Gazing into Existence: A Discussion of “A Patient Who Does Not Look: A Collaborative Treatment with Video Feedback”

In this innovative and collaborative paper (Sandberg & Beebe, this issue) self and interactive regulation and the role of gaze are astutely demonstrated. The clinical material focuses on a patient who is unable to make eye contact due to early attachment trauma. This patient’s perceptual world, identified with maternal hatred, is disturbed by a delusional self-loathing. Initial analytic work, which provided an insightful and benign presence, was enhanced by video viewing of the second analyst’s facial reactions. The video introduced, on the non-verbal, implicit level, a process of moment-to-moment contingent matching and being matched. This visually experienced affective resonance proved to be transformative for the patient.     

Finding Sandra: Dr. Beebe’s Second as Analytic Third: A Discussion of “A Patient Who Does Not Look: A Collaborative Treatment with Video Feedback”

Larry Sandberg and Beatrice Beebe (this issue) offer a moving account of their work with Sandra, a gaze-averse woman with a painful and traumatic childhood history. Drs. Sandberg and Beebe describe their work together in the context of an innovative conjoint treatment model including psychotherapy, video feedback consultation, and dance movement therapy. Dr. Beebe’s Interventions at the sensorial, bodily, and affective register facilitated Sandra’s movements from being in the grips of a terrifying object world, to an experience of companioning with Dr. Beebe, giving her a greater sense of holding and emotional security. Further, “Dr. Beebe’s Second,” an image from Dr. Beebe’s own reverie offered Sandra an “emotional third”; a new found internal experience of herself-with-others that helped her lift her gaze to the future.     

The Patient Who Was Not There

Many clinicians attest to the challenges of working with the adolescent patient. The phase itself prescribes resistances to forming a transference relationship, not to mention that passions and conflicts can be stirred in the therapist that had long been dormant. Various theoretical positions have dictated different paths, from systems theory to Freud’s treatment of Little Hans. This article describes a case that took an unorthodox route based on an adolescent’s refusal and Lacan’s formulation of the function of a child’s symptom in the intrapsychic world of the parent. The outcome opened pathways for growth for both the adolescent and the parents, suggesting that the uniqueness of the phase of adolescence allows for new pathways for clinical intervention as well.     

患"愚"而不知"愚"者令人堪忧

在现实生活中,每每观察一下社会现象,人们不免总会发现一些叫人奇怪的事情:不久前,笔者从朋友的闲谈中得知,湖北省鄂州市沙窝乡有个牌楼村,村民何某在出外打工前,为了求得财运亨通,找到一位高明的神仙道人,得到的道法是:若想赚大钱,必须到高处过火(即人从火上跃过去)。于是,他根据神仙的指引,在出外打工的那天早晨,来到附近的山上,点燃一棵枯     

Physicians' Silent Decisions: Because Patient Autonomy Does Not Always Come First

Physicians make some medical decisions without disclosure to their patients. Nondisclosure is possible because these are silent decisions to refrain from screening, diagnostic or therapeutic interventions. Nondisclosure is ethically permissible when the usual presumption that the patient should be involved in decisions is defeated by considerations of clinical utility or patient emotional and physical well-being. Some silent decisions—not all—are ethically justified by this standard. Justified silent decisions are typically dependent on the physician's professional judgment, experience and knowledge, and are not likely to be changed by patient preferences. We condemn the inappropriate exclusion of the patient from the decision-making process. However, if a test or treatment is unlikely to yield a net benefit, disclosure and discussion are at times unnecessary. Appropriate silent decisions are ethically justified by such considerations as patient benefit or economy of time.     

Situational and Individual Determinants of Feedback Seeking: A Closer Look at the Process

The present study investigated the effects of situational (the feedback seeking context) and individual (public self-consciousness and self-esteem) determinants on the feedback seeking process (cf. Ashford & Northcraft, 1992; Northcraft & Ashford, 1990). A model was developed based on past research and theory (Ashford & Cummings, 1983; Larson, 1989; Morrison & Bies, 1991) which attempts to explicate how both situational and individual variables fit into this complicated process. Multiple measures of the seeking process were used to further our understanding in this area. Individuals′ intent to seek feedback, feedback seeking frequency, and the tendency to reconsider and modify their initial intentions were measured behaviorally over time. The importance of each of these variables was empirically demonstrated through the use of a computerized scheduling task on which individuals had the opportunity to request feedback. The results provide new insight into the feedback seeking process and have widespread organizational implications. Some new directions for feedback seeking research are also suggested.     

A Comparison of Suicide Note Writers with Suicides Who Did Not Leave Notes

There is disagreement in the suicide literature on the value of suicide notes as a data source, particularly regarding the extent to which suicide decedents who write notes differ from those who do not. Using 10 years of suicide cases from Summit County, Ohio, these two groups were compared on 40 variables including sociodemographic characteristics, reported affect before death, precipitating events, physical and mental health status and care, and method of suicide. The only differences found were that note writers were more likely to have lived alone and had made prior suicide threats. These findings suggest that for research purposes, suicide cases with and without notes are essentially similar.     

The Hard-to-Engage Patient: A Treatment Failure

I discuss the relatedness with certain hard-to-engage patients as a kind of dissociative enactment, and I present a case illustration of a man whom I liked but could not help.     

