Defining and Measuring Mechanisms of Change in Psychological Therapies: The Path Not Taken

Metcalf and Dimidjian (this issue) have provided an important review of the current evidence base for mindfulness‐based cognitive therapy (MBCT) and presented a helpful summary of the proposed mechanisms of change. It is necessary to engage in a continuous dialogue regarding the evidence base for change mechanisms, and the article by Metcalf and Dimidjian highlights an important barrier of concern to the field of treatment outcome research. The present commentary aims to expand the discussion regarding the definition, measurement, and evaluation of “mechanisms of change.” Using MBCT as an example, this commentary addresses the ambiguity surrounding the definition and operationalisation of these mechanisms in research on psychological therapies and how the method of measurement may impact the results obtained in clinical trials. It is argued that a potentially fruitful avenue of future research would involve investigation of techniques, important client‐therapeutic processes, and mechanisms in a single study in order to comprehensively evaluate how change occurs.     

Collusive induction in perverse relating: Perverse enactments and bastions as a camouflage for death anxiety

The author argues that one of the main functions of perverse relatedness is to induce the analyst into becoming the patient's unconscious accomplice in a “perverse pact” against the analytic work aimed at disavowing intolerable aspects of reality. The intense power of collusive induction in perverse relating leads the analyst to participate in transference‐countertransference enactments and to the crystallization of a silent and chronic unconscious collusion between the patient and analyst in the analytic field, stagnating the process (bastion; Baranger and Baranger). The author claims that analysis of perverse pathology should not be limited to interpretation of the patient's intrapsychic functioning but should also focus on the information obtained by the analyst through his participation in collusive enactments; the analyst should also take a “second look” at the analytic “field” to detect underlying bastions. The author reviews the main psychoanalytic contributions that have clarified the phenomenon of collusive induction in perverse relating and as an illustration, describes the analysis of a man with a perverse character; in this patient, one of the main functions of his perverse relatedness was to induce the analyst to become an accomplice in his disavowal of his terror of death. The author highlights the influence of death anxiety in the bastions that develop in the treatment of perverse patients.     

Orientations of psychotic activity in defensive pathological organizations

The author reviews some clinical experiences of the treatment of personality disordered patients suffering from internal domination of ego functioning by a defensive pathological organization. In particular, the function and purpose of perverse, sadistic attacks by the organization on the ego are considered and questions pertaining to technique are raised. It is suggested that different forms of sadistic, subjugating activity by pathological organizations may denote differences in intent borne of the type and severity of the psychopathology of the individual. Patients with severe narcissistic psychopathology for whom object contact has become associated with the arousal of intense psychotic anxieties seem more likely to be subjected to an invasive, annihilatory imperative by the pathological organization, the purpose of which appears to be to obliterate the experience of contact with any differentiated object, to avoid emotion and to use coercion to enforce a primitive identification by the ego with the psychotic organization in the mind. Certain patients with less severe narcissistic psychopathology, yet for whom object contact can also be associated with the arousal of psychotic anxieties due to intense or persistent conflict with the object, sometimes expressed as organized sadomasochistic clinging to a punishing and punished object (for example, in certain borderline or depressed patients) exhibit sadistic attacks that serve less to annihilate object contact and more to intrusively control and punish the object. Observations of these phenomena have been made by a number of psychoanalysts in recent decades and these contributions are discussed. This paper is addressed primarily to the implications for technique with such patients, particularly a need for triangulation of their experiences of oppression in order to loosen the controls over the ego by the pathological organization.     

The Unbearable Uncertainty Paradox

People can be risk seeking and risk averse, but people can also be uncertainty averse: in other words, if risk is at least the possibility of an unwanted affect, then it is not only the unwanted effect that they want to avoid, it can also be the uncertainty inherent in the possibility that they wish to avoid. This uncertainty aversion can even lead to a state where someone prefers a certain outcome at all costs, even when it is the worst case. This gives rise to the following paradox: the worst case seems to be more acceptable than the state where there is still a chance that it will not materialize. We can call this the Unbearable Uncertainty Paradox. This essay provides a first conceptual sketch of this phenomenon that seems to be widespread but nevertheless does not appear to have been identified before, either by philosophers or by psychologists.     

BE CAREFUL WHAT YOU WISH FOR! THE SURRENDER OF GENDER

Close examination of Freud's Three Essays on the Theory of Sexuality (1905a) reveals an ambiguity in Freud's language as he simultaneously tries to escape 19th‐century psychiatric paradigms concerning sexuality and perversion while also retaining a normative approach to adult sexuality that created new categories of pathology. The result is an ambivalent legacy that has both hampered and helped contemporary clinicians as they deal with a diverse array of presentations of gender and sexual orientation in today's world.     

