Therapeutic immediacy across long-term psychodynamic psychotherapy: an evidence-based case study

C. E. Hill (2004) recently developed the concept of therapist immediacy to capture discussion by the therapist about the therapeutic relationship that occurs in the here-and-now of a therapy session. This concept has been expanded to include discussion about the therapeutic relationship by both the client and therapist, captured by the term therapeutic immediacy (K. Kuutmann & M. Hilsenroth, 2011). Although prior research has examined the use of therapeutic immediacy across short-term treatment, the present study is the first to examine the use of immediacy across a long-term (4 years) psychotherapy. Also, this is the first study to assess the interrater reliability of therapeutic immediacy, which was found to achieve good to excellent levels across raters. The most frequently used categories of client and therapist immediacy are presented. Finally, the authors provide an in-depth qualitative examination of 5 therapeutic immediacy segments across the treatment judged by the raters to have high levels of depth/intensity (4.5 or higher out of 5) to examine the role of therapeutic immediacy in exploring meaningful treatment issues. Clinical utility, potential limitations, and future research on therapeutic immediacy are discussed.     

Mixing metaphors in the cerebral hemispheres: what happens when careers collide?

Are processes of figurative comparison and figurative categorization different? An experiment combining alternative-sense and matched-sense metaphor priming with a divided visual field assessment technique sought to isolate processes of comparison and categorization in the 2 cerebral hemispheres. For target metaphors presented in the right visual field/left cerebral hemisphere (RVF/LH), only matched-sense primes were facilitative. Literal primes and alternative-sense primes had no effect on comprehension time compared to the unprimed baseline. The effects of matched-sense primes were additive with the rated conventionality of the targets. For target metaphors presented to the left visual field/right cerebral hemisphere (LVF/RH), matched-sense primes were again additively facilitative. However, alternative-sense primes, though facilitative overall, seemed to eliminate the preexisting advantages of conventional target metaphor senses in the LVF/RH in favor of metaphoric senses similar to those of the primes. These findings are consistent with tightly controlled categorical coding in the LH and coarse, flexible, context-dependent coding in the RH.     

Spatial reference in multiple object tracking

Spatial reference in multiple object tracking is available from configurations of dynamic objects and static reference objects. In three experiments, we studied the use of spatial reference in tracking and in relocating targets after abrupt scene rotations. Observers tracked 1, 2, 3, 4, and 6 targets in 3D scenes, in which white balls moved on a square floor plane. The floor plane was either visible thus providing static spatial reference or it was invisible. Without scene rotations, the configuration of dynamic objects provided sufficient spatial reference and static spatial reference was not advantageous. In contrast, with abrupt scene rotations of 20°, static spatial reference supported in relocating targets. A wireframe floor plane lacking local visual detail was as effective as a checkerboard. Individually colored geometric forms as static reference objects provided no additional benefit either, even if targets were centered on these forms at the abrupt scene rotation. Individualizing the dynamic objects themselves by color for a brief interval around the abrupt scene rotation, however, did improve performance. We conclude that attentional tracking of moving targets proceeds within dynamic configurations but detached from static local background.     

The relationship between STD locus of control and STD acquisition among adolescent girls

This longitudinal study examined adolescent girls' perception of control over sexually transmitted disease (STD) acquisition. Participants were asked questions regarding their perception of their STD locus of control (internal control; control by parents, partners, peers, and health care providers; and chance) at two waves of data collection. Of the 116 participants (mean age = 17 years), 82% were African-American and 18% were Caucasian. Responses to the measure of locus of control were significantly correlated across a 6-month interval. The responses regarding internal control, control by partner, and chance were not related to the acquisition of an STD in the next 6 months. Further, they were not influenced by an STD in the preceding 6 months. These results indicate that responses to a locus of control measure were stable over a 6-month period, and internal, partner, and chance locus of control perceptions seem to be neither determined by STD experience nor directly related to future STD acquisition. However, understanding an individual's locus of control may be helpful in providing appropriate counseling. Future research could examine how adolescent girls form their perceptions of control over STD acquisition.     

Marital interaction of agoraphobic women: a controlled,behavioral observation study

Married couples with a female agoraphobic spouse (n = 22) were compared with demographically similar community control couples (n = 21) on self-report and observational measures of marital interaction. Consistent with hypotheses, husbands of agoraphobic women were more critical of their wives than were control husbands, and clinical couples were less likely to engage in positive problem solution than control couples. Contrary to hypothesis, clinical husbands were not less supportive than control husbands. Where general measures of marital distress were concerned, clinical couples, relative to control couples, evinced more distress by self-report, by their higher rate of negative nonverbal behavior, and by their longer sequences of negative exchanges.     

Differential functioning of the Beck depression inventory in late-life patients: use of item response theory

The present analyses examined age-related measurement bias in responses to items on the revised Beck Depression Inventory (BDI) in depressed late-life patients versus midlife patients. Item response theory (IRT) models were used to equate the scale and to differentiate true-group differences from bias in measurement in the 2 samples. Baseline BDI data (218 late life and 613 midlife) were used for the present analysis. IRT results indicated that late-life patients tended to report fewer cognitive symptoms, especially at low to average levels of depression. Conversely, they tended to report more somatic symptoms, especially at higher levels of depression. Adjusted cutoff scores in the late-life group are provided, and possible reasons for age-related differences in the performance of the BDI are discussed.     

Adolescents who need help the most are the least likely to seek it: the relationship between low emotional competence and low intention to seek help

It has been found that university students who were the least skilled at managing their emotions also had the lowest intention of seeking help from a variety of nonprofessional sources (e.g. family and friends). The present study sought to extend these findings by focusing on adolescents, examining a larger number of emotional competencies, and exploring the possibility that social support explains the relationship between emotional competence and help-seeking. A total of 137 adolescents (aged 16-18) completed an anonymous survey that assessed social support, emotional competencies, and intention to seek help from a variety of professional and nonprofessional sources. As expected, adolescents who were low in emotional awareness, and who were poor at identifying, describing, and managing their emotions, were the least likely to seek help from nonprofessional sources and had the highest intention of refusing help from everyone. However, low emotional competence was not related to intention to seek help from professional sources (e.g. mental health professionals). The significant results involving nonprofessional sources were only partially explained by social support, suggesting that even adolescents who had high quality support were less likely to make use of that support if they were low in emotional competence.