Measuring Responsiveness in the Therapeutic Relationship: A Patient Perspective

This article reports results from a three-country study of patient perceptions of physician responsiveness. Based on existing research in the medical and social-psychological literatures, we theorized that patients' perceptions of physician responsiveness to their needs would be an important component of the patient–physician relationship and that this construct could be distinguished reliably from more global assessments of patient satisfaction. We then developed a new measure designed to assess these perceptions from the patients' point of view. This measure was administered to large samples of patients in the United States, the United Kingdom, and Canada. Results supported our hypotheses. Patient perception of physician responsiveness significantly predicted both patient satisfaction and subjective health-related problems, over and above effects attributable to general satisfaction. We also noted the absence of significant differences across the three cultures or sex, suggesting that the process we identify has considerable generality. We also describe a short version of our measure that researchers may find useful in a variety of research or clinical settings.     

In sickness and in health: An exploration of some of the unconscious processes involved in the decision by family caregivers to place a family member with dementia in residential care

This paper explores the feelings, conscious and unconscious, evoked by the difficult decision to place a family member with dementia into residential care. In an exploratory study I interviewed five people who had made this decision with a view to exploring some of the unconscious processes involved in their decision-making. The interviews were interpreted paying attention to my understanding of the transference and my countertransference feelings and as triangulated by a psychodynamic supervision group.

Intimate contact with ageing and death evokes fears about mortality and activates primitive anxieties. The progress of dementia may amplify primitive or psychotic states of functioning, particularly those involving evacuatory projection, and family carers may resort to splitting off unbearable feelings of anxiety which such projections can evoke and may contribute to their decision to look for residential care.

Once placed in residential care different dynamics evolve and further difficult questions arise: how often to visit; whether and when to dispose of the person's possessions and ultimately how to grieve. The focus of this paper is, as far as it is possible, on the partner without dementia as an individual and the impact of their relative's dementia on their lives.     

Perceptual asymmetry and youths’ responses to stress: Understanding vulnerability to depression

This research examined the hypothesis that reduced posterior right hemisphere activity interferes with the regulation of emotions and behaviour in response to stress, creating vulnerability to depression. Consistent with a diathesis–stress model, we predicted that youths with a reduced posterior right hemisphere bias in emotional processing would engage in less adaptive responses to stress, which would be associated with depressive symptoms in those who reported the recent experience of high, but not low, levels of stress. Participants were 510 4th through 8th graders who completed the Chimeric Faces Task and measures of responses to stress and depressive symptoms. Results supported the idea that responses to stress account for the association between reduced posterior right hemisphere activity and depressive symptoms in youths who report high, but not low, levels of stress. This study provides insight into one process through which reduced posterior right hemisphere activity may confer vulnerability to depressive symptoms, and implicates responses to stress as a target for intervention.     

The role of childhood sexual seduction in the development of an erotic transference: Perversion in the psychoanalytic situation

Abstract

Based on Ferenczi's Confusion of Tongues theory of trauma we proposed the following hypothesis: “An erotic transference is an enactment in the here-and-now of the psychoanalytic situation of a childhood seduction of sexual trauma”. We delineate the relational approach to the analysis of the incest trauma, both theoretically and clinically. The concept of enactment helps us understand the emergence of the incest trauma in the psychoanalytic situation as an indication of an earlier childhood experience. Three clinical examples are discussed which illustrate ways of using the hypothesis within the analytic process. The clinical examples demonstrate the value of enactments that are contained in the unconscious communication that the erotic transference represents.

Rachman AWM et al. Die Rolle sexueller Verführung in der Kindheit bei der Entwicklung einer erotischen Übertragungsperversion in der psychoanalytischen Situation

Basierend auf Ferenczi′s Konfusion der Zungen Trauma Theorie schlugen wir die folgende Hypothese vor: Eine erotische Übertragung ist eine Inszenierung im Hier und Jetzt der psychoanalytischen Situation einer Kindheits Verführung als sexuellem Trauma. Wir entwerfen den relationalen Ansatz theoretisch und klinisch in Bezug auf die Analyse des Inzest Traumas. Das Konzept der Reinszenierung hilft uns das Auftauchen des Inzest Traumas als ein Anzeichen einer früheren Kindheitserfahrung in der psychoanalytischen Situation zu verstehen. Es werden drei klinische Beispiele diskutiert, die die Wege illustrieren, die Hypothese innerhalb des analytischen Prozesses anzuwenden. Die klinischen Beispiele zeigen den Wert von (Re-) Inszenierungen, die in der unbewußten Kommunikaton enthalten sind, welche die erotische Übertragung repräsentieren.

Rachman A WM et. al. El rol de la seducción sexual infantil en el desarrollo de una transferencia erótica: perversión en la situación analítica.

Basado en la teoría del trauma de la confusión de lenguas de Ferenczi, proponemos la siguiente hipótesis: una transferencia erótica es un enactment en el aquí y el ahora de la situación analítica del trauma de la seducción sexual infantil. Trazamos la aproximación relacional del análisis del trauma del incesto. El concepto de enactment nos ayuda a entender la emergencia del trauma del incesto en la situación psicoanalitica, como indicación de una experiencia infantil temprana.

Se presentan tres ejemplos clínicos que ilustran formas de uso de la hipótesis desde el proceso analítico. Estos ejemplos clínicos demuestran el valor de los enactments contenidos en la comunicación inconsciente que representa la transferencia erótica.     

