What Makes Susie Cry? A Symptom-Context Study of Family Therapy

The aim of this investigation was to examine the context of recurrent crying episodes during family therapy sessions. We tested the relative contribution of social versus individual intrapsychic variables within a 10-session, videotaped, structural family therapy. Segments of therapy before crying episodes when compared with control (non-crying) segments were found to have higher levels of the following variables: involvement with others in the room, rejection, and concern about supplies. Two family variables were also higher before crying episodes: family discussion about patient, and patient receives hostility. A stepwise discriminant function analysis using these variables indicated that family discussion about the patient was most important in signaling onset of crying. The results are discussed in terms of individual and family theories of symptom formation as illuminated through this case study.     

CONSIDERATION OF THE ROLE OF PSYCHOTHERAPY IN REDUCING THE RISK OF SUICIDE IN AFFECTIVE DISORDERS – A CASE STUDY

In this paper material is presented from a patient with a diagnosis of a recurrent affective disorder and exhibiting resistance to engaging in the work of therapy alongside the emergence of active suicidal intent. Supervision can help in containing intensely disturbing feelings in the therapist and aid in identifying the underlying psychosis. Through exploration of the counter‐transference feelings, the therapist can become attuned to a playing down of the psychosis by the patient and alert other involved professionals. Technically, the challenge remains one of how to make an impact in the sessions through converting a psychotic monologue into a dialogue.     

Violent computer games and their effects on state hostility and physiological arousal

An experimental study was conducted to investigate the impact of violent computer games on state hostility, state anxiety and arousal. Participants were undergraduate students, aged from 18 to 25 years. Before the experimental sessions, participants filled in self‐report measures concerning their video game habits and were also pre‐tested for aggressiveness and trait anxiety. Physiological responses (heart rate and skin conductance) were measured during the experiment. After playing, information about state hostility and state anxiety was collected. The results showed that participants who played the violent game reported significantly higher state hostility, and support the assumption that an aggressive personality moderates the effect of playing a violent game on state hostility. Aggr. Behav. 32:146–158. 2006 © 2006 Wiley‐Liss, Inc.     

Violent computer games and their effects on state hostility and Physiological arousal

An experimental study was conducted to investigate the impact of violent computer games on state hostility, state anxiety and arousal. Participants were undergraduate students, aged from 18 to 25 years old. Before the experimental sessions, participants filled in self‐report measures concerning their video game habits and were also pre‐tested for aggressiveness and trait anxiety. Physiological responses (heart rate and skin conductance) were measured during the experiment. After playing, information about state hostility and state anxiety was collected. The results showed that participants who played the violent game reported significantly higher state hostility and support the assumption that an aggressive personality moderates the effect of playing a violent game on state hostility. Aggr. Behav. 32:358–371. 2006. © 2006 Wiley‐Liss, Inc.     

Suicidal Ideation in Elderly Bereaved: The Role of Complicated Grief

This study examined whether symptoms of complicated grief at baseline predicted suicidal ideation during a depressive episode in elderly bereaved individuals. Over a 17-month period, serial ratings of suicidal ideation, hopelessness, and symptoms of depression, anxiety, and complicated grief were obtained from 130 elderly participants who had lost their spouses within the past 2 years. Groups of active and passive suicidal ideators, as well as nonideator controls, were compared via analysis of variance (ANOVA) with respect to levels of complicated grief, depression, and anxiety. Elderly bereaved with both active and passive suicidal ideation were found to have higher symptomatic levels of depression, hopelessness, complicated grief, and anxiety, as well as lower levels of perceived social support, than nonideators at study entry. Fifty-seven percent of the patients with high complicated grief scores were found to be ideators during the follow-up versus 24% of the patients with low complicated grief scores. Patients with any suicidal ideation had higher symptom levels of depression, anxiety, and complicated grief when they were ideators as compared with periods when they denied ideation. Fifteen out of the 39 ideators had recurrent depressive episodes versus 5 of the 91 nonideators. Patients with a history of suicide attempts were more likely to be ideators after loss than other bereaved. Thus, the condition of having high levels of complicated grief symptoms and depressive symptoms appears to make bereaved individuals vulnerable to suicidal ideation. Detection of high levels of complicated grief could help clinicians identify patients who may be at heightened risk for suicide.     