A Comparison Between Mexican American Youth Who Are in Gangs and Those Who Are Not

This exploratory study compares the differences between 43 Mexican American gang members and 43 Mexican American adolescents who are not members of a gang on several demographic, educational, familial, cultural, and psychological variables. Differences were analyzed using t tests and chi‐square analyses. Discussion focuses on implications for counseling. Este estudio de exploración compara las diferencias entre 43 Mexicoamericanos pertenecientes a alguna pandilla y 43 adolescentes Mexicoamericanos que no son miembros de una pandilla según distintas variables demográficas, educativas, familiares, culturales y psicológicas. Las diferencias se analizaron usando pruebas t y análisis de ji‐cuadrado. La discusión se centra en las implicaciones para la consejería.     

Unstable Embodiments: A Phenomenological Interpretation of Patient Satisfaction with Treatment Outcome

Many patients experience aspects of treatment and care as dehumanizing because the body is considered separate from the self and its life context. An attempt to transcend viewing persons in dualistic terms is posed by phenomenologists who focus not on "the body" as such but on what it means to be "embodied." In this paper, we review the relevance of the phenomenology of the body for health care and report the results of comparing Sally Gadow's phenomenological insights about body-self unity with a qualitative analysis of patients' accounts of satisfaction with the outcome of hand surgery. We illustrate the ways in which our findings were and were not congruent with Gadow's conceptualization of embodiment and highlight aspects that are ambiguous. We conclude that the body-self dialectical relationship should be recast as a body-self-society trialectic and discuss the implications of this new conceptualization for clinical practices.     

The Ethics Code Does Not Equal Ethics: A Response to O’Donohue

ABSTRACT

O’Donohue has identified 37 criticisms of the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct (Ethics Code), although many of his criticisms go far beyond what is found written in the APA Ethics Code, to include the process of adjudicating ethics complaints by the American Psychological Association Ethics Committee, and the process by which the Ethics Code was developed. The authors claim that a major shortcoming of O’Donohue’s article is that he adopted an unrealistically expansive role for the Ethics Code that was not clearly linked to furthering the goals of the ethics code revision.     

Faith-Based Sex Education Programs: What They Look Like and Who Uses Them

The purpose of this study was to explore the kinds of sex education programs for youth available in mainline churches. This research project sought to identify the kinds of programs developed, the ages of the youth involved, the reasons for implementing the programs, the goals of the programs, the topics covered, and the perceived youth response to these programs as identified by youth ministers and leaders. The sample included 92 churches/synagogues with memberships over 300 that were within a 25-mile radius of our small, urban area in southeast Michigan. Findings from this study lay the groundwork for exploring whether these programs have an impact on adolescents’ sexual behaviors.     

A Comparison of Written,Vocal, and Video Feedback When Training Teachers

We compared the effectiveness of and preference for different feedback strategies when training six special education teachers during a 5-day summer training program. In Experiment 1, teachers received written or vocal feedback while learning to implement two different types of preference assessments. In Experiment 2, we compared either written or vocal feedback to vocal feedback combined with video replays of performance while training the teachers to implement two variations of discrete-trial training. The different forms of feedback were similarly effective for all of the participants. However, all of the teachers showed a preference for vocal feedback when they could choose which form of feedback they would receive from the experimenter. Results have important implications for the use of feedback when training teachers.     

Assessment of Biopsychosocial Risk Factors for Medical Treatment: A Collaborative Approach

There is a growing body of evidence that psychosocial variables have a significant ability to predict the outcome of medical treatment procedures, especially when the procedure is performed to reduce pain. The study described in this paper serves as an illustration of the valuable role psychologists can play in dealing with the challenges of biopsychosocial assessment of patients who are candidates for medical treatments, especially elective, invasive procedures. Based on a convergent model of risk factors that can potentially influence outcomes from spinal surgery and spinal cord stimulation, exclusionary and cautionary risk factors were identified, and the BHI 2 and BBHI 2 tests were used to assess them. An estimate of the prevalence of these risk factors was calculated using data obtained from 1,254 patient and community subjects gathered from 106 sites in 36 US states. Standardized Cautionary Risk and Exclusionary Risk scores demonstrated a test-retest reliability of .85 to .91. Evidence of validity of these scores was also provided based on subjective and objective criteria, using multiple groups of patients and community subjects. Recommendations are made regarding how biopsychosocial assessments could be used in collaborative settings for presurgical candidates to identify risks that could compromise a patient’s ability to benefit from other medical treatments as well. Once identified, appropriate interventions could ameliorate these risks, or lead to the consideration of other treatments that are more likely to be effective. Methods of refining this approach for specific clinical applications are also discussed.     

One Size Does Not Fit All: Managing Radical and Incremental Creativity

This research extends creativity theory by re‐conceptualizing creativity as a two‐dimensional construct (radical and incremental) and examining the differential effects of intrinsic motivation, extrinsic rewards, and supportive supervision on perceptions of creativity. We hypothesize and find two distinct types of creativity that are associated with different motivational factors. We further consider how combinations of motivational factors are linked to the different types of creativity. Finally, theoretical and managerial implications are discussed.     

When All Is Considered: Evaluative Learning Does Not Require Contingency Awareness

We argue that the effects of evaluative learning may occur (a) without conscious perception of the affective stimuli, (b) without awareness of the stimulus contingencies, and (c) without any awareness that learning has occurred at all. Whether the three experiments reported in our target article provide conclusive evidence for either or any of these assertions is discussed in the commentaries of De Houwer and Field. We respond with the argument that when considered alongside other studies carried out over the past few decades, our experiments provide compelling evidence for a theory that posits a dissociation between evaluative learning and contingency awareness.