"Roadblocks" revisited: neural change, stuttering treatment, and recovery from stuttering

In light of emerging findings concerning untreated recovery and neural plasticity, this paper re-examines the viability of an NIH conference recommendation [Cooper, J. A. (1990). Research directions in stuttering: Consensus and conflict. In Cooper, J. A. (Ed.), Research needs in stuttering: Roadblocks and future directions (pp. 98-100). Rockville, MD: American Speech-Language-Hearing Association.] that adults who have recovered from stuttering might inform our understanding of the nature and treatment of persistent stuttering. It is suggested that those who have recovered could constitute a behavioral, cognitive, and neurophysiologic benchmark for evaluating stuttering treatment for adolescents and adults, while helping to identify the limits of recovery from a persistent disorder. This possibility seems especially promising because of findings from recent studies investigating untreated recovery during childhood and adulthood, the emerging evidence concerning neural plasticity and reorganization, and reports of neural system changes during stuttering treatment. Potential obstacles to applying findings from unassisted recovery to treatment do exist, but the benefits of attempts to fully understand stuttering certainly outweigh the difficulties. EDUCATIONAL OBJECTIVES: After completing this activity, the learner will be able to: (1) describe two complexities involved in determining whether recovery from stuttering was assisted or unassisted; (2) discuss the implications for stuttering research of two neural plasticity research findings from areas other than stuttering; and (3) evaluate the possible implications for stuttering treatment of a coordinated research program that addresses behavioral, cognitive, and neurological characteristics of assisted and unassisted recovery from stuttering.     

Assessment feedback integrating MMPI-2 and Rorschach findings

Many clinicians are committed to giving feedback to clients about assessment results, but puzzle over how to integrate Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Rorschach findings when talking to clients. When the two tests agree, findings may be combined and assessors may use the language of clients' Rorschach percepts to frame findings from the MMPI-2 or the Structural Summary. When the Rorschach shows more disturbance than the MMPI-2, assessors may discuss "levels of personality," praise clients for their usual coping mechanisms, and raise the possibility of underlying problems. When the Rorschach depicts less psychopathology than the MMPI-2, clinicians may talk with Clients about factors influencing them to present as needing help. Alternatively, assessors may hypothesize that clients constrict emotionally in interpersonal, unstructured situations.     

Effects of alcohol on psychophysiological hyperreactivity to nonaversive and aversive stimuli in men at high risk for alcoholism

Psychophysiological reactivity to nonaversive (1-KHz, 70-db tones) and aversive stimuli (shock) was examined in nonalcoholic men with multigenerational family histories (MFH) of alcoholism and family history negative (FH-) men, while sober and after consuming alcohol. In comparison with FH- Ss, sober MFH Ss had significantly larger skin conductance (SC) orienting responses (ORs), shorter OR latencies, slower habituation rates to the tones, and larger increases in heart rate and vasoconstriction to the shock. Alcohol dampened the magnitude of the SC-OR to the tones and the degree of cardiovascular reactivity to the shocks and increased the habituation rate to the tones in MFH Ss only. Alcohol consumption also increased the SC-OR recovery time in FH- Ss only. The MFH Ss' pattern of psychophysiological hyperreactivity is discussed in terms of a potential dysfunction in stimulus-response regulation.     

Chain of Care for Patients with Intentional Self‐Harm: An Effective Strategy to Reduce Suicide Rates?

Chain of care for patients with intentional self‐harm was important in the Norwegian national action plan to prevent suicide. In this study there were two aims: (1) to calculate the potential effects of chain of care on reducing suicide rates, and (2) to assess whether suicide rates decreased more in areas where chain of care had been implemented than in other areas. We observed no differences in changes in suicide rates between areas with and without the intervention. The calculated potential effects of chain of care on national suicide rates were very small, even under unrealistically favorable conditions.     

The Future of Psychoanalysis: The Debate About the Training Analyst System,edited by Peter Zagermann,Routledge, Abingdon and New York, 2018, 378 pp.

The American Journal of Psychoanalysis -     

Implications of recent research in neurobiology for psychological assessment

In this article, I highlight 3 major findings from current research in attachment, neurobiology, psychopathology, and psychotherapy: (a) attachment failures and early trauma are related to many forms of psychopathology, (b) one of the major sequelae of developmental trauma is disorganization of the right hemisphere, and (c) psychological interventions that promote emotional experience, awareness, and expression are more effective than those that rely solely on cognitive restructuring. I then suggest implications of these findings for the practice of psychological assessment: (a) the relationship between client and assessor is more important than has been acknowledged generally, (b) performance-based personality tests are very useful in part because they tap right-hemisphere and subcortical brain functioning and provide information that clients cannot directly report, and (c) when psychological assessments provide clients with powerful emotional experiences, therapeutic change is often the result. I illustrate these points with excerpts from the Therapeutic Assessment of a 27-year-old man with compulsive sexual behavior.     

Therapeutic assessment with children: intervening with parents "behind the mirror"

All the steps in the model of therapeutic assessment used with children (TA-C) are designed to involve and impact the child's parents. However, a distinctive process that parallels and accompanies the testing sessions with the child might be the most significant in helping parents shift their story of their child and family. In this process, parents are invited to observe their child's testing sessions (in an adjacent room through a live video feed, through a 1-way mirror, or in the corner of the testing room) and process the experience with the assessor (either simultaneously in the case of the 2-assessor model or after the fact in the 1-assessor model). We discuss the development and evolution of what we have come to call the "behind the mirror" method. We describe the therapeutic intent of the method and delineate 13 techniques utilized to enlist parents as active collaborators. We illustrate each technique using the case study of a 10-year-old boy where the 2-assessor model and live video feed method were used. We also provide research findings from the case study that address the parents' experience of the assessment and their changed view of their child.     

Depressed youth: treatment outcome and changes in family functioning in individual and family therapy

This study explores the role of family functioning in therapeutic change in focused individual psychodynamic psychotherapy (FIPP) and time‐limited systems integrative family therapy (SIFT) for depressed children and adolescents. After a screening process, 72 participants aged 8 to 15 were randomized to either FIPP or time‐limited SIFT. Assessments took place prior to, at the end of, and 6 months after treatment. Families in both SIFT and FIPP showed a small but significant and sustained improvement in family functioning by the end of treatment in both mothers' self‐reports and family therapists' assessments. Better family functioning at baseline in mothers' self‐reports and improved family functioning during SIFT, as assessed by family therapists, predicted a sustained decrease in self‐reported depressive symptoms. Results indicated that time‐limited SIFT may be more effective with younger children and in patients without a diagnosis of double depression than adolescents.