Group psychotherapy of the characterologically difficult patient

A broad range of characterologically difficult patients present for treatment in psychotherapy groups. Despite different clinical presentations, including features of the schizoid, borderline, and narcissistic personality disorders, these patients share a common developmental failing. Specifically, these individuals have failed to attain object constancy and the associated stable internalization of tolerably ambivalent representations of the self, and of the other, in relationship with one another. Splitting mechanisms predominate over integrative ones, as primitive defenses are utilized to deal with the individual's powerful needs and fears related to engagement and intimacy. These maladaptive interpersonal styles are clearly illuminated in group therapy, but often to the exclusion of the latent, intrapsychic derivatives of this behavior, with detrimental effects. This paper examines the group therapy of such patients from the perspective of object relations and self psychology theories, models that provide the essential link between the interpersonal and the intrapsychic worlds.     

The role of self-compassion during difficult economic times

Background and objectives: The negative effects of the financial crisis of 2007/2008 are still being felt today as seen in the relatively high levels of youth unemployment in many countries. As a result, many young people experience high stress levels when facing an uncertain and precarious job market.

Methods: Participants were 178 undergraduate students (79% female; M_age?=?20.00, SD?=?4.29) who were randomly assigned to read a news article that documented an uncertain financial future with limited job opportunities (the economic stress group), or an article that documented a tour of the Royal Canadian Mint (the control group). The role of self-compassion was explored in its relation to distress.

Results: Correlational and hierarchical regression analyses indicated that, in the economic stress group, self-compassion negatively predicted anxiety above and beyond self-esteem and familial support. In the control group, however, self-compassion did not negatively predict anxiety above and beyond self-esteem and familial support. Additionally, structural equation modeling indicated that self-compassion was directly associated with lower anxiety and indirectly related to anxiety through perceptions of financial threat.

Conclusions: These findings suggest that self-compassion may be an important resource that is associated with less distress during times of economic threat.     

Symposium: A discussion of the videotapes of a difficult group

Three conference participants (Drs. Yvonne Agazarian, Louis Ormont and Saul Tuttman), each an experienced group therapist employing distinctly different styles and theoretical frames, react to a videotape of a Difficult Group and offer their respective critique and suggestions. The material was originally presented before an audience at the Eastern Group Psychotherapy Association Annual Conference (1985) in New York City. The audience first saw the videotape at the conference and then observed the interaction among panelists. This material was submitted for publication because: 1) issues of contrasting technique and theory are heightened by a concrete comparison of different clinicians' reactions to the same material; 2) the serious task of coping with a group of difficult patients is of concern to all group therapists who are faced with such challenges; 3) the circumstances, in which patients who feel needy and neglected chronically put pressure on the therapists, occur with frequency; at the same time, 4) the therapists are also under stress in that their supervisors and evaluators are scrutinizing their work. All of this makes for a fascinating and difficult dynamic situation. Finally, 5) examining this group material resulted in a lively exchange which was stimulating and interesting to both audience and participants.Yvonne Agazarian, Ed.D., is in private practice in Philadelphia, Pennsylvania.     

Why Skinner is difficult

Skinner's views are commonly misrepresented. One reason for this difficulty is that changes in the way that Skinner formulated his views occurred in a gradual evolution over time throughout Skinner's career, and the changes and their significance were not as conspicuously marked as they might have been. Among these changes were a movement from a two-term necessity to a three-term contingency; a movement from discriminative stimulus to setting as the first term in his three-term contingency; and a movement from determinism to random variation as a foundational principle in his selectionist behaviorism. When not seen in their historical development over time, a sample reading of Skinner's views may readily result in misleading or inaccurate interpretations, particularly in respect to his later work. Seen in historical context, however, the accounts that survived after the changes Skinner made are well integrated in a selectionist theory of behavior.     

