Re-enactments in their developmental context

The power of the repetition compulsion is felt in an especially keen way during re-enactments within psychodynamic psychotherapy. In this paper, the authors recommend greater attention to the developmental aspects of re-enactments as providing valuable information about the affective character of the crisis being brought to life in the treatment. Specifically, the authors suggest that the current developmental stage of the patient influences the experience and expression of the core developmental conflict that lies at the heart of the re-enactment in the treatment dyad. Re-enactments in childhood, adolescence and young adulthood, as well as at midlife and in the later years, each have different signatures. Thus, increased knowledge and awareness of both developmental stage and developmental core conflict is important for the following reasons: It provides a firmer theoretical foundation for understanding what is, by definition, a formidable moment in treatment; it adds another dimension and thus enhanced flexibility to the clinician’s clinical stance during a time of greater countertransference potential; and it adds to the theoretical perspective that the compulsion to repeat functions, at least in part, as an attempt to master an intrapsychic, affectively charged, previous experience of defeat. Clarifying the developmental nature of re-enactments for both patient and therapist can serve an orienting function during what is often a confusing and destabilizing time in the treatment relationship, and it can help differentiate developmentally appropriate behaviour from re-enacted conflict.     

Role of motivation to respond to provocation, the social environment, and trait aggression in alcohol-related aggression

Little attention has been paid to the motivation to respond to provocation and to the interaction between this motivation, alcohol, the drinking environment, and individual characteristics. Undergraduates at six Canadian universities (N = 1,232) read three vignettes describing conflict situations with social environmental manipulations while imagining themselves as either sober or intoxicated. Self-ratings assessed likelihood of assertive and aggressive responses and motivational indices of anger, offensiveness of the instigator's actions, and importance to respond to the provocation. Respondents also completed a measure of trait aggression. Multi-group structural equation models supported the hypothesis that perceived likelihood of reactive aggression is influenced by perceived alcohol intoxication, gender, trait aggression, social environmental factors, and motivation to respond to the provocation. In addition, a number of interactions were found among the predictors. These results provide insight into the types of factors that may influence aggression in drinking situations.     

Recognition of psychopathology with religious content by clergy members: a case vignette study

Clergy members (CMs) frequently offer support and counselling for people with mental health problems. The current study aims to obtain insight into the ability among CMs to recognise psychopathology and need for psychiatric treatment. A random sample of CMs (N?=?143) and a control sample of mental health professionals (MHPs, N?=?73), were compared as to their evaluations of four vignettes. CMs considered the psychiatric states to be related to religious or spiritual problems to a similar degree as they did for the non-psychiatric states. Sensitivity of CMs with regard to the need of psychiatric care for the psychiatric states was modest (66%) and differed significantly from MHPs (96%). Specificity of the CMs was 89%, which was significantly lower than the MHPs (97%). The CMs did recognise psychopathology with religious content but clearly to a lower extent than MHPs. Requests by CMs for education about recognising psychopathology may be considered as justified.     

The social unconscious in clinical work

An analyst who is unaware of the constraints of social facts and forces will be insensitive to their unconscious recreation within therapeutic situations, and unable to provide space for patients to imagine how their identities have been formed at particular social and political junctures. The concepts of the social unconscious and of equivalence are defined and located within the traditions of Group Analysis and British Object Relations Theory. A model of maturity is outlined, the central element of which is the willingness and ability to take the role of citizen. These ideas are illustrated with clinical vignettes from psychoanalysis and group analysis.     

The changing meaning of sport during forced immigrant youths' acculturative journeys

ObjectivesTo facilitate intercultural understanding by centralizing forced immigrant youths' voices in the knowledge development phase of a community-based participatory action research (CBPAR) project. The aim of this paper is to reveal the role of sport in forced immigrant youths' acculturative journeys in different communities.MethodologyWe utilized ‘get-to-know-you’ arts-based conversational interviews (m time = 38 min) held at the onset of a community-based participatory action research project. A polyphonic (i.e., multi-voiced) vignette is used to portray an interpretive account of the stories told by 22 refugee and asylum seeking (i.e., forced immigrant) youth (m age – 13.4 years) developed through a reflexive thematic analysis.ResultsThe three-scene polyphonic vignette stories the role sport has played, and continues to play, in forced immigrant youths' life journeys. The opening scene brings to light stories related to home country sport involvement. The second scene depicts how sport was engaged in during their journey to their current host community. The third scene completes the story focusing on how youth engage in sport during resettlement in their host Canadian community.ConclusionsThe meaning of sport, and what it means to be safe in sport, changes over the course of forced immigrant youths' acculturative journeys. Feeling safe in sport offers a unique opportunity for youth to feel a sense of sharing their acculturative journey with those around them.     

Development of clinical vignettes to assess healthcare decision-making capacity in elderly with mild cognitive impairment and Alzheimer's disease

IntroductionCognitive impairment can constrict healthcare decision-making capacity, as it affects the ability to understand, appreciate, and reason with information, as well as communication abilities. Therefore, decision-making capacity of elders with mild cognitive impairment or Alzheimer's disease should be carefully assessed when patients are asked to make decisions regarding their health. Vignettes are particularly relevant to assess healthcare decision capacity, since they can come close to real life situations and improve statistical reliability of capacity assessment instruments.ObjectiveThis paper describes the construction and development process of three hypothetical vignettes, to be included in a new Portuguese assessment tool of healthcare decision-making capacity (CAI-Health).MethodFor vignettes’ development, examples from other assessment tools were first reviewed to summarize their text length, language complexity and health information contained. Most prevalent causes of mortality and morbidity in Portuguese elders were then identified, in order to select the health issues to include in CAI-Health’ vignettes. Seven vignettes were developed, and three were selected to be included in CAI-Health. After vignette's selection, these were reviewed by three experienced medical experts, during a focus group.ConclusionVignettes final version include cases of increased complexity, presenting situations of mild cognitive impairment, lung tumor and knee arthrosis.