Relational-Cultural Practice: Working in a Nonrelational World

SUMMARY

While more and more clinicians are practicing a relational-cultural approach to therapy, many work in settings that continue to reinforce the normative values of separation and disconnection. Consequently, practitioners face the challenges of helping clients heal and grow-through-connection while navigating work settings that are all too often professionally disempowering, disconnecting, and isolating, i.e., “cultures of disconnection.” This article begins a conversation about the complexities of practicing Relational-Cultural Theory in nonrelational work situations and explores new possibilities for creating movement and change in these settings.     

The Welch Emotional Connection Screen: Adapting observational methods to pediatric primary care via resident training

The Welch Emotional Connection Screen (WECS) is a novel instrument that is a brief, practicable, evidenced-based observational screening tool for assessing relationship health between parent and child. The WECS requires observing 2−3 min of face-to-face interactions between parent and child, without toys, prompts, paradigms or technology. Here, we describe a translational project from the coding lab to the primary care provider via a residency training program conducted with 50 residents during a 30-day developmental and behavioral pediatrics medical resident education rotation. The aims of this study were to evaluate the efficacy of WECS pediatric resident training: 1) to improve residents' accuracy in recognizing the dyadic behaviors of emotional connection (EC) via WECS training; and 2) to improve residents' attitudes, self-efficacy, and perceived professional norms (ASPPN) pertaining to Early Relational Health in Pediatrics. Results indicate that using a rapid prototyping approach to training, residents improved in their identification of dyads showing low to midrange levels of emotional connection. As well, resident attitudes about the importance of relationship health in pediatrics and their self-efficacy in identifying emotional connection improved significantly after this brief resident training.     

Affective commitment,trust, and the psychological contract: contributions matter,too!

ABSTRACT

Employees’ receipt of inducements is associated with trust and affective commitment, and employees pay for their inducements with their contributions (e.g., time, and physical and intellectual effort). Yet this relationship does not fully mirror events as they occur in an employment relationship where employees’ promises and delivery of inducements and contributions are ongoing, and relatively continuous. Our premise is that promising and delivering contributions may enhance or reduce employees’ trust in and commitment to the organization depending on how well they fulfill psychological needs. We tested a social exchange theory model and our alternative model. Survey results favoured our alternative model and suggested that employees’ contributions were related to trust and commitment, independent of the role of inducements. Tests of the social exchange model exhibited worse fit to the data. Breach and fulfilment results from polynomial regression and response surface analyses revealed that commitment was higher when delivered contributions equal promised contributions and declined when delivered amounts were deficient of, or exceeded, promised amounts. Employees’ promised and delivered contributions to organizations may constitute a path to their feelings of commitment, but commitment was highest when delivered contributions were within close range of promised amounts.     

Telling the Truth About Power

SUMMARY

In this culture, those in power do not usually talk about it and the rest of us tend not to recognize it either. A similar situation exists in therapy, where the therapist herself may not be aware of her own power-over tactics. This article suggests methods that may help therapists to acknowledge their power and also to change from power-over actions to mutually empowering relationships. From this line of thinking, there follows an exploration of altering the concept of boundaries in therapy into mutually constructed agreements between patient and therapist. This article was presented at the Summer Training Institute of the Jean Baker Miller Training Institute, June, 2003.     

Facets of the NEO-PI-R and smoking cessation

Knowing more about the personality of smokers may help to increase the effectiveness of smoking cessation treatments and can contribute to relapse prevention. The aim of the present study was to analyze the influence of 30 specific facets of the Five-Factor Model of personality on the outcomes at the end of treatment and at 12-month follow-up, in a sample of 281 smokers seeking psychological treatment to stop smoking. Personality facets were assessed with the Revised NEO Personality Inventory (NEO-PI-R). Results showed that nicotine dependence and several facets of personality (Self-discipline, Depression, Aesthetics, Trust, and Modesty) contribute to explain short- and long-term outcomes after smoking cessation. These findings support the need of integrate information about individual smoker’s personality facets into smoking cessation programs.     

Valuing Vulnerability: New Definitions of Courage

SUMMARY

In a dominant, Western culture that celebrates strength in separation and holds unrealistic expectations for independent, autonomous functioning, vulnerability is seen as a handicap. This system creates the illusion of an invulnerable and separate self, and uses individualistic standards to measure a person's worth. Since these unrealistic expectations cannot be humanly attained, these controlling images become the source of shame and disconnection. RCT suggests that there is value in embracing vulnerability and in providing support, both at an individual and a societal level, for the inevitable vulnerability of all people. Rather than espousing the individual, mostly mythical, traits of a “lone hero,” RCT moves us toward new and important pathways to resilience and courage through connection. A version of this article was originally presented at the 2002 Learning from Women Conference, co-sponsored by Harvard Medical School and the Jean Baker Miller Training Institute.     

ON AGGRESSION TURNED AGAINST THE SELF

Deliberate self‐harm is a common presenting problem suffered by young people. Several patients referred to the NHS outpatient clinic where I work have been able to stop harming themselves during intensive psychoanalytic psychotherapy. In this paper, I shall discuss a variety of motives for persistent cutting by one adolescent girl. I am most interested to show how the healthier part of her personality overcame her motives for harming herself, and eventually allowed her to make use of my understanding of a sadomasochistic internal object that worked against us.