Conversation and Communication by J. A. M. Meerloo

Recent research shows that adolescents are a high-risk group for HIV infection, and that educational campaigns designed to reduce risk taking concerning HIV/AIDS have been largely ineffective with this population. It is probable that irrational psychodynamic processes underlie this risky behavior. In order to explore these behaviors, a sample of low-risk high-school adolescents and one of high-risk institutionalized juvenile offenders were formed into small groups for psychodynamic group therapy. This article presents preliminary findings based on qualitative analysis of the group process. Several sources of participants' difficulties in forming realistic appraisals of HIV/AIDS risk and of acting in accordance with them were unidentified, especially attempts to cope with experiences of loss, developing sexuality, and sexual identity and changing relations with adults. Certain problems were developmentally salient with all adolescents, whereas others were especially marked for the high-risk population of developmentally disturbed adolescents.     

Group therapy for eating disorders: A step-wise approach

Group therapy is emerging as a favored treatment for eating disorders. Open-ended psychodynamic group therapy is an effective treatment for the underlying conflicts in eating-disordered patients, yet these groups are difficult to form. The authors suggest a specific sequence using time-limited psychoeducational groups initially for symptom control, then offering an open-ended group for patients who are ready to address deeper issues in a group therapy setting.     

Sport and Thought. Football as therapy: A year in the life of an inner city project

‘Sport and Thought. Football as therapy, A year in the life of an inner city project’ is a paper based on a way of working that fuses football and psychodynamic thinking. The project was set up at inner city all-boys secondary school in London and was created in response to the growing need for a therapeutic intervention which was accessible to adolescent boys who would not engage via more traditional therapeutic routes. The project works with adolescents experiencing behavioural and emotional difficulties. Sport and Thought is a way of working with adolescents that fuses the sport of football, psychodynamic thinking and theory to create a space to encourage thought and act as a catalyst to promote emotional and behavioural change. Sport and Thought believes an individual’s reactions within a sporting context are no different to a societal one, and thus the sport of football can be used to enable participants to consider their own emotional and behavioural traits, and the underlying reasoning behind them.     

Medical Research: A Midcentury Survey

This article proposes an integrative model for stress management groups for women, representing a biopsychosocial point of view and drawing on theories of psychodynamic group psychotherapy, self-psychology, female development, and stress management. The basis of the model is an eight week traditional stress management group. The novel aspects of this integrative model are that it aims to increase the power of stress management groups for women by providing an articulated frame, attending to group process, promoting curiosity regarding resistance to behavior changes, encouraging the elaboration of affect, and giving importance to the role of relationships in each member's quest for self care and healthy entitlement.     

The piloting of a brief relational psychodynamic protocol (psychodynamic addiction model) for problem gambling and other compulsive addictions: A retrospective analysis

The paper describes a treatment pilot for gambling and compulsive addiction within an NHS problem gambling clinic. The pilot study used a brief relational psychodynamic treatment protocol specifically designed to meet the needs of a group of patients who had not responded to CBT and who had other addictions or co‐morbidities. Seventy‐two (n = 72) patients were offered 12 sessions of therapy by four psychodynamic counsellors. Results were assessed using scores from a pre‐ and post‐treatment patient health questionnaire, the generalised anxiety disorder—7 (GAD‐7) and the Problem Gambling Severity Index (PGSI). Weekly feedback and supervision from counsellors and patients were used to assess the treatment model. The results highlighted that the psychodynamic addiction model was associated with reduced depression (Mean = 14.9; SD: 6.7), anxiety (Mean = 11.5; SD: 5.9), and gambling severity (p < .001), suggesting that a relational psychodynamic treatment is needed for complex patients with compulsive addiction, where CBT had not been successful. These results also highlight the importance of the therapeutic relationship as a critical factor in the treatment of patients with compulsive addiction problems.     

A group treatment program for bulimia nervosa

Seventeen female patients diagnosed as exhibiting bulimia nervosa participated in a shortterm group treatment program. A combination of exposure with response prevention, life skills training, and psychodynamic group interaction was provided. Results in pretest vs. posttest scores on a battery of tests demonstrated improved control over eating behavior and lowered anxiety and depression.     

