Psychotherapy Research Needs Theory. Outline for an Epistemology of the Clinical Exchange

This paper provides an analysis of a basic assumption grounding the clinical research: the ontological autonomy of psychotherapy—based on the idea that the clinical exchange is sufficiently distinguished from other social objects (i.e. exchange between teacher and pupils, or between buyer and seller, or interaction during dinner, and so forth). A criticism of such an assumption is discussed together with the proposal of a different epistemological interpretation, based on the distinction between communicative dynamics and the process of psychotherapy—psychotherapy is a goal-oriented process based on the general dynamics of human communication. Theoretical and methodological implications are drawn from such a view: It allows further sources of knowledge to be integrated within clinical research (i.e. those coming from other domains of analysis of human communication); it also enables a more abstract definition of the psychotherapy process to be developed, leading to innovative views of classical critical issues, like the specific-nonspecific debate. The final part of the paper is devoted to presenting a model of human communication—the Semiotic Dialogical Dialectic Theory–which is meant as the framework for the analysis of psychotherapy.     

On the Innocence and Determinacy of Plural Quantification

Plural logic is widely assumed to have two important virtues: ontological innocence and determinacy. It is claimed to be innocent in the sense that it incurs no ontological commitments beyond those already incurred by the first‐order quantifiers. It is claimed to be determinate in the sense that it is immune to the threat of non‐standard (Henkin) interpretations that confronts higher‐order logics on their more traditional, set‐based semantics. We challenge both claims. Our challenge is based on a Henkin‐style semantics for plural logic that does not resort to sets or set‐like objects to interpret plural variables, but adopts the view that a plural variable has many objects as its values. Using this semantics, we also articulate a generalized notion of ontological commitment which enables us to develop some ideas of earlier critics of the alleged ontological innocence of plural logic.     

Embodying analysis: the body and the therapeutic process

This paper considers the transfer of somatic effects from patient to analyst, which gives rise to embodied countertransference, functioning as an organ of primitive communication. By means of processes of projective identification, the analyst experiences somatic disturbances within himself or herself that are connected to the split‐off complexes of the analysand. The analysty’s own attempt at mind‐body integration ushers the patient towards a progressive understanding and acceptance of his or her inner suffering. Such experiences of psychic contagion between patient and analyst are related to Jung’s ‘psychology of the transference’ and the idea of the ‘subtle body’ as an unconscious shared area. The re‐attribution of meaning to pre‐verbal psychic experiences within the ‘embodied reverie’ of the analyst enables the analytic dyad to reach the archetypal energies and structuring power of the collective unconscious. A detailed case example is presented of how the emergence of the vitalizing connection between the psyche and the soma, severed through traumatic early relations with parents or carers, allows the instinctual impulse of the Self to manifest, thereby reactivating the process of individuation.     

Cancer: A Paradoxical Form of Adaptation? Insulin-Cortisol Dominance and Epigenetic Aspects

The information contained in DNA is not definitive, but modifiable. Indeed, the environment has the power to modify the genetic material expression without altering the DNA genes sequence. The principal environmental factors that work in this way, whether in a positive or in a negative way, are diet and stress with their ruling hormones, insulin and cortisol; these hormones are normally antagonists but, when they reach their respective resistances, they become the ubiquitary etiopathogenetic factors in bidirectional convergent relationship, each other causing the disinhibition and development of low grade systemic inflammation that opens the door to a myriad of interconnected sets of problems. Among these problems the greater one is cancer, which represents the extreme junction between hyperinsulinemia and hypercortisolemia, just because cancer cells never become insulin resistant and/or cortisol resistant.     

Test-Retest Reliability of Maternal Reports of Lifetime Mental Disorders in Their Children

This study examined the test-retest reliability of maternal reports of lifetime psychopathology using DSM-III-R criteria in nonreferred offspring. Sixty-three mothers reported on 79 children, ages 6 to 18 years. Retest intervals were between one and 12 months. The results indicated acceptable reliability for all supraordinate categories (any disorder, any anxiety disorder, any disruptive disorder, externalizing disorders, internalizing disorders) as well as for most individual diagnoses (separation anxiety disorder, simple phobias, oppositional defiant disorder, attention deficit disorder with and without hyperactivity, simple phobias, and adjustment disorder). Maternal reports for any diagnosis were significantly better for intervals under 6 months than for longer retest intervals. Reliability of maternal reports was not significantly affected by child's age or gender. This study supports the expectation that a history of psychiatric disturbance in children can be obtained reliably from mothers.     

