Working with chronic and relentless self‐hatred,self‐harm,and existential shame: a clinical study and reflections (Paper 2 of 2)

This second of two papers focuses on the shame which emerged in the first 14 years of analysis of a woman who was bulimic, self‐harmed, and repeatedly described herself as ‘feeling like a piece of shit’. To explore this intense and pervasive shame I draw on Jung's and Laplanche's emphasis on experiences of unresolvable, non‐pathological ‘foreignness’ or ‘otherness’ at the heart of the psyche. Images, metaphors, elements of clinical experience, and working hypotheses from a number of analytic traditions are used to flesh out this exploration. These include Kilborne's use of Pirandello's image of shame as like a ‘hole in the paper sky’ which, I suggest, points to a crack in subjectivity, and reveals our belief in the efficacy of the self to be illusory. Hultberg's observations on shame as having an existential mode (function) are also explored, as is the nature of analytic truth. Using these ideas I describe my patient's process of finding some small but freeing space in relation to her shame and self‐hatred. Through enduring and learning from her shame in analysis she realized that it was part of a desperate unconscious attempt to draw close to her troubled father and so to ‘love him better’.     

Cognitive exercise through body movement: Using a fun and short neuropsychological tool to adapt physical activity and enhance pleasure in individuals suffering from mental illnesses

Mental illness is associated to both metabolic and cognitive deficits. The idea here is to use adapted physical activity (APA) to help both aspects of pathology within a personal-targeted cognitive intervention program in order to enhance self-efficacy and intrinsic motivation. Using a multi-experience neuropsychological tool set (comprising touch pad exercises, wood puzzles and one-on-one semi-structured interviews), the different domains of action, timing, executive functions and social cognition were evaluated in a short 30-minute session. These computerized neuropsychological data were then used to adapt the difficulty of the proposed physical activity. Results obtained in a small group of ten patients revealed that the battery was well accepted. Both quantitative and qualitative results were collected and suggested that after 4 sessions of 2 h activity, the scores were improved for motor planning, motivation and the subjective report of quality of life. These preliminary data are important as they show that new technology can now be used to adapt automatically physical activities to the motor, cognitive and emotional capacities of the targeted individuals. Touch pads may also afford an innovating way to evaluate efficiently cognitive abilities while preserving the pleasure of the moment.     

A Person‐Centered Perspective on Multidimensional Perfectionism in Canadian and Chinese University Students: A Multigroup Latent Profile Analysis

This study investigated the generalizability of the tripartite model of perfectionism across Canadian and Chinese university students. Using latent profile analysis and indicators of perfectionistic strivings, perfectionistic concerns, and neuroticism in both groups, the authors derived a 3‐profile solution: adaptive perfectionists, maladaptive perfectionists, and nonperfectionists. Furthermore, multigroup latent profile analysis supported the construct equivalence of the 3‐profile solution across groups. Results further suggested that a greater proportion of Chinese students could be classified as adaptive perfectionists. Este estudio investigó la generalizabilidad del modelo tripartito de perfeccionismo entre estudiantes universitarios canadienses y chinos. Usando un análisis de perfil latente e indicadores de esfuerzos perfeccionistas, preocupaciones perfeccionistas y neuroticismo en ambos grupos, los autores desarrollaron una solución de 3 perfiles: perfeccionistas adaptados, perfeccionistas inadaptados y no perfeccionistas. Además, el análisis de perfil latente multigrupo confirmó la equivalencia de constructo de la solución de 3 perfiles en estos grupos. Los resultados sugieren también que una mayor proporción de estudiantes chinos podría clasificarse como perfeccionistas adaptados.     

