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.     

The Effects of Effort on Helping the Physically Disabled

Abstract

Interactions with physically disabled people often elicit both the desire to avoid the stigmatized and dependent person and feelings of responsibility to help the disadvantaged. This study examined the effort required to help, the helper's gender, and the help received by disabled and nondisabled confederates in searching for a lost object. One confederate was actually disabled and totally dependent on others for completing the helping task, but the other confederate was not disabled. Results indicated a significant interaction of effort and confederates' level of ability. Post hoc tests indicated no differences in helping disabled and nondisabled confederates in the low-effort condition, but, in the high-effort condition, the disabled confederate received significantly more help. These findings suggest that when costs of helping were low, decisions about helping each confederate did not appear to differ; but when costs were high, feelings of social responsibility outweighed both the additional effort involved and tendencies for avoidance in decisions to help the disabled confederate.     

Physically disabled students and achievement orientation: Self-concept,curriculum track,and career aspirations

Little research has been done on the vocational mobility of physically disabled students (Overs, R. In J. S. Picou and R. E. Campbell (Eds.), Career behavior of special groups. Columbus, Ohio: Charles E. Merrill, pp. 177–198). A subset of data from a larger investigation on the achievement processes of youth was analyzed in two phases to describe disabled and nondisabled tenth-grade students on certain sociodemographic variables, high school curriculum track assignment, self-concept dimensions, and educational and occupational aspirations. Additionally, a process model specifying the presence or absence of physical handicaps as an ascribed status was analyzed using path analysis. Results suggest that students who report themselves as being physically disabled are not from specific social origins or differentially allocated to curriculum tracks; more importantly, they do not hold different physical or social self-conceptions or career aspirations. The multivariate analysis shows that disabled status is a significant antecedent only to academic self-concept, having a moderate, positive effect. This finding was interpreted as being a possible “overcompensation” in one particular field when there is a weakness in another. The lack of expected differences in other variables is also discussed.     

‘Fighting’ for survival: A systematic review of physically violent behavior perpetrated and experienced by homeless young people

ObjectivesThis systematic review appraises published studies reporting associations between homelessness, perpetration of physically violent behavior and experience of victimization due to others' physically violent behavior, among young people.MethodsA comprehensive systematic search of psychology, sociology, and health electronic databases, including PsycInfo and SocIndex was conducted. Search terms examined (a) homeless youth, (b) perpetration of physically violent behavior, and (c) experience of victimization due to others' physically violent behavior.ResultsTwenty-nine studies met the inclusion criteria. Findings showed homeless youth report engaging in physically violent behavior including assault, physical fights, and robbery, and commonly describe victimization experiences such as being physically assaulted, threatened with weapons, and robbed. Rates of perpetration of physically violent behavior and experiences of victimization were inconsistent across reviewed studies. It is unclear whether homelessness is a predictor of the perpetration of physically violent behavior and/or victimization. Findings suggest that perpetration of, and being victimized by others' physically violent behavior, may vary for sub-groups of homeless youth.ConclusionsFurther research embedded within theoretical perspectives that consider the influence of situational antecedents is warranted to examine whether homelessness is predictive of engagement in physically violent behavior and the experience of victimization due to others' physically violent behavior.     

Part-Time Disabled Lesbian Passing on Roller Blades,or PMS,Prozac, and Essentializing Women's Ailments

Abstract

This paper discusses the role of the medical and psychiatric systems, as well as the pharmaceutical industry, in the social construction of women's hormonally-related ailments and their treatments. For some marginalised groups, passing as “normal” is a protection strategy against discrimination and maltreatment. Lesbians and invisibly disabled persons are examples of such groups. Given that the reproductive cycle and madness have been linked historically, women suffering from disabling cyclical conditions might also be stigmatised. In this context, the dilemma between seeking treatment versus being labelled psychologically ill is expounded.     

