Thinking Developmentally: Perspectives Following Loewald and Klein

In this article, I explore two perspectives on development that are central to how I think and work as an analyst, one drawn from the work of Hans Loewald and one from Melanie Klein. Loewald turned the usual psychoanalytic way of thinking, rooted in the past, on its head when he theorized that development proceeds by internalization of the parent’s future vision of the child and, by corollary, the analyst’s future vision of the patient. Using a vignette from Klein’s work with 10-year-old Richard, I show how the analyst’s image of the patient’s potential can facilitate growth and development. Melanie Klein also introduced a radical reordering of traditional psychoanalytic theory when she theorized that the mind develops and is structured as positions, not as successive phases. For Klein, the mind is organized in groupings of anxieties, defenses, and object-relations that are in a continuous state of oscillation throughout life independent of chronological age. Through a clinical vignette, I illustrate how one understands a patient differently when development is seen as occuring in momentary shifts between different levels of the personality rather than as stages over time.     

The City Infant Faces Database: A validated set of infant facial expressions

Adults need to be able to process infants’ emotional expressions accurately to respond appropriately and care for infants. However, research on processing of the emotional expressions of infant faces is hampered by the lack of validated stimuli. Although many sets of photographs of adult faces are available to researchers, there are no corresponding sets of photographs of infant faces. We therefore developed and validated a database of infant faces, which is available via e-mail request. Parents were recruited via social media and asked to send photographs of their infant (0–12 months of age) showing positive, negative, and neutral facial expressions. A total of 195 infant faces were obtained and validated. To validate the images, student midwives and nurses (n = 53) and members of the general public (n = 18) rated each image with respect to its facial expression, intensity of expression, clarity of expression, genuineness of expression, and valence. On the basis of these ratings, a total of 154 images with rating agreements of at least 75% were included in the final database. These comprise 60 photographs of positive infant faces, 54 photographs of negative infant faces, and 40 photographs of neutral infant faces. The images have high criterion validity and good test–retest reliability. This database is therefore a useful and valid tool for researchers.     

Representational momentum and anisotropies in nearby visual space

The possibility of anisotropies in visual space in and near the final location of a moving target was examined. Experiments 1 and 2 presented a moving target, and after the target vanished, participants indicated the final location of the leading or trailing edge of the target. Memory for both edges was displaced forward from the actual final locations, and the magnitude of displacement was smaller for the leading edge. Experiments 3 and 4 also presented stationary objects in front of and behind the final location of the target, and participants indicated the location of the nearest or farthest edge of one of the stationary objects. Memory for the near or far edge of an object in front of the target was displaced backward, and memory for the near or far edge of an object behind the target was displaced forward; the magnitude of displacement was larger for objects in front of the target and when the edge was farther away. The findings (a) suggest representational momentum is associated with an anisotropy of visual space that extends across and outward from the moving target and (b) are consistent with previous findings regarding estimation of time-to-contact, anorthoscopic perception, and memory psychophysics.     

靶向药物不良反应的认识与思考

新的靶向药物出现提高了抗癌疗效,降低了毒性,使转移性恶性肿瘤患者从治疗中获益。靶向药物耐受性好,通常出现轻微或中度的毒副反应。尽管大多数不良反应是可以得到迅速处理的,但是严重的甚至危及生命的不良反应仍能够发生。因此,为更好地指导临床实践工作,该文综述了实体瘤治疗中常用靶向药物的主要不良反应和安全数据,并按照药物的作用靶...     

A Conceptual Framework for Understanding the Stigmatization of Children of Incarcerated Parents

Stigmatization is often listed as one of the adverse consequences of parental incarceration; yet, there is very little research on this phenomenon. We address this knowledge deficit by providing a conceptual model of stigmatization and describing how it may apply to children with parents in jail or prison. This model helps to explain why families conceal the fact that a child’s parent is incarcerated; the potentially protective function of social withdrawal; possible links between stigmatization and childhood emotional and behavioral problems; how fear of stigmatization may impede help seeking; and the possibility for research and advocacy to contribute to the stigmatization of children who experience parental incarceration. It also helps to define specific aspects of stigmatization requiring further study.     

Maternal Depressive Symptoms When Caring for a Child with Mental Health Problems

As primary caregivers of children with mental health problems, mothers face challenges that put them at risk for depression, which is rarely identified or addressed. The aims of this paper were to (a) identify mean differences among demographic, stressor, threat, and resource variables specified in a theoretical model and thought to be associated with maternal depressive symptoms and (b) determine how much variability in depressive symptoms is explained by these variables. High levels and prevalence of depressive symptoms were found within a quality of life study that these data were drawn from. Of 139 mothers participating in this study, 58% had a score of 16 or greater on the CES-D indicating moderate to high levels of depressive symptoms. Significant differences were found between mothers with higher versus lower levels of depressive symptoms for 11 of the 18 variables. Hierarchical regression was used to examine the variance explained in depressive symptoms based upon the conceptual model with 4 composite variables. Income (step 1), behavioral problems (step 2), threat appraisal (step 3), and resource appraisal (step 4) combined explained 42% of the variance.     

