Motivational enhancement treatment in outpatient addiction centers: A multisite randomized trial

Background/Objectives: Motivational Enhancement Treatment in Spanish (METS) is a brief intervention aimed at resolving patient ambivalence towards behavior change that has demonstrated efficacy in substance use disorder treatment to reduce use and increase treatment engagement in different populations. In order to have evidence for its implementation in Mexico, a multi-site, randomized, two-arm, controlled clinical trial was conducted at three outpatient addiction treatment centers in the country to compare the effect of METS with Counseling as Usual (CAU). Method: One hundred and twenty patients were randomized to receive three sessions of METS (n = 54) or CAU (n = 66) during the first four weeks of treatment and were assessed during the following 12 weeks. Primary outcome measures were self-reported days of substance use and of treatment services utilization, which were tested using Generalized Estimating Equations. Results: Results associated both conditions with significant changes in substance use over, whereas there were no differences between conditions in substance use or in service utilization. Conclusions: Findings do not support the hypothesis that METS is more effective than CAU, but suggest that brief interventions at treatment initiation may improve patient outcomes.     

Motivational interviewing and smoking behaviors: a critical appraisal and literature review of selected cessation initiatives

The present paper systematically reviewed and critically appraised three different dimensions of motivational interviewing currently utilized in smoking cessation initiatives: social support, motivation, and tailored interventions. A review of four databases generated 57 primary articles, 17 of which met the inclusion criteria of an intervention study utilizing at least one dimension of motivational interviewing, adults between 18 and 64 years, no comorbidities, and a follow-up period of at least 6 weeks. More than 11,600 participants are represented in this review. The implementation of social support, motivation, and tailored interventions yielded mixed results. Furthermore, threats to validity emerged, including self-report, follow-up period, sample sizes, a priori differences in groups, and web-based and text-based interventions. Further research must ascertain the efficacy of the three dimensions of motivational interviewing indicated by the mixed results reported in terms of statistical significance of cessation rates. More empirically rigorous designs with evaluations based on stringent replicable criteria are needed.     

A Case Study: A Discussion of Depression,Ambivalence, Attachment,and Culture Portrayed in the Therapeutic Environment

ABSTRACT

This paper uses object relations theory to conceptualize and manage the complexities of a home-based case that was followed for a period of six months. It discusses maternal depression in relation to the caregiver role, self-harm, and self-determination. The client's ambivalence issues are addressed, with particular emphasis on transference and countertransference issues in the relationship and the use of transitional space and objects. Also discussed is the effect of maternal depression and ambivalence on mother-infant attachment, with the introduction of interaction-guidance as a treatment modality. An examination of cultural differences and the concomitant ethical implications that arose in the treatment process is provided. Finally, therapeutic implications and reflexivity are addressed.     

Anger - the hidden destroyer A psychodynamic approach with the physically disabled

Abstract

A basic challenge in the psychodynamic counselling of the physically disabled is the engagement of anger in relation to the patient's disability. Regardless of a patient's age at the onset of disability, they will exhibit anger, resentment and frustration for losses they may have, or perceive themselves to have, endured. Healthy physical and psychological adaptation requires the disabled patient to ‘cope’ with their anger. Feelings of anger may impede, obstruct or even derail the impetus towards healthy psychological and behavioural functioning. The manner in which we learn to negotiate the vicissitudes of daily life is linked to our selfobject development. This development does not end when we become adolescents or young adults, but continues throughout our life span. The normative, healthy psychological maturation required for adaptive behaviour is vulnerable to a wide range of impediments acquired at any point along the individual's developmental continuum. As clinicians we need to keep in mind that the self-regulation of internalized emotional states is transacted through a complex set of characterological and personality traits that may be impaired, or wanting, eventually leading to maladjusted psychopathological states. The therapeutic function of the clinician is to redress those ego deficits that stand in the way of a fully creative and productive life. The intended aim of this paper is to illustrate the manner in which I engage with those physically disabled persons presenting anger. I shall consider the use of counter-transference responses as behavioural in modifying various forms of anger formation manifested by disabled clients. It is my position that a positive shift in a disabled person's ego ideal through empathic transference will help to alleviate their underlying hostility and other forms of anger. The paper commences with a brief review of the experience of the disabled in Western society. I shall then turn to an examination of the psychotherapeutic approach underpinning my work with disabled clients. The third section will describe and illustrate, through case material, the clinician's use of self in the dyadic transaction with disabled clients.