Comparison of cognitive-behavioural therapy and psychodynamic therapy in the treatment of anxiety among university students: an effectiveness study

The aim of the present study was to compare the effectiveness of cognitive-behavioural (CBT) and psychodynamic (PDT) therapies in the treatment of anxiety among university students. To this aim, the Symptom Questionnaire (SQ) was completed by 30 students assigned to CBT and by 24 students assigned to PDT, both at the beginning and at the end of treatment. The main problem presented by all patients was anxiety. Except for one sub-scale, we observed significant differences in the scores of all sub-scales and scales of SQ, with lower scores at the end of the therapy, indicating lower distress, regardless of the type of treatment. The present findings suggest that both therapies are effective in the treatment of anxiety among university students.     

Ethnography in Community Psychology: Promises and Tensions

Community psychology recognizes the need for research methods that illuminate context, culture, diversity, and process. One such method, ethnography, has crossed into multiple disciplines from anthropology, and indeed, community psychologists are becoming community ethnographers. Ethnographic work stands at the intersection of bridging universal questions with the particularities of people and groups bounded in time, geographic location, and social location. Ethnography is thus historical and deeply contextual, enabling a rich, in-depth understanding of communities that is aligned with the values and goals of community psychology. The purpose of this paper is to elucidate the potential of ethnography for community psychology and to encourage its use within the field as a method to capture culture and context, to document process, and to reveal how social change and action occur within and through communities. We discuss the method of ethnography, draw connections to community psychology values and goals, and identify tensions from our experiences doing ethnography. Overall, we assert that ethnography is a method that resonates with community psychology and present this paper as a resource for those interested in using this method in their research or community activism.     

History Matters: Effects of Culture‐specific Symbols on Political Attitudes and Intergroup Relations

A theory of the historical anchoring and mobilization of political attitudes is proposed, arguing that culture‐specific symbols, configured by historical charters, are an important resource in defining nationhood and legitimizing public opinion in a way that makes some political attitudes difficult to change. Five studies in New Zealand and Taiwan using diverse methods converged to show that historical events with “charter status” have an additive effect in explaining variance in political attitudes regarding biculturalism in New Zealand and independence in Taiwan even after controlling for the effects of Social Dominance Orientation, Right‐Wing Authoritarianism, relevant social identities, and collective guilt. Field and lab experiments showed that the impact of historical symbols did not depend on the mobilization of social identity (e.g., increasing mean scores and indirect effects), but the historical anchoring of political attitudes in representations was resistant to change. Manipulations of the salience of historical events changed levels of social identification, but did not change mean levels of support for New Zealand biculturalism or Taiwanese independence. Even an intense and immersive pretest/posttest design taking high school students on a national museum tour failed to change attitudes towards biculturalism in New Zealand.     

The Uncertainty Paradox: Perceived Threat Moderates the Effect of Uncertainty on Political Tolerance

People respond to dissimilar political beliefs in a variety of ways, ranging from openness and acceptance to closed‐mindedness and intolerance. While there is reason to believe that uncertainty may influence political tolerance, the direction of this influence remains unclear. We propose that threat moderates the effect of uncertainty on tolerance; when safe, uncertainty leads to greater tolerance, yet when threatened, uncertainty leads to reduced tolerance. Using independent manipulations of threat and uncertainty, we provide support for this hypothesis. This research demonstrates that, although feelings of threat and uncertainty can be independent, it is also important to understand their interaction.     

Interethnic Factors as Predictors of the Subjective Well‐Being of Minority Individuals in a Context of Recent Societal Changes

Our research examined the impact of contextual intergroup variables on the subjective well‐being of ethnic Russians in Estonia (N = 190) who have experienced major social changes with the demise of the Soviet Union. A mediational model was tested where aspects of intergroup relations (i.e., relative deprivation, status legitimization, and temporal comparisons) acted as mediators of the influence of cultural identity and representations of history on subjective well‐being. Preliminary analyses indicated polemical representations of history in which Estonian historical narratives are established around the struggle for independence, and Russian representations of history are consolidated around victory in World War II. Mediation analyses demonstrated that the importance of Russian history increased the perceptions of relative deprivation, status delegitimization, and the frequency of temporal comparisons, which negatively affected life satisfaction. At the same time, the importance of Estonian history led to positive perceptions of the intergroup situation and, in turn, to greater subjective well‐being. The effect of Russian identity on well‐being was mediated by delegitimizing beliefs, but not by relative deprivation and temporal comparisons. Estonian identity did not exert a significant effect on the proposed mediators. The research demonstrates the salience of the effects of contextual intergroup factors on subjective well‐being, and the article discusses implications for the study of intergroup relations and subjective well‐being.