Psychoanalysis--with whom, for what, and how? Comparisons with psychotherapy

If psychoanalytic treatment is to survive in the era of evidence-based medicine and managed care systems, empirical evidence is needed to demonstrate its unique nature and effectiveness. To address this need, comprehensive analyses were conducted of data from the Menninger Psychotherapy Research Project (Wallerstein 1986). These analyses addressed three questions: (1) What are the differences in outcome between psychoanalysis (PSA) and supportive-expressive psychotherapy (SEP)? (2) With what types of patient, and in what ways, are these two psychodynamic treatments differentially effective? (3) Are these differences in outcome the consequence of possibly different mechanisms of therapeutic action? PSA was found to contribute significantly to the development of adaptive interpersonal capacities and to the reduction of maladaptive interpersonal tendencies, especially with more ruminative, self-reflective, introjective patients, possibly by extending their associative capacities. SEP, by contrast, was effective only in reducing maladaptive interpersonal tendencies and only with dependent, unreflective, more affectively labile anaclitic patients, possibly by containing or limiting their associative capacities.     

The pregnant therapist and the psychotic client: A phenomenological understanding of the impact of the therapist’s pregnancy on the therapeutic process

This original paper examines the underresearched area of therapist pregnancy. It explores the impact of psychosis as an additional complicating factor to the therapeutic process and the experience of one British counselling psychologist working in the National Health Service whilst pregnant. Five brief client summaries/clinical examples are presented to explore the common themes of anger, rejection, abandonment and envy that often emerge following the disclosure of a therapist’s pregnancy or the opposite reactions of over-protectiveness and an unwillingness to engage in therapy for fear of harming the therapist. Recommendations are made for further research within this neglected area and the need to incorporate the themes within training for therapists and training for supervisors.     

It’s not what you said,it’s how you said it: An analysis of therapist vocal features during psychotherapy

Psychotherapy is a conversation, whereby, at its foundation, many interventions are derived from the therapist talking. Research suggests that the voice can convey a variety of emotional and social information, and individuals may change their voice based on the context and content of the conversation (e.g. talking to a baby or delivering difficult news to patients with cancer). As such, therapists may adjust aspects of their voice throughout a therapy session depending on if they are beginning a therapy session and checking in with a client, conducting more therapeutic ‘work’ or ending the session. In this study, we modelled three vocal features—pitch, energy and rate—with linear and quadratic multilevel models to understand how therapists’ vocal features change throughout a therapy session. We hypothesised that all three vocal features would be best fit with a quadratic function—starting high and more congruent with a conversational voice, decreasing during the middle portions of therapy where more therapeutic interventions were being administered, and increasing again at the end of the session. Results indicated a quadratic model for all three vocal features was superior in fitting the data, as compared to a linear model, suggesting that therapists begin and end therapy using a different style of voice than in the middle of a session.     

Authors’ response: what are emotions and how are they created in the brain?

In our response, we clarify important theoretical differences between basic emotion and psychological construction approaches. We evaluate the empirical status of the basic emotion approach, addressing whether it requires brain localization, whether localization can be observed with better analytic tools, and whether evidence for basic emotions exists in other types of measures. We then revisit the issue of whether the key hypotheses of psychological construction are supported by our meta-analytic findings. We close by elaborating on commentator suggestions for future research.     

Cross-racial psychotherapy with the borderline patient: Should the patient fire the therapist?

The purpose of this paper is to examine the effects of race on the psychotherapy of a white borderline patient treated by a black therapist. Some authors state that effective cross-racial psychotherapy is unattainable because of a marked divergence in the psychological biases of patients and therapists, while others feel that there is a more rapid unfolding of the transference in cross-racial therapy. While racial homogeneity may be desirable for some therapeutic issues, it is clearly not a prerequisite for effective therapy, nor is it realistic to assume that you've got to be one to treat one.     

‘Tied together feelings’ Group psychotherapy with latency children: the process of forming a cohesive group

In this paper we describe our experience of running a psychoanalytic psychotherapy group for six children, ranging in age from 4-8 years old. The group ran for a year, with sessions held weekly for an hour. The rationale for group work, selection criteria and the treatment setting are discussed. The paper charts the evolution within the children of the concept of an internal 'work group' (Bion, 1961), as opposed to a 'gang', as their self-awareness and capacity to relate to each other improved. This reflected a corresponding shift in their relationship to the two group leaders, moving from their initial perception of us as neglectful and in conflict with each other, towards recognizing us as a therapist couple who could work together thoughtfully for their benefit. The children's relationship to the group leaders, representing a 'parental couple' in the transference, was the focus of much of the work group. The positive outcomes for most of the children, resulting from this treatment, are reported.     

Measuring the quality of life: Why,how and what?

