Clinical Exchange: The Architectural Failure

The Clinical Exchange invites eminent clinicians of diverse persuasions to share, in ordinary language, their clinical formulations and treatment plans of the same psychotherapy patient—one not selected or nominated by those therapists—and then to discuss points of convergence and contention in their recommendations. This Exchange concerns a Mr. L, a 47-year-old, married man presenting for outpatient individual psychotherapy with chief complaints of depression, anxiety, and a lengthy history of vocational underachievement. Drs. Herbert Fensterheim, Leslie Greenberg, and Leigh McCullough, who anchor their practices in the cognitive-behavioral, experiential, and psychodynamic orientations, respectively, are the featured commentators. Finally, Dr. Jerold Gold, the case contributor and Mr. L's psychotherapist, provides a few closing comments.     

Resilient Response to Battering

Spouse abuse remains an important social problem. Recent research has begun to explore resiliency in a variety of areas: Why, despite harsh life circumstances, do some people survive and later thrive after experiencing trauma? What are the processes associated with a successful departure from abuse? The authors worked with a local shelter to identify three groups of women: (a) those currently at the shelter; (b) those who had been away from an abusive relationship for at least one year; and (c) those who were identified by shelter staff as having demonstrated a resilient response to battering, and compared experiences and recommendations between groups and discuss clinical and service implications.     

Proximal and Distal Defense: A New Perspective on Unconscious Motivation

Death-related thoughts produce different effects on thought and behavior when they are in current focal attention and when they are on the fringes of consciousness. When such thoughts are conscious, people attempt to either remove them from consciousness or push death into the distant future by distorting their beliefs to logically imply that they have many remaining years to live. When such thoughts are highly accessible but outside current focal attention, people increase efforts to view themselves as persons of value living in a meaningful universe. In this way, awareness of the inevitability of death produces diverse effects on human thought and behavior that bear little obvious resemblance to the problem of death.     

Prior experience and patterning in a prisoner's dilemma game

Female college students first played a pseudo-prisoner's dilemma (PPD) game with the experimenter, who followed a fixed strategy. In the first experiment the experimenter's strategies for different groups of subjects were: (a) play tit-for-tat; (b) play randomly; (c) always cooperate; (d) always defect (‘cooperation’ and ‘defection’, defined as in an actual prisoner's dilemma game). Only the tit-for-tat group increased cooperation over trials; other groups decreased cooperation. After playing the PPD with the experimenter, subjects played an actual prisoner's dilemma (PD) game with each other. In the PD game, subjects began cooperating moderately but cooperation deteriorated regardless of what the experimenter's strategy had been in the earlier (PPD) game. In a second experiment, subjects again played a PPD game with the experimenter and then played a PD game with each other. Half played one trial at a time as in the first experiment while half played in patterns of four trials at a time. In the PD game, patterning of trials retarded the development of mutual defection regardless of previous experience. The cooperation-preserving effect of patterning of trials in this social task is compared with similar effects on individual tasks involving self-control and risk-aversion. © 1998 John Wiley & Sons, Ltd.     

Special perspective: An immodest proposal: should treating mental health professionals be barred from testifying about their patients?

Notwithstanding ethical rules that address therapeutic and forensic role conflicts for psychologists and psychiatrists, overzealous patient advocacy by therapists, tightened reimbursement for therapy, and a growth market for forensic psychology and psychiatry, have led many therapists to appear willingly as forensic experts on behalf of their patients. Existing ethical rules, as well as other proposed approaches to address this problem, assume that it can be resolved by modest changes in existing practice that permit therapists to testify as long as their testimony avoids psycholegal opinions. This essay questions whether these modest changes can adequately address this problem and advances consideration of a more radical proposal to address this problem, prohibiting therapists from testifying about their patients. © 1998 John Wiley & Sons, Ltd.     

Trust,anger, resentment,forgiveness: On blame and its reasons

A discussion of the scope that exists for the normative assessment of blame. The paper starts from the assumption that blame is to be understood in terms of the reactive attitudes. A particular crux is the question of whether blame can be assessed critically if conditions are in place that render the reactive attitudes apt or warranted. The paper argues that even warranted blame can be managed critically and that this is something we often have reason to do, given the oppositional nature of reactive blame. The point is illustrated through a discussion of forgiveness and hypocrisy. A further claim is that, once reasons for reactive blame are distinguished from distinct reasons for managing it in different ways, space opens up for interesting global challenges to reactive blame, even when it is internally apt or warranted.     

Spatial attention is necessary for object-based attention: Evidence from temporal-order judgments

Attentional selection is a dynamic process that relies on multiple types of representations. That object representations contribute to attentional selection has been known for decades; however, most evidence for this contribution has been gleaned from studies that have relied on various forms of spatial cueing (some endogenous and some exogenous). It has thus remained unclear whether object-based attentional selection is a direct result of spatial cuing, or whether it still emerges without any spatial marker. Here we used a novel method—the temporal-order judgment (TOJ)—to examine whether object-based guidance emerges in the absence of spatial cuing. Participants were presented with two rectangles oriented either horizontally or vertically. Following a 150-ms preview time, two target stimuli were presented on the same or on different objects, and participants were asked to report which of the two stimuli had appeared first. The targets consisted of stimuli that formed a percept of a “hole” or a “hill.” First, we demonstrated that the “hill” target was indeed processed faster, as evidenced by a positive perceived simultaneity (PSS) measure. We then demonstrated that if two targets appeared with equal probabilities on the same and on different objects, the PSS values, although positive, were not modulated by the objects. In a subsequent set of experiments, we showed that objects can modulate attentional allocation—however, only when they are biased by a spatial (endogenous) cue. In other words, in the absence of a spatial cue or bias, object representations do not guide attentional selection. In addition to providing new constraints for theories of object-based attentional guidance, these experiments introduce a novel paradigm for measuring object-based attentional effects.     

Child Conduct Problems Across Home and School Contexts: a Person-Centered Approach

To examine patterns of conduct problems across the home and school context, we used latent class analysis to analyze primary caregivers’ and teachers’ ratings on the conduct problems subscale of the Strengths and Difficulties Questionnaire (Goodman Journal of Child Psychology and Psychiatry, 38, 581–586, 1997) in the Family Life Project (N?=?1,292), a prospective study of child development in rural and small town contexts. We found a similar four-class solution at 5 and 7 years of age. In decreasing prevalence, the following classes were identified: (1) low symptoms reported by both informants (low cross-context); (2) high parent-reported symptoms, low teacher-reported symptoms (home context); (3) low parent-reported symptoms, moderate teacher-reported symptoms (school context); and (4) high symptoms reported by both informants (high cross-context). Classes exhibited stability from age five to age seven: children were more likely to remain in the same class than to transition to a different class, and longitudinal stability was especially high for children in the low cross-context class at age 5. A number of child and family characteristics measured in early childhood (executive function, verbal ability, poverty-related risk, sensitive parenting, and parental depressive symptoms) were associated with class membership at age five and age seven, but were generally not associated with longitudinal transitions between classes.