Projective identification as a communication its grammar in borderline psychotic children

This paper distinguishes between the grammar of wishes in neurotic patients and the grammar of imperative needs in borderline patients. The treatment of a borderline psychotic boy 30 years ago was uninformed by subsequent developments in technique arising from the theory of projective identification as a communication rather than as an attack or a defense. Issues that need addressing in borderline patients, especially those who are children, include (a) developmental delay, (b) the distinction between defenses and overcomings in the paranoid position, (c) rectification fantasies of vengeance, and (d) rectification fantasies of justice and other moral imperatives.     

Negotiating Religious Differences: The Strategies of Interfaith Chaplains in Healthcare

Chaplains in healthcare increasingly work in interfaith roles with patients and families from a range of religious and spiritual backgrounds. Some move with ease between their own religious backgrounds and those of the individuals with whom they work. Others encounter tensions as their status as a person of faith comes into conflict with their status as an interfaith chaplain. We explore the two main strategies—neutralizing and code‐switching—chaplains at one large academic medical center use when working with patients and families whose religious and spiritual backgrounds are different from their own. Through training in clinical pastoral education and experiences on the job, chaplains learn to neutralize (use a broad language of spirituality that emphasizes commonalities rather than differences) and to code‐switch (use the languages, rituals, and practices of the people with whom they work). To the extent that the strategies evident here are present among chaplains in a broader range of institutional settings, they suggest a kind of spiritual secularism or broad approach to meaning makings that may be facilitated by interfaith chaplains in a range of settings.     

Cross-Ethnic Measurement Equivalence of the RCMAS in Latino and White Youth With Anxiety Disorders

In normal vision, the various “gestalt-free” combinations which form early in a percept, are repressed by the emergence of the veridical composite perception; but in schizophrenic vision, with its inadequate repressive powers, the early combinations emerge as the completed composite. This completed composite, if at all veridical, is so only partially. Rorschach studies support the idea of a range of perceptual abortions among schizophrenics, varying directly with the process-reactive range.     

Constructive Thinking and Firm Disagreement Versus Neuroticism and Mild Agreement: Asymmetric Correlations of Content and Response Measures

All correlations among the principal content and response option measures of Costa and McCrae's (1985) NEO-Personality Inventory (NEO-PI) and Epstein and Meier's (1989) Constructive Thinking Inventory (CTI) were surveyed in data from 303 university students. A bipolar cluster of adjustment-related scales, anchored by CTI Constructive Thinking versus NEO-PI Neuroticism (r = -.74), undergirded the 12 content scales' intercorrelations. Assenting and dissenting responses correlated positively across inventories and within firm, moderate, and neutral categories but correlated negatively across those categories. The content scales had notably asymmetric but consistently coherent associations with response options, strongest but opposite with firm dissent and mild assent and clearly weaker with firm assent, mild dissent, and noncommittal options. Findings indicate that response styles have psychological meanings that merit increased attention.     

Constructive Thinking and Elevated Ratings of Self in Interpersonal Groups

Probing Taylor and Brown's (1988) connection of mental health with favorably slanted self-evaluations, responses to Epstein's (1987) Constructive Thinking Inventory (CTI) were correlated with ratings of interpersonal behavior. Several weeks after completing the CTI, 103 small-group members rated themselves and each other for self-accepting and other-accepting conduct. Separately for each acceptance scale, eight CTI measures were correlated with differences of self-ratings (S) from the mean rating individuals' received (R) from others, the mean rating each gave (G) to these others, and all components. Agreeing substantially, indicators S and R also correlated with the CTI measures similarly but in a pattern opposite to G's correlations. Supporting Taylor and Brown, 12 of 16 correlations of CTI measures with intrarater (S – G) differences attained statistical significance (p < .05) unlike any parallel correlation with interrater differences (S – R). Constructive thinking and rating oneself above peers—especially for acceptance of self—consistently correlated positively, suggesting an underlying sense of independence.     

The Puzzle of Regional Brain Activity in and Anxiety: The Importance of Subtypes and Comorbidity

The literature on brain activity in depression and anxiety is reviewed with an on highlighting discrepancies and inconsistencies. In particular, and posterior asymmetries have been reported for both depression anxiety, but the magnitude and direction of these asymmetries has been We propose that by identifying subtypes of depression and anxiety of these inconsistencies can be explained. In addition, we review suggesting that issues of comorbidity are important to consider in to account for regional brain activity in depression and anxiety.     

