Conceptualizing Psychopathy: A Psychodynamic Approach

Drawing from analytic theory and clinical conceptualization, three major types of psychopathy are detailed: Superego deficit, aggression driven, and sadism. The types of psychopathy are discussed in terms of their overlap with personality disorders. The range of sadism is charted from the enjoyment of inflicting pleasure to the borderline manifestations in compulsive reenactments in psychopathic patients. Two categories of antisocial behavior— low social intelligence and poor impulse control—are elaborated clinically as inconsistent with the psychodynamic formulation of characterological psychopathy. The divergence between psychodynamic and behavioral approaches to antisocial behavior is discussed, and unresolved enigmas in the formulation of psychopathy are outlined.     

Multigenerational Sexual Abuse: A Cognitive Developmental Approach to Understanding Mothers in Treatment

This paper takes a cognitive developmental perspective in the qualitative analysis of 9 interviews of women who were sexually abused as children and whose children were also sexually abused. It discusses ways in which the development of cognitive self-understanding can by stymied by childhood sexual abuse and how this, in turn, can affect a woman's ability to parent her children and take full advantage of psychotherapy. It studies the recovery process that participants describe at various stages of a social cognitive developmental model of self-understanding. Finally, it promotes the use of a cognitive developmental perspective in clinical work and offers suggestions for counselors addressing issues of childhood sexual victimization.     

A Contextual Approach to Scientific Understanding

Achieving understanding of nature is one of the aims of science. In this paper we offer an analysis of the nature of scientific understanding that accords with actual scientific practice and accommodates the historical diversity of conceptions of understanding. Its core idea is a general criterion for the intelligibility of scientific theories that is essentially contextual: which theories conform to this criterion depends on contextual factors, and can change in the course of time. Our analysis provides a general account of how understanding is provided by scientific explanations of diverse types. In this way, it reconciles conflicting views of explanatory understanding, such as the causal-mechanical and the unificationist conceptions.     

A Psychodynamic Treatment for Severe Personality Disorders: Issues in Treatment Development

We describe a psychodynamic treatment modified for patients with severe personality disorders identified as borderline personality disorder in DSM-IV, Axis II, and understood as borderline personality organization from a psychoanalytic perspective. This treatment is labeled transference-focused psychotherapy (TFP) in order to highlight the centrality of working with these patients in the here-and-now treatment interaction. The empirical development of TFP is described, including the generation of a treatment manual, the utility of various methods to teach the treatment, and preliminary data on efficacy. The latest step in the development of this treatment is an ongoing randomized clinical trial comparing the efficacy of TFP to a cognitive-behavioral and a supportive treatment.     

A Short-term Psychodynamic Supportive Psychotherapy for Adolescents with Depressive Disorders: A New Approach

Depression is one of the most common psychiatric disorders in both adolescents and adults. In this article, we introduce Short-term Psychodynamic Supportive Psychotherapy (SPSP) for adolescents, a relatively new form of psychodynamic therapy for depression that has been studied in a range of randomized controlled trials with adult patients. SPSP emphasizes the relational aetiology and significance of depression and is characterized by a supportive attitude which focuses more on working in the here-and-now relational patterns rather than interpreting transference manifestations. The supportive attitude of the therapist is advocated to engage the adolescent in the therapeutic relationship and to foster his or her innate developmental capacities by attending to previously unaddressed developmental needs. The developmental perspective’s interest in defense styles and stagnation resulting from problems in past and current relationships opens up opportunities for acquiring insight and change. The focus on relational functioning makes it a promising approach for adolescents because they can implement any positive change immediately in their actual environment, immersed as they are in many new and varied relationships.     

A Systems Approach to Understanding and Improving Research Integrity

Science and Engineering Ethics - Concern about the integrity of empirical research has arisen in recent years in the light of studies showing the vast majority of publications in academic journals...     

From Dyad to Triad: On Psychodynamic Meanings of Psychiatric Treatment

The professions of psychiatry and psychotherapy are both complementary and competitive. This paper examines the dialectic tension between the two. It observes the complexity in having psychiatric evaluation and treatment in the context of ongoing psychotherapy. A referral to a psychiatrist is a meaningful, and a charged intrapsychic and interpsychic event for the patient as well as for the two therapists involved. The nature of the triangle is affected by the inner worlds of the three participants; therefore, the more awareness to the shared work, the better the communication between the three sides of this triangle. The referral to a psychiatrist by a psychotherapist is described as a specific type of an enactment in which the therapeutic dyad is becoming a tirade with all the implications attached. As opposed to the dichotomous perception of the psychiatric intervention as a temporary interruption and reduction of the therapy, this paper offers a model of cooperation between professions that will create a wider and deeper therapeutic space.     

Stuttering: Significant Theories and Therapies by Eugene F. Hahn

Video feedback amplifies critical individual and group processes that have implications for a social theory of the self. The judicious use of video replay facilitates the reworking of identity by (1) inciting the self to “become an object to itself,” thereby triggering new self-reflexive loops of awareness; (2) assisting the self to experience the various perspectives that group members hold toward it, thereby altering its own perspective of itself; (3) enabling the group to become an object to itself, thereby galvanizing a sense of identity and meaning; and (4) allowing clients to view and re-view themselves in a wide range of roles, thereby fostering a multidimensional concept of self. Literature on the use of video in groups is reviewed, and a social theory of the self as explicated by George Herbert Mead is summarized.     

