The adaptive significance of destructiveness in primitive personalities

Destructiveness in primitive personalities is not restricted to a segment of the person as it is in the case of neurotics, but is global and pervasive. This destructiveness is meaningfully configured in a manner which cannot fully be accounted for by constitutional factors or be comprehended from the individual, intrapsychic, conflictual viewpoint of classical psychoanalysis. It follows an interpersonally meaningful pattern and therefore has adaptive significance in the contemporary life of the individual. The adaptive model I propose does not violate essential canons of psychoanalytic theory, for it can simultaneously be conceptualized in terms of intrapsychic structure and dynamics. This model holds out the possibility for a therapeutic approach to primitive personality organization which differs in some but by no means all respects from classical analysis.     

Somatic response to stress, physical symptoms and health service use: The role of current stress

The study examined physical symptoms and health service utilization of subjects high or low on a measure of the tendency to experience stress somatically and high or low on a measure of current stress. High somatic responders reported greater numbers of symptoms than low somatic responders regardless of stress level. However, high somatic responders who were experiencing high levels of current stress reported significantly more symptoms than high somatic responders who were experiencing low levels of stress. These findings indicate that somatic response to stress reflects both a general tendency to focus on physical symptoms, and a specific tendency to focus more on physical symptoms when under stress. Analysis of health service records indicated that high somatic responders had more visits prompted by symptoms than low somatic responders, but did not differ in frequency of health service visits designed to maintain health. The findings further clarify the relationship between somatic response to stress, physical symptoms and health service use.     

The long-term evaluation of a behavioral treatment program for child molesters

Recidivism data derived from various sources over a follow-up period of 1–11 yr, provided the basis for appraising the effectiveness of a comprehensive cognitive-behavioral treatment program for familial and nonfamilial child molesters. Unofficial records held by police and Children's Aid Societies proved to be the best data for estimating recidivism. These data revealed increases in recidivism with longer follow-up periods, but there were consistent advantages for the treated over the untreated patients. Men who had sexually abused the daughters of other people demonstrated the clearest treatment benefits. The younger offenders and those who had engaged in genital-genital contact with their victims were more likely to reoffend even if they were treated. Contrary to the expectations of behavior therapists, indices of deviant sexual preferences did not predict outcome.     

On working through: a model from artificial intelligence

Working through is centrally important to clinical psychoanalysis. It is inadequately explained in analytic theory. An artificial intelligence model of the process is proposed. Models of problem solving show that the complexity of necessary computation is an important determinant of how a problem is solved. Not optimal, but only good enough solutions are usually found. The quality of solutions depends on the time and resources available. Generally it is far easier to use existing methods than to develop new approaches. When problems must be solved in an emergency fashion, as in trauma, poor solutions are likely to emerge. In studying the annealing of metals and other complex optimization problems, a process, the Boltzman algorithm, was discovered, which continues the search for better solutions while gradually developing a coherent structure of the overall solution. The algorithm provides a model both for psychoanalytic working through and for the normally ongoing process of psychological development and reworking whose deficiency is characteristic of much psychopathology. Working through in the analytic situation is the reactivation of this normal process, and a good analytic outcome is achieved when the process can continue without the analyst. Properties of the Boltzman algorithm clarify such concepts as "optimal" frustration and anxiety which correspond to working in the area where the stable but not rigid structures emerge in the algorithms operation. These studies are an example of how computer science and artificial intelligence are a potentially rich source for psychoanalytic theory.