On shame,countertransference, and analytic style

Some analysands experience a restricted space in the analytic situation with special counter-transferential consequences. The author discusses how shame is involved in these situations, and projected on to the analyst. This leads to an important choice of direction for the analyst regarding counter-transference acting out or conditions for a real analytic situation. Shame plays a special rôle in these choices of direction. The author illustrates the problem with a clinical vignette and shows how integration of shame is accomplished clinically, and continues with a discussion of the connections between the analyst's analytic style, his own communicative style as a defense against shame and the analytic styles of different analytic “schools”. A discussion of Liberman's concept, of “asymmetrical dialogue” and its connection with countertransference acting out and analytic styles, forms a conclusion to the paper.     

Guidance of attention by information held in working memory

Information held in working memory (WM) can guide attention during visual search. The authors of recent studies have interpreted the effect of holding verbal labels in WM as guidance of visual attention by semantic information. In a series of experiments, we tested how attention is influenced by visual features versus category-level information about complex objects held in WM. Participants either memorized an object’s image or its category. While holding this information in memory, they searched for a target in a four-object search display. On exact-match trials, the memorized item reappeared as a distractor in the search display. On category-match trials, another exemplar of the memorized item appeared as a distractor. On neutral trials, none of the distractors were related to the memorized object. We found attentional guidance in visual search on both exact-match and category-match trials in Experiment 1, in which the exemplars were visually similar. When we controlled for visual similarity among the exemplars by using four possible exemplars (Exp. 2) or by using two exemplars rated as being visually dissimilar (Exp. 3), we found attentional guidance only on exact-match trials when participants memorized the object’s image. The same pattern of results held when the target was invariant (Exps. 2–3) and when the target was defined semantically and varied in visual features (Exp. 4). The findings of these experiments suggest that attentional guidance by WM requires active visual information.     

Understanding communicative intentions and semiotic vehicles by children and chimpanzees

Developmental and comparative studies of the ability to understand communicative intentions using object-choice tasks raise questions concerning the semiotic properties of the communicative signals, and the roles of rearing histories, language and familiarity. We adapted a study by Tomasello, Call, and Gluckman (1997), in which a “helper” indicated the location of a hidden reward to children of three ages (18, 24, and 30 months) and to four chimpanzees, by means of one of four cues: Pointing, Marker, Picture and Replica. For the chimpanzees, we controlled for familiarity by using two helpers, one unfamiliar and one highly familiar. Even 18-months performed well on Pointing and Marker, while only the oldest group clearly succeeded with Picture and Replica. Performance did not correlate with scores for the Swedish Early Communicative Development Inventory (SECDI). While there were no positive results for the chimpanzees on the group level, and no effect of familiarity, two chimpanzees succeeded on Pointing and Marker. Results support proposals of a species difference in understanding communicative intentions, but also highlight the need to distinguish these from the complexity of semiotic vehicles and to consider both factors.     

Development of a new fear of hypoglycemia scale: FH-15

Hypoglycemia is the most common adverse event associated with insulin treatment in diabetes. The consequences of hypoglycemia can be quite aversive and potentially life threatening. The physical sequelae provide ample reason for patients to fear hypoglycemia and avoid episodes. For these reasons, our purpose in this study was to develop a new measure that explores specific fear of hypoglycemia (FH) in adult patients with type 1 diabetes and to examine its psychometric properties. The instrument developed to assess FH was initially made up of 20 items, of which 18 were negative and 2 were positive, assessed on a 5-point Likert scale (1-5). This scale was completed by 229 patients with type 1 diabetes. Additionally, a structured interview and a closed question called subjective fear of hypoglycemia were included as diagnostic criteria. A factor analysis employing the principal-components method and promax rotation was carried out, resulting in a new scale composed of 15 items. Three factors (fear, avoidance, and interference) were obtained and explained 58.27% of the variance. The scale showed good internal consistency (Cronbach's α = .891) and test-retest reliability (r = .908, p < .001), as well as adequate concurrent and predictive validity. The cutoff score that provided the highest overall sensitivity and specificity was set at 28 points. The Fear of Hypoglycemia 15-item scale (FH-15) demonstrated good reliability and validity. This study suggests that the new instrument may serve as a valuable measure of specific FH for use in research and clinical practice.     

Family caregiver's self-perceived health status and its relation to burden

The study aims to analyze how health is self-perceived by a sample of caregivers of dependant relatives and how it compares with general Spanish population scores. The study also focuses on the relations between self-perceived health and burden. The sample comprised 1,257 caregivers living in Biscay who completed the protocol including sociodemographic data, measures of health-related quality of life (SF-36) and burden (Zarit Burden Inventory). Results show that the health perception of the caregivers taking part into the study reached lower scores in comparison to general Spanish population and that this perception was lower in mental than in physical health. Correlational data supports previous findings indicating that high levels of burden are associated with a worse perception of mental and physical health and provide information on how to guide interventions to improve family caregivers' quality of life.     

Accuracy of diagnosis of depression in patients with Type 1 diabetes mellitus

This study assesses the clinical accuracy of physicians (Specialists in Endocrinology and Nutrition: SEN) to make the diagnosis of depression in patients with Type 1 diabetes mellitus (DM1). This study involved 11 SEN physicians, and 153 patients with DM1. The diagnosis of depression was performed using the SCID-1 structured interview and clinical assessment. From the initial sample, 50 patients were randomly selected (imposing the condition that it was included 25 patients with depression and 25 without depression). The results show that clinicians performed a higher percentage of negative diagnoses (patients without depression) than positive ones (patients with depression). A significant percentage of patients with depression were not diagnosed (25%). It therefore seems necessary to provide adequate clinical protocols to evaluate the presence of this disorder in DM1, as well as continuing research into the diagnostic process for clinical decision making.     

Trait complexes and academic achievement: Old and new ways of examining personality in educational contexts

Background . Although recent research has provided evidence for the predictive validity of personality traits in academic settings, the path to an improved understanding of the nature of personality influences on academic achievement involves a reconceptualization of both criterion and predictor construct spaces. Aims . For the criterion space, one needs to consider student behaviours beyond grades and level of educational attainment, and include what the student does among other things outside of the classroom. For the predictor space, it is possible to bring some order to the myriad personality constructs that have been developed over the last century, by focusing on common variance among personality and other non‐ability traits. Methods . We review these conceptual issues and several empirical studies. Conclusions . We demonstrate the possible increments in understanding non‐ability determinants of academic achievement that may be obtained by focusing on areas where there is a theoretical convergence between predictor and criterion spaces.