The uses of humor in life,neurosis and in psychotherapy: Part 2

Abstract

The first part of the paper focused on the dynamics of wit in life, literature, and psychoanalysis; the second part of this paper is devoted to the use of humor in therapy. The central concept is Freud's psychoanalytic method, as distinguished from Freud's various theories of disorder, or neurosis, with a further elaboration of Freud's inherently interpersonal conception of the analytic process, already present in the cathartic phase of the therapeutic technique. The cathartic, or discharge, function of humor is connected to reciprocal free association (a term coined by the author) to define the mutual and reciprocal free association in analysand and analyst, playing an essential role in the genesis of insight and interpretation. Humor has its role in loosening repression, facilitating the emergence of unconscious emotions and ideas, bringing to light character defenses, and thus driving the process of analysis.     

Different origins and meanings of acute acting-out in an inpatient psychotherapeutic setting

In this paper I describe four different sources of acute acting-out behaviour as may be observed in long-term hospitalised patients suffering from severe personality disorders. I hope to demonstrate that acute psychological distress does not happen in a vacuum, but that specific intrapsychic and interpersonal dynamics within the hospital setting are at the root of what appears overtly as nonspecific emotional and behavioural disturbance. I argue that the hospital team's correct insight into the factors underlying acute acting-out is crucial to the implementation of therapeutic interventions aimed to decrease the patient's disturbed state of mind.     

Remembering and repeating in multiple personality

This paper is a case-history of a student in his early twenties tortured by different personalities of different ages and sexes vying for control of his body. Guilt over an incestuous relationship with his mother is uncovered and understood in the context of his whole life. Confusion between memories of fantasies, memories of sleep dreams, memories of daydreams, and memories of actual memories are described, the elucidation of which lead to clearer thinking and memory, and more tolerance for the previously distorted affectladen situations of his past. Thus his belief that he was experimented on in an alien spaceship becomes the memory of an operating-room diagnostic experience.

A hypothesis is put forward that the separate personalities in the multiple personality are not simply the products of ego splits, but are at the instant they are formed a ‘doubling’ of the personality that is being copied. Immediately thereafter, splitting mechanisms create differences between the two separate personalities, using projective and introjective mechanisms. Integration of the various personalities, the ultimate goal in treatment, is made difficult by the patient's fear of loss of self through fragmentation, when the self is felt to be in danger of being intruded upon.     

On some types of hallucinatory experience

There are types of non-visual hallucinatory experience which occur in the psychoses other than those which have a critical and derogatory content. Wish-fulfilment plays an important part in the formation of the content of these hallucinations. In others, ‘persecutory’ anxiety also occurs. A comparison is made between hallucinatory and dream content. An hypothesis is presented to account for the perceptual quality of these hallucinatory experiences. The therapeutic implications of these considerations concludes this presentation.     

Predictors of Therapist Adherence and Emotional Bond in Multisystemic Therapy: Testing Ethnicity as a Moderator

This study examined the interaction between problem severity and race\ethnicity as a predictor of therapist adherence and family-therapist emotional bond. Data for this study came from a longitudinal evaluation of Multisystemic Therapy (MST) provided by licensed MST provider organizations in community settings. Outcome variables included mid-treatment levels of caregiver report of therapist adherence, changes in caregiver report of therapist adherence over the course of treatment, and overall levels of caregiver-therapist and youth-therapist emotional bond. Hypothesized predictors included race\ethnicity and levels of poly-substance use, externalizing behavior, and youth self-report of delinquency early in treatment as well as pre-treatment number of arrests. Participants were 185 adolescents (M age = 15.35, SD = 1.29) and their caregivers. Of the participating youth, 48 % self-identified as Caucasian, 20 % as African-American, 28 % as Hispanic\Latino, and 4 % as “other.” Two-level Hierarchical Linear Modeling analyses revealed that for Caucasian youth, lower rates of self-reported delinquency were associated with greater increases in caregiver report of therapist adherence over the course of MST. For Hispanic\Latino caregivers, higher externalizing behavior and poly-substance use were associated with reports of lower therapist adherence at mid-treatment and poorer overall levels of emotional bonding with therapists. In contrast, for African-American participants, higher levels of youth externalizing behavior and poly-substance use were associated with higher overall levels of caregiver and youth report of emotional bonding with therapists, respectively. Results provide evidence that race\ethnicity interacts with problem severity in predicting therapist adherence and family-therapist emotional bond within real-world practice settings and suggest possible therapeutic process differences across race.     

Differential efficacy of standard inpatient treatment between Mormon and non-Mormon patients

Despite differences in doctrine and belief structure, much of current research and most therapeutic practice continue to treat the thirty six recognised denominations of Christianity identically. Analysis of 298 inpatients (37.6% Mormon) at a large state psychiatric hospital found differential efficacy based on denomination (Mormon versus Non-Mormon) on seven of the 24 items of the Brief Psychiatric Rating Scale. Differential efficacy of treatment was also found based on gender for four of the 24 items with those differences possibly stemming from gender differences in openness to therapy. Finally, two denominations by gender interactions were noted as well. Taken together, the results of the current study indicate that specific denomination membership may have a more significant impact on the outcome of therapy than current practice implies. Additionally, the current study documents some of the unique challenges and issues in treating Mormon patients.     

Induced disgust affects implicit and explicit responses toward gay men and lesbians

In the current study, disgust was induced using a carefully controlled odor manipulation to observe its effect on participants' implicit and explicit responses to homosexuals. Participants were presented with a vial containing an odor that was described as “body odor” (n = 47) that induced a high level of disgust, or “parmesan cheese” (n = 43) that induced a moderate level of disgust, or an odor‐free vial (n = 53). Subsequently, participants viewed images of homosexual and heterosexual couples, and their viewing times and ratings of the images' pleasantness were recorded. Additionally, they completed a “feelings thermometer” task, the Attitudes Toward Lesbians and Gay Men scale that assessed feelings toward homosexuals, and the Three‐Domain Disgust Scale to measure sensitivity along three dimensions of disgust (pathogen, moral, and sexual). Results indicated that those in the body odor condition viewed images of gay (but not lesbian) couples for less time relative to images of heterosexual couples compared with participants in the other two conditions. With respect to explicit ratings, participants in the body odor condition reported colder feelings for gay relative to heterosexual men on the feelings thermometer compared with those in the no‐odor control condition. For pleasantness ratings, the odor manipulation served as a moderator, such that for those in the body odor condition only, higher sensitivity to sexual disgust predicted lower ratings for images of lesbian couples relative to straight couples. Thus, although induction of disgust biases implicit and explicit responses to gay couples, the degree to which this occurs for explicit ratings of lesbian couples depends on levels of sexual disgust. Copyright © 2013 John Wiley & Sons, Ltd.     

Divided attention selectively impairs memory for self-relevant information

Information that is relevant to oneself tends to be remembered more than information that relates to other people, but the role of attention in eliciting this “self-reference effect” is unclear. In the present study, we assessed the importance of attention in self-referential encoding using an ownership paradigm, which required participants to encode items under conditions of imagined ownership by themselves or by another person. Previous work has established that this paradigm elicits a robust self-reference effect, with more “self-owned” items being remembered than “other-owned” items. Access to attentional resources was manipulated using divided-attention tasks at encoding. A significant self-reference effect emerged under full-attention conditions and was related to an increase in episodic recollection for self-owned items, but dividing attention eliminated this memory advantage. These findings are discussed in relation to the nature of self-referential cognition and the importance of attentional resources at encoding in the manifestation of the self-reference effect in memory.