Relational dynamics between psychotherapy clients and clinic administrative staff: A pilot study

Extensive empirical research has established therapeutic alliance as one of the most stable predictors of psychotherapy outcomes. Nearly all the contemporary empirical literature on therapeutic alliance focuses on the therapist-client dyad without attending to the relational experiences many clients in outpatient clinics have with administrative staff. Literatures from the fields of social work, psychiatric nursing and milieu therapy suggest there are more systemic relational and environmental dynamics that impact treatment beyond the therapist-client dyad, although these issues have been considered primarily in inpatient settings. A relational ecology framework has been developed drawing upon relational psychoanalysis, attachment theory and symbolic anthropology to help conceptualise the broader relational dynamics beyond the therapist-client dyad that may impact a more systemic therapeutic alliance in certain outpatient contexts. In an initial cross-sectional pilot study with a sample of clients (N = 107) receiving psychotherapy at a community mental health clinic in the Northeastern United States, the present study found client ratings of both (a) the therapeutic alliance with their therapists and (b) their alliance with administrative staff each significantly positively predicted client ratings of treatment. Thus, ratings of administrative alliance predicted client ratings of treatment over and above the effects of the therapist-client therapeutic alliance. These findings provide preliminary support for further investigation of the relational ecology of outpatient psychotherapy and suggest that client experiences of relational and environmental dynamics with administrative staff may be important contributors to psychotherapy outcomes. Limitations of the present study and implications for future research and practice are discussed.     

Freeze-Frame: a new infant inhibition task and its relation to frontal cortex tasks during infancy and early childhood

The current study investigated a new, easily administered, visual inhibition task for infants termed the Freeze-Frame task. In the new task, 9-month-olds were encouraged to inhibit looks to peripheral distractors. This was done by briefly freezing a central animated stimulus when infants looked to the distractors. Half of the trials presented an engaging central stimulus, and the other half presented a repetitive central stimulus. Three measures of inhibitory function were derived from the task and compared with performance on a set of frontal cortex tasks administered at 9 and 24 months of age. As expected, infants' ability to learn to selectively inhibit looks to the distractors at 9 months predicted performance at 24 months. However, performance differences in the two Freeze-Frame trial types early in the experiment also turned out to be an important predictor. The results are discussed in terms of the validity of the Freeze-Frame task as an early measure of different components of inhibitory function.     

Predicting the completion of an integrative and intensive outpatient chronic pain treatment with the personality assessment inventory

The effects of intensive, integrative treatments for chronic pain are affected by patient compliance, and in many cases, selecting noncompliant individuals adversely impacts the cost-effectiveness of such programs. The pretreatment identification of individuals who are at risk for dropout could assist clinicians in augmenting treatments with motivational enhancement strategies for high-risk patients or using such information to select individuals who are most likely to complete a given intervention program. In this study, we tested the ability of indicators from the Personality Assessment Inventory (PAI; Morey, 1991), administered prior to treatment, to identify individuals who dropped out of a 20-day chronic pain program. Results replicate findings from outpatient psychotherapy research in finding that PAI Mean Clinical Elevation and Treatment Process Index significantly differentiated dropouts from graduates, particularly when the Treatment Rejection scale suggested patients were motivated for treatment. We discuss these results and offer recommendations for the prediction of treatment dropout in pain settings.     

Nuestra culpa: collective guilt and shame as predictors of reparation for historical wrongdoing

Three studies examined the hypothesis that collective guilt and shame have different consequences for reparation. In 2 longitudinal studies, the ingroup was nonindigenous Chileans (Study 1: N = 124/120, lag = 8 weeks; Study 2: N = 247/137, lag = 6 months), and the outgroup was Chile's largest indigenous group, the Mapuche. In both studies, it was found that collective guilt predicted reparation attitudes longitudinally. Collective shame had only cross-sectional associations with reparation and no direct longitudinal effects. In Study 2, collective shame moderated the longitudinal effects of collective guilt such that the effects of guilt were stronger for low-shame respondents. In Study 3 (N = 193 nonindigenous Chileans), the cross-sectional relationships among guilt, shame, and reparation attitudes were replicated. The relationship between shame and reparation attitudes was mediated by a desire to improve the ingroup's reputation.     

