Identification with the aggressor and the ‘normal traumas’: clinical implications

Ferenczi's (1933) surprisingly unknown concept of identification with the aggressor – an abuse victim's ‘eliminating’ her own subjectivity and ‘becoming’ precisely what an attacker needs her to be – has radical implications for our understanding of analytic technique. Its very frequent occurrence also forces us to broaden our understanding of what constitutes trauma. Ferenczi saw the experience of ‘traumatic aloneness’ or ‘emotional abandonment’ as the key element of trauma, since this is what enforces the traumatic responses of dissociation and identification with the aggressor. Identification with the aggressor operates in the analytic relationship in both patient and analyst. This has various consequences, including the structuring of the relationship through unconscious collusions – mutually coordinated, defensive identifications designed to help both participants feel secure. This view of the analytic relationship has clinical implications in at least four areas: the understanding of the patient's free associations, which may reflect the patient's compliance with the analyst's wishes rather than the contents of the patient's own unconscious; the need for some kind of mutuality of analysis; the traumatizing potential of the analyst's authority; and the tendency of some patients to take blame and responsibility reflexively, as a way of protecting the analyst.     

The role of additional information in the compliance,satisfaction, psychological,and emotion responses of non-surgical patients with low back pain: An exploratory investigation

Abstract

Noncompliance and the psychological and emotional states of patients with low back pain are major concerns for health professionals. The current study evaluated whether amount of information available to patients enhanced compliance to a medical regimen and whether it reduced negative emotions in patients with low back pain. Forty-five orthopaedic non-surgical patients with low back pain were randomly assigned to one of three information presentation conditions: 1) Standard, 2) Pre-examination, and 3) Post-examination. Patients were also separated by compensation and noncompensation within each information group. Patients completed questionnaires at their initial visit and at their follow-up which evaluated their: levels of compliance to a prescribed treatment program, psychological, and emotional states. Results indicated that some patients benefitted from receiving additional information as the Pre-examination and Post-examination groups demonstrated superior comprehension and recall as well as higher levels of compliance to a physical therapy program. In addition, compensation patients complained of more negative psychological and emotional behaviors in comparison to noncompensation patients. Implications of the research and future research considerations were discussed.     

Strengthening Voices

SUMMARY

As a therapist I have chosen to work with adolescent girls whose voices are among the weakest in our society. They have been sexually, physically and/or emotionally abused as children. Many have seen their mothers beaten by their boyfriends or husbands. Many have body-perfection obsessions such as anorexia and bulimia. Almost all of them have run away from home, hung out downtown, stolen property, relied on drugs and alcohol, and purposefully hurt themselves to take away their feelings. Many have resorted to selling their bodies on the streets or within their peer groups. They all operate from a self-belief of worthlessness, a belief that has gender socialization and abuse at its core. It is at this core that the therapeutic relationship must begin. This article describes a therapy relationship with a 14-year-old girl. This work with adolescent girls is described as being guided by three main principles, that of relationship, justice and soul work.     

Electronic monitoring and counseling to improve medication adherence

Electronic caps, pill caps that record the date and time of pill bottle opening provide an objective measure of adherence to prescribed medication. A promising intervention to improve adherence, cue-dose training, involves reviewing patients' pill cap-generated reports concerning their medication-taking and offering individualized recommendations for remembering to take medications at specific times of day. In this preliminary study, 79 patients prescribed the antihyperglycemic medication metformin had adherence assessed during a 4-week baseline period. Adherence, defined as proportion of prescribed doses taken within a predetermined 4-h window, was measured using electronic MEMS caps. Those who had less than 80% baseline adherence (n = 33) were randomly assigned to either receive 4 months of cue-dose training (n = 16) or to a control group (n = 17). Cue-dose training was associated with significantly better adherence to metformin (mean improvement of 15%). The effects of cue-dose training on adherence to other antihyperglycemic medication did not reach statistical significance. Glycosylated hemoglobin (a measure of blood sugar control) did not differ between groups. Data from nine patients who reviewed pill cap-generated data with their primary care providers suggested that both patients and providers found the discussion moderately helpful and not at all uncomfortable.     

