On trying something new: effort and practice in psychoanalytic change

This paper describes one of the ingredients of successful psychoanalytic change: the necessity for the analysand to actively attempt altered patterns of thinking, behaving, feeling, and relating outside of the analytic relationship. When successful, such self-initiated attempts at change are founded on insight and experience gained in the transference and constitute a crucial step in the consolidation and transfer of therapeutic gains. The analytic literature related to this aspect of therapeutic action is reviewed, including the work of Freud, Bader, Rangell, Renik, Valenstein, and Wheelis. Recent interest in the complex and complementary relationship between action and increased self-understanding as it unfolds in the analytic setting is extended beyond the consulting room to include the analysand's extra-analytic attempts to initiate change. Contemporary views of the relationship between praxis and self-knowledge are discussed and offered as theoretical support for broadening analytic technique to include greater attention to the analysand's efforts at implementing therapeutic gains. Case vignettes are presented.     

The I of the storm-relations between self and conscious emotion experience: comment on Lambie and Marcel (2002)

J. A. Lambie and A. J. Marcel (2002) outlined a framework for understanding varieties of conscious emotion experience. In their analysis, the self plays an important role in conscious emotion experience. In this critique, however, the authors propose that Lambie and Marcel's presentation of the self needs further specification if it is to account for varieties of conflicted emotional experience, particularly those characteristic of dissociative states. The authors propose that a more elaborated self-construct is necessary to account for these phenomena involving either the "splitting off of significant self-related concerns or the existence of multiple self-constructs. These arguments are illustrated by clinical and subclinical case examples.     

Regulation of emotion and behavior among 3- and 5-year-olds

In this cross-sectional study, the authors examined the relationship between emotion and behavior regulation in 3- and 5-year olds. Eighty-seven children performed a compliance sorting task. The authors manipulated the demand for emotion regulation by presenting and then hiding toys (low) or making toys visible (high). Mothers and teachers rated children's coping responses. Five-year-olds sorted less in the high condition than in the low condition, and 3-year-olds spent equal time sorting in both conditions. Compliance was positively correlated with problem-focused coping and negatively correlated with emotion-focused coping. Correlations between emotion and behavior regulation were stronger for the 5-year-olds. Age groups were differently affected by the higher demands of emotion regulation, indicating that the child's resources for regulation interact with the task demands to determine behavioral outcome.     

Size of the neocerebellar vermis is associated with cognition in healthy elderly men

Cerebellar volumes show small positive correlations with cognitive ability in young adults, but no studies have examined this relationship in older adults. Furthermore, no studies have examined relationships between sizes of subareas of the cerebellum and cognitive ability. We hypothesized that size of the two areas of the neocerebellar vermis would correlate with a battery of eight cognitive tests in 50 men aged 65-70. Size of the neocerebellar areas of the vermis correlated positively with several cognitive tests (r's=.29-.37, p<.05), whilst sizes of other parts of the vermis did not correlate with any cognitive tests. Total cerebellar volumes correlated significantly with a test of nonverbal reasoning (r=.030, p=.42). These findings suggest a specific association of neocerebellar vermis size with variations in cognitive ability in older adults.     

Deficit in selective and divided attention associated with cholinergic basal forebrain immunotoxic lesion produced by 192-saporin; motoric/sensory deficit associated with Purkinje cell immunotoxic lesion produced by OX7-saporin

