Alcoholism: etiologies proposed and therapeutic approaches tried

Alcohol, probably the most popular mood-altering drug, has frightening consequences when abused. Genetic factors and sociocultural influences contribute to alcoholic behavior. Study of endocrines, neurotransmitters, and neuropeptides may reveal biological markers to help identify those at risk for alcoholism. Drinking patterns are often based on the expectation of alcohol's mood-altering quality. The focus of treatment has expanded to include not only drinking behavior but also emotional, social, and vocational adjustment. Controlled drinking has proved effective for some, so that complete abstinence is no longer the sole goal of therapy. Behavioral, martial, group and individual, outpatient and inpatient therapy, and drugs as adjuncts, all help some alcoholics, but none is a cure for all. Answers still lag behind questions but researchers have registered some advances that challenge therapists to enlarge therapeutic approaches to fit the multifaceted picture of alcoholism.     

Negativism and countertransference

The purpose of this work is to explore the phenomenon of negativism and the analyst's response to it during the course of analytic work with a patient in whom negativism is a central behavioral pattern. Melville's short story, "Bartleby the Scrivener," describing in telling detail the response of a sympathetic lawyer to profound and pervasive negativism in his legal scribe, is discussed as a literary analogy to the analyst-analysand dyad. Aspects of the concept of negativism within psychoanalysis are discussed. The potential usefulness of understanding certain unexpected countertransference responses to pervasive negativism is explored, as this is a relatively neglected area of psychoanalytic technique. A case is presented describing the analysis of a patient whose character, like Bartleby's, is a mixture of profound negativism along with schizoid, obsessional, and masochistic elements.     

Age-appropriate behaviors: a comparison of three generations of females

The purpose of this study was to examine differences in older adolescent and adult females' perceptions of age-appropriate behavior in adults. Subjects were three generations of maternally related females (95 older adolescents, 78 mothers, 83 grandmothers) who were administered a questionnaire designed to assess age-appropriate behaviors in three broad categories: recreation, occupation/career, and family. Major findings were that older adolescents were most tolerant of behaviors performed by individuals at varying ages while older women most closely ascribed to age constraints, and that the greatest agreement on appropriateness of age constraints concerned family relationships while least agreement concerned recreational activities. Results support the view that adolescents' values on family issues are consistent with those of their parents, and suggest that adherence to age norms increases throughout the life span or are the result of generational differences in socialization.     

Research-structured vs clinically flexible versions of social learning-based marital therapy

The purpose of this study was to compare our structured research-based version of marital therapy from a social learning perspective with a clinically flexible version of the same treatment where treatment plans were individually-based and there was no specific number of treatment sessions. Thirty distressed married couples were randomly assigned to one of these two treatments. Assessment of outcome was based on global marital satisfaction, spouse reports of functioning in specific areas, and direct observational measures of communication. At posttest there were no differences in efficacy between structured and flexible treatments, although both treatments led to significant improvements. At a 6-month follow-up couples treated with the structured format were more likely to have deteriorated and flexibly treated couples were more likely to have maintained their treatment gains.     

Definitional deficit: a model of senile dementia in context

This article presents some general theoretical concepts that can be used to consider processes of reality construction in interpersonal contexts. I developed a model of family context that taps affective dimensions of reality construction and used this model to explore these processes as highlighted by the labeling of symptoms of senile dementia. Ethnographic observations of 45 families with aged members were used to sketch a dichotomous typology of family-context patterns that promote symptom identification versus patterns that do not. The model suggests that the categorization of behavior as symptomatic or normal in context may be related to the extent to which reality construction processes are shared among members.