Exploring In-Session Process with Qualitative and Quantitative Methods in Psychotherapy with an Adolescent

ABSTRACT

There is emerging evidence for the effect of psychotherapy in adolescents with depression. Research indicates that therapists often use techniques from different theoretical models when working with adults. Research on the therapy process in adolescents is scarce. We explore the therapist’s interventions in a time-limited psychodynamic adolescent therapy with Susanna suffering from major depression. Susanna quite suddenly became worse at mid-treatment, with self-harming and suicidal ideations. Rating scales for analyzing in-session relational processes included the Structural Analysis of Social Behavior (SASB), the Adolescent Psychotherapy Q-set (APQ), and the Transference Work Scale (TWS). Self-reports on symptoms, interpersonal problems, and working alliance were obtained before, during, and at the end of and one year after treatment. Different tools seemed to expose different aspects of the process and the patient’s development. Only patient-rated questionnaires revealed the mid-treatment crises. Combining different and pan-theoretical rating scales on here-and-now interventions (TWS and SASB) and whole sessions (APQ), as well as clinician-rated measures and a variety of self-reports, indicated that different psychotherapeutic techniques were integrated in the therapy and seemed beneficial to patient’s outcome. The therapist adhered to the treatment manual. This way of exploring the therapy process may be used for different treatment modalities.     

Self-affirmation versus self-consistency: a comparison of two competing self-theories of dissonance phenomena

High or low self-esteem individuals participated in a role-playing paradigm in which a friend stood them up for a dinner date. The participants received either a good explanation from the friend for the missed date (sufficient justification) or a poor explanation (insufficient justification). As predicted by self-affirmation theory (Steele, 1988), but not self-consistency theory (Aronson, 1999), low-esteem participants derogated the friend more than high-esteem participants under both insufficient and sufficient justification. Also supporting self-affirmation theory, sufficient/low-esteem participants reported more offense for being stood-up than sufficient/high-esteem participants. Discussion centers on the role of self-esteem in dissonance processes and on the need for more research that focuses on dissonance/self-threats that result from the behavior of other(s) rather than one’s own behavior.     

Outcomes of Parent Education Programs Based on Reevaluation Counseling

We report two studies in which a parent education program based on Reevaluation Counseling was field-tested on mothers randomly assigned to treatment groups or equivalent, no-treatment comparison groups. The goal was to evaluate the program's viability, whether there were measurable effects, whether those effects were sustained over time, and whether the program was effective among diverse populations. The first study involved middle income, married mothers (n = 25) with at least one child younger than age five. Eleven members of the no-treatment group participated in the program three months later. Pretest, posttest, and follow-up measures included a parental attitude survey and a parenting stress index. The second study involved 18 black mothers with children enrolled in Head Start. Six members of the no-treatment group participated in the program two months later. Added to the pretest, posttest, and follow-up measures were a parent attitude research instrument and a parenting practices questionnaire. Results were replicated within and across studies. Significant effects suggest that the program can reduce parenting-related stress, improve parental attitudes, and encourage authoritative parenting practices, although some effects tend to diminish somewhat over time. The program appears viable with mothers of various social status groups.     

Posttraumatic Symptoms, Functional Impairment, and Coping among Adolescents on Both Sides of the Israeli–Palestinian Conflict: A Cross-Cultural Approach