Adjustment, Depression, and Minimal Goal Setting: The Moderating Effect of Performance Feedback

In this study I tested hypotheses about changes in expectancy and minimal goal statements and the relations of these variables to adjustment. Seventy-seven male college students completed the Rotter Incomplete Sentences Blank and the Beck Depression Inventory and subsequently received success or failure feedback on tasks for which they provided expectancy and minimal goal statements. Expectancies and minimal goals changed differently, relative to each other, as a function of performance feedback. Modest relations of adjustment and dysphoria with minimal goals were found, but these were moderated by performance feedback: Under failure, poorer adjustment and greater dysphoria were associated with higher minimal goals; under success, poorer adjustment and greater dysphoria were associated with lower minimal goals, contrary to a widely held hypothesis. Moreover, although the effects of adjustment and dysphoria on minimal goal setting were similar in strength and direction, these effects were independent of each other. Thus, adjustment-minimal goal relations must be understood in light of situational parameters and may reflect two processes, only one of which is related to mood.     

Is self-esteem an important outcome in hyperactive children?

Using a prospective design, this study examined (a) whether hyperactive children suffer from low self-esteem as adolescents; (b) whether low self-esteem is associated with poor functioning in adolescence; (c) whether hyperactive children exhibit a positive illusory bias, in which self-esteem is independent of level of functioning; and (d) whether self-esteem in adolescence is associated with poor functioning in adulthood. Subjects were 65 children diagnosed as hyperactive in childhood, and 62 matched controls sampled from a medical clinic. After controlling for current mental disorder, the hyperactive cohort reported lower self-esteem in adolescence, was judged by clinicians to have lower levels of overall adjustment in adolescence, and had lower educational achievement and occupational rank in adulthood, as compared to controls.This study was supported in part by Public Health Service grant MH 18579 and Mental Health Clinic Research Center grant MH 30906. We gratefully acknowledge Dr. Jacob Cohen for his valuable statistical advice, Dr. Richard Rende for helpful comments, and two anonymous reviewers for useful suggestions.     

Parental bonding and personality disorder: the mediating role of alexithymia

This study explored whether alexithymic features mediate the effect of perceived adverse parenting during childhood on being diagnosed with a PD in adulthood. Two hundred sixty-five psychiatric outpatients were evaluated with the Toronto Alexithymia Scale (TAS-20), the Parental Bonding Instrument (PBI), the Structured Interview for DSM-IV Personality, the Structured Clinical Interview for DSM-IV Axis I Disorders, the Clinical Global Impression scale, and the Global Assessment of Functioning scale. The statistical model for mediation proposed by Baron and Kenny (1986) was employed to detect whether the TAS scores account for the relation between PBI scores and a PD diagnosis. The results indicated that although altered parental bonding (and specifically, excessive maternal protection) may enhance the risk of PD, its effect is completely mediated by the alexithymic feature Difficulty Describing Feelings to Others (DDF), after controlling for gender, age, educational level, type, severity and age of onset of Axis I disorders. Therefore, this study suggests that the presence of DDF accounts for the effect of maternal overprotection as a risk factor for PD.     

Same-sex parent families in Italy: Validation of the Coparenting Scale-Revised for lesbian mothers and gay fathers

Even though Italy is still struggling to establish equal rights and access to assisted reproduction techniques for sexual minorities, an increasing number of lesbian women and gay men are now becoming parents. There are only a few studies that have evaluated coparenting in same-sex couples. However, these addressed adoptive couples and not the lesbian and gay parent families through donor insemination or surrogacy, respectively. This study examined the psychometric properties of the Coparenting Scale-Revised and its relationship with dyadic adjustment, discipline management, and internalized sexual stigma in Italian same-sex-planned families. The factor structure showed a satisfactory internal consistency and criterion validity with correlates of coparenting behaviours. While Family Integrity factor was confirmed, Disparagement and Reprimand dimensions collapsed into Conflict factor. Non-genetic parents showed lower levels of conflict than genetic parents. Most importantly, coparenting emerged as a significant function not shaped by gender, but influenced by parental status and internalized sexual stigma.