Might Relationship “Techniques” Extend the Reach, Efficacy, and Efficiency of the Psychotherapies? The Challenge of Treatment-Resistant Outpatients

Study-based clinical observations and two premises are presented as indications for a need to identify therapeutic relationship techniques or the like that can extend the reach and efficiency of the psychotherapies. The premises are: (1) advances in psychotherapy practice and research now highlight one of the field's most longstanding challenges, signified by terms like treatment resistance; and (2) some proportion of outpatients whose problems are resistant to the psychotherapies (and medications) have marked limitations in the capacity to relate positively and productively to others, including therapists. Thus, ironically, they cannot optimally utilize a treatment modality that largely has developed to ameliorate problems relating to others.     

Preference and resistance to change with constant-duration schedule components

Previous research on preference between variable-interval terminal links in concurrent chains has most often used variable-duration terminal links ending with a single reinforcer. By contrast, most research on resistance to change in multiple schedules has used constant-duration components that include variable numbers of reinforcers in each presentation. Grace and Nevin (1997) examined both preference and resistance in variable-duration components; here, preference and resistance were examined in constant-duration components. Reinforcer rates were varied across eight conditions, and a generalized-matching-law analysis showed that initial-link preference strongly over-matched terminal-link reinforcer ratios. In multiple schedules, baseline response rates were unaffected by reinforcer rates, but resistance to intercomponent food, to extinction, and to intercomponent food plus extinction was greater in the richer component. The between-component difference in resistance to change exhibited additive effects for the three resistance tests, and was systematically related to reinforcer ratios. However, resistance was less sensitive to reinforcer ratios than was preference. Resistance to intercomponent food and to intercomponent food plus extinction was more sensitive to reinforcer ratios in the present study than in Grace and Nevin (1997). Thus, relative to variable-duration components, constant-duration components increased the sensitivity of both preference and relative resistance, supporting the proposition that these are independent and convergent measures of the effects of a history of reinforcement.     

Rate of conditioned reinforcement affects observing rate but not resistance to change

The effects of rate of conditioned reinforcement on the resistance to change of operant behavior have not been examined. In addition, the effects of rate of conditioned reinforcement on the rate of observing have not been adequately examined. In two experiments, a multiple schedule of observing-response procedures was used to examine the effects of rate of conditioned reinforcement on observing rates and resistance to change. In a rich component, observing responses produced a higher frequency of stimuli correlated with alternating periods of random-interval schedule primary reinforcement or extinction. In a lean component, observing responses produced similar schedule-correlated stimuli but at a lower frequency. The rate of primary reinforcement in both components was the same. In Experiment 1, a 4:1 ratio of stimulus production was arranged by the rich and lean components. In Experiment 2, the ratio of stimulus production rates was increased to 6:1. In both experiments, observing rates were higher in the rich component than in the lean component. Disruptions in observing produced by presession feeding, extinction of observing responses, and response-independent food deliveries during intercomponent intervals usually were similar in the rich and lean components. When differences in resistance to change did occur, observing tended to be more resistant to change in the lean component. If resistance to change is accepted as a more appropriate measure of response strength than absolute response rates, then the present results provide no evidence that higher rates of stimuli generally considered to function as conditioned reinforcers engender greater response strength.     

The multiple meanings of secondary gain

The historical development of the concept of secondary gain is described in this article. Freud introduced this concept as a complement to primary gain. Freud modified the scope of both concepts during his career, but they remained within the boundary of an intrapsychological mechanism. Outside psychoanalysis, the concept of secondary gain has acquired further meaning with higher emphasis on interpersonal and social aspects. Consequently, it is often unclear what a writer or speaker means when he uses the term secondary gain. The different meanings of secondary gain in and outside psychoanalysis are illustrated with reference to literature and case reports.     

Bridging the personal and the political: practices for a liberation psychology

In the Irish context, legacies of colonialism, the Northern Ireland conflict situation, and the strength of community and women's liberation movements all provide rich resources for understanding the processes involved in both oppression and liberation. This paper draws on the theoretical and research literature and on Irish experiences to develop an understanding of some of the processes and practices that aid in liberation. The research is grounded in diverse writings on oppression and liberation, which include writings on colonialism (E. Duran &B. Duran, 1995; F. Fanon, 1967; V. Kenny, 1985, L. Maracle, 1996), feminist psychology (J. B. Miller, 1986; S. Wilkinson, 1996), liberation psychology (H. A. Bulhan, 1985; L. Comas-Díaz, M. B. Lykes, & R. D. Alarcon, 1998; I. Martín-Baró, 1994; Starhawk, 1987), and psychological aspects of racism (b. hooks, 1993; A. Mama, 1995; R. J. Watts, D. M. Griffith, & J. Abdul-Adil, 1999), homophobia (A. R. D'Augelli & C. J. Patterson, 1995), poverty (K. O'Neill, 1992), and other dimensions of oppression.     