Psychoanalytic supervision of the difficult patient

Control cases from the broad group of non-neurotic but potentially analyzable patients appear with increasing frequency. The intense, complex transferences they develop place great stress on the psychoanalytic relationship and evoke marked countertransference reactions in psychoanalytic candidates, which reverberate within the supervisory relationship. Through application of a case study method, common themes emerge in the candidate-supervisor dyad: idealization of the supervisor and of classical technique, identification with the patient, parallel process enactments, difficulty maintaining the analytic frame, and the importance of concurrent training analysis. Classical supervisory techniques must be adapted to the "difficult" (non-neurotic) control case. Complex countertransference issues must be carefully addressed while maintaining the teach/treat boundary.     

The bogeyman cometh: a strategic approach for difficult adolescents

Unpredictable and threatening events can sometimes alter one's view of reality. The altered perception may in turn result in altered forms of behavior and interaction with others. Deliberate efforts to facilitate this altered perception is sometimes attempted by invoking mythical forces such as the Bogeyman, Death, Satan, a shaman, or a sorcerer. Anthropological observations of shamanic magic suggest a number of components that appear to be responsible for these reality-altering experiences. These can be employed to create such experiences in the treatment of difficult adolescents for whom usual solutions have been ineffective. The experience results in systemic changes that render the adolescent accessible to more usual forms of treatment and more functional interactions with adults. The crafting of this kind of experience is illustrated in a case example. Parallels with other clinical practices as well as ethical considerations are discussed.     

Toward engaging the difficult patient

The difficult patient is here described as the one who does not readily accept the usual definitions of the treatment relationship and who tends to get the therapist to be overly-engaged in the therapeutic process. The therapist must be clear not only about his own characterological issues and counter-transference predispositions, but also about the unique propensity of these patients for the enactment of conflicts. While empathy is the sine qua non of our therapeutic work, the need to set limits and to address hostility should not be underestimated if these patients are to be engaged in any meaningful psychotherapy. To maintain an empathic perspective, the therapist must appreciate the purposefulness of the patient's defensive characterological behavior and that it cannot simply be dismissed as mere pathology. Such a perspective may help the therapist to better respond to the patient's behavior as a communication about his sense of self and his concerns about relatedness. This will facilitate the engagement process.     

The motivational value of listening during intimate and difficult conversations

Outcomes of conversations, including those dealing with controversial, deeply personal, or threatening disclosures, result not only from what is said but also from how listeners receive these messages. This article integrates the motivational framework of self-determination theory (SDT) and the expanding literature on interpersonal listening to explore the reasons why high-quality listening is so impactful during these conversations. We describe why high-quality listening is a specific and distinguishable autonomy-supportive motivational strategy, and argue that there is much to gain by considering that listening can satisfy basic psychological needs, in particular for autonomy and relatedness. We argue that SDT can help explain why high-quality listening is effective, especially in reducing defensiveness, bridging divides, and motivating change. The discussion focuses on ways motivation science can build more effective interventions for behavioral change by harnessing listening as an interpersonal strategy.     

Acquisition of expertise on a difficult perceptual-motor task by an amnesic patient

While numerous studies have reported learning of perceptual-motor skills by amnesic patients, few if any have documented the eventual acquisition of expertise on a given task. This paper recounts the learning of the computer game Tetris by a hippocampal amnesic, whose acquisition of the task in a formal evaluation was somewhat slower than that of a comparison group, but who after many hours of self-paced practice achieved expert-level play.     

Why are moderators of self-other agreement difficult to establish?