The Development of a Methodology for Examining the Process of Family Communication of Genetic Test Results

It is important to study communication processes in families where members are undergoing testing for genetic conditions because the information received from such testing is crucial not just to the individual concerned but also to other members of the biological family. This topic has received little research attention, in part because of the complexities of methodology required. In this paper we present the development of a method specifically designed for the examination of the content and process of communication of genetic information in families. The method aims to maximize ecological validity as far as is possible. We describe how participants and other family members are recruited and how data were collected. We outline three main data analytic strategies: a graphic to show how genetic information changes as it flows from clinic and through the family, an intensive qualitative analysis of the meaning and impact of the genetic information to different family members, and an informative genogram which plots key family dynamics. This method will be illustrated in relation to a study of ten family-groups where one individual has been found to carry a genetic mutation predisposing them to hereditary breast and ovarian cancer.     

Reducing probabilistic weather forecasts to the worst-case scenario: anchoring effects

Many weather forecast providers believe that forecast uncertainty in the form of the worst-case scenario would be useful for general public end users. We tested this suggestion in 4 studies using realistic weather-related decision tasks involving high winds and low temperatures. College undergraduates, given the statistical equivalent of the worst-case scenario (1 boundary of the 80% predictive interval), demonstrated biased understanding of future weather conditions compared with those given both bounds or no uncertainty information. We argue that this was due to an anchoring effect on numeric estimates, which were closer to the worst-case scenario than was warranted and increased linearly as the anchor became more extreme. In many situations tested here, anchoring in numeric estimates also extended to subsequent binary decisions, leading participants with the worst-case scenario to take action more often than did other participants. These results suggest that worst-case scenario forecasts can mislead the user. They appear to convince people that wind speeds will be higher and temperatures will be lower than what are indicated by the forecast. In addition, participants systematically "corrected" the forecast they were given. This effect was most prominent in the condition in which no uncertainty was provided, suggesting that people feel compelled to take uncertainty into account, even when it is not acknowledged by the forecast. Both the anchoring and correction biases were least evident when both bounds were provided, suggesting that balanced uncertainty leads to the best understanding of future weather conditions.     

A Protection Motivation Theory application to date rape education

Date rape risk communication is a key component of education-based Date Rape Prevention Programs, common across colleges. In such programs, risk assessment in date rape is approached cautiously in order to avoid a tone of "victim blaming." Since it is important in the assessment of any risk to understand the surrounding social context of the risky situation and the individual's unique relationship with that social context, this study examines Protection Motivation Theory as it applies to handling the risk of date rape without victim blaming. The paper links individual personality and social contexts with risk communication. The study sample comprised 367 undergraduate women enrolled in a large Southern Public University. The study examines the relationships between dating activity, social competency, and type of information provided with the dependents variables of date rape related protection behavior (intent), belief, and knowledge. A factorial multiple analysis of covariance analysis found that the dependent variables had a significant relationship with aspects of social competency and dating activity. The exposure to varying information about date rape was not significantly related to the dependent variables of date rape-related protection behavior (intent), belief, and knowledge. The identification of social competency and dating activity status as protective factors in this study makes a significant contribution to the practice and research efforts in date rape education.     

Design of the Steps to Health Study of Physical Activity in Survivors of Endometrial Cancer: Testing a Social Cognitive Theory Model

Physical activity has been shown to benefit cancer survivors' physical functioning, emotional well-being, and symptoms. Physical activity may be of particular benefit to survivors of endometrial cancer because they are more likely to be obese and sedentary than the general population, as these are risk factors for the disease, and thus experience a number of related co-morbid health problems. However, there is little research systematically studying mechanisms of physical activity adherence in cancer survivor populations. This paper describes the design of the Steps to Health study, which applies a Social Cognitive Theory-based model of endometrial cancer survivors' adoption and maintenance of exercise in the context of an intervention to increase walking or other moderate intensity cardiovascular activity. In Steps to Health we will test the influence of self-efficacy and outcome expectations on adherence to exercise recommendations, as well as studying the determinants of self-efficacy. Endometrial cancer survivors who are at least 6 months post-treatment are provided with an intervention involving print materials and telephone counseling, and complete assessments of fitness, activity, self-efficacy and outcome expectations, and determinants of self-efficacy every two months for a six month period. In addition to testing an innovative model, the Steps to Health study employs multiple assessment methods, including ecological momentary assessment, implicit tests of cognitive variables, and ambulatory monitoring of physical activity. The study results can be used to develop more effective interventions for increasing physical activity in sedentary cancer survivors by taking into account the full complement of sources of self-efficacy information and outcome expectations.