How to address the caveat of avoiding direct contact: Reducing prejudice towards gay and lesbian people in five Balkan countries

ABSTRACT

In the Balkans, contact with gays and lesbians is typically hostile or avoided. Drawing from probability samples of young people from five Balkan countries (N = 1046), we examined whether it is possible to transfer the effects of contact with other marginalized outgroups (largest ethnic minority in every country, Roma, the extremely poor and physically disabled) to acceptance of gays and lesbians (secondary outgroup), and whether this relationship could be explained by attitude generalization and increased intergroup trust. Path analyses supported the secondary transfer effect: it confirmed that, while controlling for direct contact, contact with other marginalized groups was related to more acceptance of a secondary group; this relationship was mediated by trust. This was found across all primary groups in the combined samples, while the effect varied for different groups in country samples. The results add to the value of intergroup contact as a mean of prejudice-reduction.     

An exploration of doping-related perceptions and knowledge of disabled elite athletes in the UK and Austria

IntroductionCompared to anti-doping research in Olympic sport, the issue of doping is under-researched and poorly understood in Paralympic sport. However, with the growth of the Paralympic Games and the increased number of disabled elite athletes, the number of doping controls and doping cases has also increased. Therefore, there is a need to address the dearth of evidence in disabled sport contexts and develop an understanding of disabled elite athletes' perceptions, reasons and knowledge related to doping to ensure appropriate policy and programmes are implemented.MethodSixteen disabled elite athletes from Austria (n = 9) and the UK (n = 7) participated in semi-structured interviews. Data were analysed using inductive reflexive thematic analysis (Braun & Clarke, 2019a).FindingsFour themes were generated during the analysis. The first showed that athletes perceive doping to be a well-known and wide-spread issue in Paralympic sport. The second theme illustrated that disabled elite athletes are exposed to extreme pressure (e.g., to earn money), which they state poses a risk for using prohibited methods and/or substances. Thirdly, athletes suggested that there are several ways to cheat if someone would like to find ‘loopholes’ (e.g., misuse of Therapeutic Use Exemptions) in the current anti-doping system, which they reported only works partially. Lastly, although it is not officially named as an anti-doping rule violation, athletes proposed cheating on classification as a form of doping – and the greatest threat to the integrity of disabled sport.ConclusionsFor the first time, the current study shows that doping in the context of disabled elite sport likely stems from only a few main factors; a perception of pressure and faults in the anti-doping system. To address these risks, prize money could be distributed more broadly, the TUE process and classification system should be more closely scrutinised, and targeted anti-doping education that addresses the main risk factors in disabled elite sport should be provided for all athletes and their support team worldwide.     

When Do I Disclose?

SUMMARY

The Americans with Disabilities Act of 1990 (ADA) heralded a new era of civil rights for the disabled, including the mentally ill. This article concerns Title I of the ADA, protections against discrimination in employment. It is a revised version of an article orginally published in a consumer publication, the MDSG/New York Newsletter (Mood Disorder Support Group) to provide guidance on the pro's and con's of making disclosure of mental illness in the job environment. As such it is a valuable reference for both therapists and service recipients who wish to learn more about how the ADA relates to the employment of people with mental illness and who may be faced with the difficult decision of whether or not they should disclose their condition and request reasonable accommodation. Occupational therapists should be well-informed on this topic, to assist consumers with questions on disclosure, reasonable accommodations and other aspects of Title T. Employers can benefit by providing them with information about appropriate accommodations. And occupational therapists can advise both consumers and employers on how a psychiatric illness may affect work performance.     

Perceived autonomy support,behavioural regulations in physical education and physical activity intention

ObjectivesThe purpose of this study was to examine the relationships between students' perceived autonomy support, behavioural regulations and their intentions to be physically active outside of school.MethodParticipants were 701 secondary school students aged between 13 and 17 years from Singapore. Questionnaires were used to assess perceived autonomy support, behavioural regulation, and intentions to be physically active outside school.ResultsResults supported the hypothesised model in that perceived autonomy support fosters more self-determined forms of behavioural regulations in PE. These forms of behavioural regulations in turn, enhanced more autonomous forms of intentions. The results also yielded an interesting finding that amotivation positively predicted students' intention to be physically active outside school.ConclusionThe findings highlight the importance of perceived autonomy support in fostering more self-determined forms of behavioural regulations in PE and intention to be physically active outside school.     