Increasing access to low‐intensity interventions for childhood anxiety: A pilot study of a guided self‐help program for Scandinavian parents

Cognitive Behavior Therapy (CBT) is an effective treatment for child anxiety. However, access to treatment is limited. It has been suggested that low‐intensity formats of parent‐delivered CBT may improve access to treatment. Our aim was to develop and pilot‐test the acceptability and effect of a low‐intensity therapist‐guided parent‐delivered group program for anxious children (age 7–12 years) adjusted to the Scandinavian culture. The program required 1.5 hours of therapist‐time per family. Mothers, fathers and children reported on revised child anxiety and depression scale (RCADS) at referral, pre‐ and post‐treatment. Mothers and fathers also gave a qualitative account of their experiences. Thirty‐one families were enrolled and only one family dropped out. Mean age of the children was 9 years. Intent‐to‐treat analyses revealed significant reductions in anxiety and depressive symptoms from pre‐ to post‐treatment for all informants. Large effect sizes were found for child anxiety symptoms as reported by mothers and fathers, and for child depressive symptoms as reported by mothers. Medium to large effect sizes was found for the self‐reported anxiety symptoms by the children, and for depressive symptoms reported by both children and fathers. More than 93% of the parents would recommend the program. Results suggest that our program may provide a new approach to improve access to treatment for anxious children in Scandinavia; however, further research must be conducted before firm conclusions can be drawn.     

Hopelessness as a Risk Factor for Post‐traumatic Stress Disorder Symptoms Among Interpersonal Violence Survivors

Post‐traumatic stress disorder often co‐occurs with depression, and they may share common risk factors. One possible common cognitive risk factor is hopelessness. Thus, we examined whether hopelessness was related to symptoms of post‐traumatic stress disorder. Participants were 202 female survivors of interpersonal violence. Relationships between self‐reported and interviewer‐rated measures of hopelessness gathered at 2 weeks post‐trauma and self‐reported and interviewer‐rated symptoms of post‐traumatic stress disorder gathered at 2 weeks and 3 months post‐trauma were examined. Hierarchical, simultaneous regression analyses that co‐varied trauma type revealed that hopelessness was related to self‐reported symptoms of post‐traumatic stress disorder, both concurrently and prospectively. Follow‐up analyses revealed that relationships between hopelessness and symptoms of post‐traumatic stress disorder were due almost entirely to shared variance with depression. No relationships were found between hopelessness and interviewer‐rated symptoms of post‐traumatic stress disorder.     

A comparison of two online cognitive‐behavioural interventions for symptoms of depression in a student population: The role of therapist responsiveness

Objectives: The study aimed to compare the efficacy of eight weekly sessions of a self‐administered online CBT treatment (cCBT; n=51) to a therapist‐assisted email CBT treatment (eCBT; n=50) in University students. Design: The design was a randomised parallel group trial. The study randomised participants with symptoms of depression to one of two available treatments. Method: Participants were offered eight weekly sessions of either cCBT or eCBT. Participants completed the Beck Depression Inventory‐II (BDI‐II) and the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE‐OM) at pre‐and post‐treatment, at weeks 16 and 32 follow‐up. The Working Alliance Inventory‐Short Form (WAI‐SR) was completed at weeks 2, 4, and 6. Results: For both groups, pre‐post within group effect sizes reported were large for the BDI‐II and the CORE‐OM and these were maintained at follow‐up. Perceptions of working alliance were similar in each group, but Bond was significantly stronger for the eCBT condition. WAI scores correlated more positively with the outcome on BDI‐II for those in the eCBT condition than the cCBT condition, but not significantly. Conclusion: There were no significant differences between the two online treatments, both reduced depressive symptoms and improved general functioning. Similarly, at post‐treatment and follow‐up, clinical improvement and recovery was demonstrated for both groups equally. The study demonstrates the possibility for cCBT in a university setting that may contribute to addressing the shortcomings in meeting increasing demands that mental health services presently face.     

Positive and Negative Expectations of Hopelessness as Longitudinal Predictors of Depression,Suicidal Ideation,and Suicidal Behavior in High‐Risk Adolescents

The relationship between hopelessness and depression in predicting suicide‐related outcomes varies based on the anticipation of positive versus negative events. In this prospective study of adolescents at elevated risk for suicide, we used two Beck Hopelessness Scale subscales to assess the impact of positive and negative expectations in predicting depression, suicidal ideation, and suicidal behavior over a 2‐ to 4‐year period. In multivariate regressions controlling for depression, suicidal ideation, and negative‐expectation hopelessness, positive‐expectation hopelessness was the only significant predictor of depressive symptoms and suicidal behavior. Clinical interventions may benefit from bolstering positive expectations and building optimism.     

The manifestation of transference during early psychotherapy sessions: Exploring an alternate data source for therapist narratives in transference research

Introduction: Previous transference studies have compared in‐session client narratives about significant others to in‐session client narratives about the therapist, limiting data to the information that clients are willing to share with the therapist. Method: The first three sessions of 30 therapies with high‐functioning individuals were examined using the Core Conflictual Relationship Theme (CCRT) method. Client narratives about others were drawn from the psychotherapy sessions and client narratives about the therapist were drawn from a Participant Critical Event (PCE) interview conducted after the third session of therapy. Results: Factor analyses of the CCRT components indicated several relational patterns: a complementary pattern of relating characterised by a devaluation of the therapist and idealisation of others; a concordant relational transfer where clients feel bad with both the therapist and others; and as clients experience control issues with significant others, they wish to adopt a submissive stance toward the therapist. The results suggest that the source of therapist narratives may influence the results of transference research.     

