The double bind of personal striving: Ethnic working class women in psychotherapy

Ethnic working class women's special responsibility for transmitting their heritage ties them, often painfully, to that heritage and to their traditional gender role. Psychologically, they experience a unique set of exodus stresses. When they seek psychotherapy the process can place them in a double bind in that their personal striving deeply threatens their ethnic and class ties. These women may leave treatment prematurely unless clinicians are willing to recognize the unique configuration of symptoms that derive in large part from their subcultures of origin. By challenging their own ethnic, racial and class identities, clinicians can open up new treatment possibilities to help strengthen positive group identity, enhance self-esteem and support personal striving in their patients and in themselves.     

Interior experience within analytic process

In this paper, I consider the feeling of interiority as it evolves within the treatment relationship. A capacity to access and sustain one's interiority reflects a sense of personal solidity within which the validity of subjective process and privacy is taken for granted. When this capacity is relatively undeveloped, individuals rely on the “other”; (including the analyst) to help them contact, elaborate, or manage their affective experience. Quite paradoxically, the analyst's active investigation of dynamic or intersubjective process may obfuscate rather than clarify this core difficulty. I suggest two alternative approaches to the treatment situation that stand in some tension and yet also complement each other. One emphasizes the “active”; investigation of dynamic and dyadic process, wherein the analyst works interpretively and/or around relational issues. The other is organized around the “interior”; dimension of the treatment experience, emphasizing the patient's need to develop or manage her affective process in the relative absence of input from the analyst. Two clinical situations are described, the first illustrating the use of silence with a patient whose difficulties involved affect articulation, and the second involving a patient whose need for affect regulation made her highly dependent on the analyst for soothing.     

Value from hedonic experience and engagement

Recognizing that value involves experiencing pleasure or pain is critical to understanding the psychology of value. But hedonic experience is not enough. I propose that it is also necessary to recognize that strength of engagement can contribute to experienced value through its contribution to the experience of motivational force--an experience of the intensity of the force of attraction to or repulsion from the value target. The subjective pleasure/pain properties of a value target influence strength of engagement, but factors separate from the hedonic properties of the value target also influence engagement strength and thus contribute to the experience of attraction or repulsion. These additional sources of engagement strength include opposition to interfering forces, overcoming personal resistance, using the right or proper means of goal pursuit, and regulatory fit between the orientation and manner of goal pursuit. Implications of the contribution of engagement strength to value are discussed for judgment and decision making, persuasion, and emotional experiences.     

Engaging the consumer: The science and art of the value creation process

Regulatory engagement theory [Higgins, E. T. (2006). Value from hedonic experience and engagement. Psychological Review, 113, 439–460.] proposes that value is a motivational force of attraction to or repulsion from something, and that strength of engagement contributes to value intensity independent of hedonic and other sources of value direction. This paper reviews different sources of engagement strength, including dealing with challenges by opposing interfering forces and overcoming personal resistance, preparing for something that is likely to happen, and using “fit” or “proper” means of goal pursuit. We present evidence that each of these sources of engagement strength can intensify the value of something, and we show how stronger engagement can not only make something positive more positive but also make something negative more negative. We also discuss how these effects of stronger engagement on the value of something else are independent of actors' own personal experiences during goal pursuit. We then broaden regulatory engagement theory by describing the nature of these personal experiences from different sources of engagement strength—distinct positive experiences (e.g., feeling “pleasure” vs. feeling “right”) and distinct negative experiences (e.g., feeling “tension” vs. feeling “defiance”)—and consider the science and art of combining them with engagement strength for maximal persuasion and influence.     

What Is Unique About Supervising Couple Therapists?

Abstract

What is unique about supervising couple therapists? To answer this question I highlight three important therapeutic processes in CT and their accompanying supervisory implications. The first process, the attending to values and beliefs about the meaning of coupling to couples and therapists and its influence on CT, is facilitated by supervisors who help supervisees uncover values and beliefs about coupling. The second process, developing the therapeutic alliance which has a unique complexity in CT, is facilitated by the processing of the therapeutic alliance in supervision and discovering ways of strengthening it. The final process, attending to emotion prevalent in CT, is facilitated by supervisors who assist supervisees in becoming comfortable with the expression of emotion and work with it constructively in CT. After briefly describing each process and why it is viewed as important in CT, I suggest ways supervisors can assist supervisees' becoming more proficient in them. An abbreviated supervision illustration ends each section.     

