Transference Focused Psychotherapy for Patients with Comorbid Narcissistic and Borderline Personality Disorder

Clinical experience involving the treatment of patients with comorbid borderline and narcissistic personality disorders suggests that this patient population is among the more difficult to treat within the personality disorder spectrum. In this article, we present refinements of Transference Focused Psychotherapy (TFP) based on our clinical experience with and research data on patients with comorbid narcissistic personality disorder/borderline personality disorder (NPD/BPD). We briefly review object relations formulations of severe narcissistic pathology, as well as recent research in attachment and the allied concept of mentalization, which have provided a new lens through which to view narcissistic disorders. The research findings from two randomized clinical trials demonstrating the efficacy and effectiveness of TFP are presented. The data from the two Randomized Clinical Trials (RCT) allowed for the study of the characteristics of the subgroup of borderline personality disorder patients who have comorbid NPD/BPD. Findings on comorbidity, attachment status, capacity for mentalization, and level of personality organization of borderline patients with comorbid NPD/BPD, compared with borderline patients without comorbid narcissistic pathology (BPD), are presented. Clinical implications of the observed group differences are discussed, with a focus on refinements in the technique of TFP. Clinical case material is presented to illustrate the specific challenges posed by narcissistic patients to carrying out TFP in each phase of treatment.     

Processing of non-canonical word-order: A case-series on lesion-induced reorganized language and age-effects in typical development

Complex grammatical structures are mastered late in language acquisition. We studied age-effects on performance in object topicalization in 48 typically developing German-speaking participants (aged 8–30 years) and in five patients (children and adolescents) with lesion-induced atypical language representation. Production was tested by a sentence repetition task, comprehension by an acting out task. Three topicalized conditions with differing disambiguation (agreement, case, and case plus agreement) were contrasted with canonical control sentences.     

Language aptitude for pronunciation in advanced second language (L2) Learners: Behavioural predictors and neural substrates

Individual differences in second language (L2) aptitude have been assumed to depend upon a variety of cognitive and personality factors. Especially, the cognitive factor phonological working memory has been conceptualised as language learning device. However, strong associations between phonological working memory and L2 aptitude have been previously found in early-stage learners only, not in advanced learners. The current study aimed at investigating the behavioural and neurobiological predictors of advanced L2 learning. Our behavioural results showed that phonetic coding ability and empathy, but not phonological working memory, predict L2 pronunciation aptitude in advanced learners. Second, functional neuroimaging revealed this behavioural trait to be correlated with hemodynamic responses of the cerebral network of speech motor control and auditory-perceptual areas. We suggest that the acquisition of L2 pronunciation aptitude is a dynamic process, requiring a variety of neural resources at different processing stages over time.     

Reactive cognitive-control processes in free-report consonant–vowel dichotic listening

The relevance of cognitive-control processes has been frequently discussed and studied in the context of dichotic listening. Experimental and clinical studies indicate that directing attention to either of the two simultaneously presented phonological stimuli, but especially to the left-ear stimulus increases the requirements for cognitive-control processes. Here, we extend this view by reporting the results of a behavioural and a functional magnetic-resonance imaging (fMRI) experiment designed to analyse the involvement of cognitive-control processes also in a free-report dichotic-listening paradigm. It was hypothesised that dichotically presented pairs of stop–consonant–vowel syllables would provide different demands for cognitive-control processes as a function of the spectro-temporal overlap of the two stimuli. Accordingly, in Experiment 1 it was shown that dichotic syllables of high (e.g., /ba/ and /ga/) as opposed to low spectro-temporal overlap (e.g., /ba/ and /ka/) produce significantly faster and more correct answers, and are more often perceived as one syllable. In Experiment 2 it was further shown that pairs of low as compared to high spectro-temporal overlap trigger a more pronounced activation predominately in left-hemispheric, speech-associated brain regions, namely left posterior inferior sulcus/gyrus, bilaterally in pre-supplementary motor and mid-cingulate cortex as well as in the inferior parietal lobe. Taken together, behavioural and functional data indicate a stronger involvement of reactive cognitive control in the processing of low-overlap as opposed to high-overlap stimulus pairs. This supports the notion that higher-order, speech-related cognitive-control processes also are involved in a free-report dichotic-listening paradigm.     

