Followup in psychoanalysis: clinical and research values

Psychoanalysis has never developed a tradition of systematic followup study to evaluate outcome and to improve technique and theory for a variety of reasons, partly theoretical, stemming from the conception of the unfolding transference neurosis and its analytic resolution as the precondition for cure, and partly historical, having to do with the happenstance of its development as a private practice-based discipline and training outside of the academic setting. Freud, however, was never bound by such strictures and published whatever post-treatment data he acquired on all his best-known case histories. But following Freud most analysts, with some notable exceptions, eschewed followup activity as unanalytic. It is this tradition that more recent studies like those of Pfeffer in New York and the Psychotherapy Research Project of The Menninger Foundation in Topeka have squarely challenged. Data are presented from the Menninger project dealing specifically with the impact of routine planned followup on issues of treatment termination and resolution and on the nature of the post-treatment period. The degree and kind of patient cooperation with the followup inquiry, the impact of followup on treatment termination and resolution (both impeding and facilitating), and the role of followup intervention in relation to return to formal post-treatment therapy (or consolidating against it), are all discussed.     

Risk behaviors and health. Contrasting individual and population perspectives

This article discusses risk behaviors, seemingly voluntary actions of individuals that have adverse health consequences. The central theme is to examine these behaviors from two contrasting perspectives, that of the individual and that of the population as a whole. It is argued that distinguishing between individual and population views is important for understanding and interpreting health risk data, for developing conceptual and theoretical models for explaining these behaviors, and for devising intervention strategies to modify them. It is argued that an appreciation of both the individual and the population perspectives is important to developing effective action strategies for reducing these behaviors as public health problems.     

Private-sector care for chronically mentally ill individuals. The more things change, the more they stay the same

Two profit-making industries, nursing homes and board-and-care homes, care for about one million chronic mental patients. This care is primarily custodial and probably not very different from the care patients received in the public sector prior to deinstitutionalization. Moreover, certain characteristics of privately owned facilities encourage poor patient care so as to maximize profit. The problem could be ameliorated if chronic mental patients were strong and informed consumers or if the public sector strongly regulated proprietary care. However, neither of these two conditions now hold. Perhaps the apparent difficulties in significantly improving care for chronically mentally ill individuals despite seemingly major changes in policy reflect a fundamental problem in overall social policy--a reluctance to care for chronically indigent individuals of all kinds.     

Reducing smoking among pregnant adolescents

Pregnant adolescents who smoke present a double obstetrical risk. Not only is the adolescent mother at risk from the biological, social, educational, and economic factors associated with childbearing at a young age, she and her developing infant also risk the complications associated with maternal smoking. This paper describes a psychosocial intervention designed to reduce smoking in a group of pregnant adolescents. Five modules are presented. Each is designed to: (1) heighten awareness of the issue, (2) provide motivational messages, (3) enhance the adolescent's social skills, and (4) teach specific smoking-cessation skills.     

Occult participation: its impact on adolescent development

This study investigated the relationship between occult participation, substance abuse, and level of self-esteem in adolescents. Data were collected from 50 adolescents who ranged in age from 12 to 19 years and who spoke English as their primary language. The combined group of adolescents consisted of 25 clinical and 25 nonclinical youth. Participants completed a three-part questionnaire package which included Rosenberg's Self-Esteem Scale, the Adolescent Magic Questionnaire, and the Drug and Alcohol Assessment Scale. Results indicated that adolescent substance abuse and occult participation were significantly related. High and low occult participation groups were determined, and significant differences were found between the high versus low occult groups when compared on the primary variables of self-esteem and substance abuse. Significant differences were also noted when comparing the high versus low occult groups with various psychosocial developmental variables. Included is a discussion of the impact of occult participation on the psychosocial elements of adolescent self-esteem, self-concept, tolerance for deviance, and religious involvement.     

Emotional disturbance and the development of self-consciousness in adolescence

The development of self-consciousness and its relationship to emotional disturbance was examined in early and late adolescence. The Imaginary Audience Scale was administered to emotionally disturbed and nondisturbed adolescents. As predicted, results indicated that self-consciousness decreased with age in nondisturbed adolescents. For the emotionally disturbed adolescents, the development of self-consciousness in temporary situations did not follow consistent patterns, as indicated by interaction effects. A significant negative relationship was found between intelligence test scores and self-consciousness in the disturbed group. The findings support the premise that social-cognitive shifts found in early to late adolescence are disrupted in disturbed populations. The mediating role of social experience as a factor in cognitive and emotional development is discussed.     

School administrators, parents, and sex education: a resolvable paradox?

The emergence of AIDS as an untreatable, lethal disease, responding to educational prevention strategies in high-risk populations, has brought the issues of sex education in the public schools to the forefront. However, administrators, teachers, and parents perceive different barriers to sex education implementation. This study, undertaken in a northeastern, multigenerational, ethnic city, characterized by adolescent pregnancy rates a third higher than the state overall, polled 42 junior and senior high school administrators regarding educational priorities, perceived barriers to expansion of sex education, and preferred methods of introducing sex education. Administrators perceive parents as a major barrier to the introduction of more formalized sex education in their schools. Paradoxically, these same administrators felt that parents were generally uncomfortable in talking to their children about human sexuality. Recommendations are offered from existing models of health education for resolution of administrators' conflicting views on parental roles.     

Adolescent school performance following parental divorce: are there family factors that can enhance success?

Most research on the effects of divorce on children has focused on delineation of specific areas of child maladjustment. A more optimistic approach seeks to identify variables that may mediate negative effects of a stressor, such as parental divorce. The goal of this study was to examine the relationship between one area of child adjustment, school achievement, and family factors which may mediate the negative influence of divorce. The subjects were 71 early adolescents and their recently divorced mothers. The adolescents were divided into low, medium, and high grade achievement groups. Analyses of variance and subsequent Newman-Keuls tests revealed that adolescents with high grade point averages had mothers with a lower level of depression, a higher educational level, less conflict with their ex-spouse, and less intense levels of conflict between mother and adolescent than those in the low grade point average group. A discriminant analysis resulted in a two-variable equation which accounted for 33% of the variance between low and high grade achievers. The two variables were mother's report of conflict between her and her ex-spouse in front of the adolescent and the adolescent's report of the intensity of arguments between him/herself and mother. These results indicated that school performance following divorce is not uniform for all adolescents and that family factors may mediate scholastic achievement problems.     

The effects of kinetic occlusion and categorization on amodal completion. A comment on Gerbino and Salmaso (1987)

The experimental study of Gerbino and Salmaso (1987) focused on the process of amodal completion, i.e. the process that leads to the impression of a total pattern in the absence of information about all parts of the pattern. One of the questions that they have attempted to answer with respect to this process is whether or not it depends on the categorization of the modal part (i.e. the part about which visual information is present) as a modification of a complete prototype. The major conclusion of their experiments is that amodal completion does not depend upon categorization. Furthermore, they interpret their results as indicating that neither the truncated form of the occluded part nor the unification/segregation of contour segments are phenomenally real. We designed some variants of the tunnel effect to demonstrate (1) that the explicit categorization of some parts of the input can have an influence on amodal completion and (2) that the truncated form of a pattern can be phenomenally real. Our results corroborate these hypotheses and can, therefore, interpreted as refuting two rather central claims of Gerbino and Salmaso (1987). The conclusion of our experiment must be that amodal completion is not as primary as they have supposed but can be influenced by kinetic occlusion and categorization stored in visual memory.