Gender: A critical factor in a couples group

Couples group therapy should be considered as a primary treatment for marital couples whose dysfunctional interaction is rigidified and chronic. A gender-linked perspective for treatment is developed which expands a psychodynamic approach underscoring power as one of the central issues in marital conflict. Clinical vignettes from couples groups illustrate this model. A gender orientation facilitates the psychodynamic group process, decreases unrealistic expectations of the spouse, and encourages greater acceptance of male/female and individual differences. In this setting, individuals are able to develop new and more functional modes of interaction with their spouses, which generate an increased sense of empowerment.Excerpts from this paper were presented at the American Family Therapy Association meeting in Montreal, 1988.The authors gratefully acknowledge the helpful comments of Henry Grunebaum, M.D., and Fred Sander, M.D.     

A Healthy Lifestyle Program for the Treatment of Obesity in Minority Men

Historically, minority males have had limited success in programs designed to reduce weight. Twenty-five obese minority males participated in a healthy lifestyle program designed to treat essential hypertension, hyperlipidemia, type II diabetes, obesity, and hypothyroidism. Coined the LE ³ AN Lifestyle Program (emphasizing healthy lifestyles, realistic exercise, reasonable expectations and emotions, attitudes, and nutrition), the program offered a treatment model that involved reasonable low-intensity short exercise regimens, instruction, and extensive practice in making healthy food choices, behavior modification, and self-monitoring techniques coupled with guidance on realistic weight loss and exercise expectations. The participants were able to lose 13 Ib during the inpatient plus day treatment phases of the program and continued to maintain a 19-lb weight loss at 12 months. A program overview, case examples, and suggestions to improve outcome efficacy with difficult to manage obese, minority, male patients are provided.     

Decision Making Versus Decision Implementation: An Action Control Approach to Exercise Adoption and Adherence1

Two studies were conducted, one involving adoption of an exercise program and the other involving adherence to an aerobics exercise program. Consistent with action control theory, it was hypothesized that (a) subjective expected utility theory would predict exercise intentions but not exercise behavior in each study; (b) exercise adoption (Study 1) and attendance at an aerobics class (Study 2) would be predictable from the intentions regarding these behaviors expressed by action-oriented but not state-oriented subjects; and (c) subjects who had engaged in planning in regard to exercising would be more likely to adopt an exercise program (Study 1) and would exercise more frequently (Study 2). The findings provide some support for all three hypotheses. Implications of this research are discussed in regard to the distinction between decision making and decision implementation or action control; the relative usefulness of an action-control versus an expectancy-value approach for behavior involving complex decision implementation over a long period of time; the value of action orientation as a moderator of intention-behavior relationships; and the role of planning in exercise behavior.     

The Two Faces of Man by Joost A. M. Meerloo

Abstract

The mystery of why some people are compelled to repeatedly engage in relationships with people who are cruel to them is frequently pondered in literature and psychology. The present paper posits that the etiology of this pathological relationship pattern derives from a parental relationship that was both highly exciting and highly frustrating. Spontaneous recapitulations of the passionate masochistic relationship in the therapy group allow the patient, the therapist and the group to appreciate the exact nature of the “bad” partner’s appeal for the patient and its link to parental antecedents. In addition, the author suggests, group therapy can provide attachment experiences that are stimulating and rewarding enough to override the patient’s attraction to the toxic partner(s) and build an enhanced capacity for intimacy. The cases of two patients are presented who spent three and a half years in the same long term psychodynamic group, and who, through the processes described above, successfully resolved their masochistic relationship patterns.     

