What psychoanalysts do in their everyday clinical practice: Empirically derived prototypes of the psychoanalytic process.

The aim of this study was to investigate the therapeutic process in long-term psychoanalytic treatments. A sample of 101 psychoanalysts rated the last session they had with a selected patient who was at least 18 years old, had no psychotic disorder, whom the therapist had seen for at least 1 year (maximum of 2 years), and who was undergoing a psychoanalysis. For the assessment, analysts used the Psychodiagnostic Chart and the Psychotherapy Process Rating Scale (PPRS). Our results suggest that the typical patient seen by psychoanalysts is a high-functioning borderline-level person, who is characterized by a level of defensive functioning that involves splitting, projective identification, idealization/devaluation, and denial; who has a mean capacity to regulate impulses and affect with flexibility; and who has a sufficient quality of object relations and a good capacity for attention, memory, learning, and intelligence. By using PPRS items, we developed a general prototype of therapists' interventions in psychoanalysis, which were characterized by interventions focused on transference and affect. The psychoanalyst's intervention style was only partially related to the patient's level of functioning. By applying a cluster analysis, we found three different prototypes of the analytic process. Even though psychoanalysts' theoretical preferences varied drastically throughout the sample, psychoanalysts' intervention styles did not seem to be related to their theoretical orientation or to patients' levels of functioning.