Addressing Challenges in Individual Psychotherapy with Delusional Patients: A Case Study

Although cognitive-behavioral treatments for schizophrenia and other psychotic disorders demonstrate strong results in clinical trials, not all patients respond to these treatments. Common challenges in psychotherapy with delusional patients include a mismatch between the therapist’s and the patient’s expectations about the purpose of therapy, the patient’s lack of motivation to reduce delusional beliefs in service of other goals, and the patient’s dependence on the delusions in order to preserve an intact sense of self. This case highlights the value of integrating a psychodynamic perspective with cognitive-behavioral interventions to address challenges in psychotherapy with chronically delusional patients.     

Transformations of mathematical and stimulus functions

Following a pretest, 8 participants who were unfamiliar with algebraic and trigonometric functions received a brief presentation on the rectangular coordinate system. Next, they participated in a computer-interactive matching-to-sample procedure that trained formula-to-formula and formula-to-graph relations. Then, they were exposed to 40 novel formula-to-graph tests and 10 novel graph-to-formula tests. Seven of the 8 participants showed substantial improvement in identifying formula-to-graph relations; however, in the test of novel graph-to-formula relations, participants tended to select equations in their factored form. Next, we manipulated contextual cues in the form of rules regarding mathematical preferences. First, we informed participants that standard forms of equations were preferred over factored forms. In a subsequent test of 10 additional novel graph-to-formula relations, participants shifted their selections to favor equations in their standard form. This preference reversed during 10 more tests when financial reward was made contingent on correct identification of formulas in factored form. Formula preferences and transformation of novel mathematical and stimulus functions are discussed.     

Joseph Sandler's Contributions to The Concept of Countertransference

A few months before Joe Sandler's death, he participated in an American Psychoanalytic Association panel that focused on the Controversial Discussions that occurred in the British Psychoanalytic Society from 1941 to 1945. Our plan was to revisit the controversies in the context of British psychoanalysis some 50 years later. As we designed the panel, I suggested that we have one Kleinian panelist, one contemporary Freudian panelist, and a third panelist representing the Independents.     

A genetic two-factor model of the covariation among a subset of Multidimensional Aptitude Battery and Wechsler Adult Intelligence Scale—Revised subtests

The phenotypic and genetic factor structure of performance on five Multidimensional Aptitude Battery (MAB) subtests and one Wechsler Adult Intelligence Scale—Revised (WAIS-R) subtest was explored in 390 adolescent twin pairs (184 monozygotic [MZ]; 206 dizygotic (DZ)). The temporal stability of these measures was derived from a subsample of 49 twin pairs, with test–retest correlations ranging from .67 to .85. A phenotypic factor model, in which performance and verbal factors were correlated, provided a good fit to the data. Genetic modeling was based on the phenotypic factor structure, but also took into account the additive genetic (A), common environmental (C), and unique environmental (E) parameters derived from a fully saturated ACE model. The best fitting model was characterized by a genetic correlated two-factor structure with specific effects, a general common environmental factor, and overlapping unique environmental effects. Results are compared to multivariate genetic models reported in children and adults, with the most notable difference being the growing importance of common genes influencing diverse abilities in adolescence.     

Miscarriages of psychoanalytic treatment with suicidal patients2

The author describes a particularly perilous frontier on the psychoanalytic landscape‐ namely, the treatment of suicidal patients with serious personality disorders. Using a clinical example of egregious boundary violations by an analyst, he describes specific countertransference pitfalls that lead to mishandling the patients' expressions of suicidal despair. These include disidentification with the aggressor, failure of mentalization, collapse of the analytic play space, reactions to loss in the analyst's personal life, omnipotence, envy of the patient and masochistic surrender. The author emphasizes the unique vulnerabilities that accompany analytic treatment of such patients.     

Staying on Track in School: Religious Influences in High- and Low-Risk Settings

Religious communities are known to instill standards of achievement in their young people, but this observation may not apply as well to disadvantaged youth and their culture. In this study, we explore whether religious involvement enables youth in low-income neighborhoods to stay on track in school, rather than falling behind. Using data from two waves of the National Longitudinal Study of Adolescent Health, we find that adolescents in low-income neighborhoods do not differ in their church attendance patterns from their peers in higher-income areas. However, their religious involvement is more likely to contribute to their academic progress than it is among youth in higher-income neighborhoods, even with adjustments for key risk and protective factors. This cross-level interaction involving youth church attendance shows a consistent relationship with several other measures of neighborhood disadvantage. We explore explanations for church attendance's uniquely positive effect in impoverished neighborhoods and its broader implications.     

Choice as an Intervention to Improve Behavior: A Review of the Literature

In recent years, choice making has been evaluated as an intervention for people with disabilities. This review examines applied research during the past two decades using choice as a distinct intervention or as part of an intervention package. Fourteen studies published between 1975 and 1996 were identified that implemented choice as an intervention to increase or decrease a target behavior. These studies applied choice-making in the following three broad areas: (a) vocational or domestic activities; (b) academic activities; and (c) leisure, recreational, or social activities. All of the studies indicated that choice-making procedures resulted in behavioral improvements with some, if not all of the participants.