Introduction: babies in the consulting room: what happens when analyst, mother, and infant meet?

Analytic work with a pregnant woman may foster the psychological gestation of the self-as-mother. For the mother--as for the infant--the developmental process continues well beyond delivery. It should not surprise us, then, that many mothers continue to bring their babies to sessions after birth. Analytic work in this context can affect a patient's sense of herself, and perhaps her competence, as a mother. Yet the presence of babies in the consulting room is an underacknowledged feature of contemporary practice. For this section of JAPA, we have collected three papers that explore some of the unique challenges and opportunities that arise when a patient brings her baby to treatment. Earlier versions of each paper were first presented at a panel, "Babies in the Consulting Room," at the June 2011 meeting of the American Psychoanalytic Association in San Francisco.     

Toddlers benefit from labeling on an executive function search task

Although labeling improves executive function (EF) performance in children older than 3 years, the results from studies with younger children have been equivocal. In the current study, we assessed performance in a computerized multistep multilocation search task with older 2-year-olds. The correct search location was either (a) not marked by a familiar picture or given a distinct label, (b) marked by a familiar picture but not given a distinct label, (c) marked by a familiar picture and labeled by the experimenter, or (d) marked by a familiar picture and labeled by the participant. The results revealed that accuracy improved across conditions such that children made the fewest errors when they generated the label for the hiding location. These findings support the hierarchical competing systems model, which postulates that improved performance can be explained by more powerful representations that guide search behavior.     

Maximal care considerations when treating patients with end-stage heart failure: ethical and procedural quandaries in management of the very sick

Deciding who should receive maximal technological treatment options and who should not represents an ethical, moral, psychological and medico-legal challenge for health care providers. Especially in patients with chronic heart failure, the ethical and medico-legal issues associated with providing maximal possible care or withholding the same are coming to the forefront. Procedures, such as cardiac transplantation, have strict criteria for adequate candidacy. These criteria for subsequent listing are based on clinical outcome data but also reflect the reality of organ shortage. Lack of compliance and non-adherence to lifestyle changes represent relative contraindications to heart transplant candidacy. Mechanical circulatory support therapy using ventricular assist devices is becoming a more prominent therapeutic option for patients with end-stage heart failure who are not candidates for transplantation, which also requires strict criteria to enable beneficial outcome for the patient. Physicians need to critically reflect that in many cases, the patient’s best interest might not always mean pursuing maximal technological options available. This article reflects on the multitude of critical issues that health care providers have to face while caring for patients with end-stage heart failure.     

The Use of Propensity Scores in Mediation Analysis

Mediation analysis uses measures of hypothesized mediating variables to test theory for how a treatment achieves effects on outcomes and to improve subsequent treatments by identifying the most efficient treatment components. Most current mediation analysis methods rely on untested distributional and functional form assumptions for valid conclusions, especially regarding the relation between the mediator and outcome variables. Propensity score methods offer an alternative whereby the propensity score is used to compare individuals in the treatment and control groups who would have had the same value of the mediator had they been assigned to the same treatment condition. This article describes the use of propensity score weighting for mediation with a focus on explicating the underlying assumptions. Propensity scores have the potential to offer an alternative estimation procedure for mediation analysis with alternative assumptions from those of standard mediation analysis. The methods are illustrated investigating the mediational effects of an intervention to improve sense of mastery to reduce depression using data from the Job Search Intervention Study (JOBS II). We find significant treatment effects for those individuals who would have improved sense of mastery when in the treatment condition but no effects for those who would not have improved sense of mastery under treatment.     