The immunotoxin 192-saporin, infused intracerebroventricularly into rats, destroys cholinergic neurons in the basal forebrain nuclei. Doses required for complete cholinergic loss also kill some Purkinje cells. The immunotoxin OX7-saporin, when infused intraventricularly into rats, destroys Purkinje cells in a pattern similar to that produced by 192-saporin, without affecting cholinergic neurons. Thus, we used OX7-saporin to distinguish behavioral effects of 192-saporin due to cerebellar damage versus those due to cholinergic cell loss. Three doses of 192-saporin (1.6, 2.6, and 3.3 micrograms/rat) were chosen along with a dose of OX7-saporin (2.0 micrograms/rat) that produced Purkinje loss equivalent to the two highest doses of 192-saporin. Groups of Fischer-344 rats were trained in the multiple choice reaction time task and retested with more complex tasks after lesioning. They were also tested in the water maze, passive avoidance, acoustic startle, and open field. The OX7-saporin group exhibited changes in many tests suggesting hypermotility and sensory deficits. The 192-saporin groups differed from the OX7-saporin group when they displayed deficits in multiple choice reaction time tasks in which novel challenges were introduced, including sessions with a noise distractor, shortened and lengthened intertrial intervals, and use of nine instead of five sources of light stimulus. The 192-saporin groups showed no impairment in the other tasks. The cholinergic basal forebrain lesion may mask some of the effects of cerebellar damage up to a threshold after which effects of Purkinje cell loss predominate when 192-saporin is administered intraventricularly.     

Effectiveness of the GOFER course in decision making for high school students

The paper describes and evaluates the GOFER course in decision making for high school students (Mann, Harmoni and Power, 1988). The course was based on principles from the conflict theory of decision making (Janis and Mann, 1977) and was designed to provide adolescents with an understanding of factors that produce good and poor decision making as well as knowledge and practice of sound decision skills. Two evaluation studies were conducted to examine effectiveness of the course. Study 1 was conducted with young adolescents (12 year olds). It found a significant difference between students trained in the course and a control group on measures of self-esteem as a decision maker, self reported decision habits and knowledge of decision strategy. Study 2 was conducted with mid-adolescents (15 year olds). It, too, found a significant difference between students who took the course and a control group on measures of self esteem as a decision maker and self-reported decision habits. It is concluded that while the evaluation study fell short of an ideal test, the GOFER course met the criteria of improving student knowledge, raising confidence in decision making and changing self reported decision habits.     

Being skeptical about the medical humanities

In this paper the author challenges the prevailing view that contemporary writing in the medical humanities is serving the needs of the various health care disciplines. The current medical humanities literature assumes that physicians are the appropriate target group. This is most notably the case within health care ethics literature. There appears to be an unexamined assumption that physician-centric approaches to clinical ethical decision-making are the standard by which appropriate ethical practice is judged. The author challenges this assumption and addresses the problems that this approach engenders. The medical humanities literature appears to reinforce hierarchical, patriarchal arrangements which are themselves not morally neutral.     

Social and Academic Impairment in Youth with ADHD, Predominately Inattentive Type and Sluggish Cognitive Tempo

Sluggish cognitive tempo (SCT) was originally identified as a construct that characterized the inattention problems of some children with attention deficit disorder (ADD). Research has indicated that using SCT symptoms to identify a subset of youth with attention-deficit/hyperactivity disorder, predominately inattentive type (ADHD-IT) may elucidate distinct patterns of impairment and thereby improve the external validity of ADHD subtypes. The objective of the current study was to investigate whether youth with clinically-assessed ADHD-IT and high levels of SCT exhibit unique social and academic impairments. In a clinic-referred sample of youth (N?=?209; 23 % female) aged 6 to 17 years, participants who met criteria for three different groups were identified: ADHD, Combined Type (ADHD-CT; n?=?80), ADHD-IT with low SCT symptoms (n?=?74), and ADHD-IT with high SCT symptoms (n?=?55). These groups were compared on indicators of social and academic functioning while considering the effects of co-occurring internalizing and disruptive behavior disorders. Youth with ADHD-IT high in SCT exhibited uniquely elevated withdrawal, as well as low leadership and low peer-directed relational and overt aggression, which were not accounted for by co-occurring disorders. This high-SCT group was also the only group to have more homework problems than the ADHD-CT group, but only when other disruptive behavior disorders were absent. The distinctiveness of the high-SCT group, which was primarily evident in social as opposed to academic functioning, provides partial support for the external validity and clinical utility of SCT.