Working through and its various models

Working through is an integral part of the psychoanalytic process, one could even say its epitome. It is therefore always present in the work of an analysis but, depending on the various phases and constraints that arise in that process, changes are brought to its form, to the issues involved in it and to its economic dimension. The author explores three forms or models of how working-through functions in relation to the dominant feature of any given analytical process. In the first of these, the issue that has to be worked over involves insight into a repressed representational complex; in the second, work has to be done on bringing into consciousness drive-related impulses or mental experiences that have until then not been able to be represented, so that the analysis itself is the first occasion on which retroactive [après-coup] processing can be initiated; and in the third, when representation and some kind of symbolization of the subjective experience and the drive-related issues that are part of it have been accomplished, the analysand then has to appropriate these subjectively and integrate them.     

Self-criticism and unconscious grandiosity: transference-countertransference dimensions

The problems posed in understanding and working through the patient's layers of self-criticism are challenging for both patient and analyst. In particular, this paper explores some countertransference phenomena related to underlying grandiosity embedded in self-criticism. For patients who are self-critical, analyzing grandiose elements may create further grounds for self-reproach or open up new modes of self-experience and freedom. The paper tries to focus on how the analyst's experience of the patient's self-criticism often shifts over the course of analytic work. It is important for the analyst to not be crippled by a fear of considering the relevance of underlying grandiosity in relation to self-reproach. Understanding this dimension of self-reproach can help elucidate why it is so durable and refractory to interpretation. The patient has a stake in holding on to this self-punishment because it perpetuates self-regulatory fantasies. These fantasies sometimes relate to the feeling that the patient will be more successful or better loved by holding on to aspects of self-reproach. Sometimes these fantasies are based in competitive or dominant strategies related to winning out or retaliating over parents or siblings.     

Differential reinforcement of alternative behavior increases resistance to extinction: clinical demonstration, animal modeling, and clinical test of one solution

Basic research with pigeons on behavioral momentum suggests that differential reinforcement of alternative behavior (DRA) can increase the resistance of target behavior to change. This finding suggests that clinical applications of DRA may inadvertently increase the persistence of target behavior even as it decreases its frequency. We conducted three coordinated experiments to test whether DRA has persistence-strengthening effects on clinically significant target behavior and then tested the effectiveness of a possible solution to this problem in both a nonhuman and clinical study. Experiment 1 compared resistance to extinction following baseline rates of reinforcement versus higher DRA rates of reinforcement in a clinical study. Resistance to extinction was substantially greater following DRA. Experiment 2 tested a rat model of a possible solution to this problem. Training an alternative response in a context without reinforcement of the target response circumvented the persistence-strengthening effects of DRA. Experiment 3 translated the rat model into a novel clinical application of DRA. Training an alternative response with DRA in a separate context resulted in lower resistance to extinction than employing DRA in the context correlated with reinforcement of target behavior. The value of coordinated bidirectional translational research is discussed.     

The effects of constant versus varied reinforcers on preference and resistance to change

Previous research has demonstrated that factors such as reinforcer frequency, amount, and delay have similar effects on resistance to change and preference. In the present study, 4 boys with autism made choices between a constant reinforcer (one that was the same food item every trial) and a varied food reinforcer (one that varied randomly between three possible food items). For all 4 boys, varied reinforcers were preferred over constant reinforcers, and they maintained higher response rates than constant reinforcers. In addition, when a distraction (a video clip) was introduced, responding maintained by varied reinforcers was more resistant to distraction than responding maintained by constant reinforcers. Thus, the present experiment extended the generality of the relation between preference and resistance to change to variation in reinforcer quality.     