In this paper three questions concerning quality of life in medicine and health care are analysed and discussed: the motives for measuring the quality of life, the methods used in assessing it, and the definition of the concept. The purposes of the study are to find an ethically acceptable motive for measuring the quality of life; to identify the methodological advantages and disadvantages of the most prevalent current methods of measurement; and to present an approach towards measuring and defining the quality of life which evades the difficulties encountered and discussed. The analysis comprises measurements both in the clinical situation concerning individual patients and in research concerning whole populations. Three motives are found for evaluating the quality of human life: allocation of scarce medical resources, facilitating clinical decision making, and assisting patients towards autonomous decision making. It is argued that the third alternative is the only one which does not evoke ethical problems. As for the methods of evaluation, several prevalent alternatives are presented, ranging from scales of physical performance to more subtle psychological questionnaires. Clinical questionnaires are found to fail to provide a scientific foundation for universally measuring the quality of life. Finally, the question of definition is tackled. The classical distinction between need-based and want-based theories of human happiness is presented and discussed. The view is introduced and defended that neither of these approaches can be universally preferred to the other. The difficulty with the need approach is that it denies the subjective aspects of human life; whereas the problem of the want approach is that it tends to ignore some of the objective realities of the human existence. In conclusion, it is argued that the choice of methods as well as definitions should be left to the competent patients themselves — who are entitled, if they so wish, to surrender the judgement to the medical personnel. Technical factors as well as the requirements of respect for autonomy and informed consent support this conclusion.     

Putting down roots: the significance of technical adaptations in the therapeutic process with fostered and adopted children‡

Severely neglected and traumatised children have also suffered from a lack of the parental nurturing which is needed for ordinary emotional development to take place. Often their past experiences make them unable to utilise the nurturing that foster and adoptive families try to give them and they are delayed or stuck in their development. In therapy, when the early small signs of new emotional development start to emerge, they may be heralded by technical challenges to the therapist. Two examples are given in this paper, which are discussed in the context of Stern et al.’s ideas about moments of meeting, Winnicott’s concepts about transitional phenomena and playing, and Hurry and her colleagues’ thoughts about the therapist as a developmental object. It is argued that it is important for the therapist to be alert to the possible significance of these technical adaptations in terms of the child’s capacity for new emotional development. These often indicate that a watershed in the treatment has been reached and if positively responded to, that the patient is in the process of ‘putting down roots’ in the ground of the therapeutic relationship and starting to grow across a spectrum of developmental pathways.     

Distinguishing multi-voxel patterns and mean activation: Why, how, and what does it tell us?

The introduction of multi-voxel pattern analysis (MVPA) to the functional magnetic resonance imaging (fMRI) community has brought a deeper appreciation for the diverse forms of information that can be present within fMRI activity. The conclusions drawn from MVPA investigations are frequently influenced by both the ability to decode information from multi-voxel patterns and mean activation levels. In practice, MVPA studies vary widely in why and how they test for differing overall response levels. In this article, I examine the place of univariate information in MVPA investigations. I first discuss the variety of interpretations given to finding univariate response differences. I go on to discuss some of the analysis approaches used to investigate and compare univariate and multivariate sources of information, which can illuminate their respective contributions. It will be important for the MVPA and general fMRI community to continue to discuss and debate these important issues.     

Psychological universals: what are they and how can we know?

Psychological universals, or core mental attributes shared by humans everywhere, are a foundational postulate of psychology, yet explicit analysis of how to identify such universals is lacking. This article offers a conceptual and methodological framework to guide the investigation of genuine universals through empirical analysis of psychological patterns across cultures. Issues of cross-cultural generalizability of psychological processes and 3 cross-cultural research strategies to probe universals are considered. Four distinct levels of hierarchically organized universals are possible: From strongest to weakest claims for universality, they are accessibility universals, functional universals, existential universals, and nonuniversals. Finally, universals are examined in relation to the questions of levels of analysis, evolutionary explanations of psychological processes, and management of cross-cultural relations.     

Taking counselling and psychotherapy outside: Destruction or enrichment of the therapeutic frame?

This paper will explore emerging issues in the practice of counselling and psychotherapy in the outdoors, which the authors encountered when they took their clients outside of the traditional therapy room. The outdoors is defined as natural areas and spaces, such as woods and parks which have been termed ‘nearby nature’ (Kaplan &; Kaplan, 1989 Kaplan, R. Kaplan, S. (1989). The experience of nature a psychological perspective. New York: Cambridge University Press [Google Scholar]) and also more remote areas such as mountains and moors which are more isolated from civilisation, what some have termed wilderness (Mcfarlane, 2007). Particular emphasis will be given to the ‘frame’ of psychotherapy and how aspects of this are affected by moving outdoors, in particular contracting in relation to confidentiality and timing. The relationship in psychotherapy will be explored in relation to issues of mutuality and asymmetry alongside the role of nature in the therapeutic process. Lastly the challenges and therapeutic potential of psychotherapy in nature will be explored.     

Desire for personal feedback: Who wants it and what does it mean for psychotherapy?

Individual differences in desire for feedback did not exhibit any significant correlations with a variety of self-report personality dimensions. Additional survey studies indicated that a higher proportion of individuals in nonclinical as compared to clinical samples reported a strong desire to receive feedback about themselves. Subsequent studies revealed that the higher as compared to lower desire for feedback individuals: (1) were more willing to seek psychological help and to participate in therapy once in treatment; (2) exhibited more positive expectancies for change at the beginning of therapy; and (3) were more “responsive” to diagnostic feedback. Within the limitations of the present findings, the potential “adaptiveness” of desire for feedback is discussed and the negative motivational therapeutic consequences associated with a low desire for feedback are explored.     