How do therapists ally with adolescents in family therapy? An examination of relational control communication in early sessions

Sequential analyses examined associations between the working alliance and therapist-adolescent communication patterns in 10 Spanish cases of brief conjoint family therapy. Early sessions with strong versus problematic alliances, rated by observers, were selected for coding of relational control communication patterns. No differences were found in the frequency of exchanges, but competitive responding by the therapists (reflecting an interpersonal struggle for control) was significantly more likely in problematic alliance sessions than in strong alliance sessions. Cases in which the adolescent's alliance with the therapist remained positive from Session 1 as compared with Session 3 showed a decrease in the likelihood of competitive symmetry. Notably, when the quality of the alliance deteriorated over time, the therapists were increasingly more likely to respond to the adolescents' domineering messages in a competitive manner. Results underscore the need to avoid competitive responding in order to ally with adolescents in conjoint family treatment.     

Attributional Style, Self-Esteem, and Human Immunodeficiency Virus: A Test of the Hopelessness and Self-Esteem Theories of Depression

Research on the hopelessness and self-esteem theories of depression (Abramson, Metalsky, & Alloy, 1989; Metalsky, Joiner, Hardin, & Abramson, 1993) suggests that HIV-infected persons with depressotypic attributional style (AS) and low self-esteem (SE) may be at risk for onset of a syndrome referred to as hopelessness depression (HD). In a prospective study conducted to test these theories, measures of anxiety and depression, AS, and SE were administered to 85 HIV+ and 43 HIV– men; symptoms were reassessed 6 months later. Results indicated that: (1) The interaction of AS, SE, and HIV status predicted change in HD symptoms, but not overall depression or anxiety symptoms; (2) HIV+ men with depressotypic AS and high SE had increased HD symptom levels while other men with high SE had decreased HD symptom levels; (3) HD symptoms remained stable over the 6-month interval among men with low SE; and (4) High SE predicted decreases in anxiety symptoms among HIV– men, but not among HIV+ men. Contrary to the study hypothesis, these findings suggest that among individuals with life-threatening illnesses such as HIV infection, those with depressotypic AS and high SE may be at highest risk for onset of HD.     

A Patient Who Does Not Look: A Collaborative Treatment with Video Feedback

We describe a collaborative treatment of a woman in face-to-face psychoanalytic psychotherapy (with Larry Sandberg), whose persistent gaze aversion was a symptom immune to interpretive efforts. After many years of treatment, the patient agreed to engage in video feedback sessions (with Beatrice Beebe), which have occurred for the past decade. The face of Dr. Beebe, but not the face of the patient, was videotaped during psychotherapy sessions. Dr. Beebe and the patient then reviewed segments of the videotaped session, collaboratively observing and thinking together, translating between the verbal dialogue and the therapist’s implicit action dialogue. We examine the impact of this intervention on the psychotherapy process.     

Effects of training on age estimation

This study examined the possibility to improve accuracy of age estimates through training. Thirty‐four participants were divided into an experimental and a control group. The sessions included a pre‐test before training, six feedback or no‐feedback training tests and a post‐test after training. The experimental group performed the feedback tests and the control group the no‐feedback tests. Training was found to improve age estimation accuracy, particularly estimations of old stimuli, and training with feedback seemed to be superior to training without feedback. No difference was found between the groups at pre‐test, but at post‐test the experimental group exhibited greater accuracy in age estimation. Moreover, the experimental group increased its accuracy between the pre‐ and post‐tests. Copyright © 2006 John Wiley & Sons, Ltd.     

The relationship of sex-role stereotypy to anger expression and the report of psychosomatic symptoms

The purpose of this investigation was to assess the relationship between selected psychological and behavioral measures concenred with the expression of anger and the report of psychosomatic symptoms. Presumably healthy college students filled out a symptom inventory which served as the criterion measure. Additionally, questionnaires were used to measure sex-role stereotypy, assertiveness, various types of hostility, and hostility guilt, which were then employed in a series of related analyses. Results supporting predicted relationships consistently demonstrated a positive association between the number of symptoms and indirect expression of anger as well as certain stereotypically feminine traits. Significant negative correlations were found between the symptom measure and assertiveness and between the symptom measure and scores on masculinity scales. Predictions that symptom frequency would be negatively related to the direct expression of hostility and positively related to hostility-guilt were not supported.     

