The play's the thing how the essential processes of therapy are seen most clearly in child therapy

Analytic child therapy techniques developed as modifications of techniques from adult psychoanalysis. Child therapy continues to be regarded as an adaptation of adult analysis and to give a central place to the methods and conditions of adult analysis, such as interpretation, in its understanding of how therapy heals. I propose that child therapy is not a modified form of therapy and that the essential processes of therapy are fully present in child therapy. In fact, they often may be seen more clearly there than in adult therapy. I suggest two interrelated processes as the essential ones in all analytic therapy. The first is play. I examine several interrelated aspects of play, specifically as they occur in child therapy. These include the emergence and integration of dissociated self‐states, symbolization, and recognition. The second process I propose as essential in analytic therapy is the renegotiation of self—other relationships through action. This renegotiation is what can help patients become able to play in therapy when they have difficulty doing so. Since I suggest that action is at the heart of analytic therapy, I go on to consider the role of talking in an action therapy. Finally, I explore the dimensions of mutuality in the relationship between child and therapist, including mutual influence and regulation, mutual recognition, and mutual regression. The intersubjective nature of psychotherapy, which is increasingly appreciated in adult analytic therapy but not in child therapy, provides a fertile context for the evolution of play and for the productive renegotiation of self—other relationships.     

purging behavior in a sample of college females: a research note on general strain theory and female deviance

Tests of theories of deviance tend to focus on criminality, delinquency, or types of deviance more typically engaged in by males. Prototypical female deviance has been largely ignored. This article reports the findings from a pilot study of female deviance. Using a sample of 96 college women, we examine the utility of General Strain Theory to explain one prototypically female type of deviant behavior, purging. We explore the relationship of strain variables to purging, mediated through negative affect. Two forms of negative affect, anger and depression, are included in the model. Our findings suggest that the relationship is complex, with an interaction between anger and depression. Anger is associated with purging at high levels of depression only. The preliminary findings, when viewed in conjunction with prior research, suggest that different negative affective states may be associated with different types of deviance outcomes, and that typically "female" or self-directed types of deviance may result from the interaction of anger and depression.     

Relationship among gender-related stress,resilience factors,and mental health in a Midwestern U.S. transgender and gender-nonconforming population

Background: Transgender and gender-nonconforming individuals experience more discrimination than their cisgender peers, and this discrimination can be associated with poorer mental health. This study used the gender minority stress model as a framework to examine the relationship among gender-related stressors and resilience factors and mental health outcomes. The study particularly aimed to increase knowledge of the gender-nonconforming population.

Methods: A community sample of 83 individuals that identify as a gender different than the sex assigned to them at birth completed an online survey. Depression and anxiety were assessed using the Center for Epidemiological Studies Depression Scale (CES-D) and Beck Anxiety Inventory (BAI), respectively. The Gender Minority Stress and Resilience measure was used to assess distal and proximal stressors and resilience factors.

Results: The median CES-D and BAI scores were 16 and 13, respectively. Forty percent had a history of non-suicidal self-injury (NSSI), 75% had experienced suicidal ideation, and 45% had attempted suicide. Proximal stress was found to be a positive predictor of depressive symptoms. Resilience was a weak negative predictor of anxiety symptoms. Distal stress was a positive predictor of suicide attempts, and resilience factors and hormone use were marginal negative predictors of suicide attempt. Trans women were significantly less likely to have engaged in NSSI, but had a significantly higher proximal stress score than trans men and gender-nonconforming individuals.

Conclusion: Our study found high rates of mental health problems in the trans and gender-nonconforming sample. Our findings in part support the gender minority stress model, with gender-related stress predicting certain mental health problems and resilience being a negative predictor. Overall, gender-nonconforming individuals have had similar experiences and mental health findings as transgender individuals.     

Intervening response events between identification targets do not always turn repetition benefits into repetition costs

When there is a relatively long interval between two successive stimuli that must be detected or localized, there are robust processing costs when the stimuli appear at the same location. However, when two successive visual stimuli that must be identified appear at the same location, there are robust same location costs only when the two stimuli differ in their responses; otherwise same location benefits are observed. Two separate frameworks that inhibited attentional orienting and episodic integration, respectively, have been proposed to account for these patterns. Recent findings hint at a possible reconciliation between these frameworks—requiring a response to an event in between two successive visual stimuli may unmask same stimulus and same location costs that are otherwise obscured by episodic integration benefits in identification tasks. We tested this hybrid account by integrating an intervening response event with an identification task that would otherwise generate the boundary between same location benefits and costs. Our results showed that the intervening event did not alter the boundary between location repetition benefits and costs nor did it reliably or unambiguously reverse the common stimulus-response repetition benefit. The findings delimit the usefulness of an intervening event for disrupting episodic integration, suggesting that effects from intervening response events are tenuous. The divide between attention and feature integration accounts is delineated in the context of methodological and empirical considerations.     

