Countertransference as object of empirical research?

Abstract

The concept of countertransference as a robust cornerstone of psychoanalytic work has gained momentum over the last five decades. It is a prime example of elastic concepts covering the range from microprocesses to global clinical phenomena. Empirical research on the treatment process has for a long time – and for good reasons – avoided even trying to measure countertransference. We report here on various efforts for approaching a methodology for measuring it. The paper organizes the various approaches in terms of stages of research.     

Perspectives on Systems Change Among Local Change Agents: A Comparative Study

Community organizers and activists draw on multiple traditions of community building and collective action in attempts to galvanize change. The diversity of perspectives on social change processes indicates corresponding differences in perspectives on systems and what is required to change them. Twenty‐two in‐depth interviews with community organizers and activists in the Midwestern USA were conducted to identify differences in perspectives on systems change efforts. Four models used by organizers were identified: action/issue‐centric, identity‐centric, relationship‐centric, and organizing‐development. Strategies for recruitment, issue selection, leadership determination, and action were compared across models. Analyses revealed that some models might be better suited to action on certain issues (e.g. identity‐centric models when organizing around homelessness), whereas others may have advantages for use in certain settings (e.g. relationship‐centric models in congregations). These findings suggest that practitioners and scholars should pay close attention to contextual factors and focal issues when determining strategies for creating systems change. Copyright © 2014 John Wiley & Sons, Ltd.     

Ethical Ambiguities in Participatory Action Research With Unauthorized Migrants

There is increased recognition of the importance of well-designed scholarship on how immigration status and policies impact migrants in the United States, including those who are unauthorized. Some researchers have looked to community-based and participatory methods to develop trust, place migrants’ voices at the forefront, and engage collaboratively in using research as a tool for social change. This article reviews three ethical ambiguities that emerged in the process of a series of participatory action research (PAR) projects with migrants in the United States, many of whom were unauthorized. Specifically, three themes are discussed: (a) the tension between the human desire to respond to injustices, and the challenges of doing so in ways that recognize one’s privilege and power as an outsider and supports the migrants’ agency and autonomy; (b) the complex definition, explanation, and dimensions of “risk”; and (c) the complexity of using a methodology (PAR) that prioritizes participants’ collective identity and community in the context of regulations that are designed primarily to protect individuals.     

Psychometric Properties and Responsiveness to Change of 15‐ and 28‐Item Versions of the SCORE: A Family Assessment Questionnaire

The SCORE (Systemic Clinical Outcome and Routine Evaluation) is a 40‐item questionnaire for completion by family members 12 years and older to assess outcome in systemic therapy. This study aimed to investigate psychometric properties of two short versions of the SCORE and their responsiveness to therapeutic change. Data were collected at 19 centers from 701 families at baseline and from 433 of these 3–5 months later. Results confirmed the three‐factor structure (strengths, difficulties, and communication) of the 15‐ and 28‐item versions of the SCORE. Both instruments had good internal consistency and test–retest reliability. They also showed construct and criterion validity, correlating with measures of parent, child, and family adjustment, and discriminating between clinical and nonclinical cases. Total and factor scales of the SCORE‐15 and ‐28 were responsive to change over 3–5 months of therapy. The SCORE‐15 and SCORE‐28 are brief psychometrically robust family assessment instruments which may be used to evaluate systemic therapy.     

Analytic change: Assessing ways of being in a psychoanalytic follow‐up interview

The article argues that the concepts of relational scenario, structuralized affect and actualized affect are proposed candidates for observation of changes in relational ways of being as it is expressed in transference. A psychoanalytic follow‐up interview of a former analytic patient is presented in order to illustrate how change in relational ways of being may be registered and studied. By triangulating the patient's verbal report of change with nonverbal information and transference–countertransference dynamics, one may grasp qualitative changes in relational ways of being. The case presented illustrates a former patient's on‐going process of working towards representing aggression in a more direct manner and how this process is made observable with the aid of the proposed concepts in the interview situation. The proposed concepts of relational scenario, structuralized and actualized affect discussed are compared to the concept of transference used in studies of core conflictual relationship theme (CCRT).     

