Macrointervention processes and strategies for leaders,changemakers, advocates,allies, and targets: A new framework to address macroaggressions in systems

The presence of macroaggressions, or obvious, overt, system-wide racial offensives and abusive acts evidenced in organizational systems and structures (e.g., confederate flags; signs in public places that read: “we only speak English”), have continued to penetrate American society at an unparalleled rate. The onslaught of violence toward racial, ethnic, and cultural minority citizens—in particular Black Americans and the disproportionate death rates of Black, Indigenous, and People of Color linked with the coronavirus disease 2019 (COVID-19) underscores an urgent need for broad-based systemic action. While microaggressions are well-documented in the psychological literature, less attention has been directed toward macroaggressions and how to address the ever-present forms of racism that propagate inequity within all aspects of organizations and larger systems (e.g., health care, legal, education). We propose a six-step conceptual framework to address macroaggressions evinced in these systems. Additionally, we introduce macrointervention strategies and illustrative examples that can be deployed and tested in diverse ecologies by institutional leaders, changemakers, advocates, allies, and targets of bias. We recommend well-designed empirical investigations to evaluate the proposed conceptual framework and to what extent it can affect changes at the macro-level.     

The Russian Orthodox Church as moral norm entrepreneur

Conflicts over religious symbols in the public sphere, gay marriage, abortion or gender equality have shown their disruptive potential across many societies in the world. They have also become the subject of political and legal debates in international institutions. These conflicts emerge out of different worldviews and normative conceptions of the good, and they are frequently framed in terms of competing interpretations of human rights. One newcomer voice in conflicts over rights and values in the international sphere is the Russian Orthodox Church (ROC), which in recent years has become an active promoter of ‘traditional values’ both inside Russia and internationally. This article studies the ideational prerequisites and dynamics of Russian Orthodox ‘norm protagonism’ in the international arena.     

When views about alternative medicine,nature and god come in the way of people's vaccination intentions

In spite of the safety and efficiency of the COVID-19 vaccines and the many promotion efforts of political and expert authorities, a fair portion of the population remained hesitant if not opposed to vaccination. Public debate and the available literature point to the possible role of people's attitudes towards medical institutions as well as their preference for complementary and alternative medicine (CAM) on their motivations and intentions to be vaccinated. Other potential ideological factors are beliefs about environmental laissez-faire and divine providence insofar as they encourage people to let the pandemic unfold without human interference. In three cross-sectional samples (total N = 8214), collected at successive moments during the Belgian vaccination campaign, the present research examines the distal role of these psychological and ideological factors on vaccination intentions via motivational processes. Study 1 gauges the relation between trust in medical institutions and preference for CAM on intentions to get vaccinated via motivations. Study 2 examined the role of beliefs in the desirability of letting nature take its course (‘environmental laissez-faire beliefs’) on vaccination intention via motivations. Study 3 tests whether people's adherence to environmental laissez-faire and beliefs about divine providence are linked to their motivations for vaccination via trust in the medical institutions and CAM. Results show that adherence to CAM has a deleterious effect on vaccination intentions, whereas trust in medical institutions has a positive effect. Both ideological factors pertaining to external control are only moderately related, with environmental laissez-faire beliefs having stronger effects on CAM, medical trust and vaccination motivations. We discuss the importance of this set of results in light of the growing interest in CAM and the increasing presence of messages appealing to the environment.     

Self-Disclosure and the Therapeutic Frame: Concerns for Novice Practitioners

Under the influence of the intersubjective or relational perspective, guidelines for establishing the therapeutic frame in psychoanalysis and psychoanalytic psychotherapy are undergoing modification. Therapeutic interventions such as disclosing subjective reactions have a sound theoretical basis, but they must be executed judiciously within a context of general neutrality, anonymity, and abstinence. Novice practitioners ought not attempt the more difficult relational interventions until they have acquired experience and security in the basic tenets of psychoanalytic practice, including how to maintain the traditional therapeutic frame. Inexperience in knowing when and under what circumstances to attempt self-disclosure of therapist affect, and insecurity in examining one's countertransference, have the potential to exacerbate enactments and entanglements for beginning therapists, as is illustrated in a case example.     