Out of sight,out of mind: Matching bias underlies confirmatory visual search

Confirmation bias has recently been reported in visual search, where observers who were given a perceptual rule to test (e.g. “Is the p on a red circle?”) search stimuli that could confirm the rule stimuli preferentially (Rajsic, Wilson, & Pratt, Journal of Experimental Psychology: Human Perception and Performance, 41(5), 1353–1364, 2015). In this study, we compared the ability of concrete and abstract visual templates to guide attention using the visual confirmation bias. Experiment 1 showed that confirmatory search tendencies do not result from simple low-level priming, as they occurred when color templates were verbally communicated. Experiment 2 showed that confirmation bias did not occur when targets needed to be reported as possessing or not possessing the absence of a feature (i.e., reporting whether a target was on a nonred circle). Experiment 3 showed that confirmatory search also did not occur when search prompts referred to a set of visually heterogenous features (i.e., reporting whether a target on a colorful circle, regardless of the color). Together, these results show that the confirmation bias likely results from a matching heuristic, such that visual codes involved in representing the search goal prioritize stimuli possessing these features.     

Evaluation of the Effectiveness and Transportability of Panic Control Treatment in a Private Practice Setting: Acute and Long Term Effects

Effectiveness studies have demonstrated the transportability of panic control treatment (PCT) to a variety of settings. The present study examined the acute and long-term effects of PCT in a private practice setting and explored correlates of treatment outcome. Participants (69% female, mean age = 34.8, SD = 8.8 years) were 100 consecutive private practice referrals who entered treatment for panic disorder. Using intent-to-treat analyses, 72% of patients were panic-free and 44% of patients achieved high end state functioning (HESF) at posttreatment. At 1-year follow-up, 75% of patients were panic-free and 55% of patients achieved HESF. Lower levels of agoraphobic avoidance when accompanied (MI-ACM), less misinterpretation of bodily sensations, and less frequent panic attacks at pretreatment were the strongest predictors of treatment outcome at follow-up. Pre-posttreatment changes in trait anxiety were most strongly associated with treatment response. Results support PCT as an effective, durable treatment and add to the body of evidence supporting the generalizability of PCT from research to real-world service settings.     

Notes for New Therapists

In this article, we draw on our experiences as therapists and supervisors to highlight the errors new clinicians tend to make and how they can be avoided. A critical issue is how to approach the client's narrative. We propose a stance of “respectful skepticism,” in which the factors that shape the client's truth can best be appreciated. This represents a middle way between gullible listener and prosecuting attorney. We also discuss common problems with client motivation, as well as the changing role of feelings in therapy, the importance of the therapeutic contract, the high cost of defensiveness, the concept of conversational domains, and the advantages of avoiding therapeutic platitudes, explanatory fictions, and jargon.     

Guidelines for classifying evidence-based treatments in couple and family therapy

Guidelines for Evidence-Based Treatments in Family Therapy are intended to help guide clinicians, researchers, and policy makers in identifying specific clinical interventions and treatment programs for couples and families that have scientifically based evidence to support their efficacy. In contrast to criteria, which simply identify treatments that "work" and have been employed in the evaluation of other psychotherapies, these guidelines propose a three-tiered levels-of-evidence-based model that moves from "evidence-informed," to "evidence-based," to "evidence-based and ready for dissemination and transportation within diverse community settings." Each level reflects an interaction between the specificity of the intervention, the strength and readth of the outcomes, and the quality of the studies that form the evidence. These guidelines uniquely promote a clinically based "matrix" approach in which the empirical support is evaluated according to various dimensions including strength of the outcomes, the applicability across cultural contexts, and demonstration of specific change mechanisms. The guidelines are offered not only as a basis for understanding the evidence for diverse clinical approaches in couple and family therapy within the systemic tradition of the field, but also as an alternative aspirational model for evaluating all psychotherapies.     

The role of problem solving in complex intraverbal repertoires

We examined whether typically developing preschoolers could learn to use a problem-solving strategy that involved self-prompting with intraverbal chains to provide multiple responses to intraverbal categorization questions. Teaching the children to use the problem-solving strategy did not produce significant increases in target responses until problem solving was modeled and prompted. Following the model and prompts, all participants showed immediate significant increases in intraverbal categorization, and all prompts were quickly eliminated. Use of audible self-prompts was evident initially for all participants, but declined over time for 3 of the 4 children. Within-session response patterns remained consistent with use of the problem-solving strategy even when self-prompts were not audible. These findings suggest that teaching and prompting a problem-solving strategy can be an effective way to produce intraverbal categorization responses.