Developments in cognitive neuroscience: II. Implications for theories of transference

An integration of psychoanalytic theory with contemporary developments in cognitive neuroscience offers a useful perspective on long-standing controversies about the nature of transference, and a better understanding of the precise mechanisms by which transferential processes occur. Contemporary psychoanalytic views of transference are reviewed, and the many processes that constitute transference are described. Two issues that have emerged in different guises for several decades-the role of the analyst in eliciting transference, and the nature of "real" and "transferential" components of the therapeutic relationship-are reconsidered in the light of concepts such as connectionist networks. Although a useful analytic stance is one that allows the patient's enduring dynamics to dominate the analytic field, it is suggested, anonymity is neither a cognitive possibility nor the driving force behind most transference reactions, and the distinction between "real" and "transferential" perceptions is one of therapeutic interest, not of mechanism. Certain features of the analytic situation make some dynamics more likely than others to enter the treatment relationship, notably those related to authority, intimacy and attachment, and sexuality. Transference reactions are best understood as constructed from a combination of the patient's enduring dispositions to react in particular ways under particular conditions; features of the analytic situation and of the analyst; and interactions between patient and analyst. These reactions do not unfold ineluctably from the patient's mind in the consulting room, nor are they cognitive constructions of the patient-analyst dyad or co-constructions of relatively equal partners exerting their influence on the analytic field.     

Observed classroom behavior of children with ADHD: relationship to gender and comorbidity

Examined hypothesized gender and comorbidity differences in the observed classroom behavior of children with attention deficit hyperactivity disorder (ADHD). The behavior of 403 boys and 99 girls with ADHD, ages 7–10, was compared (a) to observed, sex-specific classroom behavior norms, (b) by sex, and (c) by comorbid subgroups. Boys and girls with ADHD deviated significantly from classroom norms on 15/16 and 13/16 categories, respectively. Compared to comparison girls, girls with ADHD had relatively high rates of verbal aggression to children. Boys with ADHD engaged in more rule-breaking and externalizing behaviors than did girls with ADHD, but the sexes did not differ on more neutral, unobtrusive behaviors. The sex differences are consistent with notions of why girls with ADHD are identified and referred later than boys. Contrary to hypothesis, the presence of comorbid anxiety disorder (ANX) was not associated with behavioral suppression; yet, as hypothesized, children with a comorbid disruptive behavior disorder (DBD) had higher rates of rule-breaking, and impulsive and aggressive behavior, than did children with ADHD alone and those with ADHD+ANX. Elevated rates of ADHD behaviors were also observed in children with comorbid DBD, indicating that these behaviors are truly present and suggesting that reports of higher ADHD ratings in this subgroup are not simply a consequence of negative halo effects and rater biases.     

Cognitive and neuropsychological outcomes: more than IQ scores

Improved survival in preterm infants has broadened interest in cognitive and neuropsychological outcomes. The incidence of major disabilities (moderate/severe mental retardation, neurosensory disorders, epilepsy, cerebral palsy) has remained consistent, but high prevalence/low severity dysfunctions (learning disabilities, ADHD, borderline mental retardation, specific neuropsychological deficits, behavioral disorders) have increased. The follow-up literature contains methodologic problems that make generalizations regarding outcome difficult, and these are discussed. Although mean IQs of former VLBW infants generally are in the low average range and are 3-9 points below normal birth weight peers, these scores mask subtle deficits in: visual-motor and visual-perceptual abilities, complex language functions, academics (reading, mathematics, spelling and writing), and attentional skills. There is an increased incidence of non-verbal learning disabilities, need for special educational assistance, and behavioral disorders in children born prematurely. Males have more problems, and there is a trend for worsening outcome over time, due to emergence of more subtle deficits in response to increased performance demands. In addition to IQ and achievement testing in follow-up, there should be evaluation of executive functions and attention, language, sensorimotor functions, visuospatial processes, memory and learning, and behavioral adjustment.     

Presidential Scandal and Leadership: A Natural Laboratory Test of the Resiliency of President Clinton's Transformational Leadership During the Impeachment Crisis1

This study examined transformational and charismatic leadership assessments of President Clinton over 4 time periods beginning with his second term, continuing through the scandal of the Monica Lewinsky case and impeachment trial, and ending after he was acquitted. Our findings indicate that as the scandal unfolded, in general his leadership ratings declined among Democrats, Republicans, and “Others” (including Independents). However, his ratings did not decline at the same rate among all groups. They appeared to decline much more steeply with Republicans than with the other 2 groups. We discuss the differences in rates of decline among different factors of transformational leadership and the implications of the study for future research.     

Narcissism, Perfectionism, and Self-Termination from Treatment in Outpatient Cocaine Users

This study examines perfectionism in individuals with a Diagnostic and Statistical Manual-IV, Text Revised [American Psychiatric Association, 2000. Diagnostic and statistical manual of mental disorders (4th ed.). Text revision (DSM-TV-TR). Washington, DC: American Psychiatric Association] diagnosis of Narcissistic Personality Disorder and a coexisting diagnosis of cocaine abuse or dependence. Participating clients were treated in outpatient settings that provided cognitive-behavioral therapy. Clients were administered Hewitt and Flett's (1991b) [Journal of Personality and Social Psychology, 60, 456-470] Multidimensional Perfectionism Scale prior to treatment. Scores for dimensions of perfectionism were compared with those obtained from cocaine abusers in treatment with diagnoses of Antisocial Personality or Affective Disorder. Clients with Narcissistic Personality Disorder were characterized by relatively higher levels of other-oriented and socially prescribed perfectionism. Survival analysis suggests that self-termination from treatment by cocaine-abusing clients with a diagnosis of Narcissistic Disorder is related to high levels of other-oriented perfectionism. The clinical implications and limits of this study are discussed.     

Use of Brief Experimental Analyses in Outpatient Clinic and Home Settings

We describe the historic and current use of brief experimental analysis procedures in outpatient clinic and home settings. We discuss some applications of the designs and suggest design modifications for improving internal validity. We describe our application of the designs to longitudinal, in-home programs for children with severe behavior disorders and demonstrate how related versions of brief experimental analysis procedures can be linked to form a more comprehensive evaluation.     

The effects of presession exposure to attention on the results of assessments of attention as a reinforcer

The effects of presession exposure to attention on responding during subsequent assessments of attention as a reinforcer were evaluated across three behavioral assessments. In Experiment 1, a contingent attention assessment condition was preceded by either a noncontingent attention condition (free play) or a contingent escape condition. In Experiment 2, a diverted attention with extinction condition was preceded by either an alone or a free-play condition. In Experiment 3, a two-choice preference assessment was preceded by either 10 min of free play or 10 min of playing alone. In each experiment, the participant responded differentially within the test condition according to the presence or absence of dense schedules of attention immediately prior to that condition. The results of this study show that events occurring immediately prior to an assessment condition can influence behavior within the assessment.