A study of patients who go to a psychology clinic seeking treatment

In order to characterize a typical clinical context, as opposed to an academic or research context, this article will analyze the sociodemographic and clinical characteristics of patients who turn to a psychology clinic in need of professional help. This study was conducted using an initial sample of 1,305 patients at the Universidad Complutense de Madrid (UCM) Clínica Universitaria de Psicología. Of the sociodemographic characteristics studied, it is noteworthy that the majority of patients were women (65%) and relatively young (the average age is 29.7 years-old). The disorders for which psychological help was most often needed were anxiety and mood disorders and relationship problems, which together made up 50% of cases. In 17.70% of cases, patients had at least one comorbid disorder in addition to the one that brought them to the clinic. The generalizability and implications of the results are discussed.     

Group rounds in a day-night therapeutic clinic for psychiatric patients

The role of the group in the day-time clinic is presented, based on a more 10 years experience with this species of round, with the respects to a biopsychosocial concept of illness, to some reactions of patients, to rehabilitation, to compliance and to mediation of information; on the importance pour the psychotherapy os psychotic patients is oriented.     

Job satisfaction related to tested congruence and differentiation

Tested personality-environment congruence and differentiation, singly and in combination, as measured by the Vocational Preference Inventory (J. L. Holland, Palo Alto, California, Consulting Psychologists Press, 1977b), were predictive of reported job satisfaction for teachers employed in five subject matter areas. Time-related variables and sex were not significantly related to the job satisfaction measure used in the study.     

Barriers to condom use in primary and nonprimary relationships among Hispanic STD clinic patients

Some programs designed to reduce the spread of AIDS and other STDs encourage consistent condom use among sexually active, at-risk individuals. A random sample of 283 Hispanic men and women seeking services at a public STD clinic in New York City were surveyed in an examination of differences in their attitudinal patterns, normative beliefs, and practices related to condom use with primary and nonprimary sex partners. 60% of the participants were male. The group was of mean age 30.9 years, with 46% having graduated from high school. 44.5% were born in the US, although 73.8% had lived in mainland US for the previous ten years or longer. 52.7% were single, 19.8% married, and the remaining 27.5% were either divorced, separated, or widowed. Only 3.2% of men and women reported having same-sex relationships, although the authors suggest that the respondents may have underreported the extent of their bisexual and homosexual behavior. 58.3% of men and 53.3% of women reported having had a prior STD, 82.2% of men and 74.8% of women had experience using a condom, and 31.3% of men and 13.3% of women reported having nonprimary partners. Both the men and women report that they are more likely to use condoms in nonprimary than primary relationships and that they perceive fewer barriers to doing so. Issues related to trust and social acceptability are more salient in primary relationships. Interventions to promote condom use among Hispanics must acknowledge the different psychosocial influences upon condom use in different relationships and target the specific attitudinal and behavioral changes desired.     

Group therapy with Spanish-speaking clinic patients to enhance ego functioning

On the assumption that Spanish-speaking, culturally deprived female patients can profit from group psychotherapy, the author shares her experiences and findings with this population. After examining the differences between the Spanish-speaking psychiatric clinic patients in a large urban medical center and the traditional, verbal, motivated patient, the author suggests modification of treatment techniques in group therapy. She proposes various aproaches that take into account the disparate cultural orientation and value system of this group in order to meet their needs and provide a more effective treatment outcome.     

Damage to psychoanalysis in Anglo-Saxon emigration and its return to Europe

Parin outlines the development of psychoanalysis since the 1930s; the history of its achievements is at the same time the history of its decline.     

Psychoticism and response to treatment in neurotic patients

A study is reported of neurotic patients at St. Bartholomew's Hospital, London, who were given the Eysenck Personality Questionnaire and who were rated by their doctors for prognosis and final assessment after treatment. The results indicated that those patients who had elevated psychoticism scores took longer to improve and that doctors rated them harder to treat at final assessment. It is suggested that early knowledge of patients with a poor prognosis, in the form of their Psychoticism score, might prove helpful to psychiatrists and psychologists, both for diagnosis and (primarily) for choice of appropriate treatment.     

Converted patients and clinic patients as control cases: a comparison with implications for psychoanalytic training

All twenty-eight respondents to a recent poll of the thirty institutes affiliated with the American Psychoanalytic Association reported that they now accept cases converted from psychotherapy to psychoanalysis as control cases. This study was designed to compare converted cases to clinic cases systematically with respect to patient characteristics, treatment, and the educational experience of the treating candidate. The study followed twenty-four candidates entering analytic training between 1992 and 1995, who treated thirty-four clinic cases and forty-three converted cases between February 1993 and July 2000. Clinic and converted patients were comparable with regard to demographics, prior treatment histories, structural diagnoses, and Axis I diagnoses. In addition, the two groups of cases were indistinguishable with respect to the rate at which candidates received credit toward graduation requirements. Candidates treating converted cases earned approximately dollars 7,600 per patient per year, compared to candidates treating clinic cases, who earned nothing. Eighty-four percent of converted patients diagnosed with a mood disorder by the treating candidate were on medication, in contrast to only 20% of clinic patients with the same diagnosis. Similar differences were seen in the case of anxiety disorders. Given the prevalence of affective and anxiety disorders in control cases and the availability of a variety of medications and psychotherapies with documented efficacy in treating these disorders, candidates should be trained to discuss treatment options with patients who present with Axis I disorders.     

