Implicit relational knowing: Its role in development and psychoanalytic treatment

It is increasingly apparent that “something more” than interpretation is needed to bring about change in psychoanalytic treatment. Drawing on clinical and developmental observations, we propose that interactional processes from birth onward give rise to a form of procedural knowledge regarding how to do things with intimate others, knowledge we call implicit relational knowing. This knowing is distinct from conscious verbalizable knowledge and from the dynamic unconscious. The implicit relational knowing of patient and therapist intersect to create an intersubjective field that includes reasonably accurate sensings of each person's ways of being with others, sensings we call the “real relationship.” This intersubjective field becomes more complex and articulated with repeated patient–therapist encounters, giving rise to emergent new possibilities for more coherent and adaptive forms of interaction. During a transactional event that we term a “moment of meeting,” a new dyadic possibility crystallizes when the two persons achieve the dual goals of complementary fitted actions and joint intersubjective recognition in a new form. We argue that such moments of meeting shift the relational anticipations of each partner and allow for new forms of agency and shared experience to be expressed and elaborated. © 1998 Michigan Association for Infant Mental Health     

Toward a unified fielder theory: what we do not yet know about how people run to catch a ball.

Linear optic trajectory theory claims that people catch balls by running in a direction that keeps an optic trajectory of the ball linear. The authors show a range of ball trajectories for which departures of the optic trajectory from linearity do not predict which direction people will run, and the direction they choose does not correct these departures. Data from a wide range of ball trajectories show that people run so that the angle of elevation of gaze to the ball increases at a decreasing rate. But it is not yet known why people choose the particular path they do from the many that would achieve this.     

The application of an action system model to destructive behaviour: the examples of arson and terrorism.

This article argues that criminal and deviant behaviour can be productively viewed through an action system framework. The idea is developed by considering two forms of destructive behaviour: arson and barricade-hostage terrorist incidents. Two studies are presented. The first study tests the hypothesis that different forms of arson will reflect the four dominant states that an action system can take; integrative, expressive, conservative, and adaptive. A smallest space analysis was performed on 46 variables describing 230 cases of arson and the results identified the four themes of action system functioning. An examination of the personal characteristics of the arsonists also produced four variable groupings and a combined analysis of the four action scales and four characteristics scales also supported the structural hypothesis of the action system model. The second study applied the action system model to the study acts of terrorist barricade-hostage incidents. A smallest space analysis of 44 variables coded from 41 incidents again revealed four distinct forms of activity, which were psychologically similar to the four modes of arson identified in study one. Overall, these two studies provide support for the appropriateness of the action system framework as a way of classifying different forms of deviant behaviour.     

Reliability and Validity of Three Measures of Multicultural Competency

The purpose of this study was to examine the reliability and validity of 3 measures of multicultural competency, the Multicultural Counseling Awareness Scale: Form B (MCAS), the Multicultural Awareness‐Knowledge‐and‐Skills Survey (MAKSS), and the Survey of Graduate Students' Experiences with Diversity (GSEDS). Data were collected from 120 master's‐level students from counseling programs accredited by the Council for Accreditation of Counseling and Related Educational Programs or the equivalent. The findings generally support the psychometric soundness of these surveys, with some important exceptions. Guidelines for their use and directions for additional research are provided.     

Growth hormone response to different consecutive stress stimuli in healthy men: is there any difference?

The contribution of growth hormone (GH), released during acute and repeated stressful situations, to the development of stress-related disorders is often neglected. We have hypothesized that the modulation of the GH response to sequential stress exposure in humans depends mainly on the nature of the stressor. To test this hypothesis, we compared GH responses to different stressful situations, namely aerobic exercise, hypoglycemia and hyperthermia, which were applied in two sequential sessions separated by 80-150 min. In addition, administration of the dopaminergic drug apomorphine was used as a pharmacological stimulus. GH responses to submaximal exercise (bicycle ergometer, increasing work loads of 1.5, 2.0 and 2.5 W/kg, total duration 20 min) and hyperthermia in a sauna (80 degrees C, 30 min) were prevented when preceded by the same stress stimulus. Hypoglycemia induced by insulin (0.1 IU/kg intravenously) resulted in a significant GH response also during the second of the two consecutive insulin tests, though the response was reduced. Administration of apomorphine (0.75 mg subcutaneously) or insulin prevented the increase in GH release in response to a sequential bolus of apomorphine, while hypoglycemia induced a significant elevation in GH levels even if applied after a previous treatment with apomorphine. In conclusion, the feedback inhibition of the GH response to a sequential stress stimulus depends on the stimulus used. Unlike in the case of exercise and hyperthermia, mechanisms involved in the stress response to hypoglycemia appear to overcome the usual feedback mechanisms and to re-induce the GH response when applied after another stimulus.     

