Probing the Boundaries of the Relational Paradigm: Commentary on Paper by Jeremy Safran

In discussing the complexities and dialectical tensions inherent in the relational point of view, this commentary seeks to alert the reader to the simplifying dichotomies that can lead theory and clinical practice to be hostage to ideology. In exploring those dichotomies and their problematic implications for our work, emphasis is placed particularly on the nature of what constitutes evidence for our formulations and conclusions; the different blind spots that different epistemological positions are designed to alert us to or, at least partially, to overcome; the ways in which our efforts to transcend those blind spots often themselves create new blind spots; the relation between insight and new relational experience; the ambiguities associated with the (highly important but at times conceptually perilous) distinction between the one-person and the two-person models; and the tensions between the need to hear patients in a fashion that is affirming and accepting and the equally important need to hear their fervent wish to change what they also want to have accepted. Many of these tensions and complexities are examined in the context of a critique of Bion's claim that analysts should be “without memory or desire.”     

'In sickness and in health': the development of alternative discourses in work with families with parental illness

This paper outlines the development of clinical understanding and a clinical model for working with families with parental physical illness. The lens of gender to explore clinical process reveals blind spots and can uncover alternative perspectives on parental illness. The authors look at the very different needs of children and parents for coherent explanations. The impact of this way of working on therapists and the importance of reflecting teams, as part of the process of working collaboratively with families, are addressed.     

The Leader’s Illumination of Group Phenomena Hidden in Plain Sight: Why Is No One Talking About the Elephant in the Room?

This article discusses an important leadership function: calling attention to phenomena in group therapy that are NOT observed or observed but not commented on by group members. The article includes group scenarios that often generate member omission, ways to mitigate shame that can result from uncovering members’ blind spots, and misuses of this leadership function. Numerous clinical examples are provided. Concepts borrowed from attachment theory and interpersonal neurobiology help explain how the group’s internalization of this leader function may help the group become a more potent therapeutic environment. The limited contribution of neurological findings to clinical decision-making is discussed.     

Flexibility of the Frame Revisited: Commentary on Tony Bass's “When the Frame Doesn't Fit the Picture”

The author argues that the word frame is misleading because it conjures up the image of a picture frame constructed of unyielding material like wood or metal. Psychoanalytic work demands a flexible frame in which patient and analyst together jointly construct a comfortable envelope within which to interact. Bass candidly acknowledges countertransference blind spots and illustrates the complexities of frame management in the course of analytic work. The transference–countertransference dimensions of psychoanalytic relationship cannot be seen from a position outside the dyad. Hence, periodic consultation with a senior and trusted colleague can be extremely useful in frame considerations. What we think may be in the best interests of the patient can be a rationalization designed to serve our own interests, consultation may be the best strategy for us to allow our blind spots to come into our visual field.     

Dysfunctional beliefs discriminate personality disorders

This study examines whether specific sets of dysfunctional beliefs are differentially associated with five personality disorders (PDs) as predicted by cognitive theory. Seven hundred fifty-six psychiatric outpatients completed the Personality Belief Questionnaire (PBQ) at intake and were assessed for PDs using a standardized clinical interview conducted by assessors who were blind to patients' PBQ responses. Findings showed that patients with avoidant, dependent, obsessive-compulsive, narcissistic, and paranoid PDs preferentially endorsed PBQ beliefs theoretically linked to their specific disorders. The study results support the cognitive theory of personality disorders. Suggestions are made regarding the clinical utility of the PBQ with personality-disordered patients and future research on the PBQ.     

Cognitive sophistication does not attenuate the bias blind spot

The so-called bias blind spot arises when people report that thinking biases are more prevalent in others than in themselves. Bias turns out to be relatively easy to recognize in the behaviors of others, but often difficult to detect in one's own judgments. Most previous research on the bias blind spot has focused on bias in the social domain. In 2 studies, we found replicable bias blind spots with respect to many of the classic cognitive biases studied in the heuristics and biases literature (e.g., Tversky & Kahneman, 1974). Further, we found that none of these bias blind spots were attenuated by measures of cognitive sophistication such as cognitive ability or thinking dispositions related to bias. If anything, a larger bias blind spot was associated with higher cognitive ability. Additional analyses indicated that being free of the bias blind spot does not help a person avoid the actual classic cognitive biases. We discuss these findings in terms of a generic dual-process theory of cognition. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Assessing personality disorders using a systematic clinical interview: evaluation of an alternative to structured interviews

