Clinical Exchange: The Architectural Failure

The Clinical Exchange invites eminent clinicians of diverse persuasions to share, in ordinary language, their clinical formulations and treatment plans of the same psychotherapy patient—one not selected or nominated by those therapists—and then to discuss points of convergence and contention in their recommendations. This Exchange concerns a Mr. L, a 47-year-old, married man presenting for outpatient individual psychotherapy with chief complaints of depression, anxiety, and a lengthy history of vocational underachievement. Drs. Herbert Fensterheim, Leslie Greenberg, and Leigh McCullough, who anchor their practices in the cognitive-behavioral, experiential, and psychodynamic orientations, respectively, are the featured commentators. Finally, Dr. Jerold Gold, the case contributor and Mr. L's psychotherapist, provides a few closing comments.     

Proximal and Distal Defense: A New Perspective on Unconscious Motivation

Death-related thoughts produce different effects on thought and behavior when they are in current focal attention and when they are on the fringes of consciousness. When such thoughts are conscious, people attempt to either remove them from consciousness or push death into the distant future by distorting their beliefs to logically imply that they have many remaining years to live. When such thoughts are highly accessible but outside current focal attention, people increase efforts to view themselves as persons of value living in a meaningful universe. In this way, awareness of the inevitability of death produces diverse effects on human thought and behavior that bear little obvious resemblance to the problem of death.     

Special perspective: An immodest proposal: should treating mental health professionals be barred from testifying about their patients?

Notwithstanding ethical rules that address therapeutic and forensic role conflicts for psychologists and psychiatrists, overzealous patient advocacy by therapists, tightened reimbursement for therapy, and a growth market for forensic psychology and psychiatry, have led many therapists to appear willingly as forensic experts on behalf of their patients. Existing ethical rules, as well as other proposed approaches to address this problem, assume that it can be resolved by modest changes in existing practice that permit therapists to testify as long as their testimony avoids psycholegal opinions. This essay questions whether these modest changes can adequately address this problem and advances consideration of a more radical proposal to address this problem, prohibiting therapists from testifying about their patients. © 1998 John Wiley & Sons, Ltd.     

Neuropsychological characteristics and test behaviors of boys with early onset conduct problems.

School-age children and adolescents with conduct problems typically exhibit deficits in verbal IQ, language abilities, and executive functions. This study examined the extent to which this pattern was evident in a clinic group of preschool boys with early onset conduct problems who met criteria for oppositional defiant disorder (ODD) with and without attention deficit hyperactivity disorder (ADHD). A 2nd question focused on the strength of relation between clinic boys' uncooperative or inattentive test behaviors and their test performance. As expected, the clinic boys showed a neuropsychological profile highly similar to the one found in older conduct problem populations. Verbal tests distinguished clinic from matched comparison boys even after controlling for observers' ratings of disruptive behavior during testing. Clinic boys with ODD and ADHD had lower verbal and executive function scores than clinic boys with ODD alone. After general vocabulary knowledge and test behavior were controlled, clinic boys were found to have poorer vocabularies for describing affective states than comparison group boys.     

Terror Management Theory: Implications for Understanding Prejudice,Stereotyping, Intergroup Conflict,and Political Attitudes

Terror management theory posits that to maintain psychological security despite the awareness of personal mortality, humans must maintain faith in cultural worldviews. These worldviews provide ways for humans to believe they are significant enduring beings in a world of meaning rather than mere animals fated only to obliteration upon death. We review basic support for terror management theory and research exploring the implications of terror management theory for understanding prejudice, stereotyping, intergroup conflict, and political attitudes. This research shows that when the psychological need to defend these worldviews is heightened by reminders of death (mortality salience), prejudice, stereotyping, and support for charismatic leaders and aggression against outgroups is increased. Terror management concerns also lead targets of prejudice to disidentify with their ingroup and confirm negative stereotypes of their group. We conclude by considering the implications of terror management theory and research for the alleviation of prejudice and intergroup conflict.     

Spectral information in nonspeech contexts influences children’s categorization of ambiguous speech sounds

For both adults and children, acoustic context plays an important role in speech perception. For adults, both speech and nonspeech acoustic contexts influence perception of subsequent speech items, consistent with the argument that effects of context are due to domain-general auditory processes. However, prior research examining the effects of context on children’s speech perception have focused on speech contexts; nonspeech contexts have not been explored previously. To better understand the developmental progression of children’s use of contexts in speech perception and the mechanisms underlying that development, we created a novel experimental paradigm testing 5-year-old children’s speech perception in several acoustic contexts. The results demonstrated that nonspeech context influences children’s speech perception, consistent with claims that context effects arise from general auditory system properties rather than speech-specific mechanisms. This supports theoretical accounts of language development suggesting that domain-general processes play a role across the lifespan.     

Concurrent and 2-Year Longitudinal Relations Between Executive Function and the Behavior of 1st and 2nd Grade Children

Concurrent and 2-year longitudinal relations were investigated between two indicators of children’s (n =60; mean age = years 11 months) executive function, inhibitory control and sequencing ability, and behavior problem symptomatology. Dependent measures were parent and teacher reported internalizing and externalizing behavior. Hierarchical multiple regression analyses demonstrated few significant concurrent associations between either inhibitory control or sequencing ability, and behavior problem symptoms. In contrast, baseline inhibitory control predicted decreased teacher reported externalizing, and parent reported externalizing and internalizing behavior problems over a 2-year period. Baseline sequencing ability also predicted decreased teacher reported externalizing and parent reported internalizing behavior over this same time period. Results suggest that some aspects of executive function in early elementary grade-school children may be more strongly associated with change in behavior over time than concurrent behavior. Implications of these findings for the prevention of behavior problems are discussed.     

The effects of syntactic structure on letter detection in adjacent function words

In the present study, we examined letter detection in very frequent function-word sequences. It has been claimed that such sequences are processed in a unitized manner, thus preempting access to their constituent letters. In contrast, we showed that letter detection in the words for and the (1) was no more difficult when the words appeared in adjacent locations in a sentence (familiar) than when they appeared apart (less familiar sequence) and (2) was contingent upon the words' syntactic roles within the phrase. Thus, letter detection in for was easier when the sequence was separated by a clause boundary than when the words were part of the same clause. The advantage derived from clause separation was strongest when a comma divided clauses. These results challenge the unitization account of the "missing-letter" effect in common phrases and support a position where this phenomenon is seen to reflect the extraction of phrase structure during reading.     

Alcohol consumption, drinking patterns, and alcohol problems among managerial versus non-managerial women and men

In the present study, we examined alcohol consumption and alcohol problems between managerial and nonmanagerial men and women. We also examined alcohol problems as a function of drinking context (i.e., when they drink and with whom they drink) for each of these four groups. Survey data and data from company records were collected from a large sample of blue and white collar employees (n = 2279). Participants completed a detailed questionnaire aimed at assessing many work-related attitudes, general mental and physical health-related perceptions, motivations for alcohol use, alcohol consumption indices, and alcohol problems. We found that several of the demographic variables differentially predicted alcohol consumption and problems for the four groups. In addition, drinking alone and immediately after work were associated with alcohol problems for women managers at a significantly higher rate than for the other groups of employees. These results support the assertion that more complex models are needed to understand the linkages between work and alcohol use. The research reported in this paper was supported by Grant AA 10690-02, National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health.