Reconsidering the Role of Attitudes in Exercise Behavior: A Decision Theoretic Approach1

Two studies demonstrated that subjective expected utility (SEU) theory predicted interest in, but not adherence to, a weightlifting exercise program. The studies also showed that attitudes were related to adherence for certain individuals. Specifically, attitudes toward not weightlifting were related to the number of days experienced subjects weightlifted. In addition, in Study 1, experienced subjects had more positive attitudes toward weightlifting and more negative attitudes toward not weightlifting than did inexperienced subjects, and the two groups differed on a number of underlying beliefs. Similarly, in Study 2, experienced subjects had more positive attitudes toward weightlifting and differed from inexperienced subjects on a number of underlying beliefs. These results are discussed in terms of their implications for several issues: the usefulness of SEU theory in the exercise domain; the importance of considering attitudes toward alternative courses of action (including inaction) when attempting to predict exercis–or any other–behavior; the need to distinguish between exercise adoption (initiation) and maintenance (adherence); and the importance of Beach's (1982, 1985) distinction between deasion making and decision implementation.     

Self-determined motivation,physical exercise and diet in obese children: A three-year follow-up study

The present study's objective was to track long term (three years intervention and six months “detraining”) the influence of an exercise program with or without diet on the motivation of sedentary obese children. The participants were 27 children (8-11 years), divided into two groups according to the program they followed. The G1 group followed a physical exercise program (three 90-minute sessions per week), and the G2 group this physical exercise program plus a low calorie diet. The participants’ motivation to engage in exercise was measured using the Behavioural Regulation in Exercise Questionnaire-2. Both groups showed improvements in amotivation in the 3rd year and in the detraining period (in the G1 and G2, respectively) and in intrinsic regulation of exercise behaviour (in the G1 and G2, respectively). There were also differences between the two groups in external regulation in the intervention and detraining periods. This appears to be indicative of the appropriateness of long-term physical exercise to generate greater autonomous motivation, and hence changes towards healthy living habits that are stable in time.     

A systematic review of the effectiveness of psychoanalysis,psychoanalytic and psychodynamic psychotherapy with adults with intellectual and developmental disabilities: progress and challenges

Objectives: This systematic review aimed to critically appraise the literature on the efficacy and effectiveness of psychoanalysis, psychoanalytic and psychodynamic psychotherapy in adults with intellectual and developmental disabilities (IDD). Method: A systematic search of electronic databases was carried out. The methodological quality of the studies was assessed using a quality assessment tool and comparisons were made with a review of the quality of research on the effectiveness of cognitive behavioural therapy (CBT) for people with IDD. Results: The search yielded 13 papers which provided evidence for the effectiveness but not efficacy of psychoanalytic and psychodynamic psychotherapy; but none were found for psychoanalysis. The quality of the research was generally poor compared to the current research on the effectiveness of CBT. Conclusions: Positive outcomes have been indicated for psychoanalytic and psychodynamic psychotherapy with people with IDD. Larger scale, more controlled research is necessary to advance the evidence base.     

Assessing Level of Personality Organization With the Psychodiagnostic Chart: A Validity Study

Heterogeneity within diagnostic types and comorbidity across diagnostic groups render a specific personality disorder anything but specific, leading researchers and clinicians to increasingly focus on the general severity of personality pathology. Personality pathology severity is reflected in one's level of personality organization (LPO) and research has demonstrated that LPO is a significant predictor of treatment response. This investigation examined the reliability and validity of the Psychodiagnostic Chart (PDC) in assessing the LPO dimension of the Psychodynamic Diagnostic Manual (PDM; PDM Task Force, 2006). Among a sample of 88 urban-dwelling women seeking primary medical care, the LPO dimension of the PDC received fair to good interrater reliability among 6 psychodynamic psychologists. Convergent validity was demonstrated with contrast analysis and individual correlations that yielded statistically significant associations between LPO scores and conceptually related psychodynamic variables (e.g., defensive functioning, object relations) and self-reported personality pathology scores. Support for discriminant validity was limited by the modest power associated with the sample size. Exploratory analyses examining LPO scores and measures of physical health and intimate partner violence were conducted. Our results supported the reliability, validity, and practical use of the LPO dimension of the PDC.     