“Compliance” to “Concordance”: A Critical View

Advocates of “concordance” describe it as a new model of shared decision-making between physicians and patients based on a partnership of equals. “Concordance” is meant to make obsolete the notion of “compliance,” in which patients are seen as, ideally, following doctors’ orders. This essay offers a critical view of concordance, arguing that the literature itself on concordance, including materials at the web site of Medicines Partnership, the implementation arm in Great Britain of the concordance model, is full of contradiction; concordance, in fact, harbors an ideology of compliance. The essay suggests that an improvement in patient medication use will more likely come from a frank consideration of the relation of compliance issues and commercial ones, and that a key question across domains is, “how are patients/health agents/consumers persuaded to acquire certain drugs and take them as directed?”     

The hypothalamo-pituitary-adrenal axis in chronic fatigue syndrome and fibromyalgia syndrome

The hypothalamo-pituitary-adrenal (HPA) axis plays a major role in the regulation of responses to stress. Human stress-related disorders such as chronic fatigue syndrome (CFS), fibromyalgia syndrome (FMS), chronic pelvic pain and post-traumatic stress disorder are characterized by alterations in HPA axis activity. However, the role of the HPA axis alterations in these stress-related disorders is not clear. Most studies have shown that the HPA axis is underactive in the stress-related disorders, but contradictory results have also been reported, which may be due to the patients selected for the study, the methods used for the investigation of the HPA axis, the stage of the syndrome when the tests have been done and the interpretation of the results. There is no structural abnormality in the endocrine organs which comprise the HPA axis, thus it seems that hypocortisolemia found in the patients with stress-related disorder is functional. It may be also an adaptive response of the body to chronic stress. In this review, tests used in the assessment of HPA axis function and the HPA axis alterations found in CFS and FMS are discussed in detail.     

Crossmodal change blindness between vision and touch

Change blindness is the name given to people's inability to detect changes introduced between two consecutively-presented scenes when they are separated by a distractor that masks the transients that are typically associated with change. Change blindness has been reported within vision, audition, and touch, but has never before been investigated when successive patterns are presented to different sensory modalities. In the study reported here, we investigated change detection performance when the two to-be-compared stimulus patterns were presented in the same sensory modality (i.e., both visual or both tactile) and when one stimulus pattern was tactile while the other was presented visually or vice versa. The two to-be-compared patterns were presented consecutively, separated by an empty interval, or else separated by a masked interval. In the latter case, the masked interval could either be tactile or visual. The first experiment investigated visual-tactile and tactile-visual change detection performance. The results showed that in the absence of masking, participants detected changes in position accurately, despite the fact that the two to-be-compared displays were presented in different sensory modalities. Furthermore, when a mask was presented between the two to-be-compared displays, crossmodal change blindness was elicited no matter whether the mask was visual or tactile. The results of two further experiments showed that performance was better overall in the unimodal (visual or tactile) conditions than in the crossmodal conditions. These results suggest that certain of the processes underlying change blindness are multisensory in nature. We discuss these findings in relation to recent claims regarding the crossmodal nature of spatial attention.     

Depressogenic inferential styles, negative events, and depressive symptoms in youth: an attempt to reconcile past inconsistent findings

Research examining the diathesis-stress component of the hopelessness theory (HT) in youth has provided mixed support for the theory. One explanation for inconsistent findings is the failure to consider relationships among the three inferential styles posited to serve as vulnerability factors by the theory. The weakest link hypothesis posits that an individual is as vulnerable to depression as his/her most depressogenic inferential style (DIS) makes him/her. A second explanation is that researchers have operationalized "high stress" from a nomothetic, as opposed to an idiographic, perspective. The current study tested the diathesis-stress component of the HT in 230 third-grade and 152 seventh-grade schoolchildren using both a weakest link and an idiographic approach towards analysis. Children completed measures assessing depressive symptoms and DISs. Children subsequently completed measures assessing depressive symptoms and negative events once a week for 6 weeks. Hierarchical linear modeling and time-lagged analyses indicated that a depressogenic weakest link was associated with greater elevations in depressive symptoms following elevations in stress.     

Responding to symptoms of depression and anxiety: emotion regulation, neuroticism, and engagement in risky behaviors

The current study examined whether neuroticism, emotional regulation deficits, and/or their interaction predict increased engagement in risky behaviors following increases in symptoms of depression or anxiety over the course of 6 weeks. Results of hierarchical linear modeling analyses indicated that individuals who exhibited high levels of both neuroticism and emotional regulation deficits were more likely than other individuals to report increased engagement in risky behaviors following increases in symptoms of either depression or anxiety. Unexpectedly, individuals who exhibited high levels of neuroticism and adaptive emotion regulation strategies exhibited decreased engagement in risky behaviors following increases in depressive or anxious symptoms.