Investigating a socially anxious‐impulsive subgroup of adolescents: A prospective community study

Previous research has identified a subgroup of socially anxious adults who are both anxious and impulsive. To date, however, this subgroup has not been identified in adolescence. Therefore, in this study we aimed to identify this subgroup in a sample of adolescents. In addition, we hypothesized that this subgroup would be higher on problem behaviors, and that these processes would be moderated by gender. We used longitudinal data from 714 adolescents who were in the 7th and 8th grades at Time 1. They were followed annually for three years. Cluster analyses identified an anxious‐inhibited subgroup as well as an anxious‐impulsive subgroup in early adolescence (Time 1). The socially anxious‐impulsive adolescent boys were generally higher on both intoxication frequency and delinquency compared with all other adolescents in all clusters at each time point. Findings suggest that social anxiety subgroups may differ on problem behavior, and that early detection of an anxious‐impulsive subgroup may be important to prevent maladjustment, especially for adolescent boys.     

‘I don't want to be the mother of a paedophile’: the perspectives of mothers whose adolescent sons with learning disabilities sexually offend

The subject of sexual abuse is a major focus of professional and public concern. Sexual abuse of (and by) people with learning disabilities evokes even greater disquieting emotions, and makes severe demands on the social services, and the criminal justice system. The aims of the project were: 1) to determine whether group psychotherapy produced effective outcomes for adolescent boys with learning disabilities who exhibit sexually abusive behaviour, 2) to explore the perspectives of parents and other care-givers, and 3) to document the nature and extent of service support to families. This paper focuses solely on the mothers' perspectives. This was a three-year project with six boys (under 16) receiving group psychotherapy, using both quantitative and qualitative methods. Clinical measures were used to track changes throughout the course of psychotherapy. Semi-structured interviews (taped and transcribed) were held (separately) with the boys, their parents, paid care-givers and the therapists. The mothers tried hard to make sense of, and come to terms with, what was happening to their sons and to themselves, they struggled to reconcile their own confused and often conflicting emotions, and to maintain their own sense of identity. They felt almost totally unsupported by the services, both in the past and present, and could see little hope for the future. There is an urgent need for development of effective and sympathetic services for the parents of boys with learning disabilities who have been abused, and who are now showing abusive behaviour.     

Adapting School-Based Substance Use Prevention Curriculum Through Cultural Grounding: A Review and Exemplar of Adaptation Processes for Rural Schools

A central challenge facing twenty-first century community-based researchers and prevention scientists is curriculum adaptation processes. While early prevention efforts sought to develop effective programs, taking programs to scale implies that they will be adapted, especially as programs are implemented with populations other than those with whom they were developed or tested. The principle of cultural grounding, which argues that health message adaptation should be informed by knowledge of the target population and by cultural insiders, provides a theoretical rational for cultural regrounding and presents an illustrative case of methods used to reground the keepin’ it REAL substance use prevention curriculum for a rural adolescent population. We argue that adaptation processes like those presented should be incorporated into the design and dissemination of prevention interventions.     

Premature twins on a neonatal intensive care unit

This paper presents observations of boy and girl twins on a neonatal intensive care unit, following them through from 10 days old to return home. The observer hypothesizes about the experience of the twins as they progress, based on detailed notes of their actions. The preoccupations of the parents are incorporated, as are reactions and interventions of staff. The place and possible functions of such observation by a child psychotherapist attached to such a unit are elaborated in the concluding section.     

Maternal Psychopathology and Early Child Temperament Predict Young Children’s Salivary Cortisol 3 Years Later

Neuroendocrine dysfunction is hypothesized to be an early emerging vulnerability marker for depression. We tested whether the main and interactive effects of maternal psychopathology and early child temperamental vulnerability for depression assessed at age three predicted offspring’s basal cortisol function at age 6 years. 228 (122 males) children participated in the baseline and follow-up assessments. At age three, maternal lifetime psychopathology was assessed with a diagnostic clinical interview, and child temperamental positive affectivity (PA) and negative affectivity (NA) were assessed using laboratory observations. At age six, children’s waking and evening cortisol were assessed on 2 days. Maternal lifetime anxiety predicted offspring’s higher morning cortisol at age six. Child temperamental NA at age three predicted higher evening cortisol at age six. There was a significant interaction between maternal lifetime depression and child temperamental PA at age three in predicting offspring’s morning cortisol at age six. For the offspring of mothers with lifetime depression, higher PA at age 3 predicted lower morning cortisol at age 6. These findings highlight the importance of examining the main and interactive effects of maternal psychopathology and early child temperamental vulnerability in predicting the development of offspring’s stress physiology. Findings hold significance in identifying etiological mechanisms of risk and delineating the complex developmental pathways to psychopathology.     

Do as you’re told! Facets of agreeableness and early adult outcomes for inner-city boys

With data from the middle cohort of the Pittsburgh Youth Study, a prospective longitudinal study of inner-city boys, we examined whether Big Five agreeableness facets could be reliably recovered in this sample, and whether facets predicted educational, occupational, social, and antisocial life outcomes assessed a decade later. Caregivers described their adolescent boys’ personalities using the Common California Q-Set; twelve years later, participants were interviewed and court records were obtained. Factor analyses recovered two facets: compliance and compassion. Compliance predicted more schooling and lower risk of unemployment, teenage fatherhood, and crime; compassion related to longer committed relationships. Findings highlight the value of studying personality at the facet level.