A. U. (2010) Pluralism in theory and in research—and what now? A plea for connectionism. In: M. Leuzinger-Bohleber, J. Canestri, and M. Target (Eds.), Early development and Its disturbances: Clinical, conceptual and empirical research on ADHD and other psychopathologies and its epistemological reflections (pp. 239-266). London, Karnac Books.

Dreher, A. U. (2015) Psychoanalytic research with or without the psyche? Some remarks on the intricacies of clinical research. In: Boag S., Brakel L., Talvitie, V. (eds.) Philosophy, Science, and Psychoanalysis (pp. 219-246). London: Karnac.


Psychoanalysis as a treatment method not only has generated an abundance of empirical evidence, but also - as theoretical edifice - powerful concepts, which played an essential role in the discourses of the human sciences. Concepts do change; they live just like scientific language games in general live. When the 'world' changes, when there are new clinical observations or extra-clinical empirical findings, this can influence the meaning of familiar concepts. Such constant change of meaning in the course of theoretical development, sometimes can lead to substantial differentiations, sometimes to school specific concept usages up to completely different ones.

In our psychoanalytic concepts an essential nucleus of clinical, empirically based knowledge is preserved and psychoanalysis is dependent upon attempts to constantly clarify their meaning. Conceptual research – as an ongoing research program – enables us to take such a decentred perspective on concepts through systematically reconstructing and critically discussing such changes of a concept in their respective conceptual fields and to possibly propose ways to a more homogeneous usage of central psychoanalytic concepts.

Thus, it is of fundamental significance, that whatever kind of empirical data as also the use of concepts, their role and function in psychoanalysis, should be subject of psychoanalytic research. Emphasis is on the interrelatedness and interdependency of empirical and conceptual research activities for the development of psychoanalysis as a human science.


Dr. Anna Ursula Dreher

Sternstraße 6, D-60318 Frankfurt am Main

Phone: +49 (0)69 - 59 63 682


Criteria for judging results. A study about conceptualization of goals in psychoanalysis

Westenberger-Breuer, H. (2003). Kriterien des Erfolgs. Eine Untersuchung zum Konzept des Behandlungsziels in der Psychoanalyse {Criteria of success. An investigation on the concept of treatment goals in psychoanalysis}. Tübingen: edition diskord.
Westenberger-Breuer, H. (2007). The goals of psychoanalytic treatment: conceptual considerations and follow-up interview evaluation with a former analysand, International Journal of Psychoanalysis, 88, 1-13.

There has been an increasing number of studies of the effects of psychoanalytic treatment over the past 20 years which many psychoanalysts approach rather sceptically. One of the criticisms concerns the criteria by which treatment results are judged. The sought-after changes unique to psychoanalytic treatment are seen as impossible to operationalize, i.e. according to this view, they simply cannot, or not sufficiently, be grasped within the confines of empirical research. Studying this argument reveals that the opinions of psychoanalysts concerning the goals to which psychoanalysis aspires in treating patients vary extensively, even including the position that psychoanalytic treatment ought to be utterly goalless. Without a common understanding of the results that can generally be expected from a psychoanalytic treatment conducted lege artis, it is impossible to reflect on and judge our own methods. Even if as a psychoanalyst one believes that the changes resulting from psychoanalytic treatment simply cannot be measured psychometrically, in some way or other these changes ought to be conceived of as treatment effects so that potentially necessary corrections can be developed in our understanding and technique.

There already exist a plethora of goal definitions by psychoanalysts from the various theoretical schools, so many that many authors even lament their confusing and contradictory diversity.  The wealth of goal descriptions that can be found in the literature was reduced by differentiating the definitions according to their content and their level of abstraction at which they are formulated. They were grouped in four categories. The proposal for a conceptualization was, that the goal of psychoanalytic treatment encompasses these four components: (1) Changes in symptoms and complaints, (2) Changes in life adjustment, (3) Changes in personality structure and (4) Realization of procedural goals.


