Group Cognitive Behavioral Therapy for Delusions: Helping Patients Improve Reality Testing

Group Cognitive Behavior Therapy (CBT) was used to treat residual delusions in patients with schizophrenia. Initially all patients (N = 6) reported delusions of various types, such as persecution, body/mind control, grandiosity, and religious themes. The group format allowed patients to share their experiences and beliefs, thereby eliminating shame and providing support and coping strategies; as well as allowing for peer–peer discussion of irrationalities and inconsistencies in each other's beliefs. After 13 sessions there was a statistically significant reduction in delusional conviction, unhappiness associated with thinking about a delusion, intensity of distress associated with delusion, and an increased ability to dismiss a delusional thought.     

‘Can you push a camel through the eye of a needle?’ Reflections on how the unconscious speaks to us and its clinical implications

There has been a recent surge of interest in a type of thinking seen in some patients most of the time, and all patients some of the time. In the past it was simply called regressive thinking, but attempts to be more specific have led it to be called by various names, like 'pre-symbolic', 'pre-conceptual' and 'pre-operational'. What these labels attempt to capture is that the patient's thinking, at these times, is without representations and closer to actions. As a clinical phenomena I prefer to use Loewald's term, 'action–language', that is, where words become attempts to bore, seduce, anger, etc. It is different from when words are used to communicate internal states via free association. A case is made for action–language being the primary method by which the unconscious speaks to us in psychoanalytic treatment. This paper explores some of the reasons for this type of thinking, along with the clinical methods to find the thinker where there appears to be none. Distinctions will be made as to the use of the process versus the content, on the goal of interventions as bringing insight versus the capacity for insightfulness, and the model of treatment as leading to transformations in thinking, rather than lifting of repressions. A clinical example is presented to demonstrate these perspectives.     

Mediating and Moderating Processes in the Relation between Maltreatment and Psychopathology: Mother-Child Relationship Quality and Emotion Regulation

The present study investigated underlying processes of the effect of maltreatment on psychopathology (i.e., internalizing and externalizing problems) in a group of 111 maltreated and 110 nonmaltreated 7–10 year-old children (60% boys). We tested the moderating and/or mediating roles of emotion regulation and the mother-child relationship quality (pattern of relatedness) using Structural Equation Modeling. Emotion regulation, but not the pattern of relatedness, mediated the relation between maltreatment and psychopathology. This mediation was moderated by the pattern of relatedness: For the group of children with an insecure pattern of relatedness, maltreatment was related to lower levels of emotion regulation, which was predictive of higher levels of internalizing and externalizing symptomatology. In contrast, for the secure relatedness group, there was no mediation by emotion regulation since the impact of maltreatment on emotion regulation was not significant. Implications of the mediating role of emotion regulation and the buffering role of the mother-child relationship quality were discussed.

Target-tilt and vertical-hemifield asymmetries in free-scan search for 3-D targets

In this study, asymmetries in finding pictorial 3-D targets defined by their tilt and rotation in space were investigated by means of a free-scan search task. In Experiment 1, feature search for cube tilt and rotation, as assessed by a spatial forced-choice task, was slow but still exhibited a characteristic “flat” slope; it was also much faster to upward-tilted cubes and to targets located in the upper half of the search field. Faster search times for cubes and rectangular solids in the upper field, an advantage for upward-tilted cubes, and a strong interaction between target tilt and direction of lighting (upward or downward) for the rectangular solids were all demonstrated in Experiment 2. Finally, an advantage in searching for tilted cubes located in the upper half of the display was shown in Experiment 3, which used a present-absent search task. The results of this study confirm that the upper-field bias in visual search is due mainly to a biased search mechanism and not to the features of the target stimulus or to specific ecological factors.     

