A randomized controlled trial of community-oriented and hospital-oriented care for discharged psychiatric patients: influence of personality disorder on police contacts

An important forensic psychiatric measure, contacts with police, was compared in a randomized, controlled trial of 155 patients with severe mental illness with a previous admission within the past two years. The patients, who also had their personality status addressed formally before randomization, were allocated to community multidisciplinary teams or to hospital-based care programs after discharge from in-patient care and were followed up for one year. A total of 138 patients (89%) had at least one post-baseline assessment and of these patients, 16 (12%) had at least one police contact in the year of the study, most of which were emergency assessments. The data showed significantly greater numbers of police contacts in patients with increasing severity of personality disturbance. Patients with such disturbance were six times more likely to have police contacts than those with no personality disorder. There were significantly more contacts in patients with borderline and antisocial (dissocial) personality disorder allocated to community-oriented care compared with hospital-oriented care. These findings have important implications for risk assessment in severe mental illness.     

Perfectionistic self-presentation, body image, and eating disorder symptoms

A specific model for eating disorder symptoms involving perfectionistic self-presentation and two different moderators (i.e., body image evaluation and body image investment) was tested. Participants completed measures of perfectionistic self-presentation, body image dysfunction, and eating disorder symptoms. Findings indicated that all three dimensions of perfectionistic self-presentation were associated with eating disorder symptoms. Results also showed that perfectionistic self-presentation predicted eating disorder symptoms in women who were dissatisfied with their bodies, but that it did not predict eating problems in women who liked their bodies and felt there was little or no discrepancy between their actual and ideal appearances. Body image investment did not moderate the relationship between perfectionistic self-presentation and eating disorder symptoms, suggesting that ego-involvement alone is insufficient to promote eating disturbance in the context of perfectionism. The importance of self-presentation components of perfectionism and specific body image difficulties in predicting eating disorder symptoms are discussed.     

Set ambiguity: A key determinant of reliability and validity in the picture story exercise

The picture story exercise (PSE), in which participants write imaginative stories in response to motivationally-arousing images, is the most commonly-used tool for the assessment of implicit motives. Despite decades of research into the qualities of effective individual picture cues, much less is known about the desirable properties of overall picture sets. The present research highlights a previously undocumented methodological consideration—set ambiguity—which has important implications for the reliability and validity of the PSE. In a four-part study of 74 undergraduates, motive scores derived from an ambiguous picture set comprising cues that vary in motivational focus displayed greater test–retest reliability, convergent validity, and predictive validity than those derived from an unambiguous picture set. Researchers are therefore advised to consider set ambiguity when selecting images for use in PSE research.     

A Case Study Exploring the Influence of a Gardening Therapy Group on Well-Being

In a climate of improving health-care quality and understanding, this study explored how participation in a gardening group, facilitated through a mental health service in Ireland, influenced well-being. A case study used semi-structured interviews and participant observation to explore explicit and tacit aspects of group participation. Thematic analysis clarified that gardening group participation had a positive influence on well-being for all gardeners and group facilitators. This was through promoting coping, facilitating change, and developing skills. The setting, site ethos and tasks were important in assisting people to make lifestyle changes and to develop skills in order to experience well-being.     

Relationship Maintenance Behavior and Adult Attachment: An Analysis of the Actor-Partner Interdependence Model

Associations between relationships maintenance behaviors (positivity, openness, assurances, and sharing tasks) and anxious and avoidant attachment were examined in 265 married couples. Using structural equation modeling to employ the actor-partner interdependence model, the use of positivity, assurances, and sharing tasks were found to be negatively associated with anxious and avoidant attachment for both husbands and wives. Being open and self-disclosing in marriage was not strongly associated with attachment. Results indicated that the use of maintenance behaviors in marriages could have the potential to foster increased security in partners. Research and clinical implications are discussed.     

The Effects of the Intergenerational Transmission of Family Emotional Processes on Conflict Styles: The Moderating Role of Attachment

This study of 203 emerging adults investigated the moderating role of attachment on the intergenerational transmission of the effects of family emotional processes (enmeshment and disengagement) on adult offspring's conflict management. Results indicated that higher levels of perceived disengagement led to more use of hostile and volatile and lower use of validating conflict styles. Results further indicated that attachment moderated the effects of disengagement on hostile and volatile but not validating styles. High levels of anxiety exacerbated the effects of disengagement while low levels of avoidance buffered the effects of disengagement. Clinical and research implications are discussed.     

The spider does not always win the fight for attention: Disengagement from threat is modulated by goal set

Stimulus-driven preferential attention to threat can be modulated by goal-driven attention. However, it remains unclear how this goal-driven modulation affects specific attentional components implied in threat interference. We hypothesise that goal-driven modulation most strongly impacts delayed disengagement from threat. A spatial cueing task was used that disentangles delayed disengagement from attentional capture by tightly manipulating the locus of attention at the time of target onset. Different top-down goals were induced by instructing participants to identify bird/fish targets (Experiment 1) or spider/cat targets (Experiment 2) among animal non-targets. Delayed disengagement from a non-target spider was observed only when the spider was part of the target set, not when it was task-irrelevant. This corroborates evidence that threat stimuli do not necessarily override goal-driven attentional control and that extended processing of threatening distractors is not obligatory.     

Our Theories,Our Selves: Commentary on Paper by Ruth Gruenthal

Ruth Gruenthal invites us to explore the dynamics embedded in disengagement. She suggests that this very concept is an oxymoron; by virtue of the fact that the patient is in treatment she is, in fact, engaged. Gruenthal focuses on disengagement's self-sustaining function, noting that it represents an attempt to regulate emotional distance while still retaining a connection to the other. Recognizing how difficult work with withdrawn patients can be, Gruenthal suggests that theory can actually shift the analyst's negative countertransference response. Implicitly she challenges the relational assumption that active engagement around the analyst's subjectivity always lies at the center of therapeutic process. I offer my own take on the dynamics at the heart of Gruenthal's treatment of Helen, proposing that neither disengagement nor containment can be accounted for by the patient or analyst alone. I explore how theory helps us manage our subjectivity while also embodying it.     

“So wat do u want to wrk on 2day?”: The Ethical Implications of Online Counseling

Internet counseling is an area of rapid expansion in the field of applied psychology. Internet counseling or psychotherapy involves a variety of activities such as psychoeducation, individual therapy, and automated self-help interventions delivered via the Internet. Although other professional societies such as the National Association of Social Workers, the American Counseling Association, and the National Board of Certified Counselors have tackled the issues of Internet counseling ethics head on, the American Psychological Association has been conspicuously absent from this debate. Yet online therapy clinics are operating, and intervention efficacy is being studied. This discussion provides an overview of online counseling modalities, details the ethical concerns associated with each, and offers suggestions for the ethical practice of online counseling.