This definiton of the goal in psychoanalysis was tested by presenting a transcript of two follow-up interviews with a former analysand to 19 psychoanalysts. The case comes from the follow-up study of the German Psychoanalytic Society (DPV), reported by Leuzinger-Bohleber, M. et al. in 2002. There were audio-taped discussions in the local and in the nationwide research group, in which the statements of the former analysand were evaluated. Additionally two other colleagues commented the interviews. The group included psychoanalysts of various ages, with differing interests and theoretical orientations.

Moreover the transcripts of the follow-up interviews were presented to a philosopher, a behavioural therapist, a sociologist, an educational researcher, a psychiatrist, a Gestalt therapist, a systems therapist and a manager of the Association of Statutory Health Insurance Physicians.

Those formulations which refer to goal criteria have been placed into the categories defined above. The statements have been taken from the protocols verbatim and from authorized protocols of the interviews with the experts. The selection of statements taken from the protocols and their classification in the form given here were reviewed by another person, who agreed in large part with that of the author.

In Westenberger-Breuer (2003) all the protocols can be found, as well as a complete report of the follow-up interviews with the former patient.


The judgments of the analysts who co-operated in this follow-up project can be meaningfully assigned to the defined categories. Psychoanalysts use the criteria defined above implicitly in forming their opinions about treatment outcome. None of the aspects remains unmentioned, no aspect is singled out in its importance and no special weight is accorded to specific theoretical orientations by individual psychoanalysts in their concrete overall appraisal to treatment outcome. Moreover the psychoanalysts not only employed similar criteria in their assessments, but also showed wide agreement in judging the content.

The outside experts came to similar results. There was wide agreement with the criteria used by the psychoanalysts, as well as with judging the content of the treatment outcome.


Heike Westenberger-Breuer  


Psychoanalytic considerations on psychopathology and conceptual research

Löffler-Stastka, H., Szerencsics, M., & Blüml, V. (2009). Dissociation, trauma, affect regulation and personality in patients with a borderline personality organization. Bulletin of the Menninger Clinic, 73(2), 81-98. DOI: 10.1521/bumc.2009.73.2.81
Parth, K., Hrusto-Lemes, A., Löffler-Stastka, H. (2014). Clinical reasoning processes and authentic clinical care for traumatised patients. Journal of Traumatic Stress Disorders & Treatment, 3(4), DOI: 10.13140/2.1.4065.3441

Brief Summary

While the association between dissociation and trauma has been the subject of intensive research, the relationship between dissociation, childhood trauma, and personality characteristics has not yet been explored in detail. Patients suffering from a personality disorder completed the Dissociative Experiences Scale, the Childhood Trauma Questionnaire, and the personality and affect regulation measurement instruments SWAP and AREQ. Results are critically discussed within a psychoanalytic framework, which should also help clarify the rather vague concept of dissociation. In this diagnostic context the concept of countertransference is a central foundation pillar of psychoanalytic theory and practice. It has become increasingly influential in other forms of therapy and in neuroscience research into resting-states. It is, like many other concepts in psychoanalysis, characterized by its elasticity and covers a wide range of phenomena inside and outside the clinical sector. Attempts to measure countertransference phenomena empirically, on a quantitative or qualitative level have been avoided for a long time due to ist complexity. Recently however, various methodologies and approaches to conduct empirical research in this field have become more and more successful in documenting the importance of countertransference for treatment of patients in the medical context and as well as for diagnostic purposes. We report here the findings of an exemplary study that surveyed and analysed the role of countertransference in regards to clinical care for traumatised patients. Making use of the Childhood Trauma Questionnaire and the Harvard Trauma Questionnaire, the study compared two groups of patients. One was comprised by patients who could and the other comprised by patients who could not remember having been traumatised, yet suffered from Borderline Personality Disorder and displayed symptoms characteristic for traumatisation. The Countertransference Questionnaire measured the relationship between therapist and patient. The results indicate that the measurement of countertransference feelings in the clinician can be utilized as a crucial tool for understanding unconscious dynamics in traumatised patients. The results suggest that only making use of the concept of countertransference enables accessing those traumatic fears, phantasies and memories that cannot be communicated verbally but only in the relationship to the therapist. Furthermore, the paper discusses these results, their clinical implications and contextualizes them with theoretical concepts and a case study.


