A MIMIC Model Approach to Research in Geriatric Neuropsychology: The Case of Vascular Dementia

The goal of the current study is to demonstrate a new methodology that can be used in neuropsychological research concerning differential diagnosis research. The multiple indicators, multiple causes (MIMIC) model is a latent variable methodology which can examine group differences on individual tests while controlling group differences in global cognitive impairment. As a demonstration, neuropsychological data from 217 dementia patients were incorporated into a MIMIC model to examine the influence of cerebrovascular disease (CVD) upon (1) dimensions of global cognitive impairment and (2) upon individual tests after controlling for global impairment. The presence of CVD in dementia (i.e., vascular dementia [VaD]) was not significantly related to dimensions of global impairment. In addition, the presence of CVD within dementia did not significantly contribute to impairment on 9 out of 10 neuropsychological tests/subscales examined after controlling global cognitive impairment. These results are discussed in the context of current vascular dementia research, and are focused primarily upon the MIMIC model methodology and suggestions for its use in future research.     

Creativity and the Clinical Exchange

Using examples from my small c experiences I distinguish between creativity with a big C and small c. I draw analogies between the dialogic interplay of creative artists and their medium and the analyst and his “medium”, the analysand.     

Model scenes: implications for psychoanalytic treatment.

Model scenes are constructed by analyst and patient to organize puzzling information, integrate previous understanding, and initiate further exploration of experience. They are derived from a variety of sources: literature (oedipal myth); transference; ordinary or traumatic childhood events that occupy a pivotal position. Model scenes may conceptualize experiences of any age and motivational system, and are contrasted with screen memories and "telescoping" of events. Two clinical examples are used to illustrate the relation between the model scene and the transference. Model scenes provide a valuable clinical tool for moving from general to specific experience. They afford empathic entry into the transference experience and the opportunity through which the experience of motivations representative of past and present can be conceptualized and integrated into a cohesive self organization.     

A Broader Perspective: Counseling Psychology’s Emphasis on Evidence

The process of identifying empirically supported treatments developed by the Division 12 of the American Psychological Association has been criticized from various perspectives. However, there are a number of alternative evidence-based models for using research findings to increase the efficacy of mental health services. In this article, the principles of empirically supported interventions developed and adopted by Division 17 (Society of Counseling Psychology) are presented. These principles (a) utilize a broad perspective of evidence, (b) consider a range of psychological interventions, (c) emphasize the quantitative aggregate of research evidence, (d) consider various levels of specificity, and (e) recognize philosophy of science issues that impinge on the types of conclusions that can be made.     

Sanderian activation waves: a hypothesis of a nonsymbolic influence on moods

This paper describes a hypothesis of Tronick's (2002) that positive and negative affect activation waves with changing amplitudes based on positive and negative lived experiences are the sources of persistent or regularly recurrent moods of feeling upbeat or downbeat. The characteristics of discrete affects, moods, and affect states are discussed in the light of a previous study based on clinical observation (Lichtenberg, Lachmann, and Fosshage 1996). The clinical experience theory underpinning that study is then compared with Tronick's Sanderian activation wave theory. A case example is presented, and the overall relevance of Tronick's theory to clinical work is discussed.