Measuring Responsiveness in the Therapeutic Relationship: A Patient Perspective

This article reports results from a three-country study of patient perceptions of physician responsiveness. Based on existing research in the medical and social-psychological literatures, we theorized that patients' perceptions of physician responsiveness to their needs would be an important component of the patient–physician relationship and that this construct could be distinguished reliably from more global assessments of patient satisfaction. We then developed a new measure designed to assess these perceptions from the patients' point of view. This measure was administered to large samples of patients in the United States, the United Kingdom, and Canada. Results supported our hypotheses. Patient perception of physician responsiveness significantly predicted both patient satisfaction and subjective health-related problems, over and above effects attributable to general satisfaction. We also noted the absence of significant differences across the three cultures or sex, suggesting that the process we identify has considerable generality. We also describe a short version of our measure that researchers may find useful in a variety of research or clinical settings.     

Social problem solving in early childhood: Developmental change and the influence of shyness

The purpose of this study was to examine developmental change and the influence of shyness on social problem-solving (SPS). At 24, 36, and 48 months, children (N = 570) were observed while interacting with an unfamiliar peer during an SPS task and at 24 months, maternal report of shyness was collected. Results showed that across the full sample, children displayed low but stable levels of withdrawn SPS and increasing levels of SPS competence over development. In addition, results showed multiple trajectories of withdrawn and competent SPS. Shyness was associated with high-increasing and high-decreasing withdrawn SPS trajectories compared with the low-increasing withdrawn SPS trajectory. Shyness was also associated with the low-increasing compared with the high-increasing SPS competence trajectory. Findings demonstrate the development of SPS competence over early childhood, and the influence of early shyness on this developmental course, with some shy children showing improvement in SPS skills and others continuing to show SPS difficulties over time.     

Internet pornography and paedophilia

Various indices of use of Internet pornography have drawn attention to the extent of adult sexual interest in children; clinical experience and now research evidence are accumulating to suggest that the Internet is not simply drawing attention to those with existing paedophilic interests, but is contributing to the crystallisation of those interests in people with no explicit prior sexual interest in children. Drawing on clinical experience in a specialist NHS outpatient psychotherapy service, the author argues that a dichotomous notion of paedophilia is no longer tenable, and any model of paedophilia needs to take account of eruptions of a sexual interest in children in those who appear not to be consistently paedophilic and who have had adult-to-adult sexual relationships. This phenomenon is analysed in two ways: first, by considering how it is that the adult sexual adaptation might ‘unravel’ under the influence of Internet sex to reveal underlying paedophilic currents and second, by revisiting general and psychoanalytic theories of paedophilia and by considering how predisposing factors to paedophilia might be amplified through access to Internet pornography.     

Do interpersonal features of social anxiety influence the development of depressive symptoms?

This study is a prospective examination of possible interpersonal features of social anxiety that might predict increases in depressive symptoms. It was hypothesised that social anxiety would be associated with avoidance of expressing emotion, lack of assertion, and interpersonal dependency and that these dysfunctional interpersonal styles would predict depressive symptoms one year later while controlling for Time 1 depressive symptoms. One hundred and two undergraduates completed interview and self-report measures of these interpersonal styles in addition to measures of social anxiety and depressive symptoms. Results indicated that social anxiety was associated with all three interpersonal styles. However, only avoidance of expressing emotions predicted Time 2 depressive symptoms. Theoretical implications of these results are discussed.     

The Relationship of Korean Students’ Age and Years of English-as-a-Foreign-Language Exposure with English-Reading Ability: A Cross-Age Study

The differences in spelling error features among learning disabled and normal students spelling instructionally on four grade levels of achievement were investigated. The categories of errors were determined by invented spelling research. The results indicated that the ranking of error features for each group were significantly correlated, and that the range of individual variation about the mean group pattern of spelling error variables was highly similar at each level of achievement. The findings are congruent with the theory of developmental word knowledge and support the position that learning disabled and normally achieving children acquire specific aspects of English orthography in highly similar progressions.     

“I Tried to Make it not Confusing by Fixing it”: Describing Six First Graders’ Use of Strategies to Understand Text

This study describes six first-grade students’ use of metacognitive strategies. The students (4 boys and 2 girls) represented low, average, and above-average readers and were enrolled in a rural Midwestern elementary school. A variety of data were collected throughout the year: (a) an informal reading inventory and metacognitive awareness interview were conducted at the beginning and end of the year; and (b) during the school year, think-aloud interview protocols, running records, anecdotal notes, and retellings were conducted. The analysis revealed that these first graders were reporting and using a variety of strategies to read.     

