How can we, analysts, evaluate whether analysis is generating transformations in our patients? Time for Change: Tracking Transformations in Psychoanalyses. The Three-Level Model focuses on the question of how to observe changes in psychoanalysis.

The IPA Project Committee on Clinical Observation and Testing offers a tool, a heuristic, or a guide for refining, conceptualizing, and systematizing clinical observations about patient transformations: The Three-Level Model for Observing Patient Transformations (3-LM). It enhances clinical observations, making them more accurate and more useful for theory testing and theory building through a systematic analysis of clinical material.

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.

This book presents the model and the outcome of having worked with it. Approximately 700 analysts from different parts of the world have participated in these clinical observation groups. It has been applied to adult patients, adolescents and children, as well as in analytic training. 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 exercising our abilities and clinical sharpness as well as acquiring precision when communicating our work. It provides the analyst with one way to monitor his/her work in a more subtle and meticulous way, offering a second look at the material for the benefit of both analyst and patient.

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