Spirituality and Resilience in Trauma Victims

The way people process stressors is critical in determining whether or not trauma will be experienced. Some clinical and neuroimaging findings suggest that posttraumatic stress disorder patients experience difficulty in synthesizing the traumatic experience in a comprehensive narrative. Religiousness and spirituality are strongly based on a personal quest for understanding of questions about life and meaning. Building narratives based on healthy perspectives may facilitate the integration of traumatic sensorial fragments in a new cognitive synthesis, thus working to decrease post-traumatic symptoms. Given the potential effects of spiritual and religious beliefs on coping with traumatic events, the study of the role of spirituality in fostering resilience in trauma survivors may advance our understanding of human adaptation to trauma.     

Ethnocultural resistance to multicultural training: students and faculty

Teaching diversity courses in mental health programs presents a unique set of issues for the faculty. These courses generate various forms of emotional reactions in students that could take the form of anger, silence, avoidance, and passivity. The purpose of this article is to specifically focus on the experience of students of color who find themselves in these courses and the various ways they respond. This learning process is often impeded by resistance because of the personal experiences of all students, but students of color experience a unique set of resistances in each stage of this process, either because of their own experience or because of a lack of experience with racism, racial and biracial identity development, cultural and bicultural identity, or acculturation issues. Resistance in the classroom interferes with the reciprocal communication between instructors and students and interferes with learning and the development of trust between instructors and students of color. Suggestions are made to help faculty to understand these resistances and to develop appropriate responses for working through the process.     

On Video Games,Culture, and Therapy

The increasing presence of video games in modern culture requires psychoanalysts' attention not only to better understand the world their clients live in, but to also directly aid their patients in their difficulties. Many of the real world symptoms with which a person presents to the office may be reflected in the virtual worlds in which they play, grow, or take refuge. Understanding and inquiring into these worlds and their patients' experience of them allows analysts to help them recognize their potentials as transitional spaces. By viewing video games as virtual spaces and patients' own unique methods of using them, psychoanalysts see the game worlds as having a capacity for either harnessing or hindering various paths and aspects of development.     

Childhood experience of illness as a risk factor for medically unexplained symptoms

Clinical experience suggests that a high proportion of patients with medically unexplained symptoms or somatoform disorders give histories of adverse childhood experiences. Previous work has reported that both personal and family experience of illness may be associated with later unexplained symptoms in the individual. Most of this research is subject to recall bias. This review explores data from the UK Medical Research Council National Survey of Health and Development, a population-based birth cohort study. The main finding of this work is that childhood experience of illness in parents is an independent risk factor for later unexplained symptoms. Personal experience of illness has a more complicated relationship. There is no evidence that severe physical disease in childhood is associated with later unexplained symptoms, but common childhood unexplained symptoms are predictors of symptoms in adulthood.     

Leading and Learning in the Psychotherapy Supervision Seminar: Some Thoughts on the Beginnings of Supervisor Development

Supervisor development theories typically give focus to growth of the supervisor via practice. But in what ways does the foundational psychotherapy supervision seminar stimulate and first set in motion the supervisor development process? That question is subsequently considered. Based on personal experience in training supervisors via seminars and ongoing reflection about that learning process, five seminar-induced themes that potentially reflect beginning tensions of supervisor development are proposed, and their seeming evolution over the course of the supervision seminar is considered. Points that are raised include the following: (a) the supervision seminar is the first, primary stimulus of supervisor development and sets the stage for later growth via practice; (b) early themes that are identified in supervisor development theories also make appearance in the supervision seminar experience; (c) to best understand the full arc of supervisor development, the seminar as both developmental initiator and intervention preparedness foundation merits more careful scrutiny; and (d) through more completely understanding the seminar as instigator of supervisor development, supervisor educators might be better positioned to develop seminars that most constructively affect the very beginnings of the supervisor development process.     

Suicide Survivors Groups: Results of a Survey

Little is known about the nature of suicide survivors groups. Survey responses by 149 U.S. and Canadian groups are characterized as follows: (1) they are most often sponsored by mental health or social service agencies or have no sponsor; (2) groups have operated an average of 8 to 9 years; (3) fewer than 10 people typically attend monthly or twice monthly meetings; (4) group experience predominantly involves sharing personal experiences; (5) leadership generally involves either trained facilitators, mental health professionals, or both; (6) most groups are open ended; (7) all social/ethnic, income, and adult age groups are served, but few children and teenagers attend; and (8) referrals come predominantly by word-of-mouth or medical and religious sources. Further research is required regarding survivor group attributes and processes.     

