Object relations and addiction: The role of “transmuting externalizations”

Addiction is viewed as resulting from a failure in the separation-individuation process. Due to lack of reliable selfobjects and failure to make transmuting internalizations, the addict remains dependent upon transmuting externalizations in an attempt to incorporate soothing objects into the self. As comfort provided by transmuting externalizations cannot be internalized into the self, the process inevitably fails. Treatment of addiction is thus conceived here as a multimodal strategy to help addicts complete separation-individuation and make transmuting internalizations of the soothing and realistic capacities of the therapist and peer group members.     

Probative aspects of the medical evaluation for child sexual abuse

The medical evaluation of a child for sex abuse has been viewed by some as an acid-test for the presence of abuse. This article examines the medical evaluation for child sexual abuse, evidence potentially revealed by the examination, and the probative value of such evidence.     

THE DEVELOPMENT OF CORRECT TOOTHBRUSHING TECHNIQUE IN PRESCHOOL CHILDREN

This study examined the effects of an intensive training program on the toothbrushing skills of three preschool children, using both performance measures and outcome (plaque level) indicators. Toothbrushing was broken into 16 steps that involved actual manipulation of the brush in the mouth. Correct brushing included four criteria: (a) appropriate angle of bristles, (b) appropriate motion of brush, (c) appropriate tooth surface, and (d) minimum duration of brushing. Training included instructions, a three-phase modeling procedure, physical guidance, and reinforcement. Results of a multiple baseline design across subjects showed that the children completed an average of 8.6% of the steps prior to training, as compared with an average of 95.8% of the steps following training. Plaque levels decreased from an average of 58% during baseline to 24.6% after training. Follow-up measures revealed that 86.6% of the steps were maintained. The study demonstrated that the effectiveness of the procedures in teaching very young children a complex motor skill that is essential to their future health.     

Successful Rebellious Professionals: The Black Woman's Professional Identity and Community Commitment

Using interview data from a larger career study of 25 black women who have achieved public recognition as workers for change in the black community, this paper explores the experiences of seven black professional women. The conflicts they confronted as black professionals, resolution of those conflicts, the special conditions of conflict resolution through rebellious professionalism, are explored, as well as the curious routes to success which place them in the position of role models to other human services professionals who are organizationally constrained from rebelling in such ways. The implications of these routes to professional success are explored in an effort to understand contemporary nationalism among black professionals and semi-professionals within the context of conflicts between dominant group organizational expectations and black community membership. The data suggest that particularistic commitments do not necessarily conflict with professional ideals if success is defined in terms of community achievements and positive evaluation by colleagues, rather than material rewards.     

Diffuse Lewy Body Disease: Clinical,Pathological, and Neuropsychological Review

The pathophysiological etiologies and clinical presentations of neurodegenerative dementias have been found to be complex and heterogeneous. Recently, Lewy body inclusions have been identified as an etiological factor in 20–34% of autopsied dementia cases. The term diffuse Lewy body disease (DLBD) is generally accepted as the diagnostic term representative of this currently under-reported and under-recognized disease. This article reviews the literature on the clinical, pathological, and neuropsychological features of this disorder. Differential diagnostic issues are discussed as well as current pharmacological treatment. Nine confirmed cases of DLBD are presented to demonstrate the various features of this disorder. The diagnostic implications of neuropsychological examination results are discussed in relation to other common dementing neurologic diseases.     

The Beck Anxiety Inventory: Psychometric Properties with Older Adults

The assessment of anxiety disorders in late life is often hindered by the lack of measures specifically validated with older adults. Because anxiety manifestations may vary across age groups, it is important to design new instruments or validate existing measures with older adults. This study examined the psychometric properties of the Beck Anxiety Inventory (BAI) in a sample of 281 older adults who were community-dwelling (82.6%) or living in residential care facilities (17.4%). The mean total BAI score was 6.5 (SD = 7.2), indicating minimal anxiety symptomatology in this older sample. There was a trend for older subjects to score higher. Females scored higher than males, and subjects living in a residential facility scored higher than did community dwellers. Item-total correlations were in the moderate range and the internal consistency of the BAI was adequate (alpha = 0.89). A factor analysis yielded a six-factor structure accounting for 64.6% of the variance, with a somatic factor accounting for the largest portion of the variance (32.2%). Because somatic symptoms are more prevalent with aging, such symptoms should not be weighed as heavily in the total BAI score as cognitive or behavioral symptoms. The findings indicate that the BAI is a useful self-report scale for assessing anxiety symptomatology among older adults.     

Effects of Environmental Odor and Coping Style on Negative Affect,Anger, Arousal,and Escape1

Trait coping, state anger, perceived arousal, blood pressure, negative affect, and escape behavior were measured in a sample of 240 undergraduate males and females exposed to 1 of 4 foul-odor conditions or to a no-odor condition. Consistent with Baron and Bell's (1976) negative-affect-escape model, it was hypothesized that people exposed to noxious odors would experience increased negative affect and heightened motivation to escape the situation. Results showed that negative affect and motivation to escape, but not anger or arousal, increased significantly as odor became more noxious. In addition, anger and motivation to escape significantly predicted negative affect. Variances in anger and perceived arousal, but not discomfort and escape, were accounted for mainly by trait coping styles and gender differences. Variances in discomfort and escape were accounted for mainly by odor alone.     

Cognitive modeling of consultation processes: A means for improving consultees'' problem definition skills

This study investigated whether consultees' understanding and use of problem definition skills could be enhanced by increasing their awareness of these processes during consultation interactions. Subjects assigned to a consultation with cognitive modeling group viewed videotaped consultation interactions in which consultants' verbalizations during the problem definition stage of consultation frequently included overt references to the problem-solving processes being used by these consultants. Subjects in a consultation without cognitive modeling group viewed similar interactions except that the consultants' statements did not include overt references to problem-solving processes. A control group viewed irrelevant interactions between consultants and consultees. Data analyses indicated that the subjects exposed to consultations that included cognitive modeling components wrote better problem definitions and were better able to describe the process for defining children's problems than subjects in either the consultation without cognitive modeling or control groups. The subjects in the consultation without cognitive modeling group generally did better than those in the control group.     

Sex and achievement domain: Cognitive patterns of success and failure

Subjects (N=439) were asked to write an account of an achievement of failure, and to describe it in terms of locus of standards (internal-external), conceptual focus (process-impact), and initial expectations for success (or failure). Additionally, accounts were classified on the basis of achievement domain (personal, interpersonal, mastery). Analyses of variance [2 (sex)×3 (domain)] for each cognitive measure revealed few sex differences. However, cognitive responses did vary as a function of achievement domain. Main effects for domain were observed under success instructions for locus of control (p<.0002) and under failure instructions for locus of control (p<.05), conceptual focus (p<.05), and expectations (p<.06). Interaction effects of sex and achievement domain were observed on locus of standards for success (p<.0002) and initial expectations preceding failure (p<.025), indicating that women were more responsive to domain differences than were men. Discriminant analyses indicated that cognitions were more readily patterned in terms of achievement domain than sex. Elaboration and incorporation of the concept of domain in cognitive models of achievement is suggested.