Clinical Reflection and Ritual as Forms of Participation and Interaction: Reply to Bass and Stern

We agree with the commentaries that Relational psychoanalysis has stood firmly against dichotomizing clinical reflection, on one hand, and interactional processes, on the other. Still, we wonder whether the relational literature has skewed toward interaction at the expense of concentrated attention to patients’ internal worlds. Predispositions toward interaction may diminish reflective space and quiet inwardness, which are themselves forms of analytic relating. We raise the possibility that the Relational model’s inclusive breadth, valuable as it is, might sometimes impede and even devalue discussions of specific technical matters. We consider clinical conceptualizations of ritual, “relating,” and “being in contact.”     

Youth with Oppositional Defiant Disorder at Entry into Home-Based Treatment,Foster Care,and Residential Treatment

We explored and compared rates of youth diagnosed with oppositional defiant disorder (ODD) at entry into three broad program types, home-based care, foster care, and residential care. We also explored factors other than an ODD diagnosis that could be associated with program placement, and compared the presence of these factors in youth with and without an ODD diagnosis. Analyses were conducted using data from an ongoing, private-agency led, outcome measurement project. Programs were grouped into low (home-based), moderate (foster), or high (residential) categories, based upon levels of supervision and structure provided. A sample of 9,564 youth admitted into care between years 2005 and 2007 was used. Results suggested the following rates of ODD: 14.2 % overall; 7.9 % for low level programs; 5.3 % for moderate level programs; 21.1 % for high level programs. Rates were significantly different by program level (p ≤ 0.001). Sixty of 65 additional risk factors were also significantly associated with placement by level of program. No risk factors were unique to youth with ODD. Of the significant factors for youth with ODD, 4 were particularly strong: Classification as a child in need of services (CHINS), history of neglect, verbal aggression, and truancy. Youth classified as CHINS and with substantiated or suspected neglect were more likely placed into a moderate level program. Youth with verbal aggression or truancy were more likely placed into a high level program. Results suggested many factors are considered at program entry. Given the potential for poor prognosis and social costs of ODD, results support an individualized approach to placement determinations, with increased attention to symptoms of ODD and associated features at program entry.     

Interaction Between the Parenting Alliance and Parent–Child Activities in a Clinic-Referred Sample of 2 to 18-year-olds

Several decades of research have demonstrated a link between marital, parenting, and child domains. The present study examined the nature of these links by testing the moderating effect of the parent–child relationship on the association between the parenting alliance and internalizing and externalizing problems in 324 dual-parent families of 2-to-18-year-old clinic-referred youth. Findings indicated that positive parent–child activities directly related to children’s internalizing and externalizing problems, and modified the nature of the association between the parenting alliance and internalizing problems in families of 6-to-10-year-olds. Interestingly, in families where parents engaged in fewer positive activities with their children, a strong parenting alliance actually related to greater child internalizing problems. Findings support the importance of understanding the interaction between the marital and child domains in order to effectively intervene with families of children experiencing behavior problems.     

Zipf’s word frequency law in natural language: A critical review and future directions

The frequency distribution of words has been a key object of study in statistical linguistics for the past 70 years. This distribution approximately follows a simple mathematical form known as Zipf’s law. This article first shows that human language has a highly complex, reliable structure in the frequency distribution over and above this classic law, although prior data visualization methods have obscured this fact. A number of empirical phenomena related to word frequencies are then reviewed. These facts are chosen to be informative about the mechanisms giving rise to Zipf’s law and are then used to evaluate many of the theoretical explanations of Zipf’s law in language. No prior account straightforwardly explains all the basic facts or is supported with independent evaluation of its underlying assumptions. To make progress at understanding why language obeys Zipf’s law, studies must seek evidence beyond the law itself, testing assumptions and evaluating novel predictions with new, independent data.     

Extending Parent–Child Interaction Therapy for Early Childhood Internalizing Problems: New Advances for an Overlooked Population

Although efficacious psychological treatments for internalizing disorders are now well established for school-aged children, until recently there have regrettably been limited empirical efforts to clarify indicated psychological intervention methods for the treatment of mood and anxiety disorders presenting in early childhood. Young children lack many of the developmental capacities required to effectively participate in established treatments for mood and anxiety problems presenting in older children, making simple downward extensions of these treatments for the management of preschool internalizing problems misguided. In recent years, a number of research groups have successfully adapted and modified parent–child interaction therapy (PCIT), originally developed to treat externalizing problems in young children, to treat various early internalizing problems with a set of neighboring protocols. As in traditional PCIT, these extensions target child symptoms by directly reshaping parent–child interaction patterns associated with the maintenance of symptoms. The present review outlines this emerging set of novel PCIT adaptations and modifications for mood and anxiety problems in young children and reviews preliminary evidence supporting their use. Specifically, we cover (a) PCIT for early separation anxiety disorder; (b) the PCIT-CALM (Coaching Approach behavior and Leading by Modeling) Program for the full range of early anxiety disorders; (c) the group Turtle Program for behavioral inhibition; and (d) the PCIT-ED (Emotional Development) Program for preschool depression. In addition, emerging PCIT-related protocols in need of empirical attention—such as the PCIT-SM (selective mutism) Program for young children with SM—are also considered. Implications of these protocols are discussed with regard to their unique potential to address the clinical needs of young children with internalizing problems. Obstacles to broad dissemination are addressed, and we consider potential solutions, including modular treatment formats and innovative applications of technology.     

Aging and the segmentation of narrative film

The perception of event structure in continuous activity is important for everyday comprehension. Although the segmentation of experience into events is a normal concomitant of perceptual processing, previous research has shown age differences in the ability to perceive structure in naturalistic activity, such as a movie of someone washing a car. However, past research has also shown that older adults have a preserved ability to comprehend events in narrative text, which suggests that narrative may improve the event processing of older adults. This study tested whether there are age differences in event segmentation at the intersection of continuous activity and narrative: narrative film. Younger and older adults watched and segmented a narrative film, The Red Balloon, into coarse and fine events. Changes in situational features, such as changes in characters, goals, and objects predicted segmentation. Analyses revealed little age-difference in segmentation behavior. This suggests the possibility that narrative structure supports event understanding for older adults.     

What really separates casuistry from principlism in biomedical ethics

Since the publication of the first edition of Tom Beauchamp and James Childress’s Principles of Biomedical Ethics there has been much debate about what a proper method in medical ethics should look like. The main rival for Beauchamp and Childress’s account, principlism, has consistently been casuistry, an account that recommends argument by analogy from paradigm cases. Admirably, Beauchamp and Childress have modified their own view in successive editions of Principles of Biomedical Ethics in order to address the concerns proponents of casuistry and others have had about principlism. Given these adjustments to their view, some have claimed that principlism and casuistry no longer count as distinct methods. Even so, many still consider these two conceptions of bioethical methodologies as rivals. Both accounts of the relationship between casuistry and principlism are wrong. These two conceptions of methodology in biomedical ethics are significantly different, but the differences are not the ones pointed out by those who still claim that they are distinct positions. In this article, I explain where the real similarities and differences lie between these two views.