‘WITH PSYCHOSIS IN MIND’ – the reverberations of the psychotic encounter

Psychoanalytic theory offers a varied conceptual system for considering psychosis by providing a coherent representation of the anxieties and processes at work in adult patients. But at the practical clinical level, it is not enough simply to ‘think about psychosis’ and have a theoretical system in place. The therapist must also ‘have psychosis in mind’, that is, get to grips with its forms of logic, gain familiarity with its workings, and learn to understand and accept the effects it has on the therapeutic relationship and on their own expectations. Clinicians engaged in this type of work must be able to tolerate getting back in touch with processes deemed archaic at the core of their own psychological functioning, which will impact their ability to listen and think. These chaotic processes demand a change of approach since they cause a ‘desymbolisation’ that perturbs the internal mental structure of the therapist. This ‘desymbolisation’ is therefore the locus of the therapeutic work, which must attempt to render it comprehensible and represent it. A case study illustrates these processes.     

Using Cognitive Behavior Therapy in Clinical Work With African American Children and Adolescents: A Review of the Literature

A comprehensive review of the literature on clinical work with African American youth with cognitive behavior therapy (CBT) is presented. The strengths and limitations of CBT in relation to this population are outlined. Although CBT shows promise in helping, research on the efficacy and effectiveness of CBT in this group is lacking. Se presenta una reseña exhaustiva de la literatura sobre trabajo clínico con jóvenes Afroamericanos usando terapia cognitiva conductual (TCC). Se perfilan los puntos fuertes y las limitaciones de la TCC en relación a esta población. A pesar de que la TCC muestra signos prometedores para servir de ayuda, no hay suficiente investigación sobre la eficacia y efectividad de la TCC en este grupo.     

Reducing sedentary behavior: the relationship between park area and the physical activity of youth

This study was designed to determine whether the characteristics of the neighborhood environment are related to the substitution of physical activity for sedentary behavior among youth. Fifty-eight 8- to 15-year-old youth were studied in a within-subjects crossover design with three phases: baseline, increased sedentary behavior, and decreased sedentary behavior. The relations between changes in physical activity and design, diversity, and density attributes of the neighborhood environment were determined using random coefficient models. Compared with girls, boys showed greater increases in physical activity when sedentary behaviors were reduced and greater decreases in physical activity when sedentary behaviors were increased. Greater access to parks was associated with greater physical activity when sedentary behaviors were reduced.     

Purchases of food in youth. Influence of price and income

One way to increase choice of healthy over unhealthy behaviors is to increase the cost of less healthy alternatives or reduce the cost of healthier alternatives. The influence of price on purchases of healthy and unhealthy foods was evaluated in two laboratory experiments. In Experiment 1, thirty-two 10- to 12-year-old youth were given $5.00 and allowed to purchase multiple portions of a healthy food (fruit or vegetable) and a less healthy food (higher-fat snack). The price of one type of food varied from $0.50 to $2.50, while the price of the other type was held at $1.00. Increasing the price of a type of food reduced purchases of that type of food, but did not lead to substitution with the alternative type of food. In Experiment 2, twenty 10- to 14-year-old youth were given $1.00, $3.00, and $5.00 to purchase healthy and unhealthy foods. The price of each food was raised and lowered by 25% and 50%. Raising the price of healthy or unhealthy foods resulted in decreased purchases of those foods, and income available interacted with price to predict the pattern of substitution of alternative foods. These results show the potential for controlled laboratory studies of price and food purchases, and show that the substitution of healthier for unhealthy food is related to available money.     

Early maladaptive schema and social and occupational functioning: The mediating role of psychiatric symptomatology

Early Maladaptive Schemas (EMS) are described as long‐held core beliefs which are dysfunctional to a significant degree. However, the supposition that schemas are dysfunctional by nature, while not isomorphic with psychiatric syndromes, is yet to be subjected to empirical review. The current study seeks to investigate the relationship between the Young Schema Questionnaire and the concept of ‘dysfunction’ in a community sample to determine the indirect effects of psychiatric symptomatology and validate current scoring guidelines with a convergent measure of dysfunction. A total of 464 people completed a survey online comprising of the YSQ‐Short Form, the Depression, Anxiety and Stress Scales‐21, the Social and Occupational Functioning Assessment Scales, and the World Health Organization Quality of Life Scale. Multiple regression analyses revealed a moderate relationship between EMS categories and measures of dysfunction, however only six of eighteen EMS categories were significant predictors in this model. Mediation analyses further suggest that the relationship between EMS and dysfunction is partially mediated by psychiatric symptomatology. The current dichotomous clinical scoring guidelines were found to be invalid when measures of functioning were used as convergent measures for twelve of the EMS categories. These findings suggest the YSQ is best conceptualised as a general measure of schema as opposed to a measure of EMS categories.     

Detrimental therapist-client relationships--beyond thinking of "dual" or "multiple" roles: reflections on the 2001 AAMFT Code of Ethics

This article presents reflections on and a critique of the recent revision of the AAMFT Code of Ethics on the multiple relationship ethical standard. A brief historical overview of terminology and the debate surrounding "dual" and "multiple" relationship ethical rules in marriage and family therapy is provided. The term "exploitation" is also delimited. Ethical principles and a set of standards addressing "detrimental" versus "potentially beneficial" interactions are introduced, deriving from works in other mental health professions. The article recommends: (a) the terms "dual" and "multiple" relationships should be abandoned; (b) the ethical principles underlying the AAMFT Code of Ethics need to be examined; and (c) the debate on the topic of detrimental therapist-client interactions in marriage and family therapy needs to be revisited, especially in light of a "positive ethics."