Champ or chump: strategic utilization of dual social identities of others

The Jamaican‐born, Canadian sprinter, Ben Johnson, won the gold medal at the 1988 Olympics, but afterward was disqualified for steroid use. At the time Johnson's identity in the Canadian media appeared to shift—he was ‘Canadian’ after winning the gold medal but ‘Jamaican’ after disqualification. We tested this hypothesis via an archival study of a newspaper database of Canadian newspapers. The results confirmed the speculation. In the second study with Canadian research participants, the nationality of a fictional athlete was experimentally manipulated. He either possessed Canadian‐ American (shared) or Belgian‐American (non‐shared) identity. The athlete's performance outcome at an Olympic event was also manipulated. In the shared identity condition the athlete was perceived as more Canadian when he won than when he lost. There were no significant differences in nationality judgment when neither of the athlete's dual nationalities was Canadian. Results regarding perceptions of similarity paralleled the nationality‐ratings results. Findings from these two studies illustrate an interesting extension of BIRGing and CORFing strategies in which multiple social identities of others are used strategically to include or exclude others from the in‐group. Copyright © 2007 John Wiley & Sons, Ltd.     

Phoneme-based rehabilitation of anomia in aphasia

This study investigated the effects of phonologic treatment for anomia in aphasia. We proposed that if treatment were directed at the level of the phonologic processor, opportunities for naming via a phonological route, as opposed to a strictly whole word route, would be enhanced, thereby improving naming. The participants, ten people with anomia and aphasia due to left hemisphere stroke, received 96 h of phoneme based treatment in 12 weeks. To learn if treatment improved naming, a single-subject, repeated probe design with replication was employed. The primary outcome measure was confrontation naming. Secondary outcome measures included phonologic production, nonword repetition and discourse production. Results suggest a positive treatment effect (confrontation naming), improvements in phonologic production and nonword repetition, and generalization to discourse production. When tested 3 months after the completion of treatment the effects appeared to be maintained.     

早期成长与发展研究：利用前瞻性的养子女设计研究遗传与环境的互动

“早期成长与发展研究”（EGDS）是一个前瞻性的养子女研究计划。此项目包括了360组相连的生身父母、养父母以及刚出生就被收养的子女。此项目从婴儿3个月就开始跟踪这些被试,现在又加上200组被试,从遗传与环境的关联与互动着手,本项目将研究家庭环境和养育方式如何影响遗传因素的表达。所有被试均需要是在美国国内收养的婴儿。该研究收集了儿童的心理特征、生身父母与养父母的心理特征、养育方式、父母的生活状况等数据,以及唾液和DNA,初步分析发现,遗传与环境的互动在婴儿期就已经开始。本文也从干预的角度讨论了未来行为遗传学的走向     

Cultural considerations in adolescent suicide prevention and psychosocial treatment

Ethnic groups differ in rates of suicidal behaviors among youths, the context within which suicidal behavior occurs (e.g., different precipitants, vulnerability and protective factors, and reactions to suicidal behaviors), and patterns of help-seeking. In this article, the authors discuss the cultural context of suicidal behavior among African American, American Indian and Alaska Native, Asian American and Pacific Islander, and Latino adolescents, and the implications of these contexts for suicide prevention and treatment. Several cross-cutting issues are discussed, including acculturative stress and protective factors within cultures; the roles of religion and spirituality and the family in culturally sensitive interventions; different manifestations and interpretations of distress in different cultures; and the impact of stigma and cultural distrust on help-seeking. The needs for culturally sensitive and community- based interventions are discussed, along with future opportunities for research in intervention development and evaluation.     

The who and when of internal gender discrimination claims: An interactional model

Although gender discrimination has been illegal in organizations since the passage of the Civil Right Act of 1964, individuals remain hesitant to claim internally by making members of their employing organization aware of gender discrimination. Yet surprisingly little research has examined the individual difference and contextual antecedents to internal discrimination claims. We advance an interactional model and hypothesize that gender identity (GI) and climate for diversity (CFD) will interact to predict internal claims of gender discrimination. Consistent with theory, laboratory and field studies demonstrate that strong GI individuals are more likely to make internal claims in organizations that value inclusion (i.e., positive CFD) than in organizations where discrimination is pervasive (i.e., negative CFD). In contrast to strong GI individuals, however, weak GI individuals are more likely to claim in a negative CFD than in a positive CFD. Implications for both individuals and organizations are discussed.     

Ethics, pandemics, and the duty to treat

Numerous grounds have been offered for the view that healthcare workers have a duty to treat, including expressed consent, implied consent, special training, reciprocity (also called the social contract view), and professional oaths and codes. Quite often, however, these grounds are simply asserted without being adequately defended or without the defenses being critically evaluated. This essay aims to help remedy that problem by providing a critical examination of the strengths and weaknesses of each of these five grounds for asserting that healthcare workers have a duty to treat, especially as that duty would arise in the context of an infectious disease pandemic. Ultimately, it argues that none of the defenses is currently sufficient to ground the kind of duty that would be needed in a pandemic. It concludes by sketching some practical recommendations in that regard.