The psychodynamic psychiatry service of the University of Alberta Hospital: a thirty year history

This paper describes the Psychodynamic Psychiatry Service (PPS) of the University of Alberta Hospital over its 30 years of development. This psychiatric organization consists of three clinical programs-an outpatient clinic and intensive day and evening programs-and an integral evaluation and research unit. The PPS is unique in its group therapy clinical orientation, its psychodynamic theoretical orientation, and its integration of an ongoing research program that establishes empirical validation of its clinical work. The productivity and longevity of this psychiatric organization appear to derive from several strengths, including cooperation between leaders of the clinical and research programs; the institution of staff relations groups in the three clinical programs; the operation of the fully integrated evaluation and research program that serves to provide empirical support for the treatments offered; and a unifying ideology characterized by the valuing of both psychodynamic and group oriented work. Other important factors to the success of the PPS include the strengths of the founder of the service and financial and other support of the academic department in which it is housed. This paper describes the historical development and present structure and functioning of the PPS, the challenges it has been confronted with, and the responses to those challenges. We conclude with factors contributing to its survival and productivity and with thoughts about the future.     

Treating work inhibition in group psychotherapy

Work Inhibition, defined as an impaired ability to pursue one's career goals, may be treated by combined individual and group therapy. The author presents a method for assessing the degree of work difficulty, a psychodynamic understanding of the problem, and an approach to treatment. He proposes that helping the patient work more actively in group will generalize to the workplace and reduce inhibition. A clinical illustration is provided.     

Comparison of water- and land-based exercise in the reduction of state anxiety among older adults

This study examined the effect of an acute exercise program of different exercise conditions on state anxiety among older adults. 73 healthy subjects were recruited and randomly assigned to either water exercise group (n = 36) or land exercise group (n = 37). State anxiety was assessed before exercise and following exercise. Subjects in the water exercise performed a 70-min. exercise program consisting of a 10-min. warm-up, a 20-min. brisk walking, a 20-min. rhythmic dancing, a 10-min. resistance training, and a 10-min. cool down exercise. The land exercise program contained a 10-min. warm up and a 30-min. combined endurance and resistance exercise, followed by a 10-min. cool down exercise. Analysis showed that both exercise groups scored significantly (p<.001) lower on anxiety after exercise, but there was no significant interaction for group by trial for scores on state anxiety. The data indicate that elderly persons who participate in these types of exercise report lower state anxiety.     

Treating Anti-social Behavior in Adolescents: A Comparison of Multi-modal and Psychodynamic Oriented Group Interventions

This study compared the efficacy of a multimodal intervention (MMI) and a psychodynamic oriented group intervention (POGI) on antisocial behavior among Nigerian adolescents. A pretest-posttest design was used. Forty-one adolescents drawn from the streets of a Nigerian city (N =20), and a state child correction facility (N=21) participated in the study. The children were randomly assigned to a MMI, POGI and waiting list control (WLC) groups. Ages ranged from 10 to 18 years (mean =14.5; SD=2.1). Data collected were analyzed using multiple group comparison procedures. Results showed that MMI significantly reduced self-reported antisocial behavior of the adolescents as compared to WLC and POGI, respectively. A multimodal intervention approach appears to be more effective in treating antisocial behavior in adolescents than a psychodynamic oriented group intervention.     

Psychodynamische Diagnostik

The paper describes the development and objectives of psychoanalytic diagnostics. It shows that one of the key tasks of psychoanalytic/psychodynamic interviews is to initiate the doctor-patient relationship and that the patient’s motivation for treatment is to be examined and promoted in the interview. Different sources of information for the interview are then described; following a presentation of various systematic approaches of psychodynamic diagnostics, the principles of biographic history-taking are also explained. Modern psychodynamic diagnostics provides complex access to the patient, covering both elements of open interviewing and more exploratory approaches. Options for integrating these various methodological approaches are highlighted. Finally, more recent approaches in psychodynamic diagnostics that have a stronger relation to treatment planning are presented. These include the Structural Interview developed by Kernberg and Operationalised Psychodynamic Diagnostics (OPD).