The power of a positive therapeutic outcome lies in the clinician's ability to engage with the client despite emotional content, clinical aptitude or specific approach. Empathic attunement brings into operation those mechanisms underpinning the dynamic process integral to the approach used in the above cases. Countertransference issues sometimes intervene in the unconstrained flow of therapy. Regardless, those issues that are salient to the client and are incorrectly handled by the clinician will appear recurrently until satisfactorily addressed. Further, even when errors are made in sessions, outcomes may be positive.

Whatever the initial purpose that brings a physically disabled person to therapy there will eventually be a need to address issues around their condition. It is not enough to ignore or accept a client's earliest statement that their disability Ms not a problem'. They may initially not have come into therapy for problems concerning their disability; however, the particular disability will ultimately play an important role as to how and what the person feels, thinks and believes about him or herself. In general, psychodynamic counselling with the physically disabled requires knowledge of disability issues as well as of counselling procedures. Those working with the disabled need to understand their own personal issues through analytic work and continued supervision. Working with the physically disabled can be overwhelming, frustrating and exhausting, but in the end is most rewarding.     

儿童移情与道德发展关系研究综述

移情是人际交往中情感的相互作用,是对他人情绪的觉察而导致自己情绪唤起的一种情感体验。培养儿童的移情对儿童的道德发展具有重要作用。本文从移情的概念入手,介绍和探讨儿童移情与道德发展的关系研究状况,并对儿童的移情培养提出建议。     

On Nanotechnology and Ambivalence: The Politics of Enthusiasm

The promise of scientific and technological innovation – particularly in fields such as nanotechnology – is increasingly set against what has been articulated as a deficit in public trust in both the new technologies and regulatory mechanisms. Whilst the development of new technology is cast as providing contributions to both quality of life and national competitiveness, what has been termed a ‘legitimacy crisis’ is seen as threatening the vitality of this process. However in contrast to the risk debates that dominated the technological controversies of the late 1990s the vitality of technological innovation is now cast as vulnerable to lack of public confidence and trust in the regulatory and governance structures upon which such innovation depends. In order to address this deficit in public trust, science policy has increasingly turned to the social sciences, suggesting that public values might be incorporated into the development of nanotechnology at an early stage. Public ambivalence therefore constitutes the problem addressed by the increasingly central role that public engagement and participation play in contemporary science policy. Although the recent proliferation of public engagement activities is premised on the need to address this ambivalence through direct engagement, we re-interpret ambivalence as an engaged – rather than passive – mode of relating to technological determinism. Whilst the move toward forms of direct public engagement might be regarded as symptomatic of the emergence of affective mode of governance we interpret public ambivalence as a nested set of enthusiasms and anxieties. Accordingly we suggest that public engagement might be re-thought, utilising ambivalence as a creative resource, rather than as the problem.

A circuit for video-tape interviewing and its recording reliability

A circuit to automate fully a standardized video-taped interview (SVTI) is developed. Data are reported demonstrating good instrument reliability.     

