Richard Almond

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I am a psychoanalyst with a strong interest in social phenomena, including the relationship between therapist and patient. But also the wider application of anthropology, sociology, social psychology, and the humanities to psychoanalytic thinking.

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How Do We Bridge the Gap? Commentary On Luyten, Blatt, and Corveleyn

Journal of the American Psychoanalytic Association, Jun 1, 2006

... capture the plan and tests employed by each particular patient in empirical research using an... more

Tablemate Choices of Psychiatric Patients

Journal of Nervous and Mental Disease, Jul 1, 1965

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Psychiatric Inpatient Research Social System and Planning Issues

Journal of Nervous and Mental Disease, Nov 1, 1969

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Milieu Therapeutic Process

Archives of General Psychiatry, Oct 1, 1969

T HE VALUE experience of patients, the treatment ideologies of therapists, and the cultures of tr... more T HE VALUE experience of patients, the treatment ideologies of therapists, and the cultures of treatment services are being recognized increasingly as critical aspects of therapeutic process. 1-4 Although most discussions of values have concerned individual treatment, it is now universally accepted that the value systems of psychiatric inpatient services also have powerful effects upon patient course. 5.6 This is especially true of therapeutic communities, where treatment occurs on a small group or ward level, and where group and unit norms are recognized as a critical component of the hospital experience. 7,8 The topic of induced value change in psychiatric units has received little theoretical analysis and even less empirical investigation. Research has been hampered by the difficulty in knowing what values to examine, by the fact that the value system of most hospitals are implicit, and by the lack of reliable and valid instruments for measuring value change in

Revisiting Groundhog Day (1993): Cinematic depiction of mutative process

The International Journal of Psychoanalysis, Oct 1, 2006

Cinema, with its capacity to speak to several senses at once, can portray a wide variety of inner... more Cinema, with its capacity to speak to several senses at once, can portray a wide variety of inner experiences. One of these experiences is that of the diffi cult process of character change, although it might seem unlikely in a medium limited to about 120 minutes of viewing. To do this, the writers, director, and editors manage the elements of time and plot development. Groundhog day, an offbeat comedy that features Bill Murray in a role that foreshadows his later, serious parts, shows us a man trapped by his narcissistic defenses. The device of repetition becomes a representation of developmental arrest and closure from object relatedness. Repetition also becomes a means of escape from his characterological dilemma. The opportunity to redo and learn from experience-in particular, to love and learn through experience with a good object-symbolizes the redemptive, reparative possibilities in every life. Redemption, the suggestion that we are capable of change despite the fi xed quality of character, has been a central concern in western thought. Originally a subject of biblical texts, sermons, and tracts, this theme moved into literature with the advent of the modern novel. In earlier work I termed this theme the therapeutic narrative . Indeed, a radical view of psychoanalysis would be that Freud adopted a literary narrative as the central therapeutic mode of his new science . Film, the emergent art form of the 20th century, searches out the major narrative themes in our culture, among them the therapeutic. In the paradigm of the therapeutic narrative, a troubled person plays out his/her typical pattern in relation to an other who is more anonymous, a foil who is depicted in idealized and/or mysterious terms. The other becomes an object of desire, often-though not always-in a romantic plot structure. The interactional moves of the protagonist, which reveal his/her characteristic fl aws, are met by muted, attenuating responses by the other. The consequence, eventually, is a search for alternative solutions, motivated by a wish to gain love and approval. Through a process of trial and error, the protagonist discovers internal limitations, grieves, and discovers new possibilities. In Groundhog day the other is played by Rita, the producer of a TV weather segment that Murray is sent to broadcast. She is sweet-tempered, and disregards Murray's provocative abrasiveness, maintaining an accepting, positive attitude, but also her self-respect. Groundhog day is of particular interest to analysts for two reasons. First, it shows us psychological subjectivity-the process of change from a point of view that is

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Reading Freud’s “the Dynamics of Transference” one Hundred Years Later

Journal of the American Psychoanalytic Association, Dec 1, 2011

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Patient Value Change in Milieu Therapy

