A procedural theory of therapeutic action: Commentary on the symposium,Interventions that effect change in psychotherapy

Operating largely outside of awareness, the procedural mode of processing has been neglected in psychotherapy and psychoanalysis, and yet it is critical to our understanding of therapeutic action. This group has made an outstanding contribution to a procedural theory of therapeutic action, integrating some of the most important current concepts in infant research, cognitive psychology, systems theories, and adult psychoanalysis. The procedural mode of “implicit relational knowing” is placed within the context of a moment-by-moment, mutual regulation model of co-constructed exchanges. Nonlinear dynamic systems theory has greatly influenced their theory of change. The centerpiece is Louis Sander's concept of the “moment of meeting.” Although the concept of intersubjectivity is central in all the papers, the multiple uses of the term suggests that a careful re-examination of the definitions of intersubjectivity is sorely needed. We must now integrate the work of this group with other current procedural theories of therapeutic action. © 1998 Michigan Association for Infant Mental Health     

Maternal aggression as a model for acute social stress in the rat: A behavioral-electrocardiographic study

Maternal aggression of lactating rats was used to induce acute social stress in a resident-intruder paradigm. Behavioral and electrocardiographic responses of male intruders were simultaneously recorded. Cardiac electrical activity was measured by means of a telemetry system which ensured preservation of intruder's behavioral repertoire. Behavioral response to maternal attack was evaluated in terms of percent time spent in passive/submissive (p/s) and active/non-submissive (a/ns) patterns. This allowed us to classify the intruders as submissive, non-submissive, and intermediates. During the test, a significant decrease of average R-R interval (R-R) compared to baseline conditions and the occurrence of arrythmias of different nature were found. Ventricular arrhythmias, including premature ventricular beats and ventricular tachycardias, were present in all the intruders while R-R fluctuations and II degree atrioventricular (A-V) blocks only appeared in submissive and intermediate rats. Most ventricular arrhythmias occurred within the upper range of heart rate and were preceded by periods of low R-R variability. These electrocardiographic events were temporally associated with a/ns behavioral patterns and were related to an increased prevalence of sympathetic activity. On the other hand, R-R fluctuations and II degree A-V blocks preceded by high R-R variability were synchronized with p/s behavior and were ascribed to a predominant inhibitory effect of vagal activation which becomes more pronounced as the level of sympathetic activity increases. © 1995 Wiley-Liss, Inc.     

An assessment of teratology training provided by masters level genetic counseling programs

The increasing demand in the clinical genetics setting for information about teratogen exposures has created a need for genetic counselors to have the capabilities to appropriately address patient concerns. In order to assess how training in teratogen counseling is currently being conducted, the GLaRGG Teratogen Subcommittee surveyed all 17 genetic counseling training programs in North America in September 1993. Information was obtained from training programs about coursework, resources, and clinical training. In addition, each training program was asked to provide information about how their teratogen training needs could better be met. While all programs responded that some information in their coursework applicable to teratogen counseling was provided, there was wide variation in the amount of time devoted to this topic. The programs also greatly differed in the provision of clinical training in teratogen counseling. For both coursework and clinical work, genetic counselors were the main trainers in teratogen counseling. In spite of this, fewer than 25% of training programs have a defined teratogen clinical rotation. Data from the survey are discussed and recommendations presented.     

Adaptation of Nussbaum's Capabilities Framework to Community Mental Health: A Consumer‐Based Capabilities Measure

The capabilities approach provides a rich evaluative framework to guide transformative change in the community mental health system. This study reports the content and construct validity and psychometric properties of a contextualized measure of the extent to which mental health programs foster achieved capabilities. The Achieved Capabilities Questionnaire for Community Mental Health (ACQ‐CMH), adapted from Nussbaum's capabilities framework, was developed previously with consumer collaboration. Content validity was assessed through a collaborative process, involving a panel of eight consumers, staff members, and senior researchers. The resulting shorter version (ACQ‐CMH‐98) was completed by 332 community mental health consumers sampled throughout Portugal. Factor (PCA) analysis, internal consistency reliability, and test–retest reliability over 2 weeks (N = 33) showed good psychometric properties. The resulting six‐factor structure with 48 items explains 48.88% of the total variance (KMO = 0.89; Bartlett p = .00). Internal consistency of the obtained dimensions ranges from .91 to .76. Associations of the measure with recovery, quality of life, and psychological distress scales add further evidence of construct validity. The adaptation of Nussbaum's framework stressed specific components that may enhance understanding and change within the community mental health system.     

The influence of high-risk pregnancies and social support systems on maternal perceptions of the infant

This study examines the effects of high-risk pregnancies on the maternal perception of the full-term healthy infant, as well as the influence of social support systems on these effects. Thirty mothers after high-risk pregnancy and 30 mothers after low-risk pregnancy were interviewed when their infants were 3 months old. Their perceptions of own and average baby were evaluated as well as the amount and availability of and their satisfaction with social support. The obtained results confirm the hypothesis that mothers after high-risk pregnancies tend to perceive their infant as significantly more difficult than mothers after low-risk pregnancies. A main finding of this study is that high-risk pregnancy mothers perceive an average baby in a much more positive way. Social support was not found to affect significantly the maternal negative perception of the infant after a high-risk pregnancy. These findings are discussed in the context of the continuity of the process of maternal affiliation to the infant before and after delivery.     

Ventral and dorsolateral regions of the midbrain periaqueductal gray (PAG) control different stages of defensive behavior: Dorsolateral PAG lesions enhance the defensive freezing produced by massed and immediate shock

Rats that receive nociceptive electric shock in an environment normally show the conditional fear-induced defensive response of freezing when returned to that environment. If several electric shocks are given in a massed manner they will condition less freezing than the same shocks given in a distributed manner. If a single shock is given immediately after placement in the chamber it does not support any conditioning, although the same shock given after a brief delay does. Electrolytic lesions of the dorsolateral periaqueductal gray (PAG), which damaged dorsomedial, dorsolateral, and lateral PAG, enhanced freezing under these conditions. Lesions of the ventral PAG, which caused extensive damage to the central gray below the aqueduct, reduced conditioning under the more optimal parameters (distributed or delayed shock). This was taken to indicate that both of these regions support different modes of defensive behavior and that when activated, the dorsolateral PAG inbits conditional fear-induced defensive behavior. © 1995 Wiley-Liss, Inc.     

Age and Assessments of Professional Expertise: The Relationship between Higher Level Employees’ Age and Self‐assessments or Supervisor Ratings of Professional Expertise

In this article the relationship between higher level employees’ age and assessments of professional expertise is described. Hypotheses have been tested with original survey data from 417 higher level employees and 224 direct supervisors. Concerning the analyses of the effects of age, our hypotheses have for the greater part been confirmed. In our study, we have found that age‐related stereotyping is an important phenomenon where assessments concerning professional expertise are made by supervisors. As regards the self‐ratings, there is no relationship between age and professional expertise. Further research is needed to understand the pattern of differences between the two types of ratings. Some speculations concerning improvements of the measurements are discussed.