Perfectionism and Psychological Distress: A Modeling Approach to Understanding their Therapeutic Relationship

The present study assessed the effectiveness of a web-based psycho-educational intervention protocol for decreasing levels of perfectionism and psychological distress. Different levels of therapeutic intervention (no treatment, general stress management intervention, general stress management intervention plus cognitive behavioral intervention) were provided to perfectionistic participants over a 10-week period. It was found via a longitudinal structural equation model that higher levels of therapeutic intervention predicted greater improvements in perfectionism and psychological distress. Further, amount of improvement in trait perfectionism and perfectionistic automatic thoughts was highly related to amount of improvement in psychological distress. The findings attest to the potential usefulness of a web-based intervention that combines a general stress management intervention with a cognitive behavioral intervention.     

Understanding Party Identification: A Social Identity Approach

Social identity theory holds that individuals derive their self-concept from knowledge of their membership in a group (or groups) and that they place value and emotional significance on that group membership, with resulting perceptual and attitudinal biases. Individuals favor the in-group to which they belong which they define against a relevant out-group. In this study, a partisan social identity scale was used to reinterpret perceptual features of partisanship through the lens of social identity theory. The social identity of political independents was also examined in an effort to explain the anomalous behavior and identity of partisan leaners. Social identity theory provided a viable alternative framework for understanding the common bipolarity of perceptions regarding the two major U.S. political parties. In addition, an independent social identification may, in part, explain the identity of partisan leaners.     

Stuttering: A multidimensional treatment and evaluation package

A regulated breathing method associated with systematic desensitization and cognitive restructuring was applied to eight adult stutters. Behavioral measures (percentage of stuttered syllable [%SS] and rate of speech) were taken during telephone, interview, and public speaking situations using both obtrusive and unobtrusive conditions. Cognitive and subjective assessment included the Erickson Scale of Communication Attitudes, an irrational beliefs scale, self-efficacy perception, and the percentage of improvement reported by the stutterers. Eight adult nonstutterers were also assessed in identical conditions and compared with the treated subjects in the purpose of a social validation perspective. Results showed that the treatment package significantly reduced stuttering at post-test, and therapeutic gains were maintained at 6 month follow-up study. On the %SS, no significant difference emerged at follow-up between treated stutterers and normals. The multicomponent treatment appears to be a successful treatment for stuttering.     

A Model-Based Approach to Understanding Apraxia in Corticobasal Syndrome

Limb apraxia is a neurological disorder of higher cognitive function characterized by an inability to perform purposeful skilled movements and not attributable to an elementary sensorimotor dysfunction or comprehension difficulty. Corticobasal Syndrome (CBS) is an akinetic rigid syndrome with asymmetric onset and progression with at least one basal ganglia feature (rigidity, limb dystonia or myoclonus) and one cortical feature (limb apraxia, alien hand syndrome or cortical sensory loss). Even though limb apraxia is highly prevalent in CBS (70–80%), very few studies have examined the performance of CBS patients on praxis measures in detail. This review aims to (1) briefly summarize the clinical, neuroanatomical and pathological findings in CBS, (2) briefly outline what limb apraxia is and how it is assessed, (3) to comprehensively review the literature on limb apraxia in CBS to date and (4) to briefly summarize the literature on other forms of apraxia, such as limb-kinetic apraxia and buccofacial apraxia. Overall, the goal of the review is to bring a model-based perspective to the findings available in the literature to date on limb apraxia in CBS.     

Understanding Seat-Belt Intentions and Behavior: A Decision-Making Approach1

In an experimental study designed to investigate a decision-making model of seat-belt use, 227 employees of an agrochemical company participated in a health information program in which they watched either a videotape on seat belts or a control videotape and completed questionnaires immediately afterward and at 3 months and 1 year after exposure. In terms of total effects, the seat-belt videotape influenced beliefs, fear, and intentions assessed immediately after exposure, but had no effect on self-reported frequency of belt use at 3 months or 1 year. A full path analysis indicated some support for the decision-making model. In particular, probability difference (the perceived reduction in risk of death or serious injury due to wearing a belt) had a large influence on intentions to wear a belt and partly mediated the effect of the videotape on intentions. Reported frequency of belt use at 3 months was influenced both by post-test intentions and by initial frequency of belt use. Similarly, belt use at 1 year was affected by belt use at 3 months and by initial belt use. The findings are discussed in terms of the role of subjective probabilities and habitual factors in seat-belt use.     

A Negotiation Approach to Intake and Treatment Choice

Treatment choice is the decision process whereby the psychotherapeutic methods and the psychotherapist are determined when psychotherapy is recommended for a specific client. In this article the problem of treatment choice is situated within an integrative view of psychotherapy. A review of the literature confirms the usefulness of the following concepts for treatment choice: client preferences, client control of the situation of choice, and the mutual acceptability of differing views of therapists and clients. These research findings reveal the importance of four elements in the psychotherapeutic intake strategy: exploration of the client's perspective, informing the client, negotiation as a process of confrontation between the client's and the clinician's perspective, and the client's ultimate choice between alternative treatment proposals.     

Defenses, Personality Structure, and Development: Integrating Psychodynamic Theory Into a Typological Approach to Personality

Psychodynamic theory does not conceptualize motivated unconscious defenses primarily in terms of individual traits. Rather, a person's mechanisms of defense are understood in terms of his or her personality structure and level of psychological development. This paper outlines the way in which this perspective has been integrated into a configural approach to personality assessment. The six-group typology based on the Weinberger Adjustment Inventory (WAI) identifies higher-order personality organization through the intersection of self-reported high/low distress and high/moderate/low self-restraint. The framework incorporates a developmental perspective by assessing affect regulation in conjunction with the internalization of self-regulatory controls. The primary defenses of prototypic members of each of the six groups are highlighted, and hypothesized links to personality traits, stages of ego development, attachment styles, and proneness to specific personality disorders are discussed.