On the Edge: Exploring the End of the Analytic Hour

The final moments of the analytic hour are a repetitive reenactment whose symbolic meaning can be both a challenge and an opportunity. Each member of the analytic dyad is vulnerable to the revival of deprivation and loss that is introduced by the end of the hour, and each will handle the experience in a unique way. When this cocreated moment occurs in the absence of awareness, there can be avoidance and enactment. When it occurs in the context of shared understanding, the analytic pair is free to intensify, play with, and confront the limitations and inevitabilities of life that are revived again and again when we approach and reach the end. Integrating theoretical perspectives on mourning, attachment, and self-states, along with clinical vignettes, the paper will show how existential questions are present in many of our analytic encounters. As we help our clients negotiate this moment, we too may acknowledge aspects of ourselves that can intensify our awareness, and facilitate our therapeutic effectiveness. Our capacity to explore this important edge of analytic space with our patients can help them to live and to love and can enrich our work if we can be open to its multifaceted meaning.     

Shaping Medical Students' Attitudes Toward Ethically Important Aspects of Clinical Research: Results of a Randomized,Controlled Educational Intervention

The effects of research ethics training on medical students' attitudes about clinical research are examined. A preliminary randomized controlled trial evaluated 2 didactic approaches to ethics training compared to a no-intervention control. The participant-oriented intervention emphasized subjective experiences of research participants (empathy focused). The criteria-oriented intervention emphasized specific ethical criteria for analyzing protocols (analytic focused). Compared to controls, those in the participant-oriented intervention group exhibited greater attunement to research participants' attitudes related to altruism, trust, quality of relationships with researchers, desire for information, hopes about participation and possible therapeutic misconception, importance of consent forms, and deciding quickly about participation. The participant-oriented group also agreed more strongly that seriously ill people are capable of making their own research participation decisions. The criteria-oriented intervention did not affect learners' attitudes about clinical research, ethical duties of investigators, or research participants' decision making. An empathy-focused approach affected medical students' attunement to research volunteer perspectives, preferences, and attributes, but an analytically oriented approach had no influence. These findings underscore the need to further examine the differential effects of empathy-versus analytic-focused approaches to the teaching of ethics.     

Great expectations: A meta-analytic examination of optimism and hope

Optimism and hope—two psychological constructs reflecting positive expectations about one’s future—have garnered considerable research attention and each has been the subject of several narrative reviews. In the current meta-analysis, we examined the optimism–hope relationship and we examined several potential correlates and consequences of optimism and hope. Our results suggest that optimism and hope are distinguishable from each other. Furthermore, both are related to several indices of psychological and physical well-being and both are empirically distinguishable from other personality traits, such as the Five Factor Model characteristics and trait affectivity. We conclude by discussing directions for future research on optimism and hope.     

Autobiographical memory specificity and the persistence of depressive symptoms in HIV-positive patients: Rumination and social problem-solving skills as mediators

Individuals infected with human immunodeficiency virus (HIV) are at elevated risk for depressive conditions, which in turn can negatively impact health-related behaviours and the course of illness. The present study tested the role of autobiographical memory specificity and its interaction with perceived stress in the persistence of depressive symptoms among dysphoric HIV-positive individuals. Additionally, we examined whether rumination and social problem solving mediated these effects. Results indicated that memory specificity moderated the impact of perceived stress, such that perceived stress was more strongly associated with follow-up depressive symptoms among those with greater memory specificity. Rumination, but not social problem solving, mediated this effect. Implications of these findings are discussed.     

How Loving are You Willing to Be? Empathic Interpretations of Fallibility,Capability, and Luck in Psychotherapy

This article addresses possibilities for more empathic interpretations in the clinical situation. Using both clinical case material and mythical allegories, the author, a psychotherapist and philosopher, considers the interrelated themes of human capability, fallibility, luck, and compassion within the context of clinical circumstances, especially in relation to intractable compulsive disorders. While addressing the implications of deterministic and indeterministic assumptions regarding human nature, the author attempts to show how human capability is subject to fallibility and how both are dependent on the workings of luck. Clinical material is then used to elucidate and illustrate more empathic ways of relating both to patients in particular and our fellow human beings in general. A new interpretive framework is also introduced to facilitate and to suggest ways to more compassionately understand, interpret, and respond to patients' own struggles for well being.     

Protection and vulnerability processes relevant for early onset of substance use: a test among African American children.

This research tested predictions from a self-regulation model of factors relevant for early onset of tobacco and alcohol use with a community sample of 889 African American children (mean age = 10.5 years). Criterion variables were peer substance use, willingness to use substances, and resistance efficacy (intention to refuse substance offers). Structural modeling indicated effects of temperament dimensions were mediated through self-control and risk-taking constructs, which were related to school involvement, life events, and perceived vulnerability to harmful effects of substances. Peer use was predicted by life events, poor self-control, and parent-child conflict; willingness was predicted by life events, risk taking, and (inversely) parental support; and resistance efficacy was predicted by perceived vulnerability and (inversely) poor self-control. Findings are discussed with reference to theoretical models of early protection and vulnerability processes.