Family therapy approach to incapacitating migraine

A nine-year-old boy who suffered from intractable migraine was referred for psychiatric consultation and treatment after failing to respond to congeries of medications and diets, notwithstanding thorough investigations by neurologists, pediatricians, and other specialists. The decision for a family systems treatment approach resulted in the following defined objectives: (1) to investigate triggers for the headaches and to see if these could be reduced and/or eliminated, (2) to see if therapy would help the boy stay in school, (3) to examine, and if possible, change family rules of interaction and transaction, (4) to allow for more fun within the family (5) to allow for ventilation without retribution, and (6) to clarify the mother's role as a significant contributor to the family's interactions, shifting the focus from the father as the sole generator of family tension. The principal therapeutic tools which proved efficacious involved the following: (1) scrutiny of the maternal and paternal histories, and (2) analysis of triangulations within the family system, leading to (3) the formulation of therapeutic strategies, and (4) specific task assignments. A major intervention by the therapist was the specific strategy to have the family examine the rules of transaction which were in the metapsychological sense unarticulated.     

Sex differences in sexual fantasy patterns

A detailed sexual fantasy questionnaire was completed anonymously and returned by post by a sample of 90 Londoners stratified by sex and social class and representing a 30% return rate. Men and women were equally likely to accept and return the questionnaires. Information was also collected concerning sexual behaviour, libido and satisfaction. Factor analysis revealed four main types of fantasy: (1) Exploratory (e.g., group sex, promiscuity, homosexuality); (2) Intimate (e.g., kissing, oral sex, outdoor love); (3) Impersonal (e.g., watching others, fetishism, using objects for stimulation); and (4) Sadomasochistic (e.g., whipping or spanking, being forced). These four types of fantasy were positively correlated and were all more commonly reported by men, although women were almost as high on the Intimate factor. Women were also more likely to be passive or receptive in their fantasies, and men active. All fantasies were associated with high libido as indicated by self-rated sex drive and orgasm frequency, especially for women. In general, reports of many fantasies went with satisfaction in women but with dissatisfaction (frustration?) in men. This finding is explained in terms of the higher average level of libido in men than women, with the consequent difficulty experienced by men in acting out their desires.     

Children's perception of media-portrayed sex roles

The immediate impact on preschool and elementary school children of a televised presentation in which the traditional sex roles of physician and nurse were reversed was examined. After viewing a videotape of a male nurse and a female physician, subjects were asked to identify photographs or names of the physician and nurse. Preschool, first-, and fourth-grade children selected male names or pictures for the physician and female names or pictures for the nurse, thereby reversing genders. Their immediate recall appeared strongly influenced by their stereotypes rather than by the film they had just viewed. Seventh-grade children correctly identified the names of the physician and nurse.The authors wish to thank Dr. Edward F. Meydrech, Assistant Professor, Department of Preventive Medicine and Chief of the Division of Biostatistics, University of Mississippi Medical Center, for his invaluable assistance in the analysis of the data.     

Self and external management compared with psychotherapy in the control of obesity

Seventy-four obese TOPS (Take Off Pounds Sensibly) members were assigned to one of five conditions: delayed treatment control, insight psychotherapy, self-management training plus external reinforcement, self-management training only, or external reinforcement only. The latter four groups met once per week for ten weeks and were seen at three and six months and followup. It was hypothesized that self-management plus external reinforcement would be superior to other conditions at both post-treatment and followup, and that this condition alone would produce continuing weight losses. Analysis of covariance on body weight, with pretreatment weight as covariate, indicated that self-management plus external reinforcement, self-management only, and external reinforcement only, did not differ in mean body weight at post-treatment. These three groups differed significantly from control and psychotherapy conditions, which did not differ from one another. Self-management plus external reinforcement produced better performance of techniques. At three and six month followup, differences between the four treatment conditions were no longer significant. Results are discussed in terms of evaluation of psychotherapy and behavior modification and durability of results.     

Assessment of coping: an empirical illustration of the problem of inapplicable items

The prevalence and effects of inapplicable items on the Ways of Coping Questionnaire (WOC) were studied. Three hundred seventy-six college students completed the WOC twice, referring to both heterogeneous (i.e., different types of) and homogeneous (the same) stressors. In addition to the standard procedure for administering this questionnaire, subjects were asked to identify items that were inapplicable to the stressors with which they were coping. Item inapplicability ranged from 2.1% to 83.9%, with a mean of 21.5% inapplicability across all WOC items. Application of a correction for item inapplicability demonstrated that situational effects are confounded by this phenomenon and may not hold up when the correction is applied. Implications of these findings include the possibility that previous research has over- or misidentified situational effects on coping.     

Psychic trauma and masochism

Three analyses are presented in which acute trauma (overwhelming internal or external stimulation so great as to preclude the patient's utilizing his usual defenses adequately) in childhood contributed to the development of masochism. The patients later attempted mastery through repetition, reversal, and erotization , and employed regression as a defense against feared oedipal wishes.