Commentary: Psychodynamics and Social Cognition—Notes on the Fusion of Psychoanalysis and Psychology

ABSTRACT Interest in linking psychoanalysis with scientific psychology waxes and wanes. In part, the difficulties have been caused by the preference of psychoanalysts for Freud's clinical theory (and its emphasis on narrative truth) as opposed to his metapsychology (with its requirement for historical truth). Even though contemporary scientific psychology evolved largely independently of psychoanalysis, the articles on object relations, transference, and defense published in this special issue show that the theory remains a source of inspiration, observations, and hypotheses.     

Integrating Qualitative and Quantitative Research Methods: A Research Model

A historical antagonism between proponents of qualitative methods and quantitative methods has prevented recognition of the benefits to be gained by employing both methods (that is, a multi-method approach) during the same study or program of studies. Increasingly, family therapy researchers have begun to recognize the value of a multi-method approach in bridging the current gaps among theory, research, and practice. However, current writings have yet to move beyond the discussion stage. This article proposes a bidirectional continuum that includes both qualitative and quantitative methods. An ethnographic content analysis approach is presented to illustrate the procedural stages of this continuum. The article ends with a discussion of the challenges in carrying out a bidirectional, multi-method approach and the potential contributions that an integrative research methodology will give both researchers and clinicians.     

Decision-making incapacity among nursing home residents: results from the 1987 NMES survey. National Medical Expenditure Survey

Recent legislative and regulatory developments have focused attention on older adults' capacity for involvement in health care decision-making. The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) focused attention on the rights of nursing home residents to be involved in health care decision-making to the fullest extent possible. This article uses data from the 1987 National Medical Expenditure Survey (NMES) to examine rates of incapacity for health care decision-making among nursing home residents. Elements of the Oklahoma statute were used to operationalize decision-making incapacity: disability or disorder, difficulty in decision-making or communicating decisions, and functional disability. Fifty-three percent of nursing home residents had a combination of either physical or mental impairment and an impairment in either self-care or money management. The discussion focuses on the policy and practice implications of significant rates of incapacity among nursing home residents.     

A PRELIMINARY COMPARISON OF REINFORCER ASSESSMENT METHODS FOR CHILDREN WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER

We evaluated the relative treatment utility of a verbal forced-choice questionnaire, child nomination, and direct observation for identifying the most potent reinforcers for children with attention deficit hyperactivity disorder. Results demonstrated that all three methods were more likely to disagree than to agree, that a forced-choice format may enhance verbal reinforcer assessment, and that further development and evaluation of verbal reinforcer-assessment methods are needed.     

Contrast and reallocation of extraneous reinforcers as a function of component duration and baseline rate of reinforcement

Four pigeons responded on multiple schedules arranged on a “main” key in a two-key experimental chamber. A constant schedule component was alternated with another component that was varied over conditions. On an extra response key, conjoint schedules of reinforcement that operated in both components were arranged concurrently with the multiple schedule on the main key. On the main key, changes in reinforcement rate in the varied component were inversely related to changes in response rates in the constant component (behavioral contrast). On the extra key, some reinforcers were reallocated between components, depending on the schedules in effect on the main key in the varied component. In the varied component, the obtained rates of reinforcement on the extra key were inversely related to main-key reinforcement rate. In the constant component, extra-key reinforcer rates were positively related to main-key reinforcer rates obtained in the varied component, and were not a function of response rates on the extra key. In two comparisons, the rate at which components alternated and the value of the main-key schedule in the constant component were varied. Consistent with earlier work, long components reduced the extent of contrast. Reductions in contrast as a function of component duration were accompanied by similar reductions in the extent of reinforcer reallocation on the extra key. In the second comparison, lowering the rate of reinforcement in the constant component increased the rate at which extra-key reinforcers were obtained, reduced the extent of reinforcer reallocation, and reduced contrast. Overall, the results are consistent with the suggestion that some contrast effects are due to the changes in extraneous reinforcement during the constant component, and that manipulations of component duration, and manipulations of the rate of reinforcement in the constant component, affect contrast because they influence the extent of extraneous reinforcer real-location.     