4 Being Suicidal and Elderly in Changing Times: A Case History

Mr. Andrew A, at age 67, is a physically well and mentally active man who is involved in business failures and marital conflicts, which brought him dangerously close to precipitating his own demise. He is different from my other elderly suicidal patients, most of whom were ill, disabled, and in decline. They were grieving for many reasons, such as the loss of a spouse or — frequently — themselves as they had been. Andrew's story has hopeful implications for the changing nature of aging and suicide that extend beyond himself as an individual or my interventions as a therapist.     

Psychological distress and subjective well‐being in partners of somatically ill or physically disabled: The Nord‐Trøndelag Health Study

Borren, I., Tambs, K., Idstad, M., Ask, H. & Sundet, J. M. (2012). Psychological distress and subjective well‐being in partners of somatically ill or physically disabled: The Nord‐Trøndelag Health Study. Scandinavian Journal of Psychology 53, 475–482. This study investigated the cross‐sectional associations between various somatic conditions in one partner and the level of distress and well‐being in the spouse. The study is based on survey data from the Norwegian Nord‐Trøndelag Health Study, HUNT II (1995–1997). A sample of 9,797 married or cohabiting couples with valid data on subjective well‐being (SWB), psychological distress (Hopkins Symptom Check List (SCL)‐10) and somatic illness were identified. Regression analyses stratified by sex were conducted with SCL‐10 and SWB scores as dependent variables and a joint somatic score as predictor, including; stroke, cancer, angina, myocardial infarction and physical disability (PD). The contribution of each somatic condition was also explored. Spouses of persons previously diagnosed with at least one somatic condition scored significantly lower on SWB and significantly higher on SCL‐10 than spouses of healthy persons, though effect sizes were small. The effect seems to be at least partly mediated by the ill partner’s psychological distress. Of the specific conditions, PD had the most significant contribution for both genders, though an association between male angina and spousal distress/SWB was also demonstrated.     

Interpersonal loss in the context of family caregiving: Implications of communal relationships theory

Abstract

Much is known about the emotional costs of providing care to an ill or disabled family member. However, surprisingly little attention has been devoted to investigating how caregiver distress is related to interpersonal loss (i.e., reactions to changes in the typical day-to-day support behaviors that formerly characterized the caregiver–care recipient relationship). Drawing on the theory of communal relationships (e.g., Clark & Mills, 1979, 1993), this study proposes that the magnitude of interpersonal loss that caregivers experience, as well as its contributions to depressed affect, both directly and indirectly (through impact of interpersonal loss on perceived caregiving burden) are likely to depend on the type of relationship that existed between caregiver and care recipient prior to the onset of illness or disability. In this context, several hypotheses and directions for further research are proposed. It is hoped that future researchers will incorporate loss measures into their research and consider how aspects of preexisting relationships influence associations among interpersonal loss and variables (e.g., burden, social support) known to predict caregiver well-being.     

Latent classes of posttraumatic stress and growth

Background and Objectives: Potentially traumatic events may lead to different patterns of posttraumatic stress symptoms and posttraumatic growth. The objective of the present study was to identify subgroups with different patterns of posttraumatic reactions, and to determine whether these subgroups differed in terms of personal and social resources and indicators of adjustment. Design: This study used survey data collected 10 months after the 2011 Oslo bombing attack to investigate patterns of reactions among ministerial employees (N = 1970). Methods: We applied latent class analyses with covariates to extract subgroups of individuals. Results: Three classes of individual reactions were extracted, and these were similar among those who were and those who were not physically proximate to the bombing attack: “High stress/high growth” (27% and 11%, respectively), “Low stress/high growth” (74% and 42%, respectively), and “Low stress/low growth” (only among the not physically proximate: 47%). The classes differed in terms of gender, neuroticism, and social support as well as life satisfaction and daily functioning. Conclusions: Heterogeneous patterns of posttraumatic reactions were found. Physical proximity is not necessary to experience posttraumatic stress or growth after political violence. Among individuals with low stress, posttraumatic growth may not encompass higher life satisfaction or functioning.     