Delivering a Brief Insomnia Intervention to Depressed VA Primary Care Patients

Primary care is often the place where patients with depression and comorbid insomnia seek treatment. The experience of comorbid insomnia with depression can have a significant impact on the efficacy of other depression treatments and exacerbate depressive symptoms. Using the empirically based Cognitive-Behavioral Treatment for Insomnia (CBT-I) to target the comorbid experience of insomnia in patients with depression can help improve sleep and potentially modify some depressive symptoms. Additional rationale for such an approach includes that a positive therapeutic experience may enhance engagement with or adherence to other psychotherapeutic interventions. Although other brief CBT-I interventions have been developed for primary care, none of them were actually delivered to depressed patients or implemented in primary care. Therefore, this paper describes a brief CBT-I intervention that was designed to be delivered in 4 sessions lasting from 15 to 45 minutes each within a primary care setting to depressed veterans. A case study is provided along with sample materials used in this intervention. In addition, we share implementation tips based on our experiences and feedback from eight veterans who have completed the intervention to date. Overall, the intervention was generally well received and suggests that the intervention may be feasibly delivered in a primary care setting.     

Self‐help strategies to reduce emotional distress: What do people do and why? A qualitative study

Background: Some people with psychological distress do not seek professional help but opt instead for self‐help strategies to reduce their symptoms. Little is known about these strategies. Aim: To investigate which self‐help approaches might be employed to reduce the effects of emotional distress, and the reasons for these choices. Method: Semi‐structured interviews with 11 clerical employees generated data analysed using grounded theory. Findings: Managing distress is a complex and multi‐dimensional process unique to each individual. The use of self‐help options is determined by the interconnection between the person's core beliefs, their social networks, and ideas about coping. Such beliefs may hinder help‐seeking. People tend to engage in activities that are familiar to them already, rather than attempt new ones. The purpose of self‐help strategies is to distract the person from their problems and to contribute to physical and mental well‐being. Implications for practice are discussed.     

Biases in perception and reporting following a perceived toxic exposure.

Reactions to chemical exposures often include fears of future illness, cancerphobia, reports of multiple chemical sensitivity, and other ill-defined complaints. Frequently, these complaints occur at levels of exposure not known to cause physiological harm. Although frequently dismissed as hysterical or hypochondriacal reactions, these complaints, along with other indefinite symptoms, may be better understood in terms of biases in perception and reporting. In this paper, we outline various sources of perceptual and response biases including prior beliefs, the media, influential others, reconstructed personal histories, self-perceptions, and the forensic environment. It is recommended that a thorough understanding of symptom-reporting and psychological distress following a chemical exposure involves consideration of these issues.     

Blood pressure estimation and beliefs among normotensives and hypertensives

Although health professionals believe that blood pressure (BP) is asymptomatic, most diagnosed hypertensives are confident that they experience specific symptoms and emotions that help them detect their BP levels. Several months after screening interviews that elicited subjects' BP beliefs, 14 medicated hypertensives, 15 nonmedicated mild hypertensives (diastolic BP greater than or equal to 90 mm Hg), 39 normotensives, and 13 hypotensives (systolic BP less than or equal to 100 mm Hg) participated in a 1- to 2-hr laboratory experiment that assessed each subject's symptoms, moods, and estimates of systolic BP (SBP) relative to actual SBP levels. Several self-reports and autonomic measures were collected 45 times during and after each of 22 tasks. Subjects never received SBP feedback during the experiment. Within-subject correlations indicated that all subject groups could estimate SBP at levels greater than chance (mean estimated SBP-actual SBP correlation = .25). Further, 68% of the subjects evidenced at least one significant symptom-SBP correlation. Although medicated hypertensives believed they could estimate their BP more accurately than other groups by using their symptoms and emotions, they were actually no more accurate than the other groups. They also evidenced far fewer empirically derived symptom-SBP and emotion-SBP correlations than any other group. Overall, BP beliefs were largely inaccurate. If these erroneous beliefs can be eliminated, subjects may be able to estimate BP fluctuations more accurately.     

