A perspective on the patterns of loss, lack, disappointment and shame encountered in the treatment of six women with severe and chronic anorexia nervosa

Abstract :  This paper explores how the aggressive fantasies and energies expressed in anorexic self-hatred can be recycled to become the basis of psychological growth and recovery. This shift is made possible by focusing on the telos of the analysand's psychological system as it expresses itself through her illness, and using Clark's idea that sanity is a form of recycled madness. It also draws on Jung's view of the unconscious as an active and purposive agent, and libido as a neutral psychic energy which can serve different purposes.
I discuss a number of clinical vignettes, focusing on the hard, ruthless, defiant and hateful aspects of (what might appear to be) 'monstrous' anorexic behaviour, and the kinds of countertransference reactions these behaviours can provoke. I also explore what these kinds of behaviours might represent in terms of multi-generational family dynamics, as well as mother-daughter dynamics.
At the core of the paper is the idea that the capacity to use aggression in clear ways, but within the limits of conscience, is essential for the protection of one's physical and psychological boundaries. Without the capacity to defend oneself, and the ability to decide quickly and clearly when it is right to risk hurting the other in order to do so, one cannot take any level of risk in life, or draw close to the other. I suggest that for recovery from anorexia to occur, the aggressive, self-hateful, destructive energies which are so central to the illness need to be recycled into these kinds of awarenesses and life-skills.     

Coaching behaviors associated with changes in fear of failure: changes in self-talk and need satisfaction as potential mechanisms

Cognitive-interpersonal and motivational mechanisms may regulate relations between youth perceptions of interpersonal aspects of the social ecology and their fear-of-failure (FF) levels. Youth (N=165) registered for a summer swim league rated their fear of failure at the beginning, middle, and end of the season. Extensive model comparisons indicated that youths' end-of-season ratings of coach behaviors could be reduced to three factors (affiliation, control, blame). Perceived control and blame from coaches predicted residualized change in corresponding aspects of youths' self-talk, but only changes in self-blame positively predicted changes in FF levels during the season. Perceived affiliation from coaches predicted autonomy need satisfaction which, in turn, negatively predicted the rate of change in FF levels during the season. These findings indicate that (a) youth perceptions of coaches were directly and indirectly related to acute socialization of FF and (b) both cognitive-interpersonal and motivational mechanisms contributed to this socialization process. Further research is needed to test for developmental differences in these mechanisms to determine whether findings generalize to more heterogeneous and at-risk populations and to investigate other potential social-ecological influences on socialization.     

Attention-Deficit/Hyperactivity Disorder: A Neuropsychological Perspective Towards DSM-V

Neuropsychological methods and techniques have much to offer in the evaluation of the individual suspected as having Attention-Deficit/Hyperactivity Disorder (ADHD). After a review of the historical evolution of the ADHD concept, incidence and prevalence, and DSM-IV criteria for diagnosis, especially as regards omission related to gender differences, and other associated cultural, familial, socioenvironmental, and subject influences, this paper describes a number of dilemmas and obstacles encountered in clinical practice. Included are the confounds associated with the wide range of possible comorbidities, the insufficiency of current DSM-IV criteria, the emergence of subtype differentiation and its impact on diagnosis and treatment. The complex relationship between neuropsychological constructs and ADHD, and obstacles to valid assessment are also addressed. The complexities associated with a thorough ADHD evaluation are viewed within an impressive and expansive existing scientific framework and recommendations are made for future directions.     

Token mediated tool exchange between tufted capuchin monkeys (<Emphasis Type="Italic">Cebus apella</Emphasis>)

Three experiments were conducted to test whether a pair of tufted capuchin monkeys (Cebus apella) could generalize their ability to exchange tokens and tool objects with a human experimenter to similar exchanges with a conspecific partner. Monkeys were tested in side-by-side enclosures, one enclosure containing a tool-use apparatus and one or more token(s), and the other enclosure containing one or more tool object(s). The monkeys willingly transferred tokens and tools to a conspecific with little practice. Following a small amount of training, we also found that the monkeys would select situation-appropriate tokens to exchange for specific tools, but did not select appropriate tool objects in response to another monkey’s token transfers. Implications regarding role reversal are discussed.     