The Teaching and Learning of Psychotherapy by Rudolf Ekstein and R. S. Wallerstein

The homogeneous group has been the most common form of group therapy for chronically physically ill children and adolescents. The goals of these groups have included the provision of peer support, adaptation to the realities of physical illness, and acceptance of and cooperation with the medical management of the disease. The refinement of the theory of developmental ego psychology suggests that the heterogeneous group has potential for aiding the emotional maturation of the chronically physically ill. This paper presents examples of groups of latency-age children, early adolescents, and middle adolescents that included chronically physically ill with physically healthy peers. The groups were planned under the assumption that despite external differences, children and adolescents of a similar age identify with peers in terms of normal age-specific developmental needs and conflicts.     

An ethical perspective on caregiving in the family

The emphasis on intra-family caregiving that prevailed from ancient until relatively recent times, in both philosophy and practice, was substantially displaced under the influence of the Eighteenth Century Enlightenment by an emphasis on individual independence. The ethics of familial relationships ceased to be at the center of philosophical interest. A consequence was growing inattention to the social conditions and practical arrangements needed to support family efforts to take care of the very young, the very old, the physically or mentally ill or disabled, and others in need of care. The myth of the self-sufficient family must be exploded to permit the development of a public policy that will make such support possible.     

Planning and preparatory actions facilitate physical activity maintenance

ObjectiveMany people do not behave in line with their self-imposed goal to be more physically active. To bridge this intention–behavior gap, detailed planning is regarded as being instrumental. Moreover, preparatory actions are supposed to facilitate physical activity in conjunction with planning. Thus, preparatory actions are seen as mediators between intention and behaviors. The present study examines whether intention is translated into physical activity stepwise via planning as well as via preparatory actions.DesignAt three points in time, physical activity, planning, preparatory actions, and the intention to be physically active were assessed in 338 participants.MethodsBy means of structural equation modeling, it was examined whether the pathway from intention to physical activity includes a mediating sequence of planning as well as preparatory actions.ResultsThe sequential mediation model confirmed pathways from intention to planning, from planning to preparatory behaviors, and from preparatory behaviors to follow-up physical activity, while controlling for baseline indicators. Furthermore, there was an indirect effect of intention on preparatory actions via planning, an indirect effect of planning on physical activity via preparatory actions, and an indirect effect of intention on physical activity via planning and preparatory actions thus, confirming the hypothesized sequence.ConclusionsIndividuals who are motivated to be physically active are likely to make a plan, and if they do so, they are more likely to take preparatory actions, resulting in a higher chance to perform the target behavior.     

Disability sport and activist identities: A qualitative study of narratives of activism among elite athletes’ with impairment

ObjectivesSport and exercise psychology has recently expanded into how it can be utilized to enable social missions like activism. No research, however, has examined activist identities among disabled, elite athletes. This article is the first to engage with this new and complex issue by examining narratives of activism amongst elite athletes with impairment and their adoption/rejection of various activist identities.MethodsThirty-six people were recruited using maximum variation and criterion-based purposive sampling strategies. Data was collected using interviews and fieldwork observations (e.g., observation and social media material). The large data set was rigorously analyzed using a narrative thematic analysis.ResultsAll participants adopted an athletic identity and an athletic activist identity. A small group also adopted a political activist identity that was concerned with challenging disablism. The athletes’ reasons for adopting or eschewing activist identities are identified and connections made to organizational stressors, interpellation, feeling, emotional regulation, narrative, habitus, health and wellbeing. Also revealed is the impact that sporting retirement had on activist identity construction.ConclusionsThe article makes a novel research contribution by revealing two different activist identities within the context of disability sport and what social functions each identity might serve. It also significantly develops knowledge by revealing various organizational stressors experienced by disabled athletes, the importance of embodied feelings and emotional regulation in activist identity construction, the damage that social oppression can have on wellbeing following sporting retirement, and the positive possibilities retiring may have for developing different identities. Practical suggestions are as well offered.     

