The relationship between childhood adversity,psychiatric disorder and clinical severity: results from a multi-centre study

Although several studies have shown a clear association between childhood adversities and later development of a number of psychiatric disorders, a number of recent reports have cast doubts regarding the aetiological role played by abuse, neglect and loss, arguing that they are neither necessary nor sufficient to account for the development of subsequent psychopathology. In this study, we aimed to investigate the associations and predictive power of childhood adversities on later onset of Axis-I &-II psychiatric conditions and the impact on severity of psychiatric presentation in a large sample of patients. This cross-sectional multi-centre study evaluated patients (N = 1136) recruited in fourteen NHS psychotherapy departments in the UK. Patients were assessed using a number of rater-based questionnaires and self-rated measures. Multiple regression analyses showed that childhood experiences of loss and physical abuse were predictive of severe personality disorder and borderline personality disorder, but not of other less severe PD and Axis-I diagnoses. Sexual abuse predicted later onset of Post-traumatic Stress Disorder. In addition, we found that childhood abusive experiences were strongly associated with severity of psychiatric distress, interpersonal problems and global functioning. Having experienced two or more childhood adversities significantly increased severity of psychiatric distress, interpersonal malfunctioning and CORE scores.     

Take-the-best and the influence of decision-inconsistent attributes on decision confidence and choices in memory-based decisions

Take-the-best (TTB) is a decision strategy according to which attributes about choice options are sequentially processed in descending order of validity, and attribute processing is stopped once an attribute discriminates between options. Consequently, TTB-decisions rely on only one, the best discriminating, attribute, and lower-valid attributes need not be processed because they are TTB-irrelevant. Recent research suggests, however, that when attribute information is visually present during decision-making, TTB-irrelevant attributes are processed and integrated into decisions nonetheless. To examine whether TTB-irrelevant attributes are retrieved and integrated when decisions are made memory-based, we tested whether the consistency of a TTB-irrelevant attribute affects TTB-users’ decision behaviour in a memory-based decision task. Participants first learned attribute configurations of several options. Afterwards, they made several decisions between two of the options, and we manipulated conflict between the second-best attribute and the TTB-decision. We assessed participants’ decision confidence and the proportion of TTB-inconsistent choices. According to TTB, TTB-irrelevant attributes should not affect confidence and choices, because these attributes should not be retrieved. Results showed, however, that TTB-users were less confident and made more TTB-inconsistent choices when TTB-irrelevant information was in conflict with the TTB-decision than when it was not, suggesting that TTB-users retrieved and integrated TTB-irrelevant information.     

Book Reviews

Jung, C. G. Visions. Notes on the Seminar Given in 1930–34.
Edinger, Edward F. The Psyche in Antiquity. Book 1. Early Greek Philosophy. Book 2. Gnosticism and Early Christianity.
Margaret Arden. Midwifery of the Soul: A Holistic Perspective on Psychoanalysis. Collected Papers of Margaret Arden.
Rodriguez, Leonardo S. Psychoanalysis with Children: History, Theory and Practice.     

Interviewing a Therapist in the Presence of a Couple: A Description of the Therapeutic Process

A therapy research team interviewed a therapist in the presence of a couple. Following each of six consecutive sessions with a couple, an interviewer posed questions to the therapist and couple. While one question was standard to each interview, other questions were generated by team members who tracked the entire process via live observation. These questions were directed first at the therapist, then at the couple, and then focused on therapeutic process and outcome. Findings of this process for the therapy system included decreasing the hierarchy within the client/therapist relationship; increasing the client ownership and energy in the therapy process; discovering the presence of parallel processes between the systems; and informing the direction of future therapy sessions. Practical, clinical implications are discussed for a variety of therapy settings.     

Contributors to this issue

Geoffrey Blowers
Francis X. Charet
Terence Dawson
David Hewison
John Izod
William E. Kotsch
Patricia Michán
Joe Redfearn
Julieta Besquin Rubinstein
Mara Sidoli     

The Argument from Design: What Is at Stake Theologically?

This article offers a brief overview of the argument for God's existence grounded in the evidence of design. It gives particular attention to the way the argument has evolved over time and in relation to changing scientific perspectives. The argument from de-sign has in fact been formulated and reformulated in response to the discoveries and challenges it has encountered from the field of science. The conclusion of the article explores the theological importance of this argument—its extent and its limits.     

Seek and ye shall find: test results are what you hypothesize they are

Expert clinicians were given batteries of psychodiagnostic test results (Rorschach, TAT, Draw-A-Person, Bender-Gestalt, Wechsler) to analyze. For half, a battery came along with a suggestion that the person suffers from Borderline Personality disorder, and for half, that battery was accompanied by a suggestion that he suffers from Paranoid Personality disorder. In Study 1, the suggestion was made indirectly, through a background story that preceded the test results. In Study 2, the suggestion was made directly, by the instructions given. The experts saw in the tests what they hypothesized to be there. In particular, the target diagnoses were rated higher when they were hypothesized than when they were not. Copyright © 1998 John Wiley & Sons, Ltd.     

Developing coherence in community and clinical psychology: the integration of idealism and pragmatism

Illustrations of how ideas from community psychology may be integrated with clinical psychological thinking and practice are described from the perspective of a clinical psychologist working in the NHS. The intentions are to consider socially relevant conceptualizations of the causes of people's well-being and distress, and to develop ways of helping individuals and communities to clarify and address these causes. Incorporating an analysis of social power also necessitates a critical awareness of the limited potency of psychological interventions. © 1998 John Wiley & Sons, Ltd.     

The effects of different mastery criteria on the skill maintenance of children with developmental disabilities

The acquisition of skills by individuals with developmental disabilities typically includes the attainment of a certain mastery criterion. We conducted a survey of practitioners who indicated the most commonly used mastery criterion as 80% accuracy across three consecutive sessions. Based on these results, we conducted a series of three experiments to evaluate the relation between mastery criterion and subsequent skill maintenance with 4 individuals with various developmental disabilities. Results suggest that 80% accuracy across three consecutive sessions may be insufficient for producing maintenance in some cases.