Tainted therapy and mistaken memory: Avoiding malpractice and preserving evidence with possible adult victims of childhood sexual abuse

Recent malpractice cases reflect increased liability for psychotherapists working with possible adult victims of childhood sexual abuse. These cases have related to recovery of past memory of abuse and the fashion in which the therapist managed the recovery and treatment. Ways in which therapists may harm clients by omission and commission are explored. The emerging lack of clarity between investigative and therapeutic interviews is discussed. False memory is considered in relationship to malpractice liability, standards of care, and attempts to preserve potential evidence. The author proposes written informed consent and investigative interviewing procedures for working with potential memory recovery cases. Formats for general informed consent to psychotherapy for patient record keeping of newly emergent material are appended.     

Traumatic loss and major disasters: strengthening family and community resilience

This article presents the core principles and value of a family and community resilience-oriented approach to recovery from traumatic loss when catastrophic events occur. In contrast to individually based, symptom-focused approaches to trauma recovery, this multisystemic practice approach contextualizes the distress in the traumatic experience and taps strengths and resources in relational networks to foster healing and posttraumatic growth. The intertwining of trauma and traumatic losses is discussed. Key family and social processes in risk and resilience in traumatic loss situations are outlined. Case illustrations, model programs, and intervention guidelines are described in situations of community violence and major disasters to suggest ways to foster family and community resilience.     

Commentaries on 'The symbolism of the story of Lot and his wife'

In this article, four child and adolescent psychotherapists discuss their responses, within a psychoanalytic framework, to the theoretical and technical questions raised by Monica Lanyado in her paper 'The symbolism of Lot and his wife'.     

The MMPI as a predictor of early termination from polydrug abuse treatment.

The MMPI protocols obtained upon admission to an inpatient program for treatment of polydrug abuse were studied to determine if they could identify abusers who terminated prematurely from treatment. Individual scale T scores, profile code types and discriminant scores were evaluated for 104 patients who completed treatment ("stayers") and 72 patients who left prematurely ("quitters"). Although quitters and stayers did not differentiate on primary drug of abuse, age, sex, race, or IQ, quitters were less likely to obtain normal limits or neurotic code profiles, Univariate analyses revealed that quitters obtained higher mean elevations on 6 of the 15 scales studied (F, 4/Pd, 6/Pa, 8/Sc, 9/Ma, A). Discriminant scores based on a stepwise discriminant analysis correctly identified 71% of the study sample, representing a 13.7% improvement over base rate prediction. The probable importance of initial level of psychological discomfort and ability to delay gratification, and the need to examine varied treatment modalities for polydrug abusers identified as at risk for premature termination from treatment were explored.     

The loss spiral of work pressure, work-home interference and exhaustion: Reciprocal relations in a three-wave study

This study tested the ‘loss spiral’ hypothesis of work-home interference (WHI). Accordingly, work pressure was expected to lead to WHI and exhaustion, and, vice versa, exhaustion was expected to result in more WHI and work pressure over time. Results of SEM-analyses using three waves of data obtained from 335 employees of an employment agency offered strong support for this hypothesis. It was found that T1 work pressure and exhaustion were determinants of T2 and T3 WHI, whereas T1 WHI was a causal determinant of T2 and T3 exhaustion and work pressure. In addition, work pressure and exhaustion had causal and reversed causal relationships over time. These empirical findings suggest that common theoretical models postulating the causal chain of work pressure → WHI → exhaustion are inadequate. Rather, more elaborated models including reciprocal relationships between work characteristics, WHI and employee well-being seem more appropriate.     

The symbolism of the story of Lot and his wife: the function of the 'present relationship' and non-interpretative aspects of the therapeutic relationship in facilitating change

Abstract The treatment of an adolescent patient preoccupied with thoughts about committing suicide is presented, as a vehicle for considering the significance of the 'present relationship' within the totality of the therapeutic relationship in bringing about change. The question of how the present relationship operates alongside the transference relationship is raised. It is argued that there needs to be more attention to and discussion of the therapeutic actions and re-enactments that take place within therapy which, while they may be viewed at times as unorthodox, may nevertheless be beneficial. This in turn can then lead to developments in technical and theoretical thinking based on clinical experience.     

Selective exposure and decision framing: The impact of gain and loss framing on confirmatory information search after decisions

When people make decisions, they often prefer to receive information that supports rather than conflicts with their decision. To date, this effect has mainly been investigated in the context of decisions about gains, whereas decisions about losses have received less attention. Based on Prospect Theory, we expected information search to be differently affected by whether people previously have decided about gains or losses. Three studies have revealed that selectivity of information search is stronger after gain-framed rather than after loss-framed decision problems. An investigation of the underlying psychological processes revealed that gain decisions are made with increased subjective decision certainty (i.e. they are easier and less effortful to make), which in turn systematically increases confirmatory information search.     