LISTENING AND SPEAKING PSYCHOANALYTICALLY ‐ WITHWHAT IN MIND?*

In this paper, the proposition is developed that multi‐model thinking with respect both to theories of mind and to theories of technique has always been implicitly present in psychoanalytic practice as a response to the demands of the clinical moment. But this has gone unnoticed and untheorised, in part because it is hidden in general considerations regarding tact, timing and (less discussed) variations in voice tone and also because our psychoanalytic practices, without our awareness but as adaptations to the clinical moment, do not always match our theories. The author offers reasons from the broad culture of psychoanalysis why this is so. He also offers a conceptualisation and a strategy for raising the implicit and untheorised to heightened levels of awareness; he does this by highlighting the place of patient characteristics as the underpinning of theory variation and the place of a vast array of clinical possibilities as the backdrop of analytic listening. Clinical examples are used throughout.     

Mindsets,rationality and emotion in Multi‐criteria Decision Analysis

This paper discusses the paradigm of multi‐criteria decision analysis (MCDA), and relates it to other disciplines. It concludes that MCDA needs a larger, not smaller, emphasis on values and subjectivity to increase rationality in decision‐making. The paper bases the argument on a conciliation of ethics, philosophy, neuro‐psychology and management paradigms. It observes that the MCDA ‘mindset’ relates to consequentialism, as opposed to virtue ethics and rule based ethics. Virtues and rules play an important role in practical decision‐making, however. Findings in neuro‐psychology show that reliable decision‐making requires emotions. Elicitation of emotions is therefore required in MCDA value trade‐off processes. This leads to a concept of emotional rationality, which defines rationality as a four‐dimensional concept that includes well‐founded values and breaks radically with common notions of rationality. Virtues do not easily lend themselves to value trade‐off, but questions of virtue usually creates strong social emotions, as opposed to the feebler global emotions that may arise in connection conventional trade‐off of end values. The conclusion is that MCDA should not be shy of subjectivity and emotion, but instead put more emphasis on it to increase rationality. A part of this challenge is how to deal with questions of virtue in decision‐making. Copyright © 2006 John Wiley & Sons, Ltd.     

The Relations among Maternal Depressive Disorder, Maternal Expressed Emotion, and Toddler Behavior Problems and Attachment

Direct and indirect relations among maternal depression, maternal Expressed Emotion (EE: Self- and Child-Criticism), child internalizing and externalizing symptoms, and child attachment were examined. Participants were mothers with depression (n?=?130) and comparison mothers (n?=?68) and their toddlers (M age?=?20 mo.; 53% male). Assessments included the Diagnostic Interview Schedule (maternal depression); the Five Minute Speech Sample (EE); the Child Behavior Checklist (toddler behavior problems); the Strange Situation (child attachment). Direct relations were significant linking: 1) maternal depression with both EE and child functioning; 2) Child-Criticism with child internalizing and externalizing symptoms; 3) Self-Criticism with child attachment. Significant indirect relations were found linking maternal depression with: 1) child externalizing behaviors via Child-Criticism; 2) child internalizing behaviors via Self- and Child-Criticism; and 3) child attachment via Self-Criticism. Findings are consistent with a conceptual model in which maternal EE mediates relations between maternal depression and toddler socio-emotional functioning.     

Child Maltreatment and Emergent Personality Organization: Perspectives from the Five-Factor Model

The Five-Factor Model was used to examine personality organization in 211 six-year-old children (135 maltreated and 76 nonmaltreated). Longitudinal assessments were conducted at ages 7, 8, and 9. Six-year-old maltreated children exhibited lower agreeableness, conscientiousness, and openness to experience and higher neuroticism than did nonmaltreated children. Maltreated children also were more frequently represented in less adaptive personality clusters than were their nonmaltreated counterparts. A particularly vulnerable profile occurred predominantly among maltreated children and was related to experiencing both abuse and neglect. Child maltreatment and personality clusters were related to individual differences perceived by peers. Longitudinal stability of the personality dimensions also was assessed. At age nine, evidence was found for maintenance of the organization of the personality clusters obtained at age six and for continuity of maltreated children's personality liabilities.