Followup in psychoanalysis: clinical and research values

Psychoanalysis has never developed a tradition of systematic followup study to evaluate outcome and to improve technique and theory for a variety of reasons, partly theoretical, stemming from the conception of the unfolding transference neurosis and its analytic resolution as the precondition for cure, and partly historical, having to do with the happenstance of its development as a private practice-based discipline and training outside of the academic setting. Freud, however, was never bound by such strictures and published whatever post-treatment data he acquired on all his best-known case histories. But following Freud most analysts, with some notable exceptions, eschewed followup activity as unanalytic. It is this tradition that more recent studies like those of Pfeffer in New York and the Psychotherapy Research Project of The Menninger Foundation in Topeka have squarely challenged. Data are presented from the Menninger project dealing specifically with the impact of routine planned followup on issues of treatment termination and resolution and on the nature of the post-treatment period. The degree and kind of patient cooperation with the followup inquiry, the impact of followup on treatment termination and resolution (both impeding and facilitating), and the role of followup intervention in relation to return to formal post-treatment therapy (or consolidating against it), are all discussed.     

Private-sector care for chronically mentally ill individuals. The more things change, the more they stay the same

Two profit-making industries, nursing homes and board-and-care homes, care for about one million chronic mental patients. This care is primarily custodial and probably not very different from the care patients received in the public sector prior to deinstitutionalization. Moreover, certain characteristics of privately owned facilities encourage poor patient care so as to maximize profit. The problem could be ameliorated if chronic mental patients were strong and informed consumers or if the public sector strongly regulated proprietary care. However, neither of these two conditions now hold. Perhaps the apparent difficulties in significantly improving care for chronically mentally ill individuals despite seemingly major changes in policy reflect a fundamental problem in overall social policy--a reluctance to care for chronically indigent individuals of all kinds.     

Emotional disturbance and the development of self-consciousness in adolescence

The development of self-consciousness and its relationship to emotional disturbance was examined in early and late adolescence. The Imaginary Audience Scale was administered to emotionally disturbed and nondisturbed adolescents. As predicted, results indicated that self-consciousness decreased with age in nondisturbed adolescents. For the emotionally disturbed adolescents, the development of self-consciousness in temporary situations did not follow consistent patterns, as indicated by interaction effects. A significant negative relationship was found between intelligence test scores and self-consciousness in the disturbed group. The findings support the premise that social-cognitive shifts found in early to late adolescence are disrupted in disturbed populations. The mediating role of social experience as a factor in cognitive and emotional development is discussed.     

Adolescent school performance following parental divorce: are there family factors that can enhance success?

Most research on the effects of divorce on children has focused on delineation of specific areas of child maladjustment. A more optimistic approach seeks to identify variables that may mediate negative effects of a stressor, such as parental divorce. The goal of this study was to examine the relationship between one area of child adjustment, school achievement, and family factors which may mediate the negative influence of divorce. The subjects were 71 early adolescents and their recently divorced mothers. The adolescents were divided into low, medium, and high grade achievement groups. Analyses of variance and subsequent Newman-Keuls tests revealed that adolescents with high grade point averages had mothers with a lower level of depression, a higher educational level, less conflict with their ex-spouse, and less intense levels of conflict between mother and adolescent than those in the low grade point average group. A discriminant analysis resulted in a two-variable equation which accounted for 33% of the variance between low and high grade achievers. The two variables were mother's report of conflict between her and her ex-spouse in front of the adolescent and the adolescent's report of the intensity of arguments between him/herself and mother. These results indicated that school performance following divorce is not uniform for all adolescents and that family factors may mediate scholastic achievement problems.     

Perception and its neuronal mechanisms

A classic view of the relation between sensorineural activity and perception has assumed that the former is somehow transformed into the latter at some locus in the brain. This notion conflicts with the modern view that the activity of the nervous system is restricted to transmitting and processing information. It is suggested that the conflict may be resolved by considering perception as reflective activity rather than passive reception. This cognitive process entails information about the perceiving self and the general context and not merely the stimulus input. Some aspects of perception can be related to neuronal mechanisms and even to neuronal activity at specific loci. How is this done? By identifying the characteristics of the perceptual process and finding a necessary and sufficient neuronal mechanism that receives information about the stimulus input and can perform the implied computation. Examples are taken from the study of visual development in human infants.     

Dynamic organization of intersensory function

Issues related to infant intersensory functioning are reviewed. The argument is offered that limitations of sensory inputs during early stages of development are necessary and provide structure and organization which determine behavioural characteristics at later stages. It is also suggested that infant organisms respond to the intensity of stimulation rather than organizational characteristics and that this is responsible for the form of sensory equivalence apparent during early development. A scheme for the investigation of sources of intersensory organization is presented which involves a prospective analysis of how consideration of the times of onset of sensory functions helps us to understand intra- and intersensory development. The advantages of this experimental approach are outlined.     

A sermon from hell: Toward a theology of loneliness

Loneliness as part of the human condition is first explored from an experiential-philosophical perspective. A biblical survey suggests loneliness is normative to the faith experience and may portray a more realistic religiosity. Desert imagery in Scripture indicates a strong association among solitude, spiritual development, and potential dangers of spiritual deception. God's not yet-ness-itself a cause of existential loneliness—is paradoxically the way in which communion with God functions in the here and now. The creative use of solitude may enhance social, psychological, and spiritual well-being, and provide a way to theologize about personal isolation and disorientation.He is also editor of theHarding Journal of Religion and Psychiatry.     

The 20 questions task with families of schizophrenics: divergent findings

The study attempted to replicate and extend the results of an earlier study by Wild and Shapiro (16), establishing the utility of Mosher and Hornsby's (8) 20 Questions Task as a means of differentiating families with schizophrenic patients from those of psychiatrically hospitalized but nonschizophrenic individuals. In the current study, Wild and Shapiro's original design was expanded and revised by (a) diagnosing patients using Research Diagnostic Criteria rather than hospital diagnoses and (b) including families with schizophrenic daughters and/or one-parent families, in addition to intact families with schizophrenic sons. Families were comparable on age, intelligence, and socioeconomic variables. The results failed to replicate those reported by Wild and Shapiro, and indicated that the 20 Questions Task was sensitive to differences in family constellation and offspring gender as well as offspring diagnosis. The findings suggest that forms of familial communication deviance detected with the 20 Questions Task may not be unique to families of schizophrenics, thus highlighting the need to expand research on family communication deviance in families with schizophrenic offspring to families with varied family constellations and characteristics.     

Group psychotherapy with preadolescent sexual abuse victims: literature review and description of an inner-city group

The demand for therapy groups for child sexual assault victims has risen as detection of abuse has increased, but little has been published about conducting and evaluating such groups. The authors present a comprehensive review of the literature and describe their sixteen-week therapy group with seven eleven- and twelve-year-old girls. Treatment themes, activities, group process issues, and psychometric findings on the Piers-Harris Children's Self Concept Scale and the Child Behavior Checklist are discussed. Suggestions for future groups and research are offered.