Resistance to change of operant variation and repetition

A multiple chained schedule was used to compare the relative resistance to change of variable and fixed four-peck response sequences in pigeons. In one terminal link, a response sequence produced food only if it occurred infrequently relative to 15 other response sequences (vary). In the other terminal link, a single response sequence produced food (repeat). Identical variable-interval schedules operated in the initial links. During baseline, lower response rates generally occurred in the vary initial link, and similar response and reinforcement rates occurred in each terminal link. Resistance of responding to prefeeding and three rates of response-independent food delivered during the intercomponent intervals then was compared between components. During each disruption condition, initial- and terminal-link response rates generally were more resistant in the vary component than in the repeat component. During the response-independent food conditions, terminal-link response rates were more resistant than initial-link response rates in each component, but this did not occur during prefeeding. Variation (in vary) and repetition (in repeat) both decreased during the response-independent food conditions in the respective components, but with relatively greater disruption in repeat. These results extend earlier findings demonstrating that operant variation is more resistant to disruption than is operant repetition and suggest that theories of response strength, such as behavioral momentum theory, must consider factors other than reinforcement rate. The implications of the results for understanding operant response classes are discussed.     

Resistance as a Problem for Practice and Theory

Resistance is one of the most problematic and potentially counterproductive concepts in the entire field of psychotherapy. It is at the same time one of the most crucial, pointing toward perhaps the single most important factor—or, more accurately, set of factors—in determining the success or failure of the therapeutic enterprise. Drawing on the articles by Davis and Hollon, Prochaska and Prochaska, Reid, and Eagle in this issue, as well as on the author's own perspective, this paper explores this seeming contradiction in order to point toward an integrative resolution of the differing perspectives on resistance and related phenomena.     

The shadow of familiarity: a contributor to the intersubjective field

This paper examines the influence of familiarity on the progress of analysis. It is proposed that familiarity is a particular aspect of the intersubjective field which emerges over time and begins to shape and influence the behaviours, perceptions, thoughts, and feelings of the participants. It is also proposed that states of familiarity can have facilitative or defensive functions in an analytic relationship and that it is an influence co-created in the field. The experience of familiarity operates as background to our various foreground concerns in analytic work and therefore exists primarily as an implicit, rather than explicit, experience in analysis. Defensive familiarity often creates a feeling of relatedness that is subtly unrelated, a form of pseudo-intimacy. Parallels between defensive familiarity and related concepts are examined including defences against the unknown, role responsiveness, romantic love, the image of the stranger, and unformulated experience. This paper concludes with two case examples and a discussion of procedural knowledge in the implicit domain as an explanatory framework for the understanding of familiarity states in the analytic setting.     

Contextual influences on resistance to disruption in children with intellectual disabilities

Training context can influence resistance to disruption under differing reinforcement schedules. With nonhumans, when relatively lean and rich reinforcement schedules are experienced in the context of a multiple schedule, greater resistance is found in the rich than the lean component, as described by behavioral momentum theory. By contrast, when the schedules are experienced in separated blocks of sessions (i.e., as single schedules), resistance is not consistently greater in either component. In the current study, two groups of 6 children with intellectual disabilities responded to stimuli presented in relatively lean or rich components. For both, reinforcers were delivered according to the same variable-interval reinforcement schedule; additionally, the rich component included the delivery of response-independent reinforcers. The Within group was trained on a multiple schedule in which lean and rich components alternated regularly within sessions; the Blocked group was trained on two single schedules in which sessions with either the lean or rich schedule were conducted in successive blocks. Disruption tests presented a concurrently available alternative stimulus disrupter signaling the availability of tangible reinforcers. All 6 Within participants showed greater resistance to disruption in the rich component, consistent with behavioral momentum theory. By contrast, there was no consistent or significant difference in resistance for Blocked participants. This finding is potentially relevant to the development of interventions in applied settings, where such interventions often approximate single schedules and include response-independent reinforcers.     

On the Knowledge of Politics and the Politics of Knowledge: How a Social Representations Approach Helps Us Rethink the Subject of Political Psychology

Fifty years ago, Serge Moscovici first outlined a theory of social representations. In this article, we attempt to discuss and to contextualize research that has been inspired by this original impetus from the particular angle of its relevance to political psychology. We argue that four defining components of social representations need to be taken into account, and that these elements need to be articulated with insights from the social identity tradition about the centrality of self and group constructions in order to develop original insights into political psychological phenomena. First, social representations are shared knowledge, and the way interpretations of the world are collectively elaborated is critical to the way people are able to act within the world. Second, social representations are meta‐knowledge, which implies that what people assume relevant others know, think, or value is part of their own interpretative grid, and that collective behavior can often be influenced more powerfully at the level of meta‐representations than of intimate beliefs. Third, social representations are enacted communication, which means that social influence is exerted by the factors that constrain social practices as much as by the discourse that interprets these practices. Fourth, social representations are world‐making assumptions: collective understandings do not only reflect existing realities but often bring social reality into being. Put together, these four components provide a distinctive theoretical perspective on power, resistance and conflict. The added conceptual value of this perspective is illustrated by showing how it allows revisiting ethnic conflict in the former Yugoslavia. We conclude with implications for research practices and discuss how the proposed model of social representations invites us to define new priorities and challenges for the methods used to study political psychological phenomena.