In the belly of the beast: traumatic countertransference

The authors discuss their work together in a consultation process. One author led many groups that were created to facilitate recovery for persons directly impacted by the terrorist attacks on September 11, 2001; the other acted as consultant to the therapist/leader. The leader was a resident of New York City at the time of the attacks; the consultant lived in a distant Midwestern city and the two had never met prior to the work. They describe their experience of working together and the role of this collaboration in the lives of the leader and the groups. Well aware that little exists in the literature about groups led by leaders having experienced the same trauma as group members, the authors pay special attention to the countertransference that each underwent and raise questions about the effects of that on the group process.     

Defining Moments: Catalysts for Professional Development

In this series of papers, 17 genetic counselors describe defining moments, that is, personal experiences or events that led to a further realization of themselves as genetic counselors. These experiences, both positive and negative, describe a significant impact on the authors' professional growth and development. A call for papers was issued through the National Society of Genetic Counselors listserv and through the Journal of Genetic Counseling in 2001. This call resulted in the following 15 papers in which the authors were asked to describe the nature of a defining moment and how it affected their professional identity and practice. The authors provided an account of the experience or event, what it was about the experience that made it a defining moment, how it affected them personally and professionally, and if a defining moment was negative, how they were able to derive positive outcomes. Implications of these defining moments for other genetic counselors are discussed in a concluding paper.     

BRCA1 Testing: Genetic Counseling Protocol Development and Counseling Issues

This article discusses the genetic counseling protocols which were developed and counseling issues that have arisen in the first 2 years of evaluating a large kindred with a BRCA1 mutation. The rationale for the development of the genetic counseling protocols and specific genetic counseling visual aids are presented and discussed. The protocols and counseling aids can serve as models for other programs offering cancer susceptibility testing. The observations of study counselors about study subject concerns and responses to genetic testing at the time of the pretest and posttest counseling sessions are presented.     

Unconscious fantasy: a once and future concept

The concept of unconscious fantasy should be retained as fundamental to any psychoanalytic approach. The concept is reexamined in the face of two challenges: today's theoretical pluralism and the recent integration of findings from academic research. The first section reviews post-Freudian theoretical contributions to Freud's original concept, concluding that in its evolved form it is flexible enough to serve multiple perspectives. The second section examines four features identified with primary process thinking, demonstrating that a model of early mentation based on adult dream work cannot be supported by research on early development. However, the contemporary concept of unconscious fantasy is compatible with research findings from child development studies and cognitive neuroscience, permitting psychoanalysts to enter dialogue with those fields. Our contribution is not the posit of a new form of thinking (primary process) but an understanding of how general cognitive processes are enlisted for motivated purposes.     

From dyad to dialogue: language and the early relationship in American psychoanalytic theory

The centrality of language for a Freudian theory of mind and treatment has not been retained by most post-Freudian theorists. American writers have turned to academic developmental research on mother-child interactions to depict the preoedipal period as preverbal, presymbolic, nonconscious. This view presents the early relationship as developing in linear stages in which visual observational data (e.g., contingent behavior action patterns between two persons) are privileged over aural-oral data of communicational exchanges. An alternative view is presented that redefines the earliest relationship in terms of communicational exchanges, mediation, and dialogue. The claim is that understanding the nature of mediated communication keeps language central to psychoanalysis and reestablishes an intrapsychic dimension in the concept of relationship that is lost when relationship is reduced to behavioral patterns.     

Performance dissociation during verbal and spatial working memory tasks

Past research has inconsistently distinguished the neural substrates of various types of working memory. Task design and individual performance differences are known to alter patterns of brain response during working-memory tasks. These task and individual differences may have produced discrepancies in imaging findings. This study of 50 healthy adults (M(age) = 19.6 yr., SD = .8) examined performance during various parametric manipulations of a verbal and spatial n-back working-memory task. Performance systematically dissociated on the basis of working-memory load, working memory type, and stimulus difficulty, with participants having greater accuracy but slower response time during conditions requiring verbal versus spatial working memory. These findings hold implications for cognitive and neuroimaging studies of verbal and spatial working memory and highlight the importance of considering both task design and individual behavior.     