A model of aesthetic appreciation and aesthetic judgments

Although aesthetic experiences are frequent in modern life, there is as of yet no scientifically comprehensive theory that explains what psychologically constitutes such experiences. These experiences are particularly interesting because of their hedonic properties and the possibility to provide self‐rewarding cognitive operations. We shall explain why modern art's large number of individualized styles, innovativeness and conceptuality offer positive aesthetic experiences. Moreover, the challenge of art is mainly driven by a need for understanding. Cognitive challenges of both abstract art and other conceptual, complex and multidimensional stimuli require an extension of previous approaches to empirical aesthetics. We present an information‐processing stage model of aesthetic processing. According to the model, aesthetic experiences involve five stages: perception, explicit classification, implicit classification, cognitive mastering and evaluation. The model differentiates between aesthetic emotion and aesthetic judgments as two types of output.     

Men,shame and antisocial behavior: A psychodynamic perspective

This paper discusses the psychosocial factors that contribute to male antisocial behavior. The role of shame and related affects is emphasized. Compensatory defenses associated with these affects are also described. Developmental concepts are reviewed in the light of recent research. Finally, some of the issues involved in doing psychotherapy with this population are discussed, with an emphasis on the value of group therapy.Parts of this paper were presented at the second annual conference onCulture, Race and Ethnicity in Group and Family Therapy which was sponsored by the Eastern Group Psychotherapy Society and New York University and was held in New York City, March 20–22, 1987.     

Psychosis: A Synthesis of Motivational and Defect Perspectives

Based on the evolution of human intelligence and the tremendous cognitive capacities arising from it, we have an innate tendency for the extreme thought content, thought form, and sensory perceptions of psychosis. During the conscious and awake state, cognitive regulatory control processes block these more extreme variants to facilitate reality congruency necessary for adaptive functioning. While asleep there is no need for reality congruency and the cognitive regulatory control processes are deactivated allowing psychotic equivalents to be expressed in dreams. This paper helps synthesize the two dominant perspectives regarding the etiology of psychosis: the neuroscience defect perspective and the psychoanalytic motivational perspective. Regarding the former, defective cognitive regulation arising from certain conditions, such as the deficit state of schizophrenia, allows extreme cognitive distortions, thought form variants, and sensory perceptual experiences to intrude into the conscious and awake state, thereby producing psychosis. Consistent with the psychoanalytic motivational perspective, defensive processes can motivate extreme cognitive distortions, thought form variants and sensory perceptual experiences, and also facilitate their expression by deactivating the relevant cognitive regulatory control processes.     

Ambivalence, discomfort, and motivated information processing

In two studies we examined the nature and consequence of ambivalent attitudes. In the first study, we assessed whether holding ambivalent attitudes was aversive, and tested whether this aversion was resolved through biased information processing. To do this we manipulated participants’ attributions of the discomfort associated with an ambivalent message through a pill manipulation (tense vs. relaxed). Participants who attributed their discomfort to their ambivalence reported more negative emotions and generated more one-sided thoughts than participants who attributed their discomfort to the pill. In the second study, we examined the conditions necessary for ambivalence reduction. Results suggest that people spontaneously engage in biased information processing in order to resolve their ambivalence.     

Empathy and emotion recognition in semantic dementia: A case report

Recent studies have demonstrated that patients suffering from frontotemporal lobar degeneration (FTLD) show impairments in empathy and emotional processing. In this study, we examined two different aspects of these abilities in a patient with semantic dementia (SD), a variant of FTLD. The first aspect was the assessment of the cognitive and emotional components of empathy through the Interpersonal Reactivity Index. The second was the naming and comprehension of emotions using the Ekman 60 Faces Test. The patient’s emotion word knowledge was spared and the emotional aspects of empathy preserved. Conversely, the patient performed below average for all of the basic emotions when an emotion word had to be matched with a picture. When picture-to-picture matching was tested, however, the patient was able to recognize happiness. This case is a good example of a dissociation of covert and overt emotional functioning in SD. Results are discussed in terms of the impaired empathic behavior and emotional functioning in FTLD.     