Archives of General Psychiatry, Mar 1, 1969

OBSERVERS and practitioners of psychotherapy have frequently emphasized the role of patient value... more OBSERVERS and practitioners of psychotherapy have frequently emphasized the role of patient values and value changes in the process of treatment. A series of descriptive and anthropological studies during the past two decades have demonstrated the existence of ward or hospital "cultures" in a variety of settings. These institutional value systems, it has been argued, strongly affect the attitudes of patients, and exert great power over patient behavior and prognosis. 1-5 Recognition of such cultures has led both to a more sophisticated examination of the psychiatric hospital as a complex organization, and to a more self-conscious use of the hospital community as a major therapeutic instrument. At the same time, a small number of investigators have begun to examine the specific effects of therapeutic values on the values and attitudes of patients. Most formal studies have examined value phenomena during individual

Issues in Milieu Treatment

Schizophrenia Bulletin, Jun 1, 1975

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Invited Readers 2016

Journal of the American Psychoanalytic Association, 2017

The Value System of a Milieu Therapy Unit

Archives of General Psychiatry, Nov 1, 1968

THIS paper reports the first part of a study of therapeutic values in a milieu therapy unit. We d... more THIS paper reports the first part of a study of therapeutic values in a milieu therapy unit. We deal here with the exploration and measurement of those shared beliefs and values which make up the "hospital culture." Later reports will deal with value change during patients' hospitalizations, and the relations of value change to variables such as outcome of treatment. The patient-in-the-psychiatric-hospital has been the focus of increasingly intense interest during the past two decades. Clinicians and administrators have explored a variety of approaches to the hospitalized patient beginning with "total-push," and going on to include milieu therapy, therapeutic community, patient government, and a variety of unnamed enrichments and innovations in hospital treatment. In the past ten years there has been widespread acceptance and utilization of such approaches in psychiatric inpatient facilities, especially in general hospital wards, university-affiliated services,

Psychiatry and Mental Health

Nursing Research, Mar 1, 1969

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The Healing Community; Dynamics of the Therapeutic Milieu

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Multiple criteria of treatment outcome

Journal of Psychiatric Research, Jun 1, 1971

ABSTRACT The interrelations of a variety of outcome measures are reported for a series of 65 cons... more ABSTRACT The interrelations of a variety of outcome measures are reported for a series of 65 consecutive admissions to a milieu therapy inpatient psychiatric unit. Correlations between various outcome variables were found to be suprisingly low, except when the variables were derived from the same time and the same evaluator-patient relationship. Findings were interpreted as reflecting the fact that no single criterion of ‘outcome’ is sufficient, and that a more differentiated view of the impact of treatments must be considered.

The Licensing of Journalists—A Psychiatrist's Views

American Journal of Psychiatry, 1970

The Development of Meaning in Life<sup>†</sup>

Psychiatry MMC, Nov 1, 1973

Lost in Translation: Problems of Interdisciplinary Contributions in Psychoanalysis: Reply to Commentaries

Psychoanalytic Dialogues, Feb 5, 2008

ABSTRACT Although psychoanalysis is by its nature a social process, conceptualizations of the pro... more ABSTRACT Although psychoanalysis is by its nature a social process, conceptualizations of the process have not acknowledged that the two participants function within social roles. The resistance to understanding the way that these subtle role structures affect clinical process is illustrated by the discussants&#39; responses to a paper delineating the analytic role and the patient&#39;s role. The author suggests that although psychoanalytic language is increasingly relational, resistance to a social view stems from the persistence of monadic models in analytic thinking and discourse. This tendency, in turn, stems from the vantage point of the clinical theorist, which is as observer of either self or patient. It is difficult to observe the interaction itself. The contribution of the concept of role in the analytic relationship is a beginning effort at providing some terminology for such conceptualization.

