“I’ve got you under my skin”: Relational therapists’ experiences of patients who occupy their inner world

The aim of this study was to conduct an in-depth exploration of therapists’ experiences of patients who affect them more than others and occupy their inner world beyond the context of therapy sessions. A phenomenological analysis was performed on semi-structured interviews with five relational therapists. All the therapists had a strong experience of a particular patient getting “under their skin.” In all these cases, the patient was a traumatized woman. The distinctive characteristic of the phenomenon was a sense of blurred or too permeable boundaries between the therapist and the patient. This was associated with fear and anxiety, but also with feelings of love. The therapists’ reactions to having a patient “under their skin” varied from resistance to symbiotic relatedness. The therapists’ ideas of their professional role influenced how the experience of carrying the patient’s suffering was interpreted. The phenomenon of the patient’s presence in the therapist’s representational world might be interpreted as a distinct countertransference phenomenon when working in a more “thin boundary” manner with particular cases. The therapists’ ability to effectively manage their vulnerabilities, activated in the countertransference, seems to be crucial for therapeutic progress. Implications for research, clinical practice, and training are discussed.     

High-Risk Palliative Care Patients’ Knowledge and Attitudes about Hereditary Cancer Testing and DNA Banking

Even at the end of life, testing cancer patients for inherited susceptibility may provide life-saving information to their relatives. Prior research suggests palliative care inpatients have suboptimal understanding of genetic importance, and testing may be underutilized in this clinical setting. These conclusions are based on limited research. This study aimed to estimate genetic testing prevalence among high-risk palliative care patients in a National Cancer Institute-designated comprehensive cancer center. We also aimed to understand these patients’ understanding of, and attitudes toward, hereditary cancer testing and DNA banking. Palliative care in-patients with cancer completed structured interviews, and their medical records were reviewed. Among patients at high risk for hereditary cancer, we assessed history of genetic testing/DNA banking; and related knowledge and attitudes. Among 24 high-risk patients, 14 (58.3%) said they/their relatives had genetic testing or they had been referred for a genetics consultation. Of the remaining 10 patients, seven (70%) said they would “probably” or “definitely” get tested. Patients who had not had testing were least concerned about the impact of future testing on their family relationships; two (20%) said they were “extremely concerned” about privacy related to genetic testing. Of patients without prior testing, five (50%) said they had heard or read “a fair amount” about genetic testing. No high-risk patients had banked DNA. Overall, 23 (95.8%) said they had heard or read “almost nothing” or “relatively little” about DNA banking. Written materials and clinician discussion were most preferred ways to learn about genetic testing and DNA banking. Overall, this study demonstrates underutilization of genetics services at the end of life continues to be problematic, despite high patient interest.     

Family Coordination in Families who have a Child with Autism Spectrum Disorder

Little is known about the interactions of families where there is a child with autism spectrum disorder (ASD). The present study applies the Lausanne Trilogue Play (LTP) to explore both its applicability to this population as well as to assess resources and areas of deficit in these families. The sample consisted of 68 families with a child with ASD, and 43 families with a typically developing (TD) child. With respect to the global score for family coordination there were several negative correlations: the more severe the symptoms (based on the child’s ADOS score), the more family coordination was dysfunctional. This correlation was particularly high when parents had to play together with the child. In the parts in which only one of the parents played actively with the child, while the other was simply present, some families did achieve scores in the functional range, despite the child’s symptom severity. The outcomes are discussed in terms of their clinical implications both for assessment and for intervention.     

A Case-Series of Reflective Family Play: Therapeutic Process,Feasibility, and Referral Characteristics

Evidence-based interventions for infants and preschoolers, and their families, have largely focused on the mother-child dyad. In response to the increasing need to diversify treatment approaches in the under six population and include the whole family system, we have developed a new treatment approach called Reflective Family Play (RFP). A manualized, whole-family therapy, RFP allows for the involvement of two parents and siblings when working with infants or young children. In this case-series, we used a qualitative chart review to examine the therapeutic process, acceptability, and feasibility of RFP for 22 families with children ages 0–6, who participated in RFP. We also sought to better understand the referral characteristics of those families who participated in RFP by comparing them to families who were referred to and participated in an established dyadic approach during the same time-period. Session-by-session coding of clinician chart notes revealed evidence of positive shifts throughout the RFP process, including more whole-family play, improvements in coparenting, and better parental mentalization. Parents reported improvements in presenting concerns in all but one case. Improvements in coparenting, sibling relationships, and family alliance were also reported by parents after RFP. Clinical implications and directions for future research are discussed.     