The aim of this study was to assess interrater reliability and provide initial data bearing on the validity of a method of assessing personality disorders (PDs) that does not presume that patients can accurately self-report personality pathology. In a sample of 24 outpatients, two clinician-judges independently applied the Shedler-Westen Assessment Procedure-200 (SWAP-200; Westen & Shedler, 1999a, 2000), a 200-item Q-sort procedure for assessing personality pathology, to data from the Clinical Diagnostic Interview (Westen, 2002), a systematic clinical interview that mirrors and standardizes methods used by experienced clinicians to diagnose personality. In 16 of the 24 cases, the treating clinician also independently described the patient using the SWAP-200 Q-sort, based on longitudinal knowledge of the patient over the course of treatment, blind to the interview data. Interrater reliability was uniformly high, with median correlations between interviewers at r > .80. Interviewer-treating clinician correlations were also high, with median convergent validity coefficients at r > .80. Diagnostic overlap (discriminant validity) was moderate for dimensional DSM-IV diagnoses, reflecting extensive comorbidity among disorders, but minimal for empirically derived diagnoses identified in prior research. Treating clinicians' dimensional PD diagnoses using this method also strongly predicted interviewer-rated measures of adaptive functioning. The findings provide preliminary support for the reliability and validity of an alternative to structured interviews for diagnosing personality pathology, and suggest that the way to improve validity of personality diagnosis may not be to minimize clinical inference but to quantify it using psychometric instruments.     

“A Lingering Whiff of Descartes in the Air”: From Theoretical Ideas to the Messiness of Clinical Participation: Commentary on Paper by the Boston Change Process Study Group

From a perspective in recognition of my unconscious attachment to their theoretical conceptualizations as well as intrinsic blind spots to both their and my conceptualizing, I offer a consideration of the clinical assistance and difficulty created by the Boston Change Process Study Group's formulation of the reflective, the implicit and the disjunction between the two as an “intention unfolding process.” I first consider how their conceptualizations can either clarify or obscure organizing experience for the analyst trying to make sense of what is going on between her and her analysand. Then I consider how these ideas might guide or mislead the analyst's active participation in the micromoment process flow of clinical interaction. The impact of dissociation is recognized as constitutive of a messiness and uncertainty that accompanies, and often can undermine, the adoption of any theoretical “idea,” including these, for clinical organizing and intervening activity.     

Countertransference and the female triangular situation3

This paper represents an attempt toward reconciling contemporary changes in psychoanalytic understandings of female development, particularly in respect to separation issues, with their clinical applications to female patients. Psychoanalytic thinking typically has categorized separation conflicts as pre‐oedipal, but the authors suggest that these are an integral part of the triangular situation of the girl. The authors argue that an allegiance to erroneous theory and/or individual blind spots have led to the infantilization, pre‐oedipalization or cultural stereotyping of females, which constrains the effectiveness of their analyses. The authors present a selected review of the literature on gender‐based countertransference biases in both male and female analysts, with reference to female ‘oedipal’ material. Analytic case material of two women is presented which demonstrates how theoretical misperceptions and countertransferences to triangular separation conflicts can produce an impediment to progression in analysis.     

Begin the Beguine: Relational Theory and the Pluralistic Third

Different clinical theories valorize particular aspects of clinical understanding. The author describes the need for analysts to hold themselves accountable through thinking about the blind spots that result from prizing these particular lenses. He explores the concept of the pluralistic third, which aims to think about clinical work with the use of theory external to our own. In examining the very beginning phase of an unusual analysis, he tries to examine particular aspects of his work including survival as an object for the patient, analytic play, and enactment. Even among relational analysts there are profound differences in how we interpret and make use of countertransference, particularly our disjunctive subjectivity from that of our patient. These differences point to the value of asking particular questions regarding how to hold ourselves accountable within the analytic process.     

Do adolescents who use stimulants have a different personality?

Stimulant consumption is especially important in our context because its use has greatly increased in recent years. The aim of the present study is to analyze the differences between stimulant users and nonusers (under 18 years old) in personality characteristics assessed with the MACI. The sample comprises 398 youths between 14 and 17 years old who were selected through random sampling in their homes or in recreational night spots. Results show important differences in personality features between stimulant users and nonusers. Stimulant users are characterized by having unruly, forceful, oppositional and borderline-tendency personality prototypes.     

Abh?ngigkeitserkrankungen und Pers?nlichkeitsst?rungen

Substance use disorders and personality disorders often co-occur in clinical treatment. In this review the association between substance use disorders and personality disorders is described and discussed. Clinical and neurobiological data as well as psychodynamic concepts are included to focus on the therapeutic implications for patients with these comorbidities. The consumption of substances often begins as a kind of self-medication. Patients suffering from severe personality disorders need these substance effects to avoid severe destructive affects and to regulate their self-esteem. Patients with chronic substance dependence often show changes in brain structure. In the dependency stage of addiction clinical symptoms can make the diagnosis of a specific personality disorder very difficult. The treatments can be classified by the severity of substance use disorders and personality disorders. Substance misuse can be treated with psychotherapy. In substance dependence, specific forms of addiction therapy should be included. In patients with the frequent comorbidity of substance use disorders and severe personality disorders, disorder-specific treatment can be used with good results.     

