To test or not to test: A clinical dilemma

This paper argues that clinicians are sometimes justified in not testing diagnoses or in not subjecting them to a full battery of tests. In deciding whether to conduct a test, a clinician may consider and weigh several different factors, including her confidence in her initial diagnosis, the specificity and sensitivity of the test, the consequences of making a false diagnosis, the pain, harm, and inconvenience caused by the test, and the costs of the test to the patient and society. This view suggests that diagnoses are fundamentally different from scientific hypotheses in that they are not always subjected to the same evidential standards.     

Headache triggers: To avoid or not to avoid,that is the question

Abstract

Traditional clinical advice in the management of headaches is to avoid trigger factors. There is a danger, however, that avoidance of triggers results in a sensitisation process whereby tolerance for the triggers decreases, in a manner analogous to increments in anxiety arising from avoidance of anxiety-eliciting stimuli. Reported here are six single-case experiments in which the aim was to desensitise headache sufferers to an experimentally validated trigger, namely “visual disturbance”. The results demonstrated that repeated, prolonged exposure to a headache trigger led to desensitisation with participants experiencing less visual disturbance, less negative affect and less head pain in response to the trigger. These findings have theoretical significance as they speak to the issue of the aetiology of chronic headache, and practical significance as they suggest that a key aspect of current management may contribute to the disorder becoming worse rather than better.     

To be me or not to be me: About alienation

This article is about the experiential side of the concept of alienation and its relations to the stress process in the context of work and organization. We distinguish two kinds of alienation: primary alienation, the experience or feeling that something is different from normal, and secondary alienation, the absence of an experience of or feeling about something abnormal. After having gone into everyday reality and how it can be so disturbed that alienation ensues, we go further into the experiences involved in both kinds of alienation and their positive and negative consequences. Secondary alienation is described as a common final path in the second stage of a human stress process. In the discussion, we pay attention to the social scientific tradition of alienation as result of an evil societal influence, which has turned out to be an unfortunate approach. Instead, we advocate an approach that conceives alienation as the outcome of a personal choice. Lastly we indicate shortly what can be done about secondary alienation.     

To stay or to return: Rapprochement processes in the migration of adolescents and young adults

The migration of adolescents and young adults is analyzed in terms of the separation-individuation process—an attempt at separation, reflecting conflictual feelings around autonomy and dependency needs. This paper focuses on the acute ambivalence typical of the rapprochement phase of personality development during childhood and applying this to understanding the adolescent and young adult during their migration experiences. The young immigrants to Israel are observed to alternate between physical approaching and then distancing in relation to both the new country (Israel) and the country of origin (the homeland). Four clinical examples of young persons are presented to illustrate the rapprochement process in some immigrants.     

Transition in the cotherapy dyad: To wait or not to wait

Transition within the cotherapy dyad is explored and examined in relation to institutional ethos and needs, the attitudes and needs of the psychotherapy group, and the attitudes and needs of the cotherapists. The timing of transition is discussed as are a variety of potential approaches to transition within the cotherapy dyad. Some significant dynamics which underlie the process of transition within the cotherapy dyad are examined and discussed in relation to their potential effects on the psychotherapy group and group process.This is a revised version of a paper presented at the 36th Annual Conference of the American Group Psychotherapy Assn., February, 1979, New York, NY.     

To generalize or not to generalize: spatial categories are influenced by physical attributes and language

The current work explored the conditions under which infants generalize spatial relationships from one event to another. English‐learning 5‐month‐olds habituated to a tight‐ or loose‐fit covering event dishabituated to a change in fit during a containment test event, but infants habituated to a visually similar occlusion event did not. Thus, infants’ responses appeared to be driven by the physical nature of the fit rather than visual similarity. This response pattern was replicated with Korean‐speaking adults, but English‐speaking adults showed no sensitivity to change in fit for either event. These findings suggest that language development links linguistic forms to universal, pre‐existing representations of meaning, and that linguistic experience can shape sensitivity to distinctions that are marked in one's native language.     

To be or not to be a real object: Monitoring the therapeutic relationship

Psychoanalytic theorists have lately come to acknowledge what practicing clinicians have long recognized: the importance of flexibility in psychotherapeutic technique. Adjusting the transference-countertransference expectations to the developmental level of each particular patient has become increasingly necessary as psychodynamic therapists work in depth with a wider range of difficult patients.     

To Balance or not to Balance: Confirmatory Factor Analysis of the Affect-Balance Scale

This study examined the psychometric quality of the Affect-Balance Scale (ABS) (Bradburn, 1969) using data collected from 292 middle-aged and older adults, living independently. The dimensionality of the scale was examined, the quality of individual items was tested, and the validity of the ABS was studied. Using a tetrachoric correlation matrix with the robust weighted least squares (WLSMV) estimation method of the Mplus program, we found that two moderately correlated (r = -0.37) constructs are needed to adequately account for the pattern of item scores in the ABS. Two of the 10 ABS items were found to be problematic. When raw sum scores were used in analysis, the correlation between the positive-affect and the negative-affect subscales was lower (r = -0.17), indicating that random and nonrandom measurement error masked the relationship between the two. While affect-balance correlated substantially with five criterion well-being measures, the negative-affect subscale (which constitutes half of the ABS) had a similar pattern of correlations, with only slightly lower magnitude. The theoretical construct of nobreak 'balance' is also questioned. The 'balance' scoring method (subtracting the negative-affect subscale score from the positive-affect subscale score) nets exactly the same score as does summing scores from both subscales together. Accordingly, the summed scores have the very same correlations with other variables as do the balance scores.