Henriette Löffler-Stastka,

Medizinische Universität Wien, Universitätsklinik für Psychoanalyse und Psychotherapie, Währinger Gürtel 18-20, 1090 Wien


What does Generalized Anxiety Disorder mean for psychoanalysts? An empirical qualitative approach about its conceptualization in the psychoanalytic framework

Gómez Penedo, J.M., Etchebarne, I., Juan, S., & Roussos, A. (2013). Um olhar ao transtorno de ansiedade generalizada desde a psicanalise: uma aproximação empírica sobre sua conceptualização [A View of Generalized Anxiety Disorder from the Psychoanalytic Perspective: an Empirical Approach about its Conceptualization]. Psicanálise Revista da  Sociedade Psicanalítica de Porto Alegre, 15 (2), 331-356.
Juan, S., Etchebarne, I., Gómez Penedo, J.M., & Roussos, A. (2010). Una perspectiva psicoanalítica sobre el Trastorno de Ansiedad Generalizada: Raíces históricas y tendencias actuales [A Psychoanalytic Perspective on Generalized Anxiety Disorder: Historical Roots and Current Trends]. Revista de la Sociedad Argentina de Psicoanálisis, 14, 197-219
Juan, S., Gómez Penedo, J.M., Etchebarne, I., & Roussos, A. J. (2012). El método de investigación cualitativa consensual (Consensual Qualitative Research, CQR): Una herramienta para la investigación cualitativa en psicología clínica [Consensual Qualitative Research (CQR) Method: a Tool for Qualitative Research in Clinical Psychology]. Anuario de investigaciones de la Facultad de Psicología de la Universidad de Buenos Aires, 18 (1), 47-56.

Aims and rationale of the study

This study analyzed how expert psychoanalysts conceptualized Generalized Anxiety Disorder (GAD), as it is described in DSM-IV-TR (2001). Potential GAD´s defense mechanisms, predominant anxieties, and etiological factors were explored; as well as psychoanalysts’ conceptualization on GAD´s diagnostic validity and possible underlying structure.

There are current debates regarding GAD´s psychopathological understanding and diagnostic validity that represent a challenge when identifying how different theoretical frameworks, such as psychoanalysis, conceptualize generalized anxiety phenomenon (Juan, Etchebarne, Gómez Penedo, & Roussos, 2010). This study focuses on analyzing the way in which the psychoanalytic tradition, that historically reject descriptive diagnostic manuals such as DSM, approach this condition, given that many patients in psychoanalytic treatments could be potentially diagnosable as a GAD case. Thus, studying the psychoanalytic conceptualization of GAD could help to address the gap between psychiatry and psychoanalysis in the conceptualization and treatment of these patients, as well as enrich the knowledge regarding GAD and anxiety in general terms. Further details about this study are presented in: Gómez Penedo, Etchebarne, Juan, & Roussos, A. (2013).


10 Individual semi-structured interviews were conducted with certified expert psychoanalytic psychotherapists from Buenos Aires exploring their conceptualizations about GAD. A Spanish guide (Juan, Gómez Penedo, Etchebarne, & Roussos, 2012) for conducting Consensual Qualitative Research (CQR) (Hill, Thompson y Nutt-Williams, 1997) was used for the data analysis.

Results and discussion

GAD was generally related to Freudian classical notions of anxiety neurosis (Freud, 1895/2001) and anxiety hysteria (Freud, 1909/2001). Also there was a generally trend to relate GAD with insecure attachment and primitive anxieties. Although participants typically considered that GAD did not present main defense mechanism as other pathologies, they related it to primitive defense mechanisms and even considered that worry, GAD´s main feature, could be conceptualized as a non-effective defense mechanism to avoid traumatic representations. Regarding the underlying structure, most of the psychoanalysts conceptualized generalized anxiety as a trans-structural phenomenon that could be present in both neurotic and borderline structures.