Inferring correlations: From exemplars to categories

Research and theorizing suggest a processing advantage of category-level correlations over exemplar-level correlations. That research has also shown that category-level correlations serve as a proxy for inferring exemplar-level correlations. For example, an individual may learn that the demand for a product category, like cheese, in one store predicts the demand for this category in another. The individual could then draw the unwarranted conclusion that the demand for an exemplar, like cheddar, would also predict the demand for this exemplar in the other store. This notion is supported by previous experiments demonstrating that the subjective exemplar-level correlation follows the implication of the category-level correlation. However, in virtually all previous experiments suggesting a processing advantage for category-level over exemplar-level correlations, the stimulus correlation at the category level was substantial, whereas the correlation at the exemplar level was weak. Here, we tested the hypothesis that individuals process the level that is most informative, either the exemplar or the category level. We presented participants with a zero correlation at the category level, but varied the correlation at the exemplar level. Participants presented with a zero correlation across exemplar products correctly reproduced a zero correlation across product categories. When presented with a substantial correlation at the exemplar level, however, they erroneously reproduced a similar correlation at the category level. These findings therefore imply that there is no general processing advantage for correlations at higher aggregation levels. Instead, individuals seemingly attend to the level that holds the most regular information. Findings are discussed regarding the role of covariation strength in correlation detection and use.     

On Alienation from the Built Environment

If “environment” means “that which environs us,” it isn’t clear why environmentalist thinkers so often identify it with nature and not with the built environment that a quick glance around would reveal is what we’re actually environed by. It’s a familiar claim that we’re “alienated from nature,” but I argue that what we’re really alienated from is the built environment itself. Typically talk of alienation from nature involves the claim that we fail to acknowledge nature’s otherness, but the built environment is just as other from us as the natural one. And just as we are said to fail to recognize the role of nature as the origin of everything with which we have to do in the world, so too we fail to recognize the role of socially organized human labor in the objects that surround us. Overcoming alienation would require acknowledging the builtness and the sociality of the world we inhabit.     

A Neuropsychological Model of Mentally Tough Behavior

Four studies were conducted with two primary objectives: (a) to conceptualize and measure mental toughness from a behavioral perspective and (b) to apply relevant personality theory to the examination of between‐person differences in mentally tough behavior. Studies 1 (N = 305 participants from a range of different sports) and 2 (N = 110 high‐level cricketers) focused on the development of an informant‐rated mental toughness questionnaire that assessed individual differences in ability to maintain or enhance performance under pressure from a wide range of stressors. Studies 3 (N = 214) and 4 (N = 196) examined the relationship between reinforcement sensitivities and mentally tough behavior in high‐level cricketers. The highest levels of mental toughness reported by coaches occurred when cricketers were sensitive to punishment and insensitive to reward. Study 4 suggested that such players are predisposed to identify threatening stimuli early, which gives them the best possible opportunity to prepare an effective response to the pressurized environments they encounter. The findings show that high‐level cricketers who are punishment sensitive, but not reward sensitive, detect threat early and can maintain goal‐directed behavior under pressure from a range of different stressors.     

Associations Between Maternal Mental Health and Child Emotional and Behavioral Problems: Does Prenatal Mental Health Matter?

This study examined associations between elevated symptoms of prenatal depression or anxiety and offspring emotional and behavioral problems during mid to late childhood taking into account the impact of later maternal mental health symptoms. The sample consisted of 2,891 women and their children (49 % male) from a prospective, community-based study, the Avon Longitudinal Study of Parents and Children. Women completed measures of depressive (Edinburgh Postnatal Depression Scale) and anxious (Crown Crisp Experiential Index) symptoms at regular intervals beginning in pregnancy. Mothers and teachers assessed offspring emotional and behavioral problems using the Strengths and Difficulties Questionnaire when children were 10–11 years old. Multivariable regression models were fit to address study hypotheses. Exposure to elevated symptoms of maternal depression during pregnancy was associated with increased total offspring emotional and behavioral problems, even after controlling for later maternal mental health problems and a range of sociodemographic and psychosocial characteristics, according to mothers’ but not teachers’ reports. Similarly, children exposed to elevated symptoms of maternal anxiety during pregnancy were reported to have increased total emotional and behavioral problems by mothers but not by teachers. We found support for modest associations between elevated symptoms of maternal depression and anxiety during the prenatal period and certain domains of offspring emotional and behavioral problems in mid to late childhood above and beyond the impact of later maternal mental health problems. These findings highlight the need for additional clinical and research attention to the prenatal period and to both maternal depression and anxiety.