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.     

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.     

Self-construal,affective valence of the encounter,and quality of social interactions: Within and cross-culture examination

In two samples, one from Greece and another from Germany, we examined relationships between self-construal, emotional experience, and the quality of social interactions. In Greece, a more collectivistic culture, the negative affect people experienced in social interactions was more weakly related to the quality of social interactions for those higher in interdependent self-construal than it was for those lower in interdependent self-construal. In Germany, a more independent culture, a contrasting pattern was observed such that the positive affect people experienced in social interaction was more strongly related to the quality of social interactions for those higher in independent self-construal than it was for those lower in independent self-construal. These findings suggest that positive and negative affect in social encounters can have different effects for persons with independent and interdependent cultural orientations within different cultural settings.     

On the malleability of the meaning of contexts: the influence of another person’s emotion expressions on situation perception

Research on the relationship between context and facial expressions generally assumes a unidirectional effect of context on expressions. However, according to the model of the meaning of emotion expressions in context (MEEC) the effect should be bidirectional. The present research tested the effect of emotion expression on the interpretation of scenes. A total of 380 participants either (a) rated facial expressions with regard to the likely appraisal of the eliciting situation by the emoter, (b) appraised the scenes alone or (c) appraised scenes shown together with the expressions they supposedly elicited. The findings strongly supported the MEEC. When a scene was combined with an expression signalling a situation that is undesirable, or high in locus of control or sudden, the participants appraised the scene correspondingly. Thus, the meaning of scenes is malleable and affected by the way that people are seen to react to them.     

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.