Varieties of Psychoanalytic Experience

Journal of the American Psychoanalytic Association, Oct 1, 2013

P sychoanalytic discourse often describes an ideal course of analy-sis, one that then becomes a n... more P sychoanalytic discourse often describes an ideal course of analy-sis, one that then becomes a norm for analysts and analytic discus-sion. It is well to remind ourselves that this ideal, or norm, developed first when Freud was conducting analyses in six months or a year, and believed that familiarity with unconscious process would be curative. Our idea that an analysis has a predictable course, a completeness in address-ing conflict, and a decisive termination stems from these early days. Contemporary discussions of crises and impasses in treatment, along with recognition of enactments and countertransference in general, have enriched our picture, just as Freud did in “Analysis Terminable and Interminable ” (1937). Investigations of the actual course of patients in and following analysis through follow-up has added further to creating a real understanding of where analytic experience may fit into patients’ lives (Schachter 2009; Wallerstein 1986). A recent invitation to report on my experience with psychoanalytic patients who returned for more treatment later on, and the lessons I

Patients’ Pregnancies During Treatment: The Influence of the Analyst’s Psychology

Psychoanalytic Dialogues, May 4, 2015

Psychoanalytic therapists are today far more aware of countertransference effects, intersubjectiv... more Psychoanalytic therapists are today far more aware of countertransference effects, intersubjectivity, and mutual influence. The area that has been explored least in this two-person appreciation of psychoanalytic process is the effect of the psychodynamics of the therapist in a wide sense-that is, how the therapist brings a whole psychology, with a wide array of potential transferences, to each treatment. Triggered by the unexpected announcement of a patient's expecting a baby, the author reviewed his practice and found that a large portion of his women patients ages 30-45 had become pregnant during therapy or psychoanalysis. The particulars were varied: how much the patient wanted a baby, whether the treatment was psychotherapy or psychoanalysis, the patients' personality structure. Was the analyst's psychology a common factor? The paper presents three quite different case examples and examines whether and how the author's developmental and inner experience of women, sexuality, pregnancy could have contributed to a dyadic process that, in turn, could lead to pregnancy. If such effects happen, then it is important to look beyond and behind "anonymity" and "neutrality," as well as momentary countertransferences, to the real-life effects that we have in our treatments. 1 A very rough review of my practice suggests that more than one third of the patients in the possible group got pregnant during treatment, and another third had a child subsequently (letting me know), for a total of two thirds of the total. My impression is also that this proportion increased to roughly half, as my practice continued, and I saw more women in the latter part of the child-bearing years (ages 30-45). As a baseline comparison, the average child-bearing rate for the age group 30-45 in recent years is 5.5%/year. If my treatment contacts averaged 5 years in length, the "control group" rate would be 28%. My patient population tended to be in the 35-to 45-year-old range, where the "control" rate would be 17%.

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The Holding Function of Theory

Journal of the American Psychoanalytic Association, Mar 1, 2003

As multiple theoretical models contend on the American analytic scene, the holding function of th... more As multiple theoretical models contend on the American analytic scene, the holding function of theory emerges as a unifying theme. In addition to supplying an intellectual superstructure for the working analyst, theory provides a psychological presence—a sense of conviction, affective stability, reassurance, and self-esteem— that makes effective analytic work possible from the analyst&#39;s side. Ideological passions and differences arise from the vital need for the holding function in an intense and inchoate engagement like psychoanalysis. To show how adherents of different models use theory in practice, three clinical cases are reviewed, one from Betty Joseph, one from Lewis Aron, and one from the author. The last example reconstructs the analyst&#39;s subjective experience of treatment both in the selected hours and in terms of the analyst&#39;s preconscious use of theory.

Roles in the Psychoanalytic Relationship

Psychoanalytic Dialogues, Feb 5, 2008

Who we are depends on the situation we are in. Psychoanalysis, like any other recurrent social ac... more Who we are depends on the situation we are in. Psychoanalysis, like any other recurrent social activity, is conducted under the influence of implicit social roles. Our technical emphasis on free association and other unstructured aspects of the analytic setup tends to minimize awareness of the degree to which both analyst and patient orient around role expectations. The analyst's role is the result of enculturation during training and after; the patient's role is a product of character, transference, and analytic influence. This paper explores the way in which the alternation and tension between role and nonrole aspects of the psychoanalytic relationship is at the center of therapeutic process and change. The author illustrates the way in which role and nonrole aspects of process appear in a case study, both over longer stretches of time and in particular moments. Understanding the importance of analytic roles clarifies some dilemmas and contradictions in older discussions of technique and modern relational theory.

Richard Almond

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