Agreement between the self and other rated personality profiles was studied in two samples involving 11,096 speakers of two languages, Dutch and Estonian, who completed two different personality questionnaires, the NEO-PI-3 and HEXACO-PI-R. An outstanding agreement was achieved in the most occasions: in only 4–6% of dyadic pairs was the correlation between two randomly paired profiles higher than the actually observed correlation between true pairs. As in previous studies, we found that age and sex of participants and length of acquaintance had no significant effect on the level of self-other agreement. However, intimate knowledge helped married and unmarried couples in both samples be more accurate in their personality judgments; family members, in turn, had knowledge that made them more accurate than two people who were just acquaintances or friends. We believe that these outcomes can be explained by the contention that the judgment of another’s personality is a relatively simple task, which is accomplishable for most people most of the time. In other words, because judging another person’s personality is an easy task, we are not able to determine “good targets,” “good judges,” or “good traits.” Perhaps it is only “good information” which determines the closeness of the target-judge relationship, and which has a small but reliable impact on the level of self-other agreement. This explains why it is so difficult to find individual differences in the ability to judge another person’s personality.     

The effect of anxiety,reinforcement, and intelligence on the learning of a difficult task

The effects of anxiety, reinforcement, and intelligence were studied on the learning of a difficult task (paired associates with 1% association values) in 252 subjects studying in class IX in Chandigarh schools (mean age, 14.7 years). A 2 × 3 × 3 factorial design was used with two anxiety groups (high and low), three reinforcement conditions (praise, reproof, and praise + reproof), and three levels of intelligence (high, middle, and low). In general, the results were in line with the Sarasonian theoretical framework that anxiety shows its debilitating effects under certain conditions, but not all. At upper levels of intelligence, neither anxiety nor reinforcement was found significant. At lower levels of intelligence, anxiety was found to interfere with learning under all the reinforcement conditions. It was found further that the most affected group was the middle intelligencehigh anxiety group. This group performed better under praise than under praise + reproof and reproof alone.     

Adaptation to difficult designs: Facilitating use of new technology

The interface between technology and people has long been the focus of human factors engineering. The past decade has been a growth period for cognitive psychologists and computer scientists to collaborate on research and design for human-computer interaction. Psychologists in general and organizational psychologists in particular can also contribute to this work with models that capture the dynamics of technology implementation and the impact of technology on people, their work and working relationships. Strategies to support and adapt technology can affect users' evaluation of new technology. Facilitation may take the form of job aids, training, access to technical support staff, or the design of a comprehensive service, of which new technology is only one component.The work described in this article was conducted while the author was employed at AT&T Bell Laboratories.Portions of this article were presented at the 1991 Annual Convention of the American Psychological Association in San Francisco, and at a 1992 meeting of the New York Metropolitan Human Factors Society. The author wishes to acknowledge Pamela Kidder, Karen Patten and Larry Penwell for their helpful comments on an earlier draft of this article.     

A latent growth‐curve approach to difficult temperament

A purported hallmark of temperament characteristics is that they appear very early in the course of development and are persistent across time and situation. There is, however, a small, but growing cadre of research findings that question this traditional view. It may be that temperament characteristics are not necessarily established during the first few months of development or are not stable over time. A secondary analysis of the New York Longitudinal Study (NYLS) temperament data was conducted to investigate the hypothesis that temperament has a complex developmental course over the first five years of development. A latent growth curve analysis of difficult temperament suggests that temperament development follows a non‐linear trajectory. This finding, in concert with related findings, suggests the need for a broader discussion of the possible developmental processes that underlie these patterns. Copyright © 2007 John Wiley & Sons, Ltd.     

Advantages of difficult tasks1

If people work on a hard task before proceeding to one of intermediate difficulty, success will be relevant (predictive of future success) while failure will be irrelevant (not predictive of future failure). However, if they work first on an easy task, success will be irrelevant (not predictive of future success) while failure will be relevant (predictive of future failure). Previous research thus suggests that experience with hard tasks should always lead to more favorable evaluations of one's performance and better future performance than experience with easy tasks. The present study tested these predictions by manipulating initial expectancy (high or low), perceived difficulty of a set of practice problems (practice problems easier, harder, or equal in difficulty to those on a subsequent test), and practice problem feedback (success or failure). As predicted, experience with hard practice problems was most beneficial, regardless of the level of the feedback which students received. This was more true for males than females and for students with high ability than students with low ability.     