Terminating Without Fatality

The psychoanalytic relationship is unique among intimate relationships, in that its ultimate goal is separation. After termination, the analysand mourns the loss of the analyst and while feeling vulnerable and bereft, faces demanding emotional tasks alone. The post-termination phase is a precarious time during which the hard-won gains of an analysis may be threatened or even lost. Given the analysand's vulnerability, it is disturbing that many of our common termination practices may undermine the patient's leave-taking and harm the positive internal images of the analyst and the analytic relationship that have been forged during the analysis. Findings from recent research about the patient's experience after analysis are presented and implications are drawn for practice regarding the termination and post-termination phases. The author recommends that our theory and technique of termination should be reexamined and revised in light of new research and within the context of contemporary two-person theories of psychoanalysis.

In real life, only death and hostility bring a libidinal relationship to an end. The kind of termination psychoanalysis demands is without precedent.

—Martin Bergmann (1997, p. 163)     

The Role of Relationships in Understanding the Alexithymia–Depression Link

Alexithymia is associated with increased depressive symptoms in both clinical and community samples. One way that alexithymia may lead to depression is through its impact on interpersonal relationships. Individuals with alexithymia report lower perceived social support, intimacy, and relationship satisfaction. Furthermore, poor relationship functioning is a clear risk factor for depressive symptoms. Given the established alexithymia–depression link and marital dysfunction–depression link, a logical next step is to examine whether relationship dysfunction (low social support, intimacy, negative relationship behaviours, and relationship dissatisfaction) mediates the association between alexithymia and depressive symptoms. The hypothesized mediation model was assessed in a sample of 104 community couples with two analytical approaches—first with cross‐sectional measures using path analysis and second with daily diary measures collected over a seven‐day period using a multilevel modelling approach. Poor relationship functioning mediated the association between alexithymia and depressed mood in the daily diary data and partially mediated that association with the cross‐sectional measures. These results identify alexithymia as an important variable in understanding the marital functioning–depression association, and this finding has implications for treatment. Copyright © 2012 European Association of Personality Psychology     

How Much Distress Is Too Much on Deployed Operations? Validation of the Kessler Psychological Distress Scale (K10) for Application in Military Operational Settings

The aim of this study was threefold: (a) to assess the factor structure of the Kessler Psychological Distress Scale (K10) to determine whether interpreting the scale as a single dimensional measure of psychological distress is justified in military operational setting; (b) to validate the K10 for mental health surveillance in operational settings against self-reported occupational impairment; (c) to evaluate whether the K10 has better discriminatory power than de facto standards for mental health surveillance on deployment, namely the Patient Health Questionnaire and the Posttraumatic Stress Disorder Checklist, Civilian version. A convenience sample of Canadian Armed Forces personnel serving in Afghanistan (N = 1,264) completed self-report measures of psychological distress and occupational impairment. On examination of 6 competing models, the authors determined that interpreting the K10 as a measure of unspecified psychological distress is justified. Using receiver operating characteristic (ROC) curve analysis, they identified new cutoff values for dichotomous and polychotomous scoring methods. After comparing the area beneath the ROC curves for each of the 3 mental health surveillance questionnaires, the authors determined that all measures perform well as predictors of self-rated occupational impairment, with values ranging from .86 to .90. These results highlight the importance of cross-setting validation and demonstrate that validating psychological screening questionnaires against self-report measures of occupational impairment can be a useful strategy for understanding the manifestation of psychological distress on deployed military operations.     

Development of Prospective Memory: Tasks Based on the Prefrontal-Lobe Model

This study investigated the development of prospective memory using tasks based on the prefrontal-lobe model. Three groups each of 30 children, adolescents, and young adults were compared on prospective-memory performance using ongoing tasks with two levels of cognitive demand (low and high), and two levels of importance (unstressed and stressed) of remembering prospective cues. The Self-Ordered Pointing Task (SOPT), Stroop Color Word Interference Test, and Tower of London were also used to assess relationships between prospective memory and prefrontal-lobe functions. The children remembered fewer prospective cues than either the adolescents or adults, but the adolescents and adults remembered equally well. This trend increased significantly as the cognitive demand of the ongoing tasks increased. However, stressing or not stressing the importance of remembering made no difference to prospective-memory performance. Performance on the SOPT and Stroop Colour Word Interference predicted performance on the high- but not on the low-demand condition. These findings implicate the maturation of the brain's prefrontal region in the development of prospective memory.