This study assessed the effects of the ongoing violence on the mental health of Palestinian and Israeli youths. Parallel instruments were developed and adapted, as part of a collaborative project, in order to assess, in each society: (1) differential rates of exposure to the conflict, (2) the association between exposure and the severity of posttraumatic symptoms (PTS), and (3) the inter‐relationships among PTS, functional impairment, somatic complaints, and coping strategies. Participants were 1,016 Israeli and 1,235 Palestinian adolescents. A self‐report questionnaire assessed exposure. PTS was measured using the UCLA PTSD Reaction Index, functional impairment and somatic complaints were measured with the DISC, and coping strategies were assessed with Brief Cope. In both societies, greater exposure to conflict‐related violence was associated with more PTS and more somatic complaints, with girls reporting more distress than boys. A total of 6.8 per cent of the Israeli students and 37.2 per cent of the Palestinian students met criteria for Post Traumatic Stress Disorder (PTSD). In both societies, but more pronounced in the Palestinian Authority, adolescents reported significant levels of functional impairment, mainly in the area of school functioning. Students with PTSD reported more somatic complaints as well as greater functional impairment. The results show the serious psychological impact of the ongoing violent conflict on Israeli and Palestinian students and point to the need to develop appropriate school‐based interventions to address their mental health needs. Cette étude évalue les effets de la violence continuelle sur la santé mentale des jeunes palestiniens et israéliens. Des instruments analogues ont été développés et adaptés, dans le cadre d’un projet de collaboration, afin d’évaluer dans chaque société: (1) les différences de taux d’exposition au conflit, (2) l’association entre l’exposition et la sévérité des symptômes post‐traumatiques (PTS) et (3) les interrelations entre les PTS, les troubles fonctionnels, les plaintes somatiques et les stratégies de faire‐face. 1016 adolescents israéliens et 1235 adolescents palestiniens ont participéà cette étude. Un questionnaire auto‐administré mesure l’exposition au conflit. Les PTS sont mesurés par l’utilisation de l’UCLA PTSD Reaction Index, les troubles fonctionnels et les plaintes somatiques sont approchés par le DISC, et les stratégies de faire‐face par le Brief Cope. Dans les deux sociétés, une plus grande exposition au conflit et à ses violences est associée à des PTS plus importants et à plus de plaintes somatiques, les filles manifestant plus de détresse que les garçons. Un total de 6.8% des étudiants israéliens et 37.2% des étudiants palestiniens répondent à des critères du Post Traumatic Stress Disorder (PTSD). Dans les deux sociétés, mais de façon plus prononcée dans l’Autorité palestinienne, les adolescents rapportent des niveaux significatifs de troubles fonctionnels, principalement dans le domaine du fonctionnement scolaire. Les étudiants avec PTSD manifestent plus de plaintes somatiques, il en va de même pour les troubles fonctionnels. Les résultats montrent le sérieux impact psychologique d’un conflit violent et continuel sur les étudiants israéliens et palestiniens et signale le besoin de développer des interventions scolaires appropriées à leurs besoins en matière de santé mentale.     

A Jewish Modified Divine Command Theory

We claim that divine command metaethicists have not thought through the nature of the expression of divine love with sufficient rigor. We argue, against prior divine command theories, that the radical difference between God and the natural world means that grounding divine command in divine love can only ground a formal claim of the divine on the human; recipients of revelation must construct particular commands out of this formal claim. While some metaethicists might respond to us by claiming that this account leads to an inability to judge between better and worse constructions of the commanded life, we propose that an analysis of the human response to divine love—theological eros—can be the basis for an articulation of a philosophical theology (in our case, negative theology) that can guide the religious believer toward generating particular principles for ethical action that are grounded in an account of divine action. By linking divine command to imitatio Dei, the believer can have confidence that her imitative acts of God are not inaccurate constructions of the commanded life.     

Consequences of a Motor Programming Deficit for Rehearsal and Written Sentence Comprehension

The role of central motor processes in rehearsal was investigated by studying a braindamaged patient with a severe articulatory impairment. Evidence is presented that his articulatory impairment is due to a disruption of motor programming rather than to peripheral muscle weakness. Despite his motor programming deficit, the patient showed normal auditory span and evidence of rehearsal for auditorily presented sequences of words. For visual presentation, span was reduced and there was no evidence of rehearsal. Also, the patient showed excellent sentence comprehension for syntactically complex sentences for both auditory and visual presentation. The results imply that central motor processes are not critical for normal short-term memory, at least for auditory presentation, and that reading comprehension does not depend on inner rehearsal.     

The pseudohomophone effect: The role of visual similarity in non-word decisions

The pseudohomophone effect, that is, the finding that non-words that are pronounced like words (e.g. MEEN) take longer to reject in a lexical decision task than other pronounceable non-words (e.g. NEEN), has been used to support the hypothesis of phonological receding in lexical access. The lexical decision experiments reported here matched pseudohomophones to control non-words that were as visually similar to words as were the pseudohomophones. For both normal and aphasic subjects, reaction times to reject the pseudohomophones were no longer than those for the visual controls. However, the pseudohomophones did take longer to reject than other pronounceable non-words which were not as visually similar to words. The results suggest that most previous findings of the pseudohomophone effect result from the greater visual rather than phonological similarity of the pseudohomophones to words. The absence of a phonological effect on the non-words in the present study implies that phonological coding is an optional rather than a slow, but obligatory process.