Coach autonomy support predicts autonomous motivation and daily moderate-to-vigorous physical activity and sedentary time in youth sport participants

ObjectiveGuided by self-determination theory (Deci & Ryan, 1987), this study tested a trans-contextual model linking perceptions of the social environment created by the youth sport coach to levels of autonomous and controlled motivation, and objectively measured daily moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) in young football players.DesignThe study employed a cross-sectional design, assessing physical activity using accelerometers.Method105 male youth sport footballers (M age = 12.79 ± 1.85 years) wore a GT3X accelerometer for 7 days. Measures of height and weight were recorded. Participants completed a multi-section questionnaire assessing perceptions of autonomy support and controlling coaching behaviours, and motivation toward their participation in sport and physically active games.ResultsPath analysis supported a model in which players’ perceptions of coach-provided autonomy support positively predicted autonomous motivation for sport engagement. In turn, autonomous motivation was positively associated with MVPA, and negatively related to ST (min/day). Controlling coach behaviours were positively linked to controlled motivation. However, controlled motivation for sport and physically active games was unrelated to daily MVPA and ST. Perceptions of coach-provided autonomy support had a significant positive indirect effect on daily MVPA, and a significant negative indirect effect on daily ST.ConclusionsResults suggest that autonomy supportive coach behaviours are related to daily physical activity patterns in young male footballers. Theory-based interventions that aim to encourage autonomy supportive coaching, and subsequently foster autonomous reasons for sport engagement, may enhance the potential of youth sport for increasing daily MVPA and reducing ST among children and adolescents active in this setting     

Prior self-control exertion and perceptions of pain during a physically demanding task

ObjectivesExertion of self-control has been associated with impaired performance on subsequent physical tasks also requiring self-control, but it remains unknown why this occurs. This study, therefore, explored whether a) prior self-control exertion reduces subsequent persistence on a physically demanding task, and b) whether any observed performance decrements could be explained by changes in perceptions of pain.MethodIn a within-subject design, sixty-three individuals completed an easy (congruent) Stroop task or a difficult (incongruent) Stroop task that required self-control. Participants were then required to remain in a physically demanding posture (i.e., a ‘wall-sit’) until voluntary exhaustion and their perception of pain was recorded during the task.ResultsWhen participants completed the difficult Stroop task, they quit the wall-sit sooner. This decrement in performance was explained by greater perceptions of pain at the beginning of the wall-sit.ConclusionsPerceptions of pain may, therefore, be an important attentional mechanism explaining why self-control use interferes with subsequent persistence during physically effortful tasks.     

WORD RECOGNITION SKILLS OF LEARNING DISABLED CHILDREN AND AVERAGE STUDENTS’

Abstract

The ability of learning disabled and average students’ to recognize and identify words was investigated. Two informal reading measures, the Sundbye Minimal Contrast Phonics Test and an oral reading sample, were administered to three groups. The groups were composed of learning disabled students evidencing reading problems (LD), average students matched with the learning disabled group on reading level and IQ (YN), and average students matched with the learning disabled group on chronological age and IQ (ON). The LD group and average readers did not differ on identification of symbol‐sound associations, word recognition proficiency, the ability to detect and correct word recognition errors, and the ability to use information within the text to recognize words. However, the LD and ON group differed on mean number of word recognition errors. Educational implications of the findings were discussed and a profile of the word recognition skills of learning disabled children was presented.