The written summary in group psychotherapy revisited

This paper addresses the use of the weekly written summary with patients in group psychotherapy. In an effort to stimulate group process and effect cotherapist communication, the authors instituted this group recording in an ongoing psychodynamically oriented mixed adult group. While the utilization of this device did, in fact, stimulate the group process and became an important part of the group's life, the therapists additionally saw significant effects upon their working alliance. These included increased focused dialogue upon group dynamics, more purposeful planning for group interventions, and heightened awareness of the significance of interventions in the group.Ms. Bosman-Clark is formerly Clinical Instructor, Department of Psychiatry, Baylor College of Medicine.     

Countering perfectionism in research on clinical practice I: Surveying rationality changes after a single intensive ret intervention

The failure of controlled experimental research on therapy out-come to produce findings of clinical as well as statistical significance seems at least partly due to irrational, perfectionistic, beliefs about how research can be used to infer causes of therapeutic change. Irrational beliefs about controlled experimental designs and about incomplete sampling, in particular, appear to prevent appropriate consideration of probatively valuable quasi-experimental research. Models of more rational alternatives are identified, and an example of the functional advantages of adopting these rational beliefs is explicated. The example demonstrates that single-shot pre-post survey data from self-selected catch-as-catch-can samples can permit legitimate, but not absolutely certain, conclusions about the efficacy and efficiency of RET.Albert Ellis, Ph.D. is executive director of the Institute for Rational-Emotive Therapy in New York City.     

Errors in the quantification of uncertainty: A product of heuristics or minimal probability knowledge base?

The use of intuitive heuristics (e. g. representativeness and availability) has been put forward as an explanation for peoples' assignment of probabilities (Tversky and Kahneman, 1971). This phenomenon is seen as robust since experts as defined by education (professional psychologisis), despite advanced training in statistics and methodology, rely on the same heuristics as novices (lay people). Both experts and novices, as defined by education, were studied in a series of experiments and further classified as experts and novices according to their probability knowledge base, prior to receiving (or not) a brief (15-minute) training session. Immediately following training, subjects completed a probability test which consisted of ten Tversky and Kahneman (e. g. 1974) problems. The training significantly increased the number of problems correctly solved on the probability test and eliminated the expert/novice education classification. The results of a follow-up test 5 weeks after the experiment indicated that the training group maintained its superior performance. It is proposed that failure to use proper methods of probability assignment may not be due to intrinsic human inference biases or heuristics, but is a result of a minimal probability knowledge base.     

Is Pregnancy Necessary? Feminist Concerns About Ectogenesis

To what extent are women obliged to be child-bearers? If reproductive technology could offer some form of ectogenesis, would feminists regard it as a liberating reproductive option? Three lines of reproductive rights arguments currently used by feminists are applied to ectogenesis. Each fails to provide strong grounds for prohibiting it. Yet, there are several ways in which ectogenesis could contribute to women's oppression, in particular, if it were used to undermine abortion rights, reinforce traditional views of fertility, increase fetal rights in pregnancy, and perpetuate the unequal distribution of scarce medical resources. A re-thinking of women's relationship to pregnancy is needed in order to challenge ectogenetic research.     

Discrimination of facial expressions of emotion by depressed subjects

A frequent complaint of depressed people concerns their poor interpersonal relationships. Yet, although nonverbal cues are considered of primary importance in interpersonal communication, the major theories of depression focus little attention on nonverbal social perception. The present study investigated the ability of depressed, disturbed control, and normal American adults to make rapid discriminations of facial emotion. We predicted and found that depressed subjects were slower than normal subjects in facial emotion discrimination but were not slower in word category discrimination. These findings suggest that current theories of depression may need to address difficulties with nonverbal information processing. There were also no significant differences between depressed and disturbed control subjects, suggesting that the unique social-behavioral consequences of depression have yet to be identified.     

Dental phobias and anxieties: evidence for conditioning processes in the acquisition and modulation of a learned fear

The present study investigated some of the factors which differentiate individuals with dental anxieties and phobias from those without such fears. In particular, two questions were addressed: (i) What differentiates subjects who have never been anxious about dental treatment from subjects who at some time have been anxious? and (ii) What factors lead to subjects changing their attitudes either from anxious to relaxed or from relaxed to anxious? The results suggest that the factors which influence the acquisition and modulation of dental anxieties are consistent with the associative and representational processes portrayed in contemporary models of human conditioning. Subjects who reported never having had anxieties about dental treatment were less likely to have had a painful dental treatment than subjects who did report an anxiety. Subjects who did report a painful dental experience but did not acquire anxiety reported a history of dental treatment favourable to the operation of latent inhibition. Subjects who reported that they were good at enduring pain were more likely to report a longer interval between their very first dental treatment and their first painful dental treatment. Under some conditions in which latent inhibition should have precluded the acquisition of a dental fear, an anxiety appeared to be acquired because a very painful experience had attenuated the latent inhibition process. Subjects whose dental anxiety did not remit reported significantly more painful and traumatic dental experiences than subjects whose anxiety did remit.     

A controlled comparative investigation of psychological treatments for chronic sleep-onset insomnia

A sample of physician-referred chronic insomniacs was randomly allocated to either progressive relaxation, stimulus control, paradoxical intention, placebo or no treatment conditions. Treatment process and outcome were investigated in terms of mean and standard deviation (night to night variability) measures of sleep pattern and sleep quality. Only active treatments were associated with significant improvement, but the nature of treatment gains varied. In particular, stimulus control improved sleep pattern, whereas relaxation affected perception of sleep quality. All improvements were maintained at 17 month follow-up. Results are discussed with reference to previous research and guidelines are given for clinical practice.     

Adolescent suicide attempters presenting to a pediatric facility

This study profiles the characteristics of adolescent suicide attempters and the treatment they received in a pediatric emergency room (ER). A retrospective chart review of 4,072 adolescents seen in the ER at a children's hospital (CH) from July 1984 to June 1985 was undertaken. Twenty-seven adolescents who had deliberately injured themselves were identified. The average age was 14 years 7 months (range 11-19 years). Fifty-two percent of the patients were white and 78% were female. Ingestion was the most common method (78%), followed by attempted hanging (11%), and wrist laceration (7%). After evaluation by a pediatrician in the ER, 30% of the patients were treated and released, 11% were transferred directly to a psychiatric hospital, and 59% were admitted to the CH, with an average hospital stay of 1.88 days. Once hospitalized, consultations from psychiatry (81%), social service (50%), psychology (19%), and neurology (6%) were obtained. At the time of discharge from either the ER or CH, the patients had a variety of plans for ongoing care, with 52% being referred to outpatient counseling, 37% being transferred to a psychiatric hospital, and 11% having no documented plan for ongoing care. These results demonstrate that the evaluation of suicidal adolescents cared for in a pediatric facility may be episodic and suggest the need for a comprehensive program to approach the problem.     

Negativism and countertransference

The purpose of this work is to explore the phenomenon of negativism and the analyst's response to it during the course of analytic work with a patient in whom negativism is a central behavioral pattern. Melville's short story, "Bartleby the Scrivener," describing in telling detail the response of a sympathetic lawyer to profound and pervasive negativism in his legal scribe, is discussed as a literary analogy to the analyst-analysand dyad. Aspects of the concept of negativism within psychoanalysis are discussed. The potential usefulness of understanding certain unexpected countertransference responses to pervasive negativism is explored, as this is a relatively neglected area of psychoanalytic technique. A case is presented describing the analysis of a patient whose character, like Bartleby's, is a mixture of profound negativism along with schizoid, obsessional, and masochistic elements.