Medical psychotherapy consultation: psychoanalytic psychiatry for the patient and professional

An NHS Mental Health Trust Medical Psychotherapy Consultation Service using psychoanalytic psychiatry to help the patient and professional is described. The Consultation Service established in 2000 is offered to secondary acute and community mental health teams and primary care. The service was evaluated as a basis for regional and national development. Between 2006 and 2013, 87 consultations from 210 were sampled to ascertain demographic and diagnostic profiles and outcomes of the consultation process. We conducted an online survey of local consultant psychiatrists’ views about the service, and undertook a thematic analysis of the free text comments. We also conducted a survey of members of the Royal College of Psychiatrists’ Medical Psychotherapy Faculty to ascertain whether similar consultation services existed elsewhere in the UK and had been evaluated. The Leeds model of psychoanalytic consultation – a ‘consultation sandwich’ – is described. From a psychoanalytic perspective, the work of consultation is seen as an extension of the dynamic field of the analytic situation. This paper develops the concept of a bastion – an omnipotent reserve in and between the patient and professional derived from adhesive identifications leading to stuck relationships. The adhesive identification in the patient and professional acts like a ‘grievance glue’ – a mutual manifestation in a last bastion of painful limitations not faced, losses not grieved.     

Top-down social modulation of interpersonal observation–execution

Cyclical upper limb movement can involuntarily deviate from its primary movement axis when the performer concurrently observes incongruent biological motion (i.e. interpersonal observation–execution). The current study examined the social modulation of such involuntary motor interference using a protocol that reflected everyday social interactions encountered in a naturalistic social setting. Eighteen participants executed cyclical horizontal arm movements during the observation of horizontal (congruent) or curvilinear (incongruent) biological motion. Both prior to, and during the interpersonal observation–execution task, participants also received a series of social words designed to prime a pro-social or anti-social attitude. The results showed greater orthogonal movement deviation, and thus interference, for the curvilinear compared to horizontal stimuli. Importantly, and opposite to most of the previous findings from work on automatic imitation and mimicry, there was a greater interference effect for the anti-social compared to pro-social prime condition. These findings demonstrate the importance of interpreting the context of social primes, and strongly support predictions of a comparison between the prime construct and the self-concept/-schema and the top-down response modulation of social incentives.     

Stories as Gift: Patient Narratives and the Development of Empathy

Critical thought and assessment of medical, emotional, and social problems faced by patients is central to genetic counselor training and development. However, primary emphasis on these critical problem-solving approaches can interfere with the development of empathic listening skills. Using a narrative medicine approach, I describe how learning to reframe one patient’s story of healing as a gift allowed me to become a more open and empathic listener. Ultimately, the empathy and understanding that I learned from this patient’s narrative added to what previous patients had taught me and helped me assist other patients (and myself) in identifying and nurturing healing narratives for people coping with illness and grief. The approach presented here emphasizes the importance of recognizing patients as valuable teachers in the development of higher-level empathy skills.     

Relationship Self-Regulation and Relationship Quality: The Moderating Influence of Gender

Relationship quality, as measured by relationship satisfaction and stability, is important to understanding how happy a couple is and the chances their relationship will end. Prior research has linked two aspects of relationship self-regulation (RSR), effort and strategies to improve a relationship, to increased levels of satisfaction and stability, but has not yet examined if gender moderates this association. Our paper addresses how both aspects of RSR are associated with increases in satisfaction and stability for male and female partners using data from the RELATionship Evaluation Survey. In the sample of 8006 men and women in a variety of romantic unions, we find that both aspects of RSR are positively associated with both aspects of relationship quality, but that this association is stronger for women’s reports of satisfaction than men’s. Additionally, relationship effort has a slightly stronger association with stability for women than men. Both clinical and research applications of these findings are discussed.     

Implicit Bias and Policing

In a time when racial prejudice is generally taboo and decision makers, including law enforcement officials, strenuously disavow the use of group‐based stereotypes to make judgments that affect others, one might expect discriminatory outcomes to be unusual. However, research repeatedly indicates that discrimination is pervasive across many domains, and specifically in policing. A major cause of biased policing is likely the implicit biases that operate outside of conscious awareness and control but nevertheless influence our behaviors. Implicit biases (e.g., stereotypes linking Blacks with crime or with related traits like violence or hostility) influence judgments through processes of misattribution and disambiguation. Although psychological science gives us good insight into the causes of racially biased policing, there are as yet no known, straightforward, effective intervention programs. Nevertheless, there are several strands of research that represent promising avenues for further exploration, including intergroup contact, exposure to counter‐stereotypic exemplars, and stereotype negation. Meanwhile, many police departments are adjusting their policies, trainings, and procedures to try to address biased policing and community complaints. Several common themes among those changes include banning racial profiling, collecting data, training officers, reducing discretion, and adopting new technologies. These adjustments are more likely to be successful if they incorporate the understanding that biased policing occurs in the absence of explicitly “racist” thoughts because of well‐documented, pernicious stereotypes that operate largely outside of conscious awareness and control.     

Conservatism positively predicted fading affect bias in the 2016 US presidential election at low,but not high,levels of negative affect

Unpleasant affect fades faster than pleasant affect and this Fading Affect Bias (FAB) phenomenon is positively related to healthy outcomes and negatively related to unhealthy outcomes, which makes the FAB a healthy coping process/reaction. Rehearsal seems to be the cognitive mechanism responsible for the FAB. Although the FAB and its relation to healthy outcomes and rehearsal have been examined in many contexts, they have not been evaluated in the realm of politics. Therefore, we evaluated the FAB across event type and we examined the relation of FAB to political leaning (conservatism), unhealthy variables, healthy variables, and rehearsal for the 2016 US Presidential Election. We expected and found that FAB was larger for non‐political events than for election/political events, and conservatism positively predicted FAB. We also expected and found that unhealthy/healthy outcome variables related to FAB in predictable ways. Importantly, we found that negative affect moderated the relation of FAB and conservatism, and rehearsal ratings mediated this 3‐way interaction. The results supported emotion regulation models, such as the mobilization‐minimization hypothesis and self‐enhancement theory.     

When seeing is knowing: the role of visual cues in the dissociation between children's rule knowledge and rule use

The Dimensional Change Card Sort (DCCS) task requires children to switch from sorting cards based on shape or color to sorting based on the other dimension. Typically, 3-year-olds perseverate, whereas 4-year-olds flexibly sort by different dimensions. Zelazo and colleagues (1996, Cognitive Development, 11, 37-63) asked children questions about the postswitch rules and found an apparent dissociation between rule knowledge and rule use, namely that 3-year-olds demonstrate accurate knowledge of the postswitch rules despite sorting cards incorrectly. Here, we show that children's success with these questions is grounded in their use of available visual cues; children who fail sorting use the target cards to correctly answer questions, and when the cards are unavailable they guess. This suggests that there might not be a dissociation between children's rule knowledge and rule use in the DCCS.