The study performed has triggered some questions and hypotheses about the nature of GAD from a psychoanalytic perspective. Future studies are needed to increase knowledge of the relationships (and potential mutual enrichment) between GAD and fundamental concepts of the psychoanalytic framework for clinical practice and psychotherapy research.

Limitations of the study and future directions

The qualitative and exploratory nature of this research was not orientated to test hypotheses but to generate them. Because of the non-probabilistic sampling, and the fact that we only studied expert psychoanalysts, generalization of these results to the population of psychoanalysts is unknown. Further research may analyze GAD conceptualization from the psychoanalytic perspective in a bigger sample and also study the links between these conceptualizations and the way in which psychoanalysts treat patients with GAD.


Juan Martín Gómez Penedo1, 2, 3, Ignacio Etchebarne2, Santiago Juan1, & Andrés J. Roussos1,2,3

1Universidad de Buenos Aires, 2Universidad de Belgrano, 3CONICET.

E-mail :

The Three-Level Model for Observing Patient Transformations (3-LM)

Altmann de Litvan (Ed.), Bernardi, R., Hernandez, S., Ungar, V., Fitzpatrick-Hanly, M., Leuzinger-Bohleber, M., Gullestad, S., Leibovich de Duarte, A., Sebek, M., White, R., Kantrowitz, J., Hurvich, M., de León, B., Fudin de Winograd, L. & Miller, D., White, R. (2014) Time for change. Tracking transformations in psychoanalysis. London: Karnac

Bernardi, R. (2019). Clinical Research and Systematic Empirical Research: What Can We Learn about Them from Current Controversies? International Journal of Psychoanalysis.

Bernardi, R. (2014a). La formulación clínica del caso. Su valor para la práctica clínica. Revista de Psiquiatría Del Uruguay, 78(2), 157–172.

Bernardi, R. (2010). DSM-5, OPD-2 y PDM: Convergencias y divergencias entre los nuevos sistemas diagnósticos psiquiátricos y psicoanalíticos. Revista de Psiquiatría del Uruguay, 74(2), 179–205.

Brief Summary

The 3-LM is a guide or heuristic to observe clinical materials from three different levels: 1) Phenomenological description of transformations; 2) Identification of the main diagnostic dimensions of change; and 3) Explanatory hypotheses of change. It proposes a second look to what occurs to a particular patient with a particular analyst in the context of their work, taking as a reference not ideal theoretical models, but what takes place in real practice, seaking to assess transformations in the patient, while observing the analytic process with the analyst.

This model centres on patients as persons in their context, the reason that brought them to analysis, and how and in which ways patients’ answers were heard and explored at different moments of their analysis.

This model is used for the group discussion of clinical material and it helps analysts examine the explicit and implicit theories they have applied with patients and consider if other approaches would be better to promote patients’ transformations of the aspects that are worked on in analysis, sheding light on blind spots or specific challenges that the particular patient may pose to the analyst.
With the three-level model, the group of analysts discussing the clinical material acts as a “consensus of experts” that validates or not the analyst’s observations and systematically documents convergences and divergences with clinical observation (method developed in the DPV follow-up study by Leuzinger-Bohleber et al.)

The IPA Clinical Observation Committee has been working on and with the The Three-Level Model for Observing Patient Transformations (3-LM) in different groups formed by analysts in different regions. Up to April 2015 approximately 800 analysts have participated in working groups with the 3-LM.


Analysts participating in the groups are asked to fill a questionnaire with items regarding their evaluation of the changes in the patient ex ante and ex post the group discussion.

Some members of the Committee are working in a research project to study the degree of agreement among analysts with different theoretical assumptions regarding how they assess transformations in patients during long periods of analysis.


Dr. Marina Altmann de Litvan

Asociación Psicoanalítica del Uruguay