Compliance in crisis: Concern,trust and distrustful complacency in the COVID-19 pandemic

Two studies tested a distrustful complacency hypothesis, according to which either concern or political trust would be enough to sustain law-abiding attitudes and compliance with health-protective policies during the COVID-19 pandemic; but the absence of both concern and trust would result in markedly lower support and compliance. Study 1 supported this hypothesis with NatCen nationally representative sample of Great Britain (N = 2413; weighted regression analyses), focussing on law-abiding attitudes. Study 2 (preregistered) replicated these findings with a representative sample (N = 1523) investigating support for COVID-19 policies and compliant behaviour. Participants who were less concerned about the consequences of the pandemic (for themselves and for others) and simultaneously less trustful of the government expressed weaker law-abiding attitudes and reported less compliance with COVID-19 restrictions. These findings have implications for policy and public health strategies in time of crisis.     

Blinded by trust in close others: Examining the effect of social closeness on cooperative behaviors during the COVID-19 pandemic

In the context of public health crises such as the COVID-19 pandemic, it is essential that individuals cooperate by complying with preventive measures (e.g., wearing a mask). The current research examines how high trust in close others is linked to less cooperation—that is, less compliance with measures—and thus, undermines collective interests. Specifically, we test whether individuals are less willing to comply with preventive measures when interacting with close others they trust. We conducted two experiments in which participants read a vignette depicting a social interaction with either close others (e.g., family) or strangers. Participants had to report the extent to which they would (1) trust the other people in the situation and (2) comply with the mask wearing and physical distancing measures during this interaction. In both experiments, we find that when individuals are considering an interaction with close others, they report experiencing higher trust which is then linked to lower compliance with preventive measures. In Experiment 2, we further demonstrate that participants report less compliance with preventive measures around close others, even when they perceive non-compliance with the measures as morally “wrong”. Our findings shed light on the challenges that compliance with preventive measures poses during social interactions in a context of high trust.     

MAINTENANCE FACTORS IN COERCIVE MOTHER-CHILD INTERACTIONS: THE COMPLIANCE AND PREDICTABILITY HYPOTHESES

Two stimulus control processes by which some parent-child dyads occasionally escalate their aversive exchanges into progressively more coercive interactions are described. The compliance hypothesis suggests that aversive actions have instructional properties for the dyad and that parent compliance with such child instructions maintains behavior chains of increasing aversiveness. The predictability hypothesis suggests that social interactions are most likely to function as aversive stimuli in the dyad when delivered in unpredictable fashion by either party and that responses instrumental in reducing dyadic unpredictability maintain aversive behavior chains. Expectations derived from both hypotheses are evaluated in a series of correlational analyses of mother-child interactions obtained in extended baseline observations of three dyads seeking psychological help for severe interactional problems. Results provide tentative support for the predictability hypothesis and suggest important avenues of further research.     

Effects of differential negative reinforcement on disruption and compliance

We examined the effects on compliance of two types of differential negative reinforcement (DNR) with a 5-year-old girl with a history of severe disruption. During DNR (communication), escape from instructional trials was provided contingent on a communicative behavior. During DNR (compliance), escape was provided contingent on compliance. Both interventions decreased inappropriate behavior and increased appropriate behavior. However, during DNR (communication), compliance rarely occurred.     

USING HIGH-PROBABILITY INSTRUCTION SEQUENCES WITH FADING TO INCREASE STUDENT COMPLIANCE DURING TRANSITIONS

Making efficient transitions from one instructional activity to another has been shown to increase academic learning time and therefore student achievement. Because compliance with teacher instructions is a prerequisite for efficient transitions, we sought to determine if high-probability (high-p) instruction sequences issued by a classroom teacher would increase student compliance and decrease latency to comply during transitions. Three children in a regular second-grade classroom participated. Each day at the beginning of morning calendar time, the teacher issued five instructions to the class as a group while compliance data were recorded for the 3 target students. Following baseline, a multielement design was used to examine the effects of the high-p instruction sequence. We then systematically faded the number of instructions included in the high-p sequence as a means of transferring stimulus control to low-probability instructions. The procedure was effective for 2 of the 3 participants, and the results were maintained at 2-and 3-week follow-up. The implications of these findings for group applications of the high-p instruction sequence in regular education classrooms are discussed.