What Every Therapist Should Know,Be and Do: Contributions from Humanistic Psychotherapies

Humanistic psychologists have made major contributions to the theory, practice and research in psychotherapy. Many of their contributions are applicable to a variety of therapeutic approaches. In this article I articulate what I believe to be some of the most useful things for all practitioners to consider incorporating into their therapeutic practice. Carl Rogers’ contributions are considered to be universal and foundational since his strong emphasis on the therapeutic relationship and the importance of empathic responding are considered to be core aspects of effective therapies. A variety of humanistic therapists have emphasized the importance of working with client emotion, effective use of the self, relational involvement and depth, working within the client’s frame of reference, focusing on the self-concept, being present and helping clients embrace choice and responsibility, all of which are addressed in this article.     

A psychodynamic approach to suicide: a critical and selective review

This paper begins by critically exploring Freudian and post-Freudian understandings of suicide, although due to limitations of space it is not comprehensive. Several examples drawn from clinical practice are then considered in relation to the theoretical ideas previously discussed. The paper then moves on to reconsider psychodynamic approaches to suicidal clients from a Levinasian ethical position. The possibility that suicide may be a logical part of what it is to be human, rather than an indication of mental illness, is advanced.     

Attitudes and uptake of a screening test: The moderating role of ambivalence

This study examined the extent to which ambivalence moderates the relationship between attitudes and screening behaviour in a clinical setting using an objective measure of behaviour. For this study 979 pregnant women eligible for prenatal Down syndrome screening completed questionnaire measures of attitudes, ambivalence and intentions towards undergoing the test. Screening behaviour, assessed by test uptake, was determined from medical records. Attitudes predicted intentions to undergo the test and screening behaviour. The correlations between attitudes and intentions and between attitudes and behaviour were greater in women with lower levels of ambivalence (r?=?0.85 and r?=?0.58, respectively) than in those with higher levels of ambivalence (r?=?0.50 and r?=?0.27, respectively). Regression analyses revealed that ambivalence moderated the relationships between attitudes and intention and between attitude and behaviour. In addition, a three-way interaction was found between ambivalence, attitudes and intention when predicting behaviour. Given that behaving consistently with attitudes is central to making an informed choice, ambivalence appears to undermine the making of such choices.     

Cocaine addiction and personality: A mathematical model

The existence of a close relation between personality and drug consumption is recognized, but the corresponding causal connection is not well known. Neither is it well known whether personality exercises an influence predominantly at the beginning and development of addiction, nor whether drug consumption produces changes in personality. This paper presents a dynamic mathematical model of personality and addiction based on the unique personality trait theory (UPTT) and the general modelling methodology. This model attempts to integrate personality, the acute effect of drugs, and addiction. The UPTT states the existence of a unique trait of personality called extraversion, understood as a dimension that ranges from impulsive behaviour and sensation‐seeking (extravert pole) to fearful and anxious behaviour (introvert pole). As a consequence of drug consumption, the model provides the main patterns of extraversion dynamics through a system of five coupled differential equations. It combines genetic extraversion, as a steady state, and dynamic extraversion in a unique variable measured on the hedonic scale. The dynamics of this variable describes the effects of stimulant drugs on a short‐term time scale (typical of the acute effect); while its mean time value describes the effects of stimulant drugs on a long‐term time scale (typical of the addiction effect). This understanding may help to develop programmes of prevention and intervention in drug misuse.     

Affect, unconscious and sensemaking. A psychodynamic, semiotic and dialogic model

The work presents a psychodynamic, semiotic and dialogical model of affect and of the role it plays in sensemaking. The model is based on the following three general assumptions.A) Affective semiosis works in accordance to the dynamic unconscious which Freud conceptualized in terms of primary process. According to this interpretation, the unconscious is the mind’s homogenising way of functioning, which transforms every categorical relation into a relation of identity. B) Affect is the generalized, homogenising and absolutizing embodied basic intersubjective meanings according to which experience is interpreted. C) Affective semiosis performs both the grounding and regulative functions in sensemaking, orienting the way people interpret experience.