Assessments in Psychotherapy with Suicidal Patients: The Precedence of Alliance Work

Journal of Contemporary Psychotherapy - In this article the aim was to explore how therapists handle suicide risk assessment in connection with patient’s experience of alliance in...     

Typology,the eight-function model,and archetypal complexes

This clinical presentation shows what insights a typology-conscious analysis of clients and their families may lead to and points out what is added by applying John Beebe’s eight-function, eight-archetype model. To reflect on the inner balance between archetypal complexes in the eight-function structure that holds our psyche, the author invites clients to do a typological analysis, including an analysis of their archetypal patterns, which may, itself, provoke anxiety. This article includes a presentation of ideas and experiences sparked when confronting these complexes in clinical work. Clients are introduced to six stages of coping with stress that may allow them to be more conscious of their complexes when triggered. These stages are Faint, Freeze, Flight, Fidget, Fight, and Flow. To identify whether the stress is physiological, emotional, or intellectual, the idea of the Triune Brain is introduced. The therapeutic work may lead to redemption from opposites, which is an ethical task.     

Maternal soothing and infant stress responses: soothing, crying and adrenocortical activity during inoculation

The relation between maternal soothing and infant stress response during inoculation was examined in a sample of 37 mothers and their 3-month-old infants. The mothers' soothing and the infants' cry vocalizations and the mothers' and the infants' salivary cortisol level pre- and post-injection were analysed. There was a positive relation between infants' cry vocalization post-injection and maternal soothing pre- and post-injection. The sample was divided in two sub-groups depending on whether the mothers evidenced most soothing of the infants in the period before (Preparatory group; n=20) or after (Contingent group; n=17) the syringe injection. In the Preparatory group, the duration of infant cry vocalizations was related to amount of maternal soothing before and after the injection, while cry vocalizations in the Contingent group was related to amount of maternal soothing after the injection. The Contingent infants responded to the injection with a significant increase in cortisol, while there was no increase in the Preparatory infants. The Preparatory infants evidenced significantly longer duration of looking at the target stimuli in a visual marking task, suggesting greater difficulties in disengaging attention. These findings indicate that 3-month-olds' stress responses and their mothers' situational behaviour are mutually regulated.     

The influence of war on moral judgments about harm

How does war influence moral judgments about harm? While the general rule is “thou shalt not kill,” war appears to provide an exception to the moral prohibition on intentional harm. In three studies (n = 263, n = 557, n = 793), we quantify the difference in moral judgments across peace and war contexts, and explore two possible explanations for the difference. The findings demonstrate that third-party observers judge a trade-off of one life for five as more morally acceptable in war than in peace, especially if the one person is from an outgroup of the person making the trade-off. In addition, the robust difference in moral judgments across “switch” and “footbridge” trolley problems is attenuated in war compared to in peace. The present studies have implications for moral psychology researchers who use war-based scenarios to study broader cognitive or affective processes. If the war context changes judgments of moral scenarios by triggering group-based reasoning or altering the perceived structure of the moral event, using such scenarios to make decontextualized claims about moral judgment may not be warranted.     

The Relationship Between Sluggish Cognitive Tempo,Subtypes of Attention-Deficit/Hyperactivity Disorder,and Anxiety Disorders

The objective of the present study was to examine the relationship between sluggish cognitive tempo (SCT), subtypes of attention-deficit/hyperactivity disorder (ADHD), and anxiety disorders (AnxDs). One hundred and forty-one children (90 males, 51 females) aged 7–13 years were assigned to four groups, i.e., referred children with comorbid AnxDs and ADHD (n = 25), ADHD (n = 39), AnxDs (n = 41), and nonreferred controls (n = 36). Furthermore we explored the association between SCT and several neurocognitive measures (reaction time, verbal memory, and spatial memory). Diagnoses were established using Kiddie-SADS P/L. SCT was assessed using a 17-item mother-reported questionnaire. SCT correlated significantly with inattentiveness, regardless of the subtype of ADHD. Furthermore, we found significant differences in the levels of SCT among the four groups, with the highest SCT scores observed in the comorbid group. SCT correlated with variability in spatial memory; in contrast, there was no correlation between SCT and reaction time.     