Prospective memory in a language-trained chimpanzee (Pan troglodytes)

Prospective memory involves the encoding, retention, and implementation of an intended future action. Although humans show many forms of prospective memory, less is known about the future oriented processes of nonhuman animals, or their ability to use prospective memory. In this experiment, a chimpanzee named Panzee, who had learned to associate geometric forms called lexigrams with real-world referents, was given a prospective memory test. Panzee selected between two foods the one she wanted to receive more immediately. That food was scattered in an outdoor yard where she could forage for it. Also outdoors were lexigram tokens, one of which represented the food item that remained indoors throughout a 30 min period, and that could be obtained if Panzee brought in the token that matched that food item. After foraging for the selected food item, Panzee consistently remembered to retrieve and return the correct token when food was available indoors, whereas on control trials involving no indoor food she rarely returned a token. This indicated that Panzee encoded information relevant to the future action of token retrieval after extended delays for one type of food, even when a more immediately preferred food was available.     

Psychophysical investigation of vigilance decrement in jumping spiders: overstimulation or understimulation?

The inability to maintain signal detection performance with time on task, or vigilance decrement, is widely studied in people because of its profound implications on attention-demanding tasks over sustained periods of time (e.g., air-traffic control). According to the resource depletion (overload) theory, a faster decrement is expected in tasks that are cognitively demanding or overstimulating, while the underload theory predicts steeper decrements in tasks that provide too little cognitive load, or understimulation. Using Trite planiceps, a jumping spider which is an active visual hunter, we investigated vigilance decrement to repetitive visual stimuli. Spiders were tethered in front of two stimulus presentation monitors and were given a polystyrene ball to hold. Movement of this ball indicates an attempt to turn towards a visual stimulus presented to a pair of laterally facing (anterior lateral) eyes for closer investigation with high acuity forward-facing (anterior median) eyes. Vigilance decrement is easily measured, as moving visual stimuli trigger clear optokinetic responses. We manipulated task difficulty by varying the contrast of the stimulus and the degree of ‘noise’ displayed on the screen over which the stimulus moved, thus affecting the signal:noise ratio. Additionally, we manipulated motivation by paired testing of hungry and sated spiders. All factors affected the vigilance decrement, but the key variable affecting decrement was stimulus contrast. Spiders exhibited a steeper decrement in the harder tasks, aligning with the resource depletion theory.     

Screening for and Preventing Perinatal Depression

New York City (NYC) public hospitals recently mandated that all pregnant women be screened for depression, but no funds were allocated for screening or care coordination/treatment, and research suggests that unfunded mandates are not likely to be successful. To address this, we implemented an on-site depression prevention intervention (NYC ROSE) for positive depression screens among pregnant, mostly Black and Hispanic, lower-income women in one public hospital. In this paper, we used Aarons’ implementation model to describe the successes and challenges of screening and intervention. Patient tracking sheets and electronic medical records were abstracted. Key informant interviews and an informal focus group were conducted, and staff observations were reviewed; common implementation themes were identified and fit into Aarons’ model. We found that a lack of funding and staff training, which led to minimal psychoeducation for patients, were outer context factors that may have made depression screening difficult, screening results unreliable, and NYC ROSE enrollment challenging. Although leadership agreed to implement NYC ROSE, early involvement of all levels of staff and patients would have better informed important inner context factors, like workflow and logistical/practical challenges. There was also a mismatch between the treatment model and the population being served; patients often lived too far away to receive additional services on site, and economic issues were often a higher priority than mental health services. Screening and interventions for perinatal depression are essential for optimal family health, and a detailed, thoughtful and funded approach can help ensure effectiveness of such efforts.