IMPROVING RESIDENTIAL TREATMENT SERVICES: IMPLEMENTATION AND NORM-REFERENCED EVALUATION OF A COMPREHENSIVE MANAGEMENT SYSTEM

Ensuring effective service delivery by direct-care personnel in institutional living units for persons with developmental disabilities historically has been a difficult process, despite considerable attention from researchers, service providers, and governmental regulatory agencies. In this investigation, we conducted a normative evaluation of the extent and quality of treatment services currently provided in residential living units (Experiment 1) and evaluated a comprehensive management system designed to improve such services (Experiment 2). Results of the first experiment, encompassing 22 living units in three states, indicated that on the average two thirds of observed resident behavior did not involve any therapeutic activity. The results also provided social validity for the criteria used to evaluate the quality of treatment provision based on opinions of mental retardation professionals. Results of the second experiment indicated that a behavioral management program implemented during 23 separate time periods across five living units was accompanied by consistent and durable decreases in resident nontherapeutic activity as well as increases in specifically designated habilitative activity. The results provide support for the successful incorporation of behavioral management technology into human service settings on a large-scale, long-term basis.     

论制度安排的正义

制度对我们的一切活动 ,既是基础、保证 ,又是规范、制约 ,还是赏罚、导向。这决定着我们可以在多大的空间里、向什么方向和方位去作为 ;并在付出自己的作为之后 ,应该、可以、事实上得到的是什么、有多少。因此 ,制度的首要价值是正义 ;制度安排是正义的还是不正义的 ,有决定性的意义。     

Psychodynamic assessment of changes in children with autism under psychoanalytic treatment

In this article the authors report insights into autism developed through their extensive experience of psychoanalytic therapy with children with autism. The fi rst stages of body psychic development are seriously disrupted by this pathology, resulting in primitive anxieties of falling and of being liquefi ed. These anxieties are connected to the fragile development of body ego and of its related spatiotemporal organisation. The changes in children observed by the authors during the therapeutic process lead them to offer a psychodynamic assessment tool, which revolves principally around the development of body ego. After the initial state of 'severe autism', the authors describe three stages: the stage of 'recovery of the skin' (Bick); the established 'symbiotic phase', subdivided into 'vertical then horizontal splitting of the body ego'; and fi nally the stage of 'individuation'. First, the authors describe the principal psychoanalytic approaches to autism and refl ect on the links possible with nonpsychoanalytic work.     

The Güttingen study of psychoanalytic therapy: First results

Results of a naturalistic study of the effectiveness of psychoanalytic therapy are reported. Outcome data are presented for a sample of N = 36 patients who were treated with psychoanalytic therapy. For a sample of n = 23 of these patients, data for 1-year follow-up are available at present. According to the results, psychoanalytic therapy yielded signifi cant improvements in symptoms (Symptom Checklist 90-R, SCL-90-R and rating of psychoanalysts), in interpersonal problems (Inventory of Interpersonal Problems, IIP), in quality of life (Questionnaire of Quality of Life, FLZ), in well-being (Questionnaire of Changes in Experience and Behaviour, VEV) and in target problems defi ned by the patients (Goal Attainment Scaling, GAS). Large effect sizes between 1.28 and 2.48 were found in symptoms (GSI of the SCL-90-R), interpersonal problems (IIP-total), quality of life (FLZ-total), well-being (VEV) and target problems (GAS). At 1-year follow-up, all improvements proved to be stable or even increased. The self-reported improvements in symptoms were corroborated by the ratings of the psychoanalysts. At the end of therapy, 77% of the patients showed clinically signifi cant improvements. In the 1-year follow-up group, this was true for 80%. Further results are presented and discussed.     

An in-depth observational study of an acute psychiatric ward: combining the psychodynamic observational method with thematic analysis to develop understanding of ward culture

The question of how to create benign organisational cultures in health care is a topic of particular concern in the UK at the present time. The current study aimed to further understanding of complex health care cultures in the National Health Service (NHS), with a focus on an acute adult in-patient psychiatric ward. The psychoanalytic observational method was used for this purpose. The first author conducted six-hour long observation sessions on the ward at weekly intervals, writing detailed process recordings after each observation to take to a supervision group for discussion. The six presentations of observational material and the responses of the supervision group were audiotaped and transcribed. These data were then analysed thematically. The picture that emerged was of a fragile ward environment in which staff appeared fearful of engagement with patients, there was a sense of confusion regarding roles and decision-making processes, and the nursing team felt burdened by responsibility, isolated and anxious about criticism from outside. Contemporary developments within the social defence paradigm are applied to these findings in the context of the intense pressures currently facing staff in the NHS.     

Introductory remarks by the issue editors: The multiple dimensions of the parent–baby story

Abstract

In their introductory remarks, the guest editors, themselves presenters at the conference “Parent–Infant Disturbance: Theory and Therapy,” introduce the philosophy and methodology underlying this interdisciplinary psychoanalytic conference and outline the multiple dimensions of the issue at hand, as they are addressed by the individual contributions to this volume. The paper concludes with a remembrance of and dedication to the victims of the Paris terrorist attack of November 13, 2015.