Short-term psychodynamic intervention in an urban health clinic: A case report

This paper describes the application of short-term dynamic therapeutic techniques to treat both symptom disturbance and character pathology in an urban mental health clinic. Short-Term dynamic psychotherapy focuses extensively on the subjectivity and inner life of the patient with emphasis on repressed anger, sadness and desire. Methods to overcome patient ambivalence and resistance to psychotherapy are presented. The clinical psychodynamics associated with early life trauma are illustrated with a case of an African-American patient.Acknowledgments for support & critical feedback are expressed to Christine Baker, Ph.D., John Swanson, ACSW, Duncan Walton, Ph.D., and Isabelle Beveridge (Graphics).     

Pessimistic explanatory style and response to illness

Previous studies have shown that a pessimistic explanatory style is a risk factor for illness, but the factors linking explanatory style and illness are unknown. One's characteristic response to poor health may mediate this relationship. Perhaps pessimistic individuals act helplessly in the face of their symptoms, thereby exacerbating disease. In the present study, we investigated this possibility by asking 96 young adults to complete measures of explanatory style, habitual response to illness, and ways of coping during their most recent episode of illness. Subjects who explain bad events pessimistically (with internal, stable, and global causes) reported more frequent illnesses during the past year and rated their overall health more poorly than those who habitually favor external, unstable, and specific explanations. When ill, the pessimistic subjects were less likely than their optimistic counterparts to take active steps to combat their illness. Our results suggest that one pathway leading from pessimistic explanatory style to poor health is mundane: passivity in the face of disease.     

Racial bias and the MCMI

We studied the scores obtained on the Millon Clinical Multiaxial Inventory (MCMI) by Black and White male psychiatric inpatients to determine the presence or absence of racial bias. In predicting psychopathology for the two races, comparisons of MCMI performance indicated significant differences for all diagnoses except the personality disorders. The subjects were then matched into two groups of 209 patients each, according to DSM-III psychiatric diagnoses. The data were analyzed at the item, scale, and structural levels. At the item level, application of the Mantel-Haenszel Procedure revealed that 45 of the 175 items of the inventory were answered significantly different by the two racial groups. Because this number was higher than what could be expected by chance, the finding suggested possible deficiencies in terms of the culture-fairness of the items used in the test. At the scale level, an analysis of variance (ANOVA) demonstrated that the scores obtained by the Black and White groups were significantly different in 9 of the 20 scales (Histrionic, Narcissistic, Antisocial, Paraphrenia, Hypomania, Dysthymia, Alcohol Abuse, Drug Abuse, and Psychotic Delusion). With the exception of the Dysthymic scale, all of the differences were in the direction of the Blacks obtaining a higher score than the Whites. At the structural level, however, a principal components factor analysis performed on each group resulted in factor structures that looked identical.     

Harming future people

Hanser examines Derek Parfit's contention in his treatise on rationalism, Reasons and Persons (Oxford University Press; 1984) that acts that are not reproductive in nature can nonetheless predictably affect the identities of future people, and that this fact has unexpected and important consequences for ethical theory. Hanser argues tht this fact is not as significant as Parfit believes it to be. The arguments of both scholars concern the morality of choices that, while causing future persons to be badly off, do not make them worse off than they would have been if the choices had not been made. Hanser concludes his essay with a discussion of responsibility for acts that will affect the health of future offspring.     

Do substance abuse and mental health clients prefer automated assessments?

In both psychiatric and substance-abuse services, clinicians have been concerned with the introduction of automated assessments and with their clients’ reactions toward those assessments. The positive reactions of psychiatric clients have been well documented, but little has been known about substance-abusing clients’ impressions of automated assessments. The impact of automated assessment on clients seeking substance-abuse services was evaluated and compared with a previously analyzed sample of clients seeking mental health services. On the whole, both groups responded similarly and positively to automated assessments. Factor analyses revealed three underlying dimensions in client attitudes toward automated assessment,Completeness and satisfaction,Ease of use and enjoyment, andNegative attitudes. In addition, statistically, though not clinically, significant differences in attitudes were found between various demographic groups. Overall, the results support the use of automated assessments with individuals seeking either substance-abuse or mental-health services.     

Clinical pragmatism: a method of moral problem solving

This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinical pragmatism for the use of principles in moral problem solving are discussed.     

Minds and Bodies: Human and Divine

Does God have a mind? Western theism has traditionally construed God as an intentional agent who acts on creation and in relation to humankind. God loves, punishes, and redeems. God's intentionality has traditionally been construed in analogy to human intentionality, which in turn has often presumed a supernatural dualism. Developments in cognitive science, however, render supernatural dualism suspect for explaining the human mind. How, then, can we speak of the mind of God? Borrowing from Daniel Dennett's intentional stance, I suggest that analogical reasoning regarding the mind of God be abandoned in favor of an ontologically agnostic approach that treats God as an intentional system. In this approach, God's purposive action is an explanatory feature of the believer's universe, a real pattern that informs our values and beliefs about the world and our place in it.     

Life after Trauma: Personality and Daily Life Experiences of Traumatized People

In this study, we explored differences in personality and daily life experiences of traumatized (n= 26) versus nontraumatized (n= 30) college students. Study participants completed a variety of personality measures as well as a 28–day experience sampling study assessing daily activities, emotions, and physical health. Although not differing on general demographics, traumatized individuals reported more trait anxiety and lower self–esteem than nontraumatized individuals. They scored higher on Neuroticism, were more introverted, and were less emotionally stable than nontraumatized participants. Traumatized individuals also reported more cognitive disturbances, emotional blunting, and interpersonal withdrawal. They did not report being more depressed, but did endorse cognitive styles associated with heightened risk for depression. Earlier age of trauma was associated with more pathological outcomes: lower self–esteem and psychological well–being, more anxiety, more pessimism, and emotional constriction of positive mood. We compare this symptom profile to that of posttraumatic stress disorder.     

Television distraction and the performance of introverts and extroverts

An experiment was run to test the effect on reading comprehension of distraction by a television programme, which was presented while reading took place. Respondents, classified in terms of extroversion or introversion, carried out two reading comprehension tests in silence and in the presence of a television drama programme. As predicted, extroverts and introverts both performed better in silence, but there was a significant interaction that showed that extroverts performed better than introverts in the presence of television distraction. The findings are discussed in relation to previous research on this subject.