Couple Therapy with Veterans: Early Improvements and Predictors of Early Dropout

Family services within Veterans Affairs Medical Centers fulfill an important role in addressing relationship distress among Veterans, which is highly prevalent and comorbid with psychopathology. However, even for evidence‐based couple therapies, effectiveness is weaker compared to controlled studies, maybe because many Veteran couples drop out early and do not reach the “active” treatment stage after the 3–4 session assessment. In order to improve outcomes, it is critical to identify couples at high risk for early dropout, and understand whether couples may benefit from the assessment as an intervention. The current study examined (a) demographics, treatment delivery mode, relationship satisfaction, and psychological symptoms as predictors of dropout during and immediately following the assessment phase, and (b) changes in relationship satisfaction during assessment. 174 couples completed questionnaires during routine intake procedures. The main analyses focused on 140 male Veterans and their female civilian partners; 36.43% dropped out during the assessment phase and 24.74% of the remaining couples immediately following the first treatment session. More severe depressive symptoms in non‐Veteran partners were associated with dropout during assessment. Relationship satisfaction improved significantly during the assessment phase for couples who did not drop out, with larger gains for non‐Veteran partners. No demographics or treatment delivery mode were associated with dropout. Although more research is needed on engaging couples at risk for early dropout and maximizing early benefits, the findings suggest that clinicians should attend to the civilian partner's and Veteran's depressive symptoms at intake and consider the assessment part of active treatment.     

Daily Events for Clinical Couples: Examining Therapy Interventions,Positive Events,Arguments, and Exercise in the Beginning Stage of Therapy

This study examined the daily association of several events within the beginning phase of couple therapy. Events examined were as follows: trying something from therapy, an argument, a positive event, and physical exercise. Participants were 33 couples in a treatment‐as‐usual setting who completed the Daily Diary of Events in Couple Therapy (DDECT). A dyadic multilevel model was used to explore the daily associations between predictor and outcome variables. Results showed when male partners tried something from therapy at rates greater than the average their female partners reported a more positive relationship while when female partners tried something from therapy at rates greater than the average it contributed to a more negative relationship. In addition, results showed that clients in couple therapy rarely try things from therapy on a daily basis. Finally, relative to other predictors trying something from therapy had a smaller, but significant relationship with outcomes.     

Studying Stepfamilies: Four Eras of Family Scholarship

Historically, there have always been stepfamilies, but until the early 1970s, they remained largely unnoticed by social scientists. Research interest in stepfamilies followed shortly after divorce became the primary precursor to stepfamily formation. Because stepfamilies are structurally diverse and much more complex than nuclear families, they have created considerable challenges for both researchers and clinicians. This article examines four eras of stepfamily scholarship, tracing the development of research questions, study designs and methods, and conceptual frameworks from the mid‐1970s to the present and drawing implications for the current state of the field.     

Specificity of the Association between Marital Discord and Longitudinal Changes in Symptoms of Depression and Generalized Anxiety Disorder in the Irish Longitudinal Study on Ageing

This longitudinal study was conducted to evaluate actor and partner effects of marital discord on changes in symptoms of depression and generalized anxiety disorder (GAD) in a large population sample of Irish adults (N = 1,445 couples), adjusting for the potential confounds of quality of other social relationships and other psychopathology symptoms. The Actor–Partner Interdependence Model was used to examine actor and partner effects of marital discord on changes in symptoms of depression and GAD at a 2‐year follow‐up. Additional models examined these associations adjusting for family and friend discord and symptoms of the other type of psychopathology (depressive or GAD symptoms). Actor effects of marital discord on depressive and anxiety symptoms were greater for men than for women. There were significant, positive actor effects of marital discord on depressive symptoms for husbands and wives, which remained significant when adjusting for family and friend discord and GAD symptoms. There were significant, positive actor effects of marital discord on GAD symptoms for husbands, which remained significant when adjusting for family and friend discord and depressive symptoms. Results demonstrate that longitudinal associations between marital discord and depressive symptoms (for wives and husbands) and GAD symptoms (for husbands) are incremental to other rival explanations (family and friend discord and the other set of symptoms). Findings provide evidence for a potential causal association leading from marital discord to symptoms of depression and GAD.