Affects, agency, and self-regulation: complexity theory in the treatment of children with anxiety and disruptive behavior disorders

In an increasingly unsettled and violent world, with swelling numbers of children who are abused, abandoned, or neglected, emotionally if not physically, and an increasing population of aggressive preschool children with anxiety and disruptive behavior disorders who cannot be contained in ordinary settings, psychoanalysts can make a contribution. Early intervention is essential. In very early childhood, new procedural memories for interacting with others and for regulating affects can be formed more easily than they can ever be again. Intervention should aim toward helping the child develop a sense of agency, establish moral standards, assume self-responsibility, and attain the capacity for emotional regulation. The principles of complex dynamic systems can inform psychoanalytic treatment strategies, as demonstrated with five children whose cases are presented.     

Differences in Individual Approaches: Communication in the Familial Breast Cancer Consultation and the Effect on Patient Outcomes

This multicenter study aimed to assess (i) whether individual clinical geneticists and genetic counselors vary in their communication skills and (ii) whether this variation in communication impacts on patient outcomes, such as anxiety, depression, genetics knowledge, and satisfaction. One hundred and fifty women from high-risk breast cancer families attending their first genetic counseling consultation completed pre and post-consultation self-report questionnaires. The consultations were audiotaped and transcribed verbatim. Univariate analyses showed highly significant differences between individual clinical geneticists and genetic counselors in: facilitating understanding (p 0.001); facilitating active involvement (p 0.001); facilitating partnership building (p = 0.003); addressing emotional concerns (p 0.001); and discussing prophylactic mastectomy (p = 0.017). Multivariate linear regressions showed that this variation in communication resulted in a greater change in patients depression 4 weeks after the counseling session (p = 0.017). These findings suggest clinical geneticists and genetic counselors have achieved some standardization in communicating information, but showed diversity in their facilitation skills. Communication skills may be a useful area to explore further in this field.     

Heart Follows Head: Influencing Violence-related Attitudes in the Classroom

We examined whether an undergraduate course on violence would influence students’ violence-related attitudes and beliefs. Students (N=145) completed the Violence-Related Attitudes and Beliefs Scale (V-RABS) at the beginning (Time 1) and end (Time 2) of the semester-long course. As expected, support for the death penalty, punishment, and catharsis decreased significantly, as did belief in an association between mental illness and violence. Acceptance of environmental influences on violent behavior increased significantly, although belief in biological influences did not change. Support for violence prevention efforts was high at both Times 1 and 2, and did not change significantly. Consistent with previous research, the results of this study confirm that college curricula may influence students’ attitudes and beliefs in addition to imparting knowledge.     

Analyzing the Process and Content of Genetic Counseling in Familial Breast Cancer Consultations

A detailed examination of the process of genetic counseling has been identified as a priority area for research by previous authors. This multicenter longitudinal study examined the process and content of genetic counseling in initial consultations with women from high-risk breast cancer families. One hundred and fifty-eight consultations with women unaffected and affected with breast cancer were audio taped and transcribed verbatim. A detailed coding system was developed. Clinical geneticists and genetic counselors demonstrated consistently good practice in giving detailed information on essential aspects related to familial breast cancer such as screening and management, genetic testing, breast cancer genetics, and prophylactic surgery. Eliciting emotional concerns and facilitating communication were found to be inconsistently present. As clinical practice guidelines and the general communication literature emphasize the importance of these factors, this is an area where training in or self-monitoring of such behaviors may assist consultants to further develop these skills.     

Form and variability during sit-to-stand transitions: children versus adults

In performing the sit-to-stand transition, young children (6- to 7-year-olds) were expected to display a movement form similar to that of adults. However, movement consistency was predicted to be poorer in children than in adults because they lack refinement of motor control processes. Kinematic analysis of 10 repetitions of the sit-to-stand movement was carried out for 6 typically developing children and 6 adults. Supporting the authors' prediction of comparable form, no differences were evident between age groups for sequence of joint onsets, proportional duration of segmental motion, or in angle-angle plots of displacement at 2 segments. In contrast, within-participant variability was found to be higher for children: Coefficients of variation for most kinematic measures were twice those seen for adults. The authors interpret the children's lack of movement consistency as a reflection of inadequate stabilization of an internal model of intersegmental dynamics. Whereas adults have attained a skill level associated with refinement of that model, children have not. Children have an additional control problem because changes in body morphology throughout childhood require ongoing updating of the internal model that controls intrinsic dynamics.     

Crossing the Line: Case Studies of Identity Development in First-Generation College Women

In this paper we present four case studies of adult women from working class backgrounds who attended Hillside College (a pseudonym for one of the seven-sister colleges) during the early 1990s. Although research on women has led, over the past few decades, to a more complex picture of the contexts in which women develop their identities, one important context that has been underexplored is social class. Drawing on data from three lengthy interviews with each of our four participants, our purpose was to explore the identity concerns of adult women from working class backgrounds in their experience getting to and attending Hillside College, which has historically been home to the middle and upper social classes. Implications for college retention are discussed.     

Can the Media Create Public Opinion? A Social-Identity Approach

The media remains a powerful presence in U.S. culture. It gives people news of world and local events, it entertains, and it may even function as a companion to children. Because it functions as a window to the outside world, what appears across its landscape actually may become people's reality. Thus, the potential for distorting their view of that world is high if the picture provided is unrepresentative of actual events. For example, the prevalence of violent acts on television has been linked to increased aggression and escalating impressions of a dangerous world, and the overrepresentation of youth and beauty may be a causal factor of eating disorders. In this article, we explore the possibility that the media may also serve as a powerful creator of the very public opinions it seeks to reflect in its news. Subtle nonverbal cues of newscasters have been shown to influence voting behavior, and the media's overrepresentation of the proportion of blacks in poverty may decrease whites' support of welfare. By portraying a world in which people's opinions are based on their ethnic or demographic group membership, the media may also subtly but powerfully create the very opinions they seek to reflect.     

Musings on the “Seasoned Therapist”

This is a brief essay offering the personal reflections and musings of a therapist in her ninth decade.