Achieving difficult agreements: Effects of Positive Expectations on negotiation processes and outcomes

Two studies demonstrate that negotiation processes and outcomes can be altered by the creation of Positive Expectations. Study 1 participants were American undergraduates seeking agreement with a confederate about allocation of funds to programs differentially favoring undergraduates vs. graduates. Study 2 participants were Israeli Business School students seeking agreement with an Arab confederate about allocation of funds to projects differentially favoring Israelis vs. Palestinians. In both studies prior information suggesting the consistent success of previous dyads prompted acceptance of the confederate’s “final proposal” whereas merely urging participants to try to reach agreement resulted in consistent rejection of the same proposal. Moreover, participants reaching agreement in these Positive Expectations conditions subsequently offered more positive assessments of the negotiation process and of their counterpart than those doing so in control conditions. The theoretical and applied relevance of these findings, including the role played by post-agreement dissonance reduction, are discussed.     

Successive relearning improves performance on a high-stakes exam in a difficult biopsychology course

Successive relearning combines two effective learning techniques (retrieval practice and spaced practice) and involves practicing retrieval until some level of mastery has been reached (i.e., at least one correct retrieval attempt) in each of multiple sessions. Several laboratory studies have demonstrated the promise of successive relearning for enhancing student learning, but attempts to evaluate its effectiveness in authentic educational contexts are limited. In the current research, we implemented successive relearning in a difficult biopsychology course to examine its effectiveness at enhancing student learning on a high-stakes exam. Students successively relearned some course content via a virtual flashcard program, whereas other course content was learned with business-as-usual activities. In two experiments, successive relearning boosted students' learning of course content by at least 10% (with ds ranging from 0.54 to 1.10). These findings suggest that implementing successive relearning in courses can be an effective method of promoting student achievement.     

Mind wandering while reading easy and difficult texts

Mind wandering is a phenomenon in which attention drifts away from the primary task to task-unrelated thoughts. Previous studies have used self-report methods to measure the frequency of mind wandering and its effects on task performance. Many of these studies have investigated mind wandering in simple perceptual and memory tasks, such as recognition memory, sustained attention, and choice reaction time tasks. Manipulations of task difficulty have revealed that mind wandering occurs more frequently in easy than in difficult conditions, but that it has a greater negative impact on performance in the difficult conditions. The goal of this study was to examine the relation between mind wandering and task difficulty in a high-level cognitive task, namely reading comprehension of standardized texts. We hypothesized that reading comprehension may yield a different relation between mind wandering and task difficulty than has been observed previously. Participants read easy or difficult versions of eight passages and then answered comprehension questions after reading each of the passages. Mind wandering was reported using the probe-caught method from several previous studies. In contrast to the previous results, but consistent with our hypothesis, mind wandering occurred more frequently when participants read difficult rather than easy texts. However, mind wandering had a more negative influence on comprehension for the difficult texts, which is consistent with the previous data. The results are interpreted from the perspectives of the executive-resources and control-failure theories of mind wandering, as well as with regard to situation models of text comprehension.     

Belief bias is stronger when reasoning is more difficult

Three studies examine the influence of varying the difficulty of reasoning on the extent of belief bias, while minimising the possibility that the manipulation would influence the way participants approach the task. Specifically, reasoning difficulty was manipulated by making variations in problem content, while maintaining all other aspects of the problems constant. In Study 1, 191 participants were presented with consistent and conflict problems varying in two levels of difficulty. The results showed a significant influence of problem difficulty on the extent of the belief bias, such that the effect of belief was more pronounced for difficult problems. This effect was stronger in Study 2 (73 participants) where the difference in the difficulty of the problems was purposely accentuated. The results of both studies stress the importance of controlling for problem difficulty when studying belief bias. Study 3 examined one consequence of this, i.e., the classic belief vs. logic interaction could be eliminated by manipulating problem difficulty. Theoretical implications for dual-process accounts of belief bias are also discussed.