Emotional crises of those facing the draft

Summary While emotional responses will vary among young men, for many of them the draft constitutes some kind of crisis. Although it may be very difficult, most young men will be able to cope with the complicating factors of the draft and will take it in stride along with other disturbing events in the normal course of life. A young man may be able to cope with his feelings resulting from the draft in ways akin to his coping with similar situations. However, if the threat is too intense, and if there is not sufficient time to mobilize his usual coping mechanisms, the young man will be thrown into a state of crisis. In view of the nature of the developmental process, a young man between the ages of 18 and 22 has rarely developed an adequate sense of identity. Hence, he may be especially vulnerable to the emotional threat of the draft because of the very nature of the process of personality development.In such a crisis he will need someone to help him cope with the new situation. There are some guidelines which should help the counselee to mobilize his own emotional resources to cope constructively with the crisis. A pastoral counselor may help such a person to honestly face his fears and conflicts, and to face them gradually. Increasing his knowledge about the available possibilities in a particular situation will help him to increase his power to cope with the crisis. Being enabled to face his negative feelings with a sense of responsibility, he will be enabled to accept himself in terms of the situation in which he finds himself. Discovering significant other persons as supportive may give him the necessary time and support to enable him to develop a means of coping with the situation which he faces.     

Why we need to write openly about our clinical cases

To learn more about what is and is not effective in the psychoanalytic situation, analysts need to develop a library of detailed analytic case material. Open case writing, by not overconstraining readers, allows them enough access to the analytic couple's affective experience to persuade them of the authenticity and validity of the analyst-author's views. They are then free to rethink the material creatively on their own, to use it as they need to, and to learn from others, in order to enhance their analytic skills. Closed case writing hinders readers' creative freedom to understand and interpret, and hence to learn. To encourage analyst-authors to share their affective experiences in the analytic situation more openly, analysts need to establish a constructively collaborative attitude toward playing with clinical material. They need to take for granted that new readers, even authors themselves newly rereading their work, will discover something new. A dialectical process can then be established in which clinical authors and readers contribute to each other in an ongoing imaginative interchange.     

Connecting the dots between fantasy and reality: The social psychology of our engagement with fictional narrative and its functional value

This essay provides an overview of research and theory on narrative and its important, functional role in human experience, including the ways people use media to interrogate their own beliefs and feelings, and derive social meaning. Thought‐provoking film, television, and books can help us make meaning of our lives and grow in ways that are important for our successful social functioning. Research reviewed here demonstrates that exposure to fiction can increase empathy and social skills and reduce prejudice. Our connection to characters and stories has been studied in various ways as extensions of the self into another, while at the same time bringing the other into the self. Bringing together disparate perspectives, we propose that connecting to story worlds involves a process of “dual empathy”—simultaneously engaging in intense personal processing while also “feeling through” characters, both of which produce benefits. Because the value of entertainment narratives may not always be well understood, we explain how those experiences can be personal, social, and can serve important adaptive functions.     

On the advantages of symptoms: Exploring the client''s construing

From the perspective of George A. Kelly's Personal construct theory the article outlines points of view concerning "advantages of symptoms" A procedure for eliciting possible advantages is presented ("The ABC-model") and compared with a more conventional psychoanalytic approach as exemplified in a previously published case story. From a Kellyan view people are "personal scientists", seeking—by testing their hypotheses—to predict and control events. Personal scientists may, however, get stuck with their hypotheses, possibly resulting in "symptoms", and may need a fellow scientist (e.g. therapist) to encourage them to see and try out alternative procedures. The authors underscore that the therapist should beware of imposing own interpretations on the clients, but rather invite them to participate in a joint effort to elaborate and understand (analyze). This is a joint process, but principally based on the client's own personal meaning structure (construction). Since there is more than one alternative or one answer to the client's situation, the therapeutic process will probably call for frequent reconstructions.     

A Warrior's Stance: Commentary on Paper by Terry Marks-Tarlow

This commentary highlights specific aspects of a psychoanalytic complexity perspective in considering and discussing Terry Marks-Tarlow's article, “Merging and Emerging: A Nonlinear Portrait of Intersubjectivity During Psychotherapy.” The advantages of a complexity theory sensibility reside in the areas of (a) providing a robust theoretical framework for understanding the sources and phenomenology of complex emotional life and (b) understanding the clinical implications of thinking through a complexity theory lens. The latter involves examining the attitudes that emanate from such a revolutionary perspective and their impact on the therapeutic relationship and on therapeutic action and change. Special emphasis is placed on the distinction between two vital dimensions of psychoanalytic discourse: the phenomenological and the explanatory. This distinction is used as a lens through which the author considers the essential themes of understanding the complexity of the multiple sources of personal lived experience and their concomitant meanings, personal situtatedness (or “thrownness”), emotional responsibility, and personal freedom.