El papel de los procesos de atribución en la conformidad y el disentimiento: Reencontrando la situación de Asch

RESUMEN

El presente artículo reexamina la situación de los experimentos sobre conformidad de Asch. La situación experimental propuesta procura ser más representativa del modo en el que las presiones a la conformidad actúan fuera del laboratorio, definiendo tres condiciones que permiten distintas atribuciones. Los resultados apoyan las hipótesis de partida, destacando que la condición experimental que reproduce la situación de Asch permite menos inconformismo y menos confianza entre los disconformes que las otras dos, y entre éstas, la situación en la que debían postularse diferencias de prioridades en los evaluadores para explicar la propia disidencia era menos propicia para el inconformismo y la confianza en el criterio propio. Finalmente se discuten las implicaciones del experimento sobre las presiones a la conformidad y los procesos de atribución.     

Women–Focused Treatment Agencies and Process Improvement: Strategies to Increase Client Engagement

Behavioral health treatment agencies often struggle to keep clients engaged in treatment. Women clients often have additional factors such as family responsibilities, financial difficulties, or abuse histories that provide extra challenges to remaining in care. As part of a national initiative, four women-focused drug treatment agencies used process improvement to address treatment engagement. Interviews and focus groups with staff assessed the nature and extent of interventions. Women-focused drug treatment agencies selected relational-based interventions to engage clients in treatment and improved four-week treatment retention from 66% to 76%. Process improvement interventions in women-focused treatment may be useful to improve engagement.     

From Enemy Combatant to Strange Bedfellow The Role of Religious Narratives in the Work of W. R. D. Fairbairn and D. W. Winnicott

Psychoanalysis has a well-documented history of antipathy toward religion. As a consequence of the postmodern shift in philosophy, however, there are those who, albeit cautiously, are attempting to approach religion with a renewed spirit of dialogue and inquiry as a narrative among many narratives that has informed and even enriched the development of psychoanalysis.

In this spirit of dialogue, the author traces the influence of early religious affiliations on two object relations theorists, W. R. D. Fairbairn and D. W. Winnicott. Fairbairn's early imbibing of Calvinist theology in Scotland and Winnicott's involvement in the Wesleyan church are detailed. The theological differences between these Protestant perspectives (which form counterpoints to one another) are clarified and the perspectives are positioned within the framework of British culture. These religious themes are then identified within the works of Fairbairn and Winnicott.

As a final consideration, the relational nature of the Judeo-Christian God, and the subsequent view of human life that flows from that theology, are posited as influential in the development of the relational shift in psychoanalysis. The author details the association between this shift and the seminal work of Fairbairn and Winnicott.     

Therapeutic Passion in the Countertransference

The place of the analyst's “influence” in psychoanalytic theory and practice is explored. There is a current in the literature in which it is welcomed as an aspect of “corrective experience,” although usually legitimized by being forced into the narrow channel of interpretation and understanding. A taboo on influence persists despite theoretical shifts that would seem to clear the way for greater acceptance of its importance. Among other factors, the aversion to influence is traced to its association with hypnotic “suggestion,” which implies little room for the patient's autonomy. Opening the door to embracing the possibility of influence goes hand in hand with, on one hand, the analyst respecting the patient as a competent free agent and, on the other hand, the analyst combining willingness to take a stand with willingness to reflect critically on his or her participation. In that context, and with those caveats, the analyst takes on the responsibility to combat destructive introjects and to become an inspiring, affirmative presence in the patient's life. The analyst's passion for the patient's well-being and for changes that entail the realization of dormant potentials now has its place. Different kinds of expression of therapeutic passion in the countertransference are described and illustrated.     

Response to Layton: Considering the Sociopolitical Context of Dialectical Constructivism

What is commonly missing from psychoanalytic formulations, including my own, that Lynne Layton rightfully challenges us to correct is the locating of the possible dysfunctionality of the individual and the family within the context, not just of a brutally indifferent universe but also of an arguably brutally indifferent economic, political, and institutional environment. I differ with Layton in that I am more prepared to consider possible universals that bear on human experience and moral standards. For example, I would say that “reflection on the foundations of knowledge” trumps nonreflective fundamentalist thinking in capturing the best attitude to assume towards pursuit of truth. Also, the universality of the human tendency to deny death may underlie many diverse cultural belief systems. Nevertheless, Layton challenges us to reflect on how conventional psychoanalytic practices may collude with aspects of our own culture we would do well to try to combat, in ourselves and in our patients, through owning and proactively exercising our moral influence.     