The ability to process emotional information predicts loss aversion

On the basis of previous research it was hypothesized that alexithymia is associated with a higher tolerance for losses. This hypothesis is extended to explore whether the putative link between loss aversion and alexithymia remains once traits associated with risk taking (sensation seeking) and broad based personality traits (the Big 5) are controlled. Participants (N = 260) completed indices of alexithymia, sensation seeking and the Big 5 and both a riskless (endowment effect) and risky (lottery task) measure of loss aversion. It was found that the higher the alexithymia score the lower the loss aversion for both riskless and risky decisions even when sex, sensation seeking and the Big 5 are taken into account. The implications for this finding are discussed in the light of a neurological explanation of the relationship between alexithymia and loss aversion.     

An affective absence: Memorialising loss at Pike River Mine,New Zealand

Pike River Mine was an ordinary, everyday workplace, unremarkable, pragmatic, an industrial aesthetic inserted into a pristine landscape. Following an explosion in November 2010, 29 men became entombed in the mine and their bodies remain there. Unfolding revelations of the culpability of the mine's management and a shocking narrative of events left the mine suspended in time. As a crime scene, it remained sealed off until mid-2019, when the process of re-entry began. All of this is set within one of the country's most sublime landscapes, with lush rainforest, dripping, moist, tranquil. The living and the dead continue to communicate, families shouting names into the portal, Mines Rescue leaving a note for the dead men to read, and out of the mine flows the water that has crossed their bodies. The dead, the living, the mine, the forest, and the deep history of Māori, coalesce in the affective landscape of Pike River. This paper explores affectivity in the context of co-designing a memorial landscape with the dead men's families, local Māori, and the Department of Conservation.     

Power and loss aversion

Four experiments tested the prediction that power reduces loss aversion by increasing the anticipated value of gains and shrinking the negative anticipated value of losses. Experiment 1 provided initial support for the prediction that those in power are less loss averse by replicating a classic paradigm of loss aversion in riskless choice and demonstrating moderation by power. Experiments 2 and 3 expanded on this finding by breaking apart the components of loss aversion to determine how power may reduce it: via gains, losses, or both. Across two scenarios and two different measures of anticipated value, power reduced the anticipated threat associated with a loss. However, the prediction that power increases the anticipated value of gains was not supported. Finally, Experiment 4 replicated the results of Experiments 2 and 3 in the context of a choice with real consequences for the participants. Implications of these findings are discussed.     

The recovering female alcoholic: A family affair

Supported by a review of relevant literature and a case study, the author argues that family therapy intervention enhances the likelihood of a female alcoholic's positive prognosis. With a basis in systems theory, family therapy views the family as a system and, hence, perceives the alcoholism as a symptom of that family. A profile of the female alcoholic, how her drinking affects her family, and the role that family therapy plays in the recovery process are examined.     

Social strategies during university studies predict early career work burnout and engagement: 18-year longitudinal study

This longitudinal study spanning 18 years examined the role of social strategies in early career adaptation. The aim was to find out whether individuals' social strategies measured during their university studies had an impact on work burnout and work engagement measured 10–18 years later. A sample of 292 university students completed the SAQ questionnaire three times while at university and the work burnout inventory three times and the work engagement inventory twice during their early career. According to the results, the higher the initial level of social optimism and the more it increased during university studies, and the lower the initial levels of social withdrawal and social handicapping and the more they decreased, the lower was the level of work burnout and the higher the level of work engagement in the early career. The effects of the level of social strategies were stronger on the professional efficacy subscale of burnout.     

Perceived training intensity and work effort: The moderating role of perceived supervisor support

This study explored the relationships between perceived training intensity, perceived supervisor support, and work effort. The results from a cross-lagged study across a 10-month time span among 323 employees at a Norwegian power supply company revealed a nonsignificant relationship between perceived training intensity and self-reported work effort. Moderation analyses revealed a negative relationship for employees reporting low levels of perceived supervisor support. These findings suggest that line managers are of vital importance for maintaining employees’ work efforts in settings where competence-related stress is prevalent. Among several potential implications for practice, we encourage managers to engage in supportive behaviour, particularly under stressful working conditions.     

'To walk the last bit on my own' - narcissistic independence or identification with good objects: issues of loss for a 13-year-old who had an amputation

This paper describes two years of psychotherapy with Michael, a 13-year-old boy who had undergone a recent emergency amputation of his leg and hip for bone cancer. The work follows Michael's struggle with the enormity of the loss, in the face of his, as well as the system's, use of denial. The amputation as an 'attack' on his physical and emotional autonomy strikes at his early adolescent development. The therapeutic process is aided by his capacity 'to go back to the unhappiness'. The therapy develops from his initial shock, to despair and self-blame, as he struggles with a tendency - in the middle period of the therapy - to lose his mind as well as his leg in a retreat to withdrawal and mindlessness, or to mania. He struggles between an omnipotent, at times self-destructive, wish to 'go it alone', versus a capacity to feel sad and to value life. His capacity to think about the trauma and to find meaning emerges. The paper raises questions about whether some trauma can ever be fully assimilated, and whether, for Michael, the mourning process could lead to a reintegrated sense of self and of a 'psychic intactness', dependent on the survival of his good 'internal couple'. Hospital and ward-based child psychotherapy and its limitations are explored.     