Behavioral Skills Training With Teachers: Booster Training for Improved Maintenance

Behavioral skills training (BST) has been employed within many different populations for the reduction of problem behaviors and acquisition of new skills; however, these changes have not always maintained over time. This study evaluated the effects of a booster training for re-establishing the classroom management proficiencies that teachers had acquired previously, but had declined over a 12-month period. The single-subject experimental results showed the booster training to be effective in re-establishing teacher performance of skills as measured by both analogue role-play and in situ postassessments within the classroom. These findings suggest that a booster training utilizing BST may be an important strategy for maintaining skill performance over time.     

Treating PTSD in active duty service members using cognitive processing therapy or prolonged exposure therapy: Examining everyday practice at a military outpatient clinic

The Institute of Medicine has stressed the need for evaluations of evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD) among active duty service members (AD) using a variety of evaluation approaches (Institute of Medicine, 2012). The current study examined the clinical files of 134 service members who completed treatment for PTSD using either prolonged exposure (PE) or cognitive processing therapy at an outpatient clinic. At the completion of each session, therapists made a clinical rating as to whether or not the session was protocol adherent. The total number of treatment sessions and the proportion of sessions rated as being protocol adherent were calculated. Multi-level models estimated the change in patient PTSD and other psychological symptoms over time as a function of clinician-rated protocol adherence and total number of sessions. Approximately 65% of clinic encounters were rated by therapists as being protocol adherent. Significant reductions in PTSD and psychological symptoms were associated with protocol adherence, and this was particularly true for patients who began treatment above clinical thresholds for both PTSD and other psychological symptoms. However, as the number of sessions increased, the impact of protocol adherence was attenuated. Patient characteristics, including gender, ethnicity, and co-morbidity for other psychiatric disorders were not related to symptom change trajectories over time. These findings suggest that protocol adherence and efficiency in delivery of EBTs for the treatment of PTSD with AD is critical.     

Gender-Moderated Dorsolateral Prefrontal Reductions in 22q11.2 Deletion Syndrome: Implications for Risk for Schizophrenia

To investigate the impact of the microdeletion on morphology of the prefrontal cortex in 22q11.2 Deletion Syndrome (22q11.2 DS), high-resolution, anatomic magnetic resonance imaging was performed on 19 children and adolescents with 22q11.2 DS (11 females, 8 males) and 18 unaffected controls (10 females, 8 males). Tissue volumes of the dorsolateral, dorsomedial, orbitolateral, and orbitomedial prefrontal cortex were measured. Tasks of executive function and working memory were administered to investigate the association between anatomy and function. Whole brain volume and frontal lobe tissue volume were preserved in girls but reduced in boys with 22q11.2 DS relative to age-matched controls. Dorsolateral prefrontal cortex (DLPFC) volumes were reduced in participants with 22q11.2 DS, although the gender-by-diagnosis effect found for frontal lobe was not as robust for DLPFC. DLPFC volumes were associated with performance on tasks of planning and emotional facial recognition. Longitudinal studies are needed to clarify whether gender differences in frontal lobe and DLPFC persist with development, and whether the volumes of the DLPFC are associated with eventual deterioration in adaptive/psychosocial function that may presage the onset of schizophrenia, for which individuals with 22q11.2 DS are at a disproportionately high risk.     

Spearman's law of diminishing returns: A statistical artifact?

Spearman's Law of Diminishing Returns (SLODR) is the idea that the structure of human cognitive ability is more differentiated and g a weaker determinant of cognitive performance at higher levels of ability. In this study, we distinguish between ‘traditional’ methods of testing SLODR and ‘contemporary’ methods of testing SLODR. It is the former set of methods from which the vast majority of the evidence base for SLODR derives. We demonstrated that it is easy to mimic SLODR and reverse SLODR effects in these traditional methods of assessing SLODR by using data with skewed observed variable distributions. The skewness magnitudes did not need to be large to produce these effects and they fell well within the range of values that are usually considered unproblematic for parametric statistic analysis. In simulated datasets, positive subtest skewness resulted in SLODR and negative subtest skewness resulted in reverse SLODR. In contemporary methods of testing SLODR, non-linear g-loadings or a skewed g are assumed to reflect evidence for SLODR. When we applied contemporary methods of testing SLODR to these data, there was evidence of heteroscedastic residuals but no evidence of non-linear g-loadings or skewed g distributions. We broadly replicated the effects of subtest skew from these simulated datasets in real data from the Minnesota Study of Twins Reared Apart. Results imply that traditional methods of assessing SLODR cannot distinguish between effects due to subtest characteristics that have nothing to do with differences in ability structure at different levels of g and true SLODR effects. This calls into question the empirical support for SLODR.