On Psychodynamic Meanings of Psychiatric Treatment: Discussion of “From Dyad to Triad”

Dr. Bar-Haim has covered vast territory in her contribution “From Dyad to Triad: On Psychodynamic Meanings of Psychiatric Treatment,” (this issue) and I welcome the opportunity to offer my thoughts on her contribution and this important topic more generally. The issues touched upon include the various meanings of psychiatric treatment for patient and therapist; factors that impact compliance; resistances to suggesting medication consultation on the part of the therapist; challenges of the prescribing therapist; the role of a “disease” model in mental suffering; the overdetermined meaning of “symptom”; and, most important, recommendations for establishing effective treatment when a treatment triangle exists. I address some of these issues and comment on two clinical vignettes to illustrate my way of thinking.     

A psychometric comparison of anxiety-relevant attention measures

Background and Objectives: Preferential attention to threat, emotional response inhibition, and attentional control each purportedly play a key role in anxiety disorders. Divergent psychometric properties among attention measures may produce differential detection of anxiety-related associations and treatment-related changes. However, no studies have directly compared the psychometric properties of these attention measures in the same sample.

Design: Eighty-five young adults (M?=?19.41 years, SD?=?1.47, 48 Females) completed a cognitive task battery and a subset of 60 participants (M?=?19.42 years, SD?=?1.48, 33 Females) completed the task battery again approximately two weeks later.

Method: To assess preferential attention to threat, emotional response inhibition, and attentional control, the cognitive task battery included a dot-probe task, emotion and gender Stroop tasks, and a flanker task. Tasks varied in how attention was directed and if emotional stimuli were included. Internal consistency and test-retest reliability were compared across measures.

Results: Within the same sample, internal consistency and reliability differed across attention measures. Explicit attention measures (emotional Stroop and flanker) exhibited stronger internal consistency and greater test-retest reliability compared to implicit measures (dot-probe and gender Stroop).

Conclusions: These results inform clinical research using attention measures to assess anxiety-related differences and treatment response.     

The Longitudinal Impact of a Family-Based Communication Intervention on Observational and Self-Reports of Sexual Communication

Parents can play a vital role in shaping teenagers’ sexual attitudes, behavior, and contraceptive use through communication, however, less is known about how to modify parent–adolescent communication among youth with mental health problems. The impact of a family-based sexual risk prevention intervention on both observational and self-report of parent–adolescent sexual communication was examined at 12 months among adolescents with mental health problems. Of the 721 parent–adolescent dyads recruited for the study, 167 videotapes of sexual discussions between parents and adolescent were coded for the family-based intervention and 191 videotapes for the active comparison. Longitudinal analyses examined differences between conditions (family-based vs. comparison) in self-reported and observed parent–adolescent sexual discussions and also examined the impact of gender on intervention response. More parent I-statements, healthier parent body language, and fewer adolescent Negative Vocalizations were detected for family-based intervention participants 12 months after participating in the brief intervention (11?h of total intervention time) relative to those in the comparison condition. Parents in the family-based intervention also self-reported better sexual communication at 12 months. The current study provides supporting evidence that a relatively brief family-based intervention was successful at addressing parent–adolescent sexual communication among a mental health sample.     

Reflecting on Participatory,Action‐Oriented Research Methods in Community Psychology: Progress,Problems, and Paths Forward

This paper provides a critical reflection on participatory action research (PAR) methods as they pertain to community psychology. Following a brief review of the fundamental aspects of PAR, key developments in the field are examined. These developments include the redefinition of the research enterprise among groups such as Indigenous and consumer/survivor communities, challenges that attend the “project” framing of PAR, academic and practice context challenges, and important domains in which PAR methods need to become more engaged (e.g., social media and disenfranchised youth). Three illustrative case studies of programs of work in the areas of youth homelessness, consumer/survivor engagement, and Indigenous research are provided to illustrate these contemporary challenges and opportunities in the field. The authors make the argument that without an effort to reconsider and redefine PAR, moving away from the stereotypical PAR “project” frame, these methods will continue to be poorly represented and underutilized in community psychology.     

The Community Psychologist as Critical Friend: Promoting Critical Community Praxis

Community‐engaged researchers have a responsibility to community partners to get beyond the traditional researcher stance to take on the active role of critical friend. On the basis of my own community research experiences in the USA, in this article, I argue that there is added value in taking on the practice of critical friendship to encourage a higher degree of critical reflection and critical practice in our partners and in our work together. In the context of long‐term, trusting relationships with community partners, researchers can play the role of critical friend working together to shape critical community praxis on the basis of critical theorizing, critical reflection, and a shared commitment to working for social justice. Those trying to make a difference in communities are often isolated and can benefit from opportunities for dialogue with other community practitioners within a critical frame of reference. Although not without risks and challenges, stepping into this role allows us to put into sharper relief the gap between community practice that challenges injustice and practice that maintains it. Copyright © 2014 John Wiley & Sons, Ltd.     

Socioeconomic status and executive function: developmental trajectories and mediation

Childhood socioeconomic status (SES) predicts executive function (EF), but fundamental aspects of this relation remain unknown: the developmental course of the SES disparity, its continued sensitivity to SES changes during that course, and the features of childhood experience responsible for the SES–EF relation. Regarding course, early disparities would be expected to grow during development if caused by accumulating stressors at a given constant level of SES. Alternatively, they would narrow if schooling partly compensates for the effects of earlier deprivation, allowing lower‐SES children to ‘catch up’. The potential for later childhood SES change to affect EF is also unknown. Regarding mediating factors, previous analyses produced mixed answers, possibly due to correlation amongst candidate mediators. We address these issues with measures of SES, working memory and planning, along with multiple candidate mediators, from the NICHD Study of Early Childcare (n = 1009). Early family income‐to‐needs and maternal education predicted planning by first grade, and income‐to‐needs predicted working memory performance at 54 months. Effects of early SES remained consistent through middle childhood, indicating that the relation between early indicators of SES and EF emerges in childhood and persists without narrowing or widening across early and middle childhood. Changes in family income‐to‐needs were associated with significant changes in planning and trend‐level changes in working memory. Mediation analyses supported the role of early childhood home characteristics in explaining the association between SES and EF, while early childhood maternal sensitivity was specifically implicated in the association between maternal education and planning. Early emerging and persistent SES‐related differences in EF, partially explained by characteristics of the home and family environment, are thus a potential source of socioeconomic disparities in achievement and health across development.     

WHAT IS EFFECTIVE IN PSYCHOANALYTIC PSYCHOTHERAPY? SOME THINGS CHANGE,SOME STAY THE SAME

As a reflection on two roundtable discussions published in the American Journal of Psychoanalysis in 1957 and 1965, the author seeks to provide historical context for what has taken place within the culture, within the profession, and within himself over this period of time. The struggle to define “effectiveness” is addressed and an argument made for the inclusion of empirical research into our work, but with simultaneous appreciation for the difficulty in objectively defining and measuring what takes place within the therapeutic relationship. This difficulty is hypothesized, in part, to be a function of the non-verbal and preverbal experiences of both patient and therapist.