What’s the object of object working memory in infancy? Unraveling ‘what’ and ‘how many’

Infants have a bandwidth-limited object working memory (WM) that can both individuate and identify objects in a scene, (answering ‘how many?’ or ‘what?’, respectively). Studies of infants’ WM for objects have typically looked for limits on either ‘how many’ or ‘what’, yielding different estimates of infant capacity. Infants can keep track of about three individuals (regardless of identity), but appear to be much more limited in the number of specific identities they can recall. Why are the limits on ‘how many’ and ‘what’ different? Are the limits entirely separate, do they interact, or are they simply two different aspects of the same underlying limit?We sought to unravel these limits in a series of experiments which tested 9- and 12-month-olds’ WM for object identities under varying degrees of difficulty. In a violation-of-expectation looking-time task, we hid objects one at a time behind separate screens, and then probed infants’ WM for the shape identity of the penultimate object in the sequence. We manipulated the difficulty of the task by varying both the number of objects in hiding locations and the number of means by which infants could detect a shape change to the probed object. We found that 9-month-olds’ WM for identities was limited by the number of hiding locations: when the probed object was one of two objects hidden (one in each of two locations), 9-month-olds succeeded, and they did so even though they were given only one means to detect the change. However, when the probed object was one of three objects hidden (one in each of three locations), they failed, even when they were given two means to detect the shape change. Twelve-month-olds, by contrast, succeeded at the most difficult task level.Results show that WM for ‘how many’ and for ‘what’ are not entirely separate. Individuated objects are tracked relatively cheaply. Maintaining bindings between indexed objects and identifying featural information incurs a greater attentional/memory cost. This cost reduces with development. We conclude that infant WM supports a small number of featureless object representations that index the current locations of objects. These can have featural information bound to them, but only at substantial cost.     

Race and information processing in criminal trials: does the defendant's race affect how the facts are evaluated?

Two studies examined whether a criminal defendant's race influences Whites' sensitivity to legally relevant information. In Study 1, prosecution case strength ratings and guilt likelihood ratings were more sensitive to the strength of the defendant's alibi when he was Black than when he was White, if the experimental task was designed to elicit low processing motivation. Under high motivation, participants were equally sensitive to alibi strength, regardless of defendant race. In Study 2, the alibi strength manipulation was replaced with a manipulation of the effectiveness of the district attorney's cross-examination. As predicted, defense case strength ratings were more sensitive to the strength of the prosecutor's cross-examination with a Black defendant than with a White defendant-under low motivation. Under high motivation, sensitivity did not depend on defendant race. These results suggest that a Black defendant can elicit greater sensitivity to legally relevant information than will a White defendant.     

Propositional unity: what’s the problem, who has it and who solves it?

At least since Russell’s influential discussion in The Principles of Mathematics, many philosophers have held there is a problem that they call the problem of the unity of the proposition. In a recent paper, I argued that there is no single problem that alone deserves the epithet the problem of the unity of the proposition. I there distinguished three problems or questions, each of which had some right to be called a problem regarding the unity of the proposition; and I showed how the account of propositions formulated in my book The Nature and Structure of Content [2007 Oxford University Press] solves each of these problems. In the present paper, I take up two of these problems/questions yet again. For I want to consider other accounts of propositions and compare their solutions to these problems, or lack thereof, to mine. I argue that my account provides the best solutions to the unity problems.     

National Culture,Creativity, and Productivity: What’s the Relationship with Student Achievement?

Using Hofstede’s culture dimensions and World Values Survey (WVS) dimensions, the study uses a series of multiple regressions to explore the relationship among national culture, creativity as measured by patents, economic productivity as measured by gross domestic product per capita, and student achievement as measured by Trends in International Mathematics and Science Study. The findings of this exploratory study highlight long-term orientation value from Hofstede’s national culture dimensions and tradition versus secular-rational values from the WVS as the most significant predictors of student academic achievement. A series of 12 regression analyses indicated significant relationships among student achievement, creativity, and economic productivity with models explaining between 19.9% and 76.0% of the variance among countries.     

Semantic and perceptual priming: how similar are the underlying mechanisms?

Both semantic priming and perceptual priming consist of facilitation of the identification of primed stimuli and inhibition of the identification of nonprimed stimuli. The similarities between the two phenomena suggest that a common attentional mechanism underlies both, and this has been explicitly proposed by several attention theorists. In this article it is argued that the phenomena of semantic and perceptual priming are qualitatively different, perceptual priming reflecting a sensitivity change in the recognition process brought about by attention, and semantic priming reflecting a bias change in the recognition process brought about by attention. Because different mechanisms are required to produce sensitivity and bias changes, this implies that the attentional mechanisms responsible for semantic and perceptual priming are distinct. In terms of recent discussions of the modularity versus the unity of cognitive architecture, the present conclusion supports a modular architecture for attentional processes.