Reflections on group psychotherapy with eating-disordered patients

This paper addresses some of the dynamics, resistances, and transference and countertransference considerations in group psychotherapy with eating disordered patients. Several resistances are delineated, including guilt over being helped, the recreation of early problems around control and forced feeding, and withdrawal as a defensive operation. A brief vignette is presented which highlights the demand on the part of the therapist as well as the patient to contain and manage feelings rather than acting on them. Lastly, the author argues that group participation helps the patient to identify, articulate, and accept feelings and to promote assertiveness.This paper is based on a presentation given at the Training Institute for Mental Health on May 11, 1991.     

Representation by counsel: Right or obligation?

Since the Supreme Court's decision in Faretta v. California (1975), courts have generally permitted defendants to represent themselves, as long as they are competent to do so. The problem lies in the definition of competency to waive counsel, which has been vaguely defined by the courts. Little is known about the frequency of, or reasons for, attempts to waive counsel, about the process of forensic evaluation of such competency, and about the success of such attempts. The authors briefly review the case law on competency to waive representation, report on a longitudinal prospective study of these issues in a population of defendants referred to an inpatient forensic facility for evaluation of all types of competency related to their criminal prosecutions, and discuss the significance of the issue for forensic clinicians. A key question for courts, lawyers, and clinicians is whether a competency evaluation can be invoked to overcome a defendant's constitutional rights to self-representation and bail.     

Progressive and imaginal relaxation training for elderly persons with subjective anxiety.

Elders exposed to either progressive or imaginal relaxation procedures reported significant relaxation effects and showed improvement on measures of personal functioning. The results of the Physical Assessment Scale of the Relaxation Inventory indicated that relaxation responses were acquired within and across sessions. Large, consistent changes in relaxation occurred in all 4 sessions. The Symptom Checklist-90-R, which measures self-reported personal adjustment, showed significant positive changes following relaxation training and at 1-month follow-up. Elders who imagined muscle tension release profited as much as those engaged in actual muscle tension-release activities. This finding is of importance for older adults who may experience physical limitations that contraindicate muscle-tension-release procedures.     

Aging and shifts of visual spatial attention.

Three experiments examined adult age differences in the efficiency of endogenous (voluntary) and exogenous (involuntary) attention shifts. Younger and older subjects performed a spatial cuing task in which abruptly onset peripheral cues (Experiment 1) or central, symbolic cues (Experiments 2 and 3) were presented before a target stimulus at intervals ranging from 50 to 250 ms. With peripheral cues, the magnitude of cuing effects was at least as great for older as for younger adults and followed a similar time course. Similar results were obtained with symbolic cues, although cuing effects for older adults varied with cue difficulty. The results suggest that cue encoding may decline with advancing age but that the efficiency of the shift process is preserved.     

Type A behavior pattern and emotion expression in younger and older adults.

Eighty younger (less than 50 years, M = 28 years) and 80 older (more than 50 years, M = 69 years) Type A and Type B Ss were evaluated for Type A behavior pattern using the Structured Interview (SI) and given personality tests for anxiety, depression, anger, aggression, hostility, and anger-in-anger-out. Ss also underwent an emotion induction procedure. Videotapes of the emotion induction procedure (N = 160) and the SI (N = 80) were coded for facial expression of emotion. Type As did not differ from Bs on anxiety or depression but did on anger and aggression. Type As showed anger inhibition and anger bound to shame, as predicted by emotion socialization theory. The greatest number of differential effects were observed between age groups. Older individuals, in general, were more emotionally expressive than younger Ss across a range of emotions. Women appeared more conflicted about anger expression than men, and Type A women more so than Type A men.     

Motion perception and aging.

The authors used a correlated motion paradigm to investigate the effects of aging and gender on motion sensitivity. In 2 experiments with a total of 50 elderly and 50 young subjects, motion thresholds were significantly higher for elderly women. The correlated motion signal, which was embedded in random motion, may have been coherent to subjects in much the same way a form is in Witkin's Embedded Figures Test (EFT). In Experiment 2, EFT scores were obtained. A significant positive relationship between motion thresholds and EFT performance was found within each age group. Although gender-related perceptual style differences may contribute to motion perception effects, the authors argue that a common neural factor contributes to performance on both the EFT and the correlated motion task.     

The interpretation of life experience and well-being: the sample case of relocation.

Social psychological theories of the self postulate mechanisms through which individuals interpret their life experiences to ensure positive self-evaluation. This framework was applied to a sample of aging women (N = 120, M age = 74.9 years) who had experienced community relocation. The authors measured their reasons for moving (push factors), reasons for selecting the new setting, (pull factors), and interpretive mechanisms, including how they compared with others in their new setting, how they were viewed by significant others following the move, how their behaviors changed following relocation, and whether the above evaluations occurred in life domains central to their sense of self. Regression analyses showed that push-pull factors and interpretive mechanisms accounted for substantial variance in multiple aspects of psychological well-being, particularly environmental mastery, purpose in life, and positive relations with others.     

Gender and Wellness: A Multidimensional Systems Model for Counseling

An expanded view of health is advocated for assessment and treatment of individual clients in helping them achieve and maintain their maximum potential for high-level wellness. In addition, moderating variables, such as culture, age, and gender differences, have an impact on every dimension of health and wellness. In this article a multidimensional systems model for wellness is described, and gender differences along those dimensions are reviewed. Application of the model and implications for counseling are discussed. Finally, two illustrative case examples, one man and one woman, are described.     

The Predicament-Problem Continuum: Dealing With Stressors Outside Our Control

The author developed a practical, effective way of teaching people how to refocus their energy from predicaments to problems and thereby reduce their stress levels. Feedback about using the technique was positive. Benefits and limitations are discussed.     

The Counseling Process as Defined by Relationship Types: A Test of Helms's Interactional Model

Helms (1984) presented a model to explain the influence of Black and White racial identity development on counseling interactions. The purpose of this study was to examine her hypothesis that specific combinations of racial identity attitudes contribute to qualitatively different counseling process and outcome or relationship types.