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.     

The ventriloquist effect does not depend on the direction of automatic visual attention

Previously, we showed that the visual bias of auditory sound location, or ventriloquism, does not depend on the direction of deliberate, orendogenous, attention (Bertelson, Vroomen, de Gelder, & Driver, 2000). In the present study, a similar question concerning automatic, orexogenous, attention was examined. The experimental manipulation was based on the fact that exogenous visual attention can be attracted toward asingleton—that is, an item different on some dimension from all other items presented simultaneously. A display was used that consisted of a row of four bright squares with one square, in either the left- or the rightmost position,smaller than the others, serving as the singleton. In Experiment 1, subjects made dichotomous left-right judgments concerning sound bursts, whose successivelocations were controlled by a psychophysical staircase procedure and which were presented in synchrony with a display with the singleton either left or right. Results showed that the apparent location of the sound was attractednot toward the singleton, but instead toward the big squares at the opposite end of the display. Experiment 2 was run to check that the singleton effectively attracted exogenous attention. The task was to discriminate target letters presented either on the singleton or on the opposite big square. Performance deteriorated when the target was on the big square opposite the singleton, in comparison with control trials with no singleton, thus showing that the singleton attracted attention away from the target location. In Experiment 3, localization and discrimination trials were mixed randomly so as to control for potential differences in subjects’ strategies in the two preceding experiments. Results were as before, showing that the singleton attracted attention, whereas sound localization was shifted away from the singleton. Ventriloquism can thus be dissociated from exogenous visual attention and appears to reflect sensory interactions with little role for the direction of visual spatial attention.     

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.     

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.     

Emergent Literacy and Early Writing Skills

In the present study, the authors aimed to assess the short- and long-term predictive power of the various components of an emergent literacy model on early writing abilities in a language with a mainly transparent orthography (Italian). Emergent literacy skills were assessed in 72 children (M age = 5.05 years, SD = ± .03) who were followed longitudinally from preschool to the end of the first grade of primary school. Their early writing abilities (orthographic correctness in writing individual words) and their advanced writing abilities (orthographic correctness in text writing) were tested at the beginning and at the end of the school year. Multiple stepwise and logistic regression analyses were conducted to evaluate the predictive capacities of emergent literacy abilities on early and advanced writing competences. Results show that notational competence is a strong predictor of early writing skills and that phonological competence only has an effect insofar as it is integrated with notational competence. Emergent literacy competences do not significantly predict orthographic errors in advanced text writing. This research allows for reconsideration of the importance of phonological awareness and gives a central role to notational competence in predicting early writing competence.     

Pete the diesel: Psychotherapy with a severely disturbed five-year-old boy

The psychic significance of the figure of the grandmother in psychodynamic psychotherapy has received scant attention. This paper develops the concept of the ‘grandmaternal transference’ in parent–infant psychotherapy and explores its identification, its possible functions and its therapeutic significance. The grandmaternal transference has special relevance to parent–infant psychotherapy since the grandmother often represents both the mother’s mother and the child’s grandmother and offers a unique third position between mother and child. Three clinical vignettes illustrate how the grandmaternal transference may operate in this third position. In the first vignette, the therapist becomes in the transference a containing grandmother thereby facilitating maternal containment. In the second case, the therapist may be experienced as a differentiating grandmother able to help mother and infant with separation and individuation. In the third one, the therapist is transferentially experienced as a paternal grandmother who acts as a pseudo-father able to embody the paternal function. In each of these positions, the transference and countertransference – whether positive or negative – require that the therapist responds to rather than enacts the grandmaternal role. The three configurations of the grandmaternal transference have different clinical manifestations and offer different therapeutic ports of entry.