Counsellors' perspectives on the use of the Schedule for the Evaluation of Individual Quality of Life (SEIQoL) in an alcohol counselling setting

As part of a randomised controlled trial to investigate the feasibility of using the Schedule for the Evaluation of Individual Quality of Life (SEIQoL) within an alcohol counselling setting, counsellors' views of using the tool were sought. Data about the service users' use of SEIQoL were collected during the counselling session, and focus groups and questionnaires were used to collect data on counsellor perceptions and experiences of using the tool. SEIQoL was easy and quick to use and provided users with a graphic, visual and dynamic means to identify important areas that contributed to their quality of life; it appeared to enhance the reflective process early on in counselling. Counsellors reported that service users requested the tool be used more frequently during the counselling process and they felt it could be a useful review tool.     

Reflection in university and the employability agenda: a discourse analysis case study

In UK universities, reflection is promoted not only for its intrinsic value but also for instrumental purposes, for students to gain and demonstrate skills and attributes which are valued by employers. In this paper, I examine reflective writing produced by students seeking an award offered by the careers department of one university. By looking at the evaluative language choices made by the student writers, I shed light on some of their practices regarding self-representation and their articulations of experience. I provide a critical account of what reflective writing looks like in this particular setting, and interpret this in the broader context of the goal to foster reflection among higher education students. I argue that the reflective writing engendered by this particular context and task is different in key respects from the reflection which is commonly advocated as an element of personal, professional or academic development.     

Religion,sexuality, and (in)equality in the lives of older lesbian,gay, and bisexual people in the United Kingdom

This article explores how older lesbian, gay, and bisexual (LGB) people in the United Kingdom engage with religion in later life. Drawing on research with older persons who are LGB and with activists, it explores religious spaces as sites of both inclusion and exclusion, historically and in the present day. Particular consideration is given to the equality implications, in the form of parity of participation, including in the context of religious-based social care provision for older people. Future research implications are addressed.     

Sex, race/ethnicity, and romantic attractions: multiple minority status adolescents and mental health

This study examined the association between multiple minority statuses and reports of suicidal thoughts, depression, and self-esteem among adolescents. Data from the National Longitudinal Study of Adolescent Health were used to examine mental health outcomes across racial/ethnic groups for same-sex-attracted youths and female youths. Hispanic/Latino, African American, and White female adolescents reported more suicidal thoughts, higher depression, and lower self-esteem compared with male adolescents in their racial/ethnic group. Same-sex-attracted youths did not consistently demonstrate compromised mental health across racial/ethnic groups. Follow-up analyses show that White same-sex-attracted female adolescents reported the most compromised mental health compared with other White adolescents. However, similar trends were not found for racial/ethnic minority female youths with same-sex attractions.     

Reform of statistical inference in psychology: The case of<Emphasis Type="Italic">Memory &; Cognition</Emphasis>

Geoffrey Loftus, Editor ofMemory & Cognition from 1994 to 1997, strongly encouraged presentation of figures with error bars and avoidance of null hypothesis significance testing (NHST). The authors examined 696Memory & Cognition articles published before, during, and after the Loftus editorship. Use of figures with bars increased to 47% under Loftus’s editorship and then declined. Bars were rarely used for interpretation, and NHST remained almost universal. Analysis of 309 articles in other psychology journals confirmed that Loftus’s influence was most evident in the articles he accepted for publication, but was otherwise limited. An e-mail survey of authors of papers accepted by Loftus revealed some support for his policy, but allegiance to traditional practices as well. Reform of psychologists’ statistical practices would require more than editorial encouragement.     

Discipline behaviors of Chinese American and European American mothers

In any society, parenting beliefs are a reflection of that society's cultural values and traditions (J. U. Ogbu, 1981). Verbosity, a parenting behavior considered dysfunctional in European American culture, may not be problematic in Chinese culture. The authors recruited 31 Chinese American and 30 European American mothers and used questionnaires to measure parenting behaviors and child behavior problems. The Chinese American mothers also completed a questionnaire assessing their acculturation level. The Chinese American mothers had higher levels of verbosity than did the European American mothers; however, there were no differences between the groups in child behavior problems. The results also revealed higher levels of laxness in the Chinese American mothers compared to the European American mothers. Acculturation level did not predict verbosity or laxness levels. Results suggest that the effectiveness of a parenting style should be defined relative to cultural context.