Psychiatric diagnoses of patients visiting a sleep disorder clinic due to dyssomnias

This study analyzed the demographic characteristics and psychiatric diagnoses of 90 consecutive patients who visited a sleep disorder clinic in Taiwan with complaints of insomnia (difficulty initiating or maintaining sleep, or nonrestorative sleep) or hypersomnia (excessive sleepiness as evidenced by either prolonged sleep episodes or daytime sleep episodes that occur almost daily). All subjects were interviewed using a sleep disturbance questionnaire and the structured Mini-International Neuropsychiatric Interview supplemented by the DSM-IV criteria for psychiatric diagnoses. Among 90 patients, 79 were classified as having insomnia and 11 had hypersomnia. 53 patients also had psychiatric diagnoses other than sleep disorders. Patients with insomnia had a significantly higher rate of comorbidities with other psychiatric diagnoses (65.8%) than did subjects with hypersomnia (9.1%). These results emphasize the importance of psychiatric evaluation of patients with complaints of sleep disturbance.     

Inhibition of return for objects and locations in static displays

When orienting attention, inhibition mechanisms prevent the return of attention to previously examined stimuli. This inhibition of the return of attention (IOR) has been shown to be associated additively with location- and object-based representations. That is, when static objects are attended, IOR is associated with both the object and the location cued, and hence IOR is larger than when only spatial location is attended. Recently McAuliffe, Pratt, and O'Donnell (2001) failed to observe such additive effects except under a narrow set of conditions (at short cue-target intervals and using mixed blocks in which object- and pure location-based effects were probed in the same display). The present study shows that additive IOR effects are observed under conditions that violate all of these boundary conditions. The results also show that IOR is modulated by internal structural properties of objects. These findings are cosistent with the hypothesis that IOR operates over functionally independent object- and location-based frames of reference.     

The ego according to Klein: return to Freud and beyond

This paper explores fundamental dimensions of Melanie Klein's concept of the ego through a detailed study of the writings of Klein and her early colleagues (Paula Heimann, Susan Isaacs and Joan Riviere). The study examines three central issues: (a) the basic theoretical framework for Klein's conceptualization of the ego, and specifically how her conceptualization builds on Freud's structural and dual instinct models; (b) the processes involved in the development of the ego and its capacities (including the development from id to ego and from ego to superego); and (c) the view of the ego as an object of phantasy. Through this examination, the study demonstrates that Klein's conceptualization of the ego is firmly grounded both in Freud's formulations about the ego and in his theoretical and metapsychological approach to thinking about the ego. This counters the prevalent view that Klein was only focused on clinical understandings, unconcerned with theory and fuzzy in her abstract thinking. More specifically, it counters the view that Klein did not really have a concept of the ego in any well-structured sense of the term (Britton, 2003; Hinshelwood, 1994; Segal, 2001). The study considers the sources of these misconceived views. Finally, it argues that discarding such views allows us to appreciate better the richness of Klein's thinking, her theoretical affinities to Freud, and the role of theory in the development and justification of psychoanalysis.     

The morality of evolution and a return to subjectivity

Today societies display, almost uniformly, an aggressive demeanor that can hardly be covered by diplomacy; they are always prepared for war. The prophecy is repeatedly fulfilled and today we are engaged in protracted wars while fearing universal destruction. This basic attitude irremediably corrupts our consciousness and blemishes our self. The biological underpinnings of how we got to this point, psychologically, and the historical sublimations involved are explored here. The result, today, is that we live using a minimum of our human capacity at the huge cost in crucial energetic waste, while nature has started to protest. The self-feeding destructive mechanism is inordinate objectification, at the expense of our unique subjective power. Evolutionarily designed for balanced self-regulation—the sublimation of a dual instinctual disposition backed up by a dimorphic body and brain—nature warns us we have detoured from the moral blueprint and, were we to continue it will be at our own risk. We need to review our moral theories and return to our critical pre-patriarchal subjectivity, which was resourceful, dually-fed, balanced, and discriminating. That subjectivity is now largely replaced by pre-emptive, ideological cognitive modules and stereotypes that block intelligent dialogue and appear to be already modeled on a false Utopia of artificial intelligences.

     

Inhibition of return for expected and unexpected targets

Inhibition of return (IOR) refers to slower reaction times (RTs) to targets that occur in the same, rather than in a different, location as a preceding onset cue. The present study examined IOR for expected (likely) and unexpected (unlikely) targets under conditions in which stimulus-response (S-R) expectancies were generated on a trial-by-trial basis or maintained across a block of trials. Three boxes were aligned along the vertical midline. In Experiments 1 and 2, the appearance of a cue in the upper or lower box was a signal to generate an expectancy about the most likely color of an impending discrimination target. In Experiment 3, one target color was more likely than another across a block of trials. In all cases, cue location did not predict target location. When S-R expectancies were generated on a trial-by-trial basis, IOR occurred for Unlikely targets but not for Likely targets; this was true across a range of cue-target stimulus onset asynchronies. In contrast, when S-R expectancies were maintained over a block of trials, IOR was larger for Likely than for Unlikely targets. These findings reveal a critical interaction of S-R expectancies with IOR. This interaction not only demonstrates the modulation of IOR by cognitive expectancies, but in doing so also provides evidence that is consistent with the view that IOR reflects a conservative response bias.