Child abuse in the early postnatal period: An atypical presentation

In cases of severe physical abuse of babies, the usual dynamics uncovered are a parental history of abuse and deprivation, lack of family support, extreme family stressors, bonding failure to the baby, and/or parental mental illness, including depression or psychosis. This paper presents four cases, from a sample of several hundred abusive families, that do not encompass the usual “abusive” dynamics outlined above. In all four cases, the abuse was perpetrated in the first few months postpartum, against a background of good physical care of the baby, an apparently adequate bond to the baby, and negative psychiatric findings in the abusing parent. The similarities within these four cases were striking, particularly the use of denial to deal with conflicts and long-standing difficulty in expressing any ambivalence in attachment relationships. An explanation of the complex dynamics involved in such cases is offered, and the difficulties in detection and intervention are addressed.     

Overvaluation of shape and weight among overweight children and adolescents with loss of control eating

Little is known about the phenomenology of pediatric loss of control (LOC) eating. Overvaluation of shape and weight, however, appears to be diagnostically meaningful among binge eating adults. We explored the significance of shape and weight overvaluation among children and adolescents with LOC eating. Participants (n = 526) included 149 overweight youth with LOC eating and 377 overweight controls (CON). Participants were categorized as those reporting at least moderate overvaluation (LOC-Mod, n = 74; CON-Mod, n = 106) or less than moderate overvaluation (LOC-Low, n = 75; CON-Low, n = 271), and compared on measures of eating-related and general psychopathology. LOC-Mod evidenced lower self-esteem than CON-Low, and greater behavioral problems than CON-Mod and CON-Low, but did not differ from LOC-Low in these domains. With the exception of LOC-Low and CON-Mod, all groups differed on global eating-disorder severity, with LOC-Mod scoring the highest. Overvaluation of shape and weight appears to be of questionable importance in defining subtypes of youth with LOC eating. However, as overvaluation and LOC eating each independently predicts eating-disorder onset, their confluence may confer even further risk for eating-disorder development. Longitudinal studies should address this possibility. Developmentally appropriate discussion about body image disturbance may be indicated in interventions targeting pediatric LOC eating and/or obesity.     

Achievement strategies during university studies predict early career burnout and engagement

To examine whether individuals’ achievement strategies measured during university studies would have an impact on work burnout and work engagement measured 10, 14 and 17 years later, 292 university students completed the SAQ strategy questionnaire three times while at university, and the work burnout inventory three times and work engagement inventory twice during their early career. The results showed that optimism increased during university, while task-avoidance did not change. Moreover, high and increasing optimism during university predicted a high level of work engagement and low level of burnout 10, 14 and 17 years later. By contrast, a high level of task-avoidance during university predicted a low level of work engagement and high level of burnout during the early career.     

Maternal resolution of loss and abuse: Associations with adjustment to the transition to parenthood

This study examined relationships between mothers' resolution of past loss and abuse and their adjustment to the transition to parenthood. Three groups of mothers were compared: 1) those who were unresolved with respect to loss or abuse (Unresolved Loss/Abuse), 2) those who had experienced loss or abuse, but were considered resolved (Resolved Loss/Abuse), and 3) those who had not experienced loss or abuse (No Loss/Abuse). Mothers in the Resolved Loss/Abuse group reported more negative perceptions of the transition to parenthood than did mothers in the No Loss/Abuse group, which may reflect a greater awareness of negative emotions and a greater ability to communicate openly about them. Although mothers who have experienced loss or abuse and appear to have resolved these experiences may be at risk for distress during the transition to parenthood, they do not appear to be at risk for insensitive care giving. Unresolved loss, however, was associated with less sensitive care giving. The findings of this study highlight the importance of examining current state of mind regarding past experiences when investigating relationships between childhood loss and abuse and adjustment to subsequent life transitions. ©2004 Michigan Association for Infant Mental Health.     

Policy bundling to overcome loss aversion: A method for improving legislative outcomes

Policies that would create net benefits for society that contain salient costs frequently lack enough support for enactment because losses loom larger than gains. To address this consequence of loss aversion, we propose a policy-bundling technique in which related bills involving both losses and gains are combined to offset separate bills’ costs while preserving their net benefits. We argue this method can transform unpopular individual pieces of legislation, which would lack the support for implementation, into more popular policies. Study 1 confirms that bundling increases support for bills with costs and benefits and that bundled legislation is valued more than the sum of its parts. Study 2 shows this finding stems from a diminished focus on losses and heightened focus on gains. Study 3 extends our findings to policies involving costs and benefits of the same type (e.g., lives) generated by different sources (e.g., food vs. fire safety).