The Comorbidity of Conduct Problems and Depression in Childhood and Adolescence

An extensive body of research documents the high prevalence of comorbidity among child and adolescent disorders in general and between conduct problems and depression in particular. These problems co-occur at significantly higher rates than would be expected by chance and their comorbidity may have significant implications for nosology, treatment, and prognosis. Four main hypotheses have been put forth to account for these high rates of comorbidity. First, comorbidity may be a result of shortcomings associated with referral or informant biases. Second, comorbidity may be an artifact of overlapping definitional criteria. Third, one disorder may cause the other disorder by influencing the developmental trajectory and placing an individual at increased risk for further difficulties. Finally, comorbidity between two disorders may be explained by shared underlying causal or risk factors. The purpose of this review is to explore these possibilities, concentrating primarily on the common risk factors of parent psychopathology, emotion regulation, and cognitive biases that may underlie the co-occurrence of these two disorders. Based on our review, we propose a model for the development of comorbidity between these two disorders.     

Private-Sector Research Ethics: Marketing or Good Conflicts Management? The 2005 John J. Conley Lecture on Medical Ethics

Pharmaceutical companies are major sponsors of biomedical research. Most scholars and policymakers focus their attention on government and academic oversight activities, however. In this article, I consider the role of pharmaceutical companies’ internal ethics statements in guiding decisions about corporate research and development (R&D). I review materials from drug company websites and contributions from the business and medical ethics literature that address ethical responsibilities of businesses in general and pharmaceutical companies in particular. I discuss positive and negative uses of pharmaceutical companies’ ethics materials and describe shortcomings in the companies’ existing ethics programs. To guide employees and reassure outsiders, companies must add rigor, independence, and transparency to their R&D ethics programs.     

“More on Respect for Embryos and Potentiality: Does Respect for Embryos Entail Respect for In Vitro Embryos?”

It is commonly assumed that persons who hold abortions to be generally impermissible must, for the same reasons, be opposed to embryonic stem cell research [ESR]. Yet a settled position against abortion does not necessarily direct one to reject that research. The difference in potentiality between the embryos used in ESR and embryos discussed in the abortion debate can make ESR acceptable even if one holds that abortion is impermissible. With regard to their potentiality, in vitro embryos are here argued to be more morally similar to clonable somatic cells than they are to in vivo embryos. This creates an important moral distinction between embryos in vivo and in vitro. Attempts to refute this moral distinction, raised in the recent debate in this journal between Alfonso Gómez-Lobo and Mary Mahowald, are also addressed.     

Human and Animal Subjects of Research: The Moral Significance of Respect versus Welfare

Human beings with diminished decision-making capacities are usually thought to require greater protections from the potential harms of research than fully autonomous persons. Animal subjects of research receive lesser protections than any human beings regardless of decision-making capacity. Paradoxically, however, it is precisely animals’ lack of some characteristic human capacities that is commonly invoked to justify using them for human purposes. In other words, for humans lesser capacities correspond to greater protections but for animals the opposite is true. Without explicit justification, it is not clear why or whether this should be the case. Ethics regulations guiding human subject research include principles such as respect for persons—and related duties—that are required as a matter of justice while regulations guiding animal subject research attend only to highly circumscribed considerations of welfare. Further, the regulations guiding research on animals discount any consideration of animal welfare relative to comparable human welfare. This paper explores two of the most promising justifications for these differences␣between the two sets of regulations. The first potential justification points to lesser moral status for animals on the basis of their lesser capacities. The second potential justification relies on a claim about the permissibility of moral partiality as␣found in common morality. While neither potential justification is sufficient to justify the regulatory difference as it stands, there is possible common ground between supporters of some regulatory difference and those rejecting the current difference.