At Death's Door: Therapists and Patients as Agents

This paper explores the interrelationship between patients' exercise of will to make advances in an analysis and their readiness to forgive their analysts for their human limitations. There is a thin line between idealization of the analyst, probably a necessary component of the process, and resentment of the analyst for his or her privileged position in the world and in the analytic situation itself. The patient's “progress” emerges as a kind of reparative gift, one that implicitly overcomes the patient's tendency to withhold such change out a sense of chronic, malignant envy. Particularly poignant in terms of its potential to elicit the patient's reparative concern is the situation in which the analyst is struggling with his or her mortality because of aging or life-threatening illness. In this essay two clinical vignettes are presented to illustrate some of the issues that this situation poses. One begins with an elderly patient appearing at the door of the analyst's (the author's) home the day of his return from the hospital after coronary bypass surgery. The other begins with an analyst who is terminally ill appearing at the door of a patient who is threatening suicide. The two stories are compared in terms of their implications for human agency, the exercise of will, and the coconstruction of meaning in the face of mortality in the analytic process.     

Pediatric Sub-specialist Controversies in the Treatment of Congenital Heart Disease in Trisomy 13 or 18

Trisomy 13 and 18 are associated with congenital heart disease. Cardiac palliation has been reported in the literature, but is not usually done in this population. Thus, a multi-disciplinary team may experience controversy in formulating a care plan that includes cardiac intervention. Our objective was to determine differences in recommendations for cardiac intervention in this population between physicians specializing in pediatric cardiac critical care, neonatology, and genetics. A web-based survey was performed between April 2007 and August 2008. This survey evaluated surgical and transcatheter cardiac palliations that had been performed for individuals with trisomy 13 or 18 at the respondent’s institution, the respondent’s recommendations for cardiac intervention in hypothetical symptomatic patients with trisomy 13 or trisomy 18 and the influence of parental preference on these recommendations. Eight hundred fifty-nine responses were obtained from a primarily academic practice setting (59%). Cardiologists were most likely to recommend intervention; low risk interventions were recommended by 32% of cardiologists, 7% of neonatologists and 20% of geneticists. Parental request to intervene resulted in a 3 fold increased in the likelihood of all specialist recommending intervention. Counseling of families frequently occurred by multiple sub specialists (50%) and there was frequently (71%) a difference in opinion. Individuals with trisomy 13 or 18 are receiving cardiac intervention at many institutions. Cardiologists were more likely than geneticists or neonatologists to recommend intervention on all heart lesions other than single ventricle palliation which no specialists recommended. Parental wishes that “everything be done” significantly influenced all specialists’ recommendations.     

Parental burden associated with borderline personality disorder in female offspring

To identify aspects of parental burden associated with borderline personality disorder (BPD), an anonymous internet survey linked to BPD support websites was developed for parents to complete on their BPD offspring and unaffected siblings. The questions cover aspects of the child's life from pregnancy through young adulthood, and query about the impact of the child's BPD on six domains of the parent's life, including physical and emotional health, marriage, job, standard of living, social life, and career trajectory. Additionally, financial burden was assessed with questions pertaining to insurance and out-of pocket costs associated with the BPD disorder. BPD offspring were identified by meeting diagnostic criteria embedded within the survey and having been given a diagnosis of BPD by a professional at some point in their life. We report on 233 female offspring meeting strict criteria for BPD. Parents of daughters with BPD endorsed varying levels of impact on the six domains comprising burden with the largest impact on emotional health which was impacted in over 88% of the respondents. Over 50% of parents endorsed four or greater of the six burden items. Particular aspects of the offspring's BPD symptom profile correlated with intensity of parental burden included including problems in adolescence with acting out behavior (p < .000), property destruction (.003), delusional symptoms (.007), and hallucinatory symptoms (.008). A subgroup of respondents provided data on specific financial expenses. The average and median out-of-pocket expense was $60,087, and $10,000. Insurance costs totaled an average of $108,251 with a mean of $20,000. The average cost per year after diagnosis was $14,606 out-of-pocket and $45,573 billed to insurance. The median cost per year after diagnosis was $3,667 out-of-pocket, and $12,500 billed to insurance. After adjusting for household income, a female proband who had been raped incurred roughly $40,000 more in BPD-related costs, while a diagnosis of conduct disorder led to about $50,000 in additional costs. Parents of female offspring with BPD experience burden in multiple domains of their life and many have incurred substantial financial expense. Increasing awareness of co-morbid conditions in the BPD proband that significantly increase parental burden may be indicators for the provision of increased family support.     

Adaptive disclosure: an open trial of a novel exposure-based intervention for service members with combat-related psychological stress injuries

We evaluated the preliminary effectiveness of a novel intervention that was developed to address combat stress injuries in active-duty military personnel. Adaptive disclosure (AD) is relatively brief to accommodate the busy schedules of active-duty service members while training for future deployments. Further, AD takes into account unique aspects of the phenomenology of military service in war in order to address difficulties such as moral injury and traumatic loss that may not receive adequate and explicit attention by conventional treatments that primarily address fear-inducing life-threatening experiences and sequelae. In this program development and evaluation open trial, 44 marines received AD while in garrison. It was well tolerated and, despite the brief treatment duration, promoted significant reductions in PTSD, depression, negative posttraumatic appraisals, and was also associated with increases in posttraumatic growth.