The adaptive significance of the location of the optic disk

Although the 'filling in' of each blind spot by healthy retina in the other eye has long been described as an adaptive property of the spatial arrangement of the optic disks, an explanation of why the disks are specifically located where they are has yet to be proposed. A rationale for their horizontal position in humans is offered that is based on the projections of the blind spots in visual space in relation to fixation distance and to the protrusion of the bony facial occlusion of the nose bridge.     

Commentary on reconceptualizing personality disorder categories using trait dimensions

The ability of trait models of personality to account for categories of personality disorder is examined with particular reference to the five-factor approach. Although dimensional models are consistent with the evidence, and trait models can accommodate personality disorder categories, it is not clear that such models are directly applicable to clinical use. The lower-order or facet structure, in particular, needs further development to capture clinical concepts. It is also suggested that trait models do not account for all aspects of personality disorder-attention also needs to be paid to the organizing and integrative functions of personality.     

Measuring Mental Toughness in Sport: A Psychometric Examination of the Psychological Performance Inventory–A and Its Predecessor

The Rorschach Inkblot Method (RIM) is a performance-based personality assessment instrument used in both clinical and research settings worldwide. This investigation examines response-level, interrater reliability of U.S. graduate students enrolled in the same doctoral program and divided into two unique participant groups: 20 of those with previous Comprehensive System (CS) training background who are now trained in Rorschach Performance Assessment System (R-PAS; initial coders N = 11, blind coders N = 9), and 19 of those trained solely with R-PAS (initial coders N = 10, blind coders N = 9). Trainees’ coding was analyzed based on a sample of 50 protocols (half per group) representing a total of 1,189 responses. Blind coding was used among trainees and coding between the two investigated training groups was analyzed for each variable at the response level and expressed as percent agreement, Gwet's AC, and kappa values. Rates of agreement between the trainees were similar across both groups, and most of the concordance rates can be characterized as excellent. Overall, these results suggest that trainees may learn how to code R-PAS variables with similar reliability levels whether or not they had prior CS knowledge.     

Countertransference and reality

The psychoanalytic situation provides many opportunities for people to observe their analysts closely. These observations are inevitably woven into the fabric of patients’ transference experience. Because the observations can be uncomfortable for the analyst, there is a constant temptation to ignore or deny the plausibility of patients’ perceptions. They can be, and often are, quickly reinterpreted as derivatives of sexual or aggressive urges. Psychoanalytic drive theory, with its emphasis on impulse rather than observation as the force behind transference experience, can encourage counter‐transferential disclaimers and lead to blind spots. Some technical suggestions are offered to avoid this tendency and are based on a relational understanding of the nature of transference.     

A family study of outpatients with borderline personality disorder and no history of mood disorder

While several studies have examined psychiatric disorders in the relatives of individuals with borderline personality disorder, many of these studies have not employed a family study methodology and suffer from other methodological shortcomings. Thus, the conclusions from family data addressing the validity of borderline personality disorder, its relation to other conditions, and its distinction from mood disorders, continue to be debated. The present investigation employed a family study design with direct interviews with relatives, structured diagnostic interviews with both probands and relatives, and blind assessment of relatives. Rates of psychiatric disorders were examined in 563 relatives of outpatients with mood disorders (n = 119), 54 relatives of outpatients with borderline personality disorder and no history of mood disorder (n = 11), and 229 relatives of never psychiatrically ill controls (n = 45). Results indicate increased rates of mood disorders and personality disorders in the relatives of borderline probands compared with never psychiatrically ill controls. Familial aggregation of psychiatric disorders was generally similar for borderline personality and the mood disorder comparison group. The results suggest there may be common etiological factors between borderline personality disorder and mood disorders.     

Addressing two blind spots of commonly used experimental designs: The Highly‐Repeated Within‐Person approach

Two well documented but still neglected blind spots of often‐used study designs limit a researcher's ability to make inferences about psychological phenomenon. First, typical designs focus on effects of conditions at the group level and are not able to assess the extent to which effects characterize each participant in the study. This blind spot can lead to erroneous (or incomplete) conclusions about the effects of manipulations both for a given participant and at the group level. Second, commonly used research designs often use a limited sample of stimuli, constraining conclusions to the particular stimuli. This blind spot can lead to non‐replication when different stimuli are used. We propose that the Highly‐Repeated Within‐Person (HRWP) approach helps mitigate these limitations. Using a study on the effects of anti‐smoking messages, we illustrate how the HRWP approach helps alert researchers when the conclusions at the group level may not apply to all (or any) participant, quantifies the heterogeneity of effects of manipulations across people, and increases confidence regarding the generalizability of the effects. We discuss how the HRWP approach may help conceptualize issues of replicability in a new light.     

缺陷儿童人格诊断量表的修订

缺陷儿童人格诊断量表是日本特殊教育领域的一种专门用于测量缺陷儿童人格的著名量表。作者用三年时间对其进行了修订,建立了包括弱智、聋哑、盲等缺陷儿童的中国常模。该量表具有较高的信度与效度,是一个较好的心理测量工具。