The use of the analyst as an autistic shape

In this paper I describe through detailed clinical material the challenges posed by patients who employ entangled autistic defenses. I discuss the complicated nature of treating a patient who employed entangled autistic defenses and utilized my voice in an effort to preserve an undifferentiated state of dual unity. My patient's pursuit of dual unity took a very concrete form in her attempt to mitigate the terror of separateness. This concreteness was expressed via the patient's urgent request that I read letters she wrote to me between sessions. This type of autistic defense placed great strain on my ability to think analytically and I also became increasingly concrete in my response to the patient. Crucial to the analyst's regaining a space in which to think and a sense of separateness is the ability to contact the ground floor of her separate bodily experience. This is just the beginning step in the analyst separating herself from the powerful press to join the patient in a state of dual unity. Interpretation in action (Ogden, 1994) was an effective way to convey the importance of creating and tolerating internal space in myself and begin to create internal space in the patient. Previously such space had been closed down in order to manage primitive fears of annihilation. When a patient is absorbed in an entangling autistic retreat words do not reach the patient on a symbolic level but rather are experienced primarily as an assault on the need for dual unity with the analyst. The patient's need to be wrapped in a sensation based world of dual unity is preferable to a world of spoken words that carry the danger of delineating psychic separateness. In essence there is no self to speak words, only a whirl of an amorphous sensation self lacking definition. I believe with certain kinds of patients it may be necessary to first lose and then work to regain one's analytic mind, as I have powerfully described in the case of Linda. Linda's profound loss of connection to the ground floor of her experience could only begin to be addressed when I worked to extricate myself from ‘our magic carpet ride’ of dual unity, contacting the reality of my bodily experience, and begin to tolerate the terror I felt regarding my separateness from Linda. I also describe the confusing vacillation between entangled and encapsulated defenses in patients like Linda as previously identified by Cohen and Jay (1996). Ultimately, this kind of slow difficult analytic work began to help Linda develop a capacity to think and provided an alternative to the deadened world of her autistic protections.     

The Impact of Segmental Trunk Support on Posture and Reaching While Sitting in Healthy Adults

The authors investigated postural and arm control in seated reaches while providing trunk support at midribs and pelvic levels in adults. Kinematics and electromyography of the arm and ipsiliateral and contralateral paraspinal muscles were examined before and during reaching. Kinematics remained constant across conditions, but changes were observed in neuromuscular control. With midribs support, the ipsilateral cervical muscle showed either increased anticipatory activity or earlier compensatory muscle responses, suggesting its major role in head stabilization. The baseline activity of bilateral lumbar muscles was enhanced with midribs support, whereas with pelvic support, the activation frequency of paraspinal muscles increased during reaching. The results suggest that segmental trunk support in healthy adults modulates ipsilateral or contralateral paraspinal activity while overall kinematic outputs remain invariant.     

TMS suppression of right pars triangularis, but not pars opercularis, improves naming in aphasia

This study sought to discover if an optimum 1 cm² area in the non-damaged right hemisphere (RH) was present, which could temporarily improve naming in chronic, nonfluent aphasia patients when suppressed with repetitive transcranial magnetic stimulation (rTMS). Ten minutes of slow, 1 Hz rTMS was applied to suppress different RH ROIs in eight aphasia cases. Picture naming and response time (RT) were examined before, and immediately after rTMS. In aphasia patients, suppression of right pars triangularis (PTr) led to significant increase in pictures named, and significant decrease in RT. Suppression of right pars opercularis (POp), however, led to significant increase in RT, but no change in number of pictures named. Eight normals named all pictures correctly; similar to aphasia patients, RT significantly decreased following rTMS to suppress right PTr, versus right POp. Differential effects following suppression of right PTr versus right POp suggest different functional roles for these regions.     

Neuromuscular responses to platform perturbations in power- versus endurance-trained athletes

The purpose was to assess differences in postural response characteristics between two groups of elite athletes having power or endurance training. Participants were all men and included power- (M age = 21 yr., SD = 3, n = 12) and endurance-trained (M age = 22, SD = 3, n = 12) athletes. Muscle response characteristics and center of pressure measures were recorded during recovery from Fast (10 cm at 80 cm/sec.) and Slow (10 cm at 20 cm/sec.) horizontal platform perturbations. In response to Fast perturbations, power-trained athletes responded with significantly shorter times to stabilize the center of pressure, shorter muscle-contraction onset times, and larger muscle response amplitudes than endurance-trained athletes. This suggests power-trained athletes are more effective than endurance-trained athletes in responding to balance threats such as slips and trips in daily life and that power training should be studied to improve balance control of balance-impaired populations.     

The Spanish version of the Wisconsin Personality Disorders Inventory-IV (WISPI-IV): tests of validity and reliability

Personality disorders (PD) are a prevalent class of mental disorders that interfere with functioning and cause subjective distress while increasing the intensity and duration of Axis I clinical syndromes, and therefore assessing PD is important even when PDs are not the focus of treatment. The purpose of these studies was to develop and test a new Spanish version of a self-report measure of PD, the Wisconsin Personality Inventory-IV (WISPI-IV) that would be psychometrically equivalent to the English version while also maintaining the same interpersonal content, which is based on Benjamin's analysis of the PD criteria using her Structural Analysis of Social Behavior (SASB) model (1974). Study 1 participants completed the WISPI-IV twice over a two-week interval. For Study 2, participants from two sites in Spain and one site in Argentina completed Spanish versions of the WISPI-IV and other personality measures. SASB-analysis of the translated items showed high correspondence between the interpersonal content of the English version and the Spanish version demonstrating theoretical validation in relation to other PD measures. The Spanish WISPI-IV showed satisfactory reliability based on test-retest correlations and alphas for internal consistency. Study 2 showed the Spanish WISPI-IV had good convergent validity with the Spanish versions of the IIP and SCID-II and performed similarly to the English versions of these measures. Our goal in translating the WISPI-IV was to extend this measure to Spanish-speakers in language that would be understood by different Hispanic sub-groups, however research team members and subjects had a variety of suggestions for changes in item wording. This reflects the difficulty with creating a "neutral" Spanish version of any assessment given regional differences.     

How useful are indices of personality pathology when assessing domestic violence perpetrators?

There has been considerable debate about profiling personality pathology when assessing and treating male perpetrators of domestic violence (DV). This study used the Millon Clinical Multiaxial Inventory (MCMI-III) to explore the severity and diversity of male perpetrator personality pathology and response bias in a group of DV perpetrators being assessed for a treatment program (N = 177). We analyzed the sample using the interpretive guidelines of White and Gondolf (2000); 54% of profiles in our sample fell into categories indicative of a personality disorder, and 37% of the total sample provided profiles indicative of severe personality pathology. These percentages were higher than White and Gondolf's findings but lower than some others. There was considerable diversity of personality pathology as well, supporting the contention that there is no one male DV perpetrator profile. Because of debate concerning the manner of responding on self-report instruments, we paid special attention to response biases in our sample. Twenty-six percent of our sample exaggerated (12%) or minimized (14%) their responses. We also found that response biases on the MCMI-III Modifying Indices were related to self-reported severity of psychopathology. This suggests that assessing severity of psychopathology is inadequate without reference to such biases.