Attending to the shame: Working with addicted populations

Shame is a potent emotion that plays a major role in the life of addicted individuals. Shame's ability to penetrate and skew major motivational systems may play a part in the formation of addicted lifestyles. The shame-based or shame-prone individual, such as the addicted client, poses unique problems for the therapist. This paper explicates the processes and consequences of shame and offers guidelines to help clinicians work with addicted clients.Mitchell B. Young, MS, is a third-year doctoral student in the department of counseling and development at Purdue University.The author wishes to express appreciation to Kate Kerr, PhD, for her fine editorial work.     

Planned Happenstance: Constructing Unexpected Career Opportunities

Chance plays an important role in everyone's career, but career counseling is still perceived as a process designed to eliminate chance from career decision making. Traditional career counseling interventions are no longer sufficient to prepare clients to respond to career uncertainties. Work world shifts challenge career counselors to adopt a counseling intervention that views unplanned events as both inevitable and desirable. Counselors need to teach clients to engage in exploratory activities to increase the probability that the clients will discover unexpected career opportunities. Unplanned events can become opportunities for learning.     

Direct comparison of auditory implicit memory tests

In this experiment, we examined the degree to which four implicit tests and two explicit tests, all involving auditory presentation, were sensitive to the perceptual characteristics of the stimuli presented during study. Presenting stimuli visually decreased priming in all the implicit memory tests, relative to auditory presentation. However, changing voice between study and test decreased priming only in the implicit memory tests requiring identification of words degraded by noise or by low-pass filtering, but not in those tests requiring generation from word portions (stems and fragments). Modality effects without voice effects were observed in cued recall, but the opposite pattern of results (voice effects without modality effects) was obtained in recognition. The primary new finding is the demonstration that auditory memory tests, both explicit and implicit, differ in their sensitivity to the perceptual information encoded during study.     

Pretence–reality distinction: confusion and paradox

Peter Mitchell, Pretence–reality distinction: confusion and paradox, p.414 Ted Ruffman, Pretence–reality confusions in children and adults, p.416 György Gergely, Some confusion about pretence–reality confusions, p.417 Paul L. Harris, Delving into Uncle Albert’s cabinet: further thoughts on the pretence–reality distinction, p.419     

Exposure to internet pornography among children and adolescents: a national survey.

Estimates suggest that up to 90% or more youth between 12 and 18 years have access to the Internet. Concern has been raised that this increased accessibility may lead to a rise in pornography seeking among children and adolescents, with potentially serious ramifications for child and adolescent sexual development. Using data from the Youth Internet Safety Survey, a nationally representative, cross-sectional telephone survey of 1501 children and adolescents (ages 10-17 years), characteristics associated with self-reported pornography seeking behavior, both on the Internet and using traditional methods (e.g., magazines), are identified. Seekers of pornography, both online and offline, are significantly more likely to be male, with only 5% of self-identified seekers being female. The vast majority (87%) of youth who report looking for sexual images online are 14 years of age or older, when it is developmentally appropriate to be sexually curious. Children under the age of 14 who have intentionally looked at pornography are more likely to report traditional exposures, such as magazines or movies. Concerns about a large group of young children exposing themselves to pornography on the Internet may be overstated. Those who report intentional exposure to pornography, irrespective of source, are significantly more likely to cross-sectionally report delinquent behavior and substance use in the previous year. Further, online seekers versus offline seekers are more likely to report clinical features associated with depression and lower levels of emotional bonding with their caregiver. Results of the current investigation raise important questions for further inquiry. Findings from these cross-sectional data provide justification for longitudinal studies aimed at parsing out temporal sequencing of psychosocial experiences.     

A randomized trial comparing the efficacy of cognitive-behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face

OBJECTIVE: A major problem in the delivery of mental health services is the lack of availability of empirically supported treatment, particularly in rural areas. To date no studies have evaluated the administration of an empirically supported manual-based psychotherapy for a psychiatric condition via telemedicine. The aim of this study was to compare the relative efficacy and acceptability of a manual-based cognitive-behavioral therapy (CBT) for bulimia nervosa (BN) delivered in person to a comparable therapy delivered via telemedicine. METHOD: One hundred twenty-eight adults meeting DSM-IV criteria for BN or eating disorder-not otherwise specified with binge eating or purging at least once per week were recruited through referrals from clinicians and media advertisements in the targeted geographical areas. Participants were randomly assigned to receive 20 sessions of manual-based, CBT for BN over 16 weeks delivered either face-to-face (FTF-CBT) or via telemedicine (TV-CBT) by trained therapists. The primary outcome measures were binge eating and purging frequency as assessed by interview at the end of treatment, and again at 3- and 12-month follow-ups. Secondary outcome measures included other bulimic symptoms and changes in mood. RESULTS: Retention in treatment was comparable for TV-CBT and FTF-CBT. Abstinence rates at end-of-treatment were generally slightly higher for FTF-CBT compared with TV-CBT, but differences were not statistically significant. FTF-CBT patients also experienced significantly greater reductions in eating disordered cognitions and interview-assessed depression. However, the differences overall were few in number and of marginal clinical significance. CONCLUSIONS: CBT for BN delivered via telemedicine was both acceptable to participants and roughly equivalent in outcome to therapy delivered in person.     

Online "predators" and their victims: myths, realities, and implications for prevention and treatment

The publicity about online "predators" who prey on naive children using trickery and violence is largely inaccurate. Internet sex crimes involving adults and juveniles more often fit a model of statutory rape--adult offenders who meet, develop relationships with, and openly seduce underage teenagers--than a model of forcible sexual assault or pedophilic child molesting. This is a serious problem, but one that requires approaches different from those in current prevention messages emphasizing parental control and the dangers of divulging personal information. Developmentally appropriate prevention strategies that target youths directly and acknowledge normal adolescent interests in romance and sex are needed. These should provide younger adolescents with awareness and avoidance skills while educating older youths about the pitfalls of sexual relationships with adults and their criminal nature. Particular attention should be paid to higher risk youths, including those with histories of sexual abuse, sexual orientation concerns, and patterns of off- and online risk taking. Mental health practitioners need information about the dynamics of this problem and the characteristics of victims and offenders because they are likely to encounter related issues in a variety of contexts.     

Familial patterns and the origins of individual differences in synaesthesia

The term synaesthesia has been applied to a range of different sensory-perceptual and cognitive experiences, yet how these experiences are related to each other is not well understood. Not only are there disparate types of synaesthesia, but even within types there are vast individual differences in the way that stimuli induce synaesthesia and in the subjective synaesthetic experience. An investigation of the inheritance patterns of different types of synaesthesia is likely to elucidate whether a single underlying mechanism can explain all types. This study is the first to systematically survey all types of synaesthesia within a familial framework. We recruited 53 synaesthetes and 42% of these probands reported a first-degree relative with synaesthesia. We then directly contacted as many first-degree relatives as possible and collected complete data on synaesthetic status for all family members for 17 families. We found that different types of synaesthesia can occur within the same family and that the qualitative nature of the experience can differ between family members. Our findings strongly indicate that various types of synaesthesia are fundamentally related at the genetic level, but that the explicit associations and the individual differences between synaesthetes are influenced by other factors. Synaesthesia thus provides a good model to explore the interplay of all these factors in the development of cognitive traits in general.