Magnitude and determinants of behavioral risk reduction: Longitudinal analysis of a cohort at risk for AIDS

The magnitude and predictors of longitudinal behavioral change are reported in a cohort of homosexual men at risk for AIDS. Self-reports of sexual behavior were obtained at two points in time separated by an interval of approximately six months. These self-reports were used to construct both dichotomous and continuous measures of changes in behavior consistent with reduction in the transmission of the AIDS virus (HIV). Although there was considerable variability in behavior. mean changes were consistently in the desired direction. Avoidance of anonymous sexual partners, monogamy, and modification of receptive anal sex to reduce exposure to semen by condom use or withdrawal prior to ejaculation appeared to be especially important in this cohort. Both multiple linear regression and multiple logistic regression were used to examine the relationship between a model of health behavior and these outcomes. Variables examined included knowledge of AIDS. perceived risk of AIDS. the perceived efficacy of behavior in reducing AIDS risk, difficulties with sexual impulse control, belief in biomedical technology to provide a prevention or cure, social norms supportive of behavioral change, and gay network affiliation. Of all these factors, only the availability of supportive peer norms was consistently, significantly and positively related to multiple measures of outcome. Differences between these analyses and longitudinal analyses reported elsewhere are discussed. These results suggest the policies regarding HIV antibody testing should be developed cautiously. taking account of the failure of a sense of risk to predict subsequent behavioral change. They also emphasize the important role of gay organizations in developing social norms supportive of behavioral risk reduction.     

Individual Differences in Early Scientific Thinking: Assessment,Cognitive Influences,and Their Relevance for Science Learning

ABSTRACT

Early scientific thinking in kindergarten (6-year-olds) was investigated in a large study involving 227 participants. We investigated (1) whether individual differences across 3 scientific-thinking components (experimentation, data interpretation, and understanding the nature of science) are stable across children, (2) whether children’s increased information-processing skills (intelligence, language abilities) and their development of an advanced theory of mind (AToM) are potential mechanisms that bring about individual differences in scientific thinking, and (3) whether individual differences in scientific thinking predict individual differences in science content knowledge. Using a newly developed instrument with 30 items (the Science-K inventory), we found that a one-dimensional Rasch model provides a good fit to the data, showing that kindergarteners’ scientific thinking goes beyond competencies in single tasks. Individual differences across the diverse scientific-thinking tasks were stable, and children’s scientific thinking was correlated with their intelligence and their language abilities. AToM was an important precursor for scientific thinking, predicting it independently from the influences of information-processing skills. Children’s science content knowledge was predicted by their score on the Science-K inventory. This finding points to a specific relation between these 2 components of scientific literacy, and it supports the view that scientific-thinking skills help to better test and revise (wrong) beliefs and misconceptions about science. Our study is the first to reveal substantial individual differences in scientific thinking in children as young as kindergarteners, and it shows that scientific thinking is important for a successful learning of science concepts, even before children enter formal schooling and begin science education.     

The Imperatives of Narrative: Health Interest Groups and Morality in Network News

This article examines some of the story conventions of network television news to explain the ways in which healthcare interest groups develop and maintain their presence in this medium—a process that has significant implications for public understanding of healthcare issues, and therefore to bioethics. The article is divided into three sections. The first section focuses on three major normative conventions of television news: adherence to a simple narrative structure, the balance ethic, and avoidance of the “think-piece” and outlines the basic strategies available to interest groups for exploiting these normative conventions. Section two introduces three case studies of organizations and individuals who have run high-profile media campaigns. Section three explores the implications for bioethics of the observations made in this article.     

Normal face-based judgements of social characteristics despite severely impaired holistic face processing

Initial evidence indicates that face-based judgements of socially relevant characteristics such as people's trustworthiness or attractiveness are linked to the configural/holistic processing of facial cues. What remains a matter of debate, however, is whether such processing is actually necessary for normal social judgements to occur and whether it resembles the type of integrative processing as required for facial identification. To address these issues, we asked a well-characterized case of acquired prosopagnosia (PS) with a marked deficit in holistic processing for face identity to rate a series of faces on several dimensions of social relevance. PS provided ratings within the normal range for most of the social characteristics probed (i.e., aggression, attractiveness, confidence, intelligence, sociability, trustworthiness). Her evaluations deviated from those of healthy controls only when facial dominance was concerned. Taken together, these data demonstrate that the inability to integrate facial information during face individuation does not necessarily translate into a generalized deficit to evaluate faces on social dimensions.