Resistance to reinforcement change in multiple and concurrent schedules assessed in transition and at steady state

Behavioral momentum theory relates resistance to change of responding in a multiple-schedule component to the total reinforcement obtained in that component, regardless of how the reinforcers are produced. Four pigeons responded in a series of multiple-schedule conditions in which a variable-interval 40-s schedule arranged reinforcers for pecking in one component and a variable-interval 360-s schedule arranged them in the other. In addition, responses on a second key were reinforced according to variable-interval schedules that were equal in the two components. In different parts of the experiment, responding was disrupted by changing the rate of reinforcement on the second key or by delivering response-independent food during a blackout separating the two components. Consistent with momentum theory, responding on the first key in Part 1 changed more in the component with the lower reinforcement total when it was disrupted by changes in the rate of reinforcement on the second key. However, responding on the second key changed more in the component with the higher reinforcement total. In Parts 2 and 3, responding was disrupted with free food presented during intercomponent blackouts, with extinction (Part 2) or variable-interval 80-s reinforcement (Part 3) arranged on the second key. Here, resistance to change was greater for the component with greater overall reinforcement. Failures of momentum theory to predict short-term differences in resistance to change occurred with disruptors that caused greater change between steady states for the richer component. Consistency of effects across disruptors may yet be found if short-term effects of disruptors are assessed relative to the extent of change observed after prolonged exposure.     

Physicians' values and physician-value neutrality

For years articles have decried the lack of empathy in physicians' relationships with patients. In addition to being empathetic, physicians are called upon to assume the posture of value neutrality, i.e., not imposing one's values when dealing with patients. Empathy is clearly an expression of deeply held values; even the language used to define it is value-laden. Physicians are consistently called upon to exhibit traits which are expressions of their underlying values. However, if proponents of value-neutrality are to be taken literally one must not impose any of one's values on one's patients. But then one wonders how empathy could ever be expressed; further, it is hard to imagine what a truly value neutral physician would be like. It is time we recognize that any relationship between two persons requires the expression of values from both parties. These values help shape that relationship and define its further history. Physicians are not excluded from this process just because they consider themselves professionals. Divulging personal values to patients is both more honest and more in keeping with the concepts of justice, beneficence, non maleficence, and autonomy than to feign value-neutrality. A presentation of some type statement of values is timely and would give patients an idea of where a physician stands on a myriad of issues. Rather than being value-neutral, value non-neutrality seems a more right and reasonable posture for physicians to assume.     

Attachement,solitude et détresse psychologique chez des jeunes adultes

La présente étude vise à examiner la nature des liens entre les styles d'attachement (sécurisant, anxieux/ambivalent et évitant), la solitude et la détresse psychologique (dépression, anxiété, agressivité et problèmes cognitifs) chez des jeunes adultes. L'échantillon se compose de 407 étudiants de niveau collégial dont l'âge moyen se situe à 18 ans. Les sujets doivent répondre à deux questionnaires d'évaluation du style d'attachement, à l'échelle de solitude UCLA, ainsi qu'à l'index de symptômes psychiatriques. Les résultats laissent voir que les individus ayant un style d'attachement sécurisant rapportent moins de symptômes de dépression et de sentiments de solitude que les sujets des styles anxieux/ambivalent et évitant. De même, ils vivent moins d'anxiété, d'agressivité et de problèmes cognitifs que les individus du style anxieux/ambivalent. Par ailleurs, les individus du style d'attachement anxieux/ambivalent sont plus déprimés, anxieux et agressifs que les individus du style évitant. Par contre, aucune différence significative ne ressort entre les sujets des styles d'attachement anxieux/ambivalent et évitant sur le plan des problèmes cognitifs et de la solitude. Des analyses de régression multiple montrent que l'attachement anxieux/ambivalent et la solitude expliquent un pourcentage significatif de la variance associée à la détresse psychologique. Enfin, il ressort que la solitude joue un rôle modérateur dans la relation unissant l'attachement non sécurisant et les problèmes de nature cognitive, alors qu'elle joue un rôle médiateur dans la relation entre l'attachement sécurisant, la dépression et l'anxiété.