Combined therapy with borderline and narcissistic inpatients at the cassel hospital

An account is given here of a rather unorthodox approach to psychodynamic therapy with Borderline patients in part of the therapeutic community at the Cassel Hospital. ‘Combined therapy’ here refers to the setting in which one therapist sees patients in groups and individual sessions concurrently. The paper demonstrates the manner in which this approach brings to the fore the massive destructiveness and rage which so often lies at the core of these patients' difficulties. This is done by describing the development of the group over its first nine months. The therapist comes to be split in the patient's perception, the group sessions representing separation in all its most hated aspects rather than as a prerequisite for differentiation and growth. The resultant rage and destructiveness threaten to render the group unworkable and dangerous. The individual sessions, by contrast, represent a fantasy of being regressed and at one with the ideal mother. It is my belief that these difficulties can be contained only within a therapeutic community. The strength of this approach lies in the vivid reconstruction of a central conflict for these patients and corresponding potential for working through difficulties in the area of separation and individuation. It is also particularly effective in bringing the therapeutic community alive within the therapy. The discussion attempts to address some of the complex theoretical issues raised by the transformation of the transference in both settings which occurs when they are used together and with the same therapist.     

Improving psychological critical thinking in Australian university students

This study tested the psychological critical thinking attributes of students undertaking an Australian Psychology Accreditation Council (APAC) approved course. It also assessed an instructional based teaching practice designed to improve psychological critical thinking skills. The participants were 84 second year and 60 fourth year psychology students enrolled at the University of Western Sydney, Australia. Participants were tested at the beginning and end of the semester with the Psychological Critical Thinking Exam (PCTE) ( Lawson, 1999 ) and only the second year group received specific critical thinking instructions. The results revealed a significant (p < .001) increase in mean PCTE score for the second year group, but no significant increase for the fourth year group. These results confirm the value of the instructional based teaching practice and support the graduate attributes expected by the APAC.     

Genetic Counseling for Fetal Abnormalities in a South African Community

Fetal abnormalities are congenital abnormalities identified prenatally. Women who have a fetal abnormality detected often have to make difficult decisions regarding continuation or termination of the pregnancy. The aims of this research project were: to investigate some of the factors that influenced the decision to terminate a pregnancy in which fetal abnormalities were diagnosed; and to determine the implications for genetic counseling practice in South Africa. The study was retrospective and file-based. A total of 171 women counseled for fetal abnormalities, between 2002 and 2006, were identified and relevant data were collected from their records. Altogether 116/170 (68.2%) women were offered termination of pregnancy, and 73/113 (65%) requested the procedure. Early gestation, gestation at the time termination was offered, and ethnicity of the patient, were significantly associated with a termination request. Black patients were less likely to request termination, but more likely to receive a late diagnosis than other patients. Genetic counselors need to adopt an advocacy and educational role to improve this situation. Furthermore, a better understanding of the cultural and ethnicity-related issues is required.     

Development of the Collectivist‐Sensitive Trait Forgivingness Scale

Mounting evidence suggests that experiences of forgiveness vary across cultures. However, culturally sensitive conceptualizations of forgiveness lack empirical support, in part because psychometrically sound instruments designed to capture unique aspects of forgiveness in non‐Western cultures are rare. For this reason, we developed the Collectivist‐Sensitive Trait Forgivingness Scale (TFS‐CS), which is designed to measure trait forgivingness within societies characterized by a blend of individualistic and collectivistic worldviews. In Study 1 (N = 597), exploratory factor analysis revealed a 16‐item three‐factor structure of third‐party forgiveness, collectivistic forgiveness, and interpersonal resentment among South Africans. In Study 2 (N = 897), the three‐factor model replicated in an independent South African sample. Findings also offered preliminary evidence supporting the construct validity of the TFS‐CS. Overall, these studies support a conceptualization of trait forgivingness with similarities and differences relative to Western models and highlight the importance of appreciating the influence of culture when measuring forgiveness.     

Effects of administrator-witness contact on eyewitness identification accuracy

Concern that lineup administrators can influence eyewitness identifications has led researchers to suggest implementing double-blind testing, an idea that police resist. Using a typical eyewitness paradigm (video event followed by photographic identification test), the present study demonstrated that an alternative technique, minimizing the level of contact between lineup administrators and witnesses, could reduce false identifications without reducing hits. Specifically, witnesses were more likely to make decisions consistent with lineup administrator expectations when the level of contact between the administrator and the witness was high than when it was low. These results are explained within the experimenter expectancy framework. Implications for applied settings are discussed.     

Tracking exceptional human capital over two decades

Talent-search participants (286 males, 94 females) scoring in the top 0.01% on cognitive-ability measures were identified before age 13 and tracked over 20 years. Their creative, occupational, and life accomplishments are compared with those of graduate students (299 males, 287 females) enrolled in top-ranked U.S. mathematics, engineering, and physical science programs in 1992 and tracked over 10 years. By their mid-30s, the two groups achieved comparable and exceptional success (e.g., securing top tenure-track positions) and reported high and commensurate career and life satisfaction. College entrance exams administered to intellectually precocious youth uncover extraordinary potential for careers requiring creativity and scientific and technological innovation in the information age.     

Subjective health complaints

A variety of subjective illnesses with few or no objective findings have appeared at regular intervals as epidemics in our society under different labels. There are few or no objective findings that might explain the "disease" or the complaints go beyond what is regarded as "reasonable" by the physician. Muscle pain and other types of subjective health complaints are among the most frequent reason for encounters with general practitioners, and one of the major causes for sickness absence. The prevalence of subjective health complaints is very high, with at least 75% of the population reporting one or more subjective health complaints the past 30 days. From a statistical point of view, it is "normal" to have complaints. It is when they become intolerable that assistance is required. The difficult thing is that this threshold is individual and subjective. The psychiatric definitions of these complaints, therefore, refer only to the tip of an iceberg.     

Correlates of relative lethality and suicidal intent among deliberate self-harm patients

Conflicting findings have been reported regarding the relationship between the potential lethality of acts of deliberate self-harm (DSH) and suicidal intent, and how each relates to patient characteristics. This study examines the relationship of suicidal intent of DSH to lethality, the relationship of both to patient characteristics, and determines if intent or lethality are risk factors for repetition of DSH. Potential lethality and Suicide Intent Scale (SIS) scores for DSH episodes were examined in a representative sample of 150 patients presenting to a general hospital. Follow-up interviews were completed 12 to 20 months later. Lethality was strongly associated with high intent. Both lethality and intent were associated with male gender. Suicidal intent but not lethality was associated with the presence of psychiatric disorder and depression. Intent was significantly correlated with hopelessness scale score. Although intent was correlated with both depression and self-esteem scale scores, these correlations became nonsignificant when the effect of hopelessness was removed. Repetition of DSH during the follow-up period was related to neither lethality nor intent scores for the original episodes. Lethality and suicidal intent, although related, have somewhat different correlates. Both should be considered when assessing DSH patients, but their relationship to further suicidal behavior does not appear to be straightforward.