Why Bioethics Should Be Concerned With Medically Unexplained Symptoms

Biomedical diagnostic science is a great deal less successful than we've been willing to acknowledge in bioethics, and this fact has far-reaching ethical implications. In this article I consider the surprising prevalence of medically unexplained symptoms, and the term's ambiguous meaning. Then I frame central questions that remain answered in this context with respect to informed consent, autonomy, and truth-telling. Finally, I show that while considerable attention in this area is given to making sure not to provide biological care to patients without a need, comparatively little is given to the competing, ethically central task of making sure never to obstruct access to biological care for those with diagnostically confusing biological conditions. I suggest this problem arises from confusion about the philosophical value of vagueness when it comes to the line between biological and psychosocial needs.     

JUMPING TOGETHER: A WAY FROM SOCIOBIOLOGY TO BIO‐SOCIO‐HUMANITIES

Sociobiology is a grand narrative of evolutionary biology on which to build unified knowledge. Consilience is a metaphorical representation of that narrative. I take up the same metaphor but apply it differently. I evoke the image of jumping together, not on solid ground but on the strong, flexible canvas sheet of a trampoline, on which natural sciences, social sciences, and the humanities jump together. This image overlaps with the traditional East Asian way of understanding—that is, the “Heaven‐Earth‐Person Triad.” Using recent insights from cognitive science—metaphor, embodiment, and conceptual blending—I propose the alternative way of “bio‐socio‐humanities” to understand and experience the world.     

Moral Evaluations of Lying for One's Own Group

This study investigated the development of moral judgments of blue lies, which occur when a speaker makes false statements to benefit a group of which he or she is a member. We investigated this issue in China, where there is substantial emphasis on the nature of children's associations with groups they belong to. Participants ranged in age from 9 to 17, and we asked them to evaluate lies that were told to benefit a team representing a speaker's class, school, or country. Judgments varied systematically as a function of age, with the 17‐year‐olds rating lying for any form of collective less negatively than did the younger age groups. In addition, across the age groups, children's affinity tended to shift from smaller groups to broader and more abstract collectives: 9‐ and 11‐year olds were least critical of blue lies told to benefit a speaker's class, 13‐year olds were least critical of blue lies told to benefit a speaker's school, and 17‐year olds were least critical of blue lies told to benefit a speaker's country. Copyright © 2015 John Wiley & Sons, Ltd.     

Are Infants’ Theory-of-Mind Abilities Well Integrated? Implicit Understanding of Intentions,Desires, and Beliefs

The development of theory of mind (ToM) in infancy has been mainly documented through studies conducted on a single age group with a single task. Very few studies have examined ToM abilities other than false belief, and very few studies have used a within-subjects design. During 2 testing sessions, infants aged 14 and 18 months old were administered ToM tasks based on the violation-of-expectation paradigm which measured intention, true belief, desire, and false-belief understanding. Infants’ looking times at the congruent and incongruent test trials of each task were compared, and results revealed that both groups of infants looked significantly longer at the incongruent trial on the intention and true-belief tasks. In contrast, only 18-month-olds looked significantly longer at the incongruent trial of the desire task and neither age group looked significantly longer at the incongruent trial on the false-belief task. Additionally, intertask comparisons revealed only a significant relation between performance on the false-belief and intention task. These findings suggest that implicit intention and true-belief understanding emerge earlier than desire and false-belief understanding and that ToM constructs do not appear to be integrated, as is the case for explicit ToM.     

Evidence that anticipated stigma predicts poorer depressive symptom trajectories among emerging adults living with concealable stigmatized identities

People living with concealable stigmatized identities are vulnerable to experiencing greater depressive symptoms as a result of occupying a lower social status. In the present research, we examine the effect of changes in enacted stigma and changes in anticipated stigma on trajectories of depressive symptoms over time. A sample of 192 college-aged emerging adults (81.0% female, 81.9% Caucasian, M_age = 18.82 years) living with a concealable stigmatized identity (e.g., mental illness and sexual minority status) completed measures of enacted stigma, anticipated stigma, and depressive symptoms at two time points across eight weeks. Hierarchical linear modeling analyses indicate that increases in anticipated stigma, but not enacted stigma, predicted poorer trajectories of depressive symptoms, controlling for the effect of baseline rumination and other identity-related variables. These data are among the first to demonstrate that worries about future devaluation predict poorer depressive symptom trajectories over time among college-aged emerging adults.