CONVERSATION ANALYSIS AND PSYCHOANALYTIC PSYCHOTHERAPY RESEARCH: QUESTIONS,ISSUES, PROBLEMS AND CHALLENGES

Understanding the talk of the ‘talking cure’ remains a central goal of researchers in psychoanalytic psychotherapy. Here, we consider whether conversation analysis (CA) can provide techniques to understand better the conduct of the psychoanalytic therapeutic interaction. Following discussion outlining the participant‐oriented nature of this qualitative methodology we consider reasons for the emergence of CA‐informed studies of psychoanalytic psychotherapy. Amongst other aims, CA focuses on uncovering the process and procedures which make the therapy encounter a distinct form of ‘institutional life’. For psychoanalytically‐oriented researchers, CA can refine their skills of attention and engender sensitivity to understanding material in sessions. Using examples from segments of talk between a training therapist and client we highlight both the advantages of, and constraints on, employing CA as an aid to understanding psychotherapeutic sessions by considering contrasting conceptions of temporality in conversation analysis and psychoanalysis. In the former participants are oriented towards the ongoing production of sequential understandings and local ‘context’ in an unfolding present, in the latter participants aim to enhance the emergence of the remote past into the present of the therapeutic interaction. While recognizing the research benefits of CA methodology concluding comments raise questions regarding the potential complementarity between our dispositions towards the close monitoring of the activity and the feelings of fellow humans.     

Psychotherapy groups and individual support to enhance mental health and early dyadic interaction among drug‐abusing mothers

The purpose of this controlled study was to examine the outcome of psychodynamic mother–infant group psychotherapy (PGT) outpatient intervention for drug‐abusing perinatal mother–infant dyads. PGT comprised 20 to 24 weekly 3‐hr sessions with 3 to 5 months of follow‐up. A comparison intervention group was formed of mothers participating in individually tailored psychosocial support (PSS) lasting, on average, 12 months and providing mother–infant support and practical counseling. We hypothesized that positive changes would occur in maternal drug abuse, mental health, and mother–infant interaction, especially in the PGT group due to its more intensive therapeutic focus. Participants were 26 drug‐abusing dyads in PGT, 25 in PSS, and 50 dyads in a non‐drug‐abusing comparison group. Assessments were pre‐intervention and at 4 and 12 months' follow‐up, including maternal depressive symptoms and mother–child interaction assessed by the Emotional Availability Scales (EA). As hypothesized, in dyadic interaction maternal hostility decreased significantly in the PGT group, and intrusiveness decreased in both intervention groups, but especially in the PTG group. However, both interventions showed a general improvement in the quality of mother–infant interaction. They also succeeded in sustaining high maternal abstinence, treatment retention, and alleviating depressive symptoms. The findings are discussed in relation to preventing negative transgenerational interaction patterns in the high‐risk dyads.     

SEXUAL MORES,ETHICAL THEORIES,AND THE OVERPOPULATION MYTH

Some of the causes of the ‘sexual revolution’ during the past few decades are widely known: The development of relatively safe and reliable contraceptives, especially the birth‐control pill; the ‘morning after’ pill; antibiotics to relieve or cure sexually transmitted diseases such as gonorrhea, herpes, and syphilis; the increased social acceptance of pre‐marital sex, homosexuality, and other behaviors that formerly were considered deviant; and the legalization of abortion as the ultimate ‘contraceptive’. But little attention has been paid to two rather cerebral factors relevant to these developments – namely, ethical theories, and theories of overpopulation. In this paper I will argue that these two less well‐known and more subtle factors have been at least as powerful as the more obvious factors mentioned above, in bringing about sea‐changes in sexual mores. More specifically, I will argue that some implicit approaches to ethical theory are more conducive than others to bringing about the present status quo in sexual mores, and that the widespread belief in world overpopulation has not only changed the moral climate regarding sexuality, but has helped to redefine what is moral and what is immoral.     

The process of change in cognitive therapy for depression: Predictors of early inter-session symptom gains

Although cognitive therapy for depression is an efficacious treatment, questions about the aspects of the therapy that are most critical to successful implementation remain. In a sample of 60 cognitive therapy patients with moderate to severe depression, we examined three aspects of therapists’ adherence to cognitive therapy techniques, the patients’ facilitation or inhibition of these techniques, and the therapeutic alliance as predictors of session-to-session symptom improvement across the first five therapy sessions. Two elements of therapist adherence (viz., cognitive methods and negotiating content/structuring sessions) emerged as the strongest predictors of symptom improvement. Patient facilitation or inhibition of therapist adherence also predicted subsequent symptom change. Neither adherence to behavioral methods/homework nor the therapeutic alliance was a significant predictor in parallel analyses. Although alliance scores did not predict subsequent symptom change, they were significantly predicted by prior symptom change. These findings support the model of change that motivates cognitive therapy for depression, and they highlight the potential role of patient facilitation of therapists’ adherence in treatment response.