Effect of self-discrepancy on specificity of autobiographical memory retrieval

Research using a cue word paradigm has consistently shown that depression, in both adults and adolescents, is associated with difficulties in retrieving specific autobiographical memories. Inspired by previous work stating that depressed feelings are related to a perceived discrepancy between attributes of the actual and the ideal self, the present study aimed to investigate the hypothesis that cues bringing discrepancies between the actual and ideal selves to the foreground might promote or facilitate the recall of overgeneral (instead of specific) autobiographical memories. In two studies adolescents provided autobiographical memories in response to 10 high-discrepant and 10 low-discrepant words. As predicted, results in both studies showed an effect of cue word discrepancy on the specificity of autobiographical memories such that participants retrieved a smaller proportion of specific and a greater proportion of overgeneral memories in response to high-discrepant words as compared to low-discrepant words. The findings are discussed in terms of the self-memory system (SMS) as a conceptual framework of autobiographical memory (Conway & Pleydell-Pearce, 2000).     

Neuropattern: a new translational tool to detect and treat stress pathology. II. The Teltow study

The present study was designed to test the clinical utility of Neuropattern (NP), a newly developed translational diagnostic tool. NP consists of biological and psychological measures that facilitate the identification of functional changes (called "neuropatterns") in patients with stress-related health problems. In this prospective, randomized control trial, we expected NP to improve therapeutic efficacy, as compared with the usual treatment. NP was applied to 101 in-patients suffering from various mental disorders (mainly depression, anxiety disorders, and adjustment disorders), and scoring high on the Symptom Checklist-90-R (SCL-90-R) somatization scale. The patients (73% females, mean?±?standard deviation age 46?±?9.03 years) were randomly assigned to two groups: in the experimental group (n?=?51), physicians received results from NP diagnostics, while in the control group (n?=?50), this information was not available until discharge from the hospital. Improvements of symptoms in consequence of treatment were monitored by two self-rating scales, the SCL-90-R and Short Form-12 health survey, and a physician's clinical global rating (Beeintr?chtigungs-Schwere Score). There was a significantly greater improvement in the experimental group in the self-rating assessments on symptom severity (p?=?0.03) and quality of life (p?=?0.05), but not in the observer rating of emotional, physical, and social-communicative functioning (p?=?0.13). Treatment efficacy in patients can be improved by providing the attendant physician and the patient with diagnostic information and treatment recommendations by NP. The role of concrete mediators of treatment efficacy awaits further research.     

Communication Between Spouses as a Resilience Factor in Families in Which a Parent Has Depression: A Condensed Report

This study focused on communication as a family resilience factor in families in which an adult suffers from a depressive disorder. Six partners of depressive adults were interviewed. Results revealed two groups of couples. The “talkative couples” have many conversations during the depression and a facilitating factor was having insight into the depression. The other group, the “taciturn couples,” indicated large difficulties in having conversations, resulting in silence being the dominant contact between the partners. The majority of the participants stated that the absence of conversation would have meant the end of their relationship.     

Mechanisms of change in cognitive behaviour therapy for panic disorder: The role of panic self-efficacy and catastrophic misinterpretations

The efficacy of cognitive behavioural therapy (CBT) for panic disorder with or without agoraphobia (PD) is well-established; however, little is known about the underlying change processes of clinical improvement during therapy. According to cognitive theories, CBT for PD primarily works by changing catastrophic misinterpretations of bodily symptoms and panic attacks. However, panic self-efficacy, i.e. the perceived ability to cope with panic attacks, has also been suggested as an important change mechanism in CBT for PD. The aim of the study was to investigate if change in catastrophic misinterpretations and panic self-efficacy mediated change in the level of anxiety during the course of thirteen sessions of group CBT for PD. Forty-five participants completed weekly self-report measures of the possible cognitive mediators and the level of anxiety throughout therapy. The results indicated that within-person change in panic self-efficacy in one session, but not in catastrophic misinterpretations, predicted within-person level of anxiety symptoms the following week. However, in a reversed analysis, prior change in level of anxiety symptoms also predicted change in panic self-efficacy the following session. These results support panic self-efficacy as a mediator of change in CBT for PD, although a reciprocal causal relationship between panic self-efficacy and level of anxiety seems to be implied.     

Defense mechanisms: An approach from the perspective of personal construct psychology

The psychoanalytic concept of defense mechanisms was theoretically and empirically approached from the perspective of personal construct psychology, in an attempt to investigate its cognitive components. Thirty neurotic clients of the Psychotherapeutic Center in Stuttgart, Federal Republic of Germany, were investigated by means of the Questionnaire for Defense Categories (Ehlers & Peter, 1989) and the Repertory Grid Test (Kelly, 1955). Tight construing, extremity of emotional evaluation, construal of the symptom as having positive implications, and construed similarity between certain aspects of the self were observed in clients who frequently used the defense mechanisms denial, rationalization, and turning against the object.