Obstacles facing the psychoanalyst when interpreting narcissistic pathologies: Characteristics of the authoritarian patient

This paper explores the unconscious agreements between patient and analyst that promote some aspects of conflict to be excluded from the content of the interpretations. This generates an experience of exerting omnipotent control over the analyst, which subsequently consolidates a narcissistic phantasy. A stagnation of the analytic process is established in the course of the analysis but this remains hidden by areas of partial progress in the patient. Clinical material is provided in order to show the vicissitudes of the interrelationship between patient and analyst. It also demonstrates the working through by the analyst of a situation of both transferential and countertransferential conflict. This leads to an inhibition on the part of the analyst in his interpreting function. The use of projective identifications, which are mutually contradictory and incompatible, is also under discussion. This, as a result of being expressed simultaneously, constitutes a paradox, which may lead the analyst to confusion and an experience of paralysis. The subsequent confusional anxieties are considered. Additionally, authoritarianism is discussed, including its attendant difficulties of establishing boundaries between the self and the object. Finally, under consideration is the risk one takes in formulating authoritarian interpretations, which, in certain cases, can impose criteria on the patient.     

Work, Leisure, and Support Groups: An Examination of the Ways Women with Infertility Respond to Pronatalist Ideology

Pronatalism embodies the belief that a woman's social value is linked to her production of biological children (C. Morell, 2000). Conceiving and bearing children is literally impossible, however, for some of the 5 million women in the United States who struggle with infertility. Women negotiate their experiences with infertility within a pronatalist society, yet their experiences therein have been given little attention. Thus, the purpose of this research was to explore women's lived experiences with infertility in a pronatalist ideology. Active interviews with 32 participants who had experienced infertility revealed that the women were aware of a pronatalist ideology, which was manifested through insensitive comments or questions and unsolicited advice. The women responded by immersing themselves in their work, leisure activities/experiences, or support groups. The findings illustrate how pronatalist ideology is manifest in social interactions, but they also suggest how it may be resisted.     

血管性认知功能障碍与胰岛素抵抗关系的临床研究

探讨在血管性认知功能障碍（vascular cognitive impairment,VCI）的发病机制中胰岛素抵抗（insulin resistance,IR）的作用及二者之问的关系。比较41例VCI患者与80例健康对照组中空腹血糖（FPG）等13个因素之间是否存在差异,及VCI的发生与上述各因素之间的关系。VCI组FPG、FINS、HOMA-IR、ISI、FIB、TC、TG、LDL明显高于对照组（P〈0．01或P〈0．05）;其中FINS、HOMA-IR、LDL为VCI发生的危险因素;MMSE评分与ISI呈显著正相关（rs=0．56,P〈O．01）。VCI中存在IR,IR是VCI发生的危险因素之一,VCI的严重程度与IR呈正相关。     

细菌耐药性及其防控中的理性思考

细菌对抗菌药物产生耐药性是自然界的普遍规律。抗菌药物的应用和研发与细菌耐药机制的发展互为因果且相互促进,细菌对抗菌药物的耐药性已对感染性疾病的治疗构成严重威胁。理性认识细菌耐药性产生的机制,并在其防控中进行理性思考是提高感染性疾病治愈率的根本所在。     

Temporal context, preference, and resistance to change

According to behavioral momentum theory, preference and relative resistance to change in concurrent-chains schedules are correlated and reflect the relative conditioned value of discriminative stimuli. In the present study, we explore the generality of this relation by manipulating the temporal context within a concurrent-chains procedure through changes in the duration of the initial links. Consistent with previous findings, preference for a richer terminal link was less extreme with longer initial links across three experiments with pigeons. In Experiment 1, relative resistance to change and preference were related inversely when responding was disrupted with response-independent food presentations during initial links, replicating a previous finding with rats. However, more food was presented with longer initial links, confounding the disrupter and initial-link duration. In Experiment 2, presession feeding was used instead and eliminated the negative relation between relative resistance to change and preference, but relative resistance to change was not sensitive to relative terminal-link reinforcement rates. In Experiment 3, with more extreme relative terminal-link reinforcement rates, increasing initial-link duration similarly decreased preference and relative resistance to change for the richer terminal link. Thus, when conditions of disruption are equal and assessed under the appropriate reinforcement conditions, changes in temporal context impact relative resistance to change and preference similarly.