Influence of Therapist and Client Behaviors on Therapy Alliance

This study considers the combined effect of therapist behaviors and couples interaction dynamics on therapeutic alliance because it seems to be a significant predictor of successful therapy outcomes. We measured therapeutic alliance using the Working Alliance Inventory, Observer Version (WAI-O), which includes three subscales: goals, tasks, and bond. We investigated the combined effect of therapist behaviors and couples interactions on therapeutic alliance. There were three significant findings: (1) the models better predicted therapeutic alliance for men clients than women clients; (2) combined consideration of partner behaviors and therapist behaviors provided the stronger prediction of therapeutic alliance; and (3) different variables predicted alliance for women clients versus men clients.     

Mental Health and Other Service Use by Youth in Therapeutic Foster Care and Group Homes

Little is known about what additional services youth receive while they reside in out-of-home treatment settings. However, such information may be crucial for explaining effectiveness and variation in outcomes for youth in such settings. Our research examines patterns of multi-sector service use for youth in two settings—Therapeutic Foster Care and group homes. Data come from in-person interviews with Treatment Foster Parents and Group Home Staff for a NC state-wide sample of youth with psychiatric disorders and aggressive behavior. Findings indicated high rates of service use by youth in both settings. Analyses indicated significant differences in service types used by youth in each setting, yet similar volume of service use between settings. Clinical and demographic factors did not significantly influence types of services received. Differences in service patterns between the two groups indicated that youth in TFC were more likely to receive community-based, individualized services while youth in group homes were more likely to receive more restrictive services.     

A Longitudinal Study of Child Maltreatment, Mother–Child Relationship Quality and Maladjustment: The Role of Self-Esteem and Social Competence

This study examined the concurrent and longitudinal relations of mother-child relationship quality, self-esteem, social competence, and maladjustment among maltreated (n = 206) and nonmaltreated (n = 139) school-aged children from low-income families. Results of the path analysis using structural equation modeling revealed that maltreatment at Time 1 was related to internalizing and externalizing symptomatology at Time 1, both directly as well as indirectly, through its influence on social competence at Time 1. Regardless of maltreatment status, secure mother-child relationship quality was negatively related to internalizing symptomatology at Time 1 and to internalizing and externalizing symptomatology at Time 2 via its influence on self-esteem at Time 1. The results are discussed as suggestive of the role of self-esteem and social competence as mediating mechanisms in the link between relational risks and children's maladjustment.     

Winnicott, Balint, and the Independent Tradition

This article compares and contrasts two main aspects of the work of Winnicott and Balint: their theories of infantile development and their theoretical and clinical work on the use of regression as a therapeutic agent. The relationship of their thinking to aspects of the British Independent Group's theories and clinical work is noted vis-à-vis the basic acceptance of classical theory and technique, acknowledgment and use of some of Klein's contributions, the influence of trauma and the external environment on psychic development and psychopathology, the importance of holding and the setting, and the reintegration of previously split off and lost parts of the self.     

Breaking the Solid Ground of Common Sense: Undoing “Structure” with Michael Balint

Balint's great merit was to question what, in the classical perspective, was assumed as a prerequisite for analysis and thus located beyond analysis: the maturity of the ego. A fundamental premise of his work was Ferenczi's distrust for the structural model, which praised the maturity of the ego and its verbal, social, and adaptive abilities. Ferenczi's view of ego maturation as a trauma derivative was strikingly different from the theories of all other psychoanalytic schools and seems to be responsible for Balint's understanding of regression as a sort of inverted process that enables the undoing of the sheltering structures of the mature mind. Balint's understanding of the relation between mature ego and regression diverged not only from the ego psychologists, who emphasized the idea of therapeutic alliance, but also from most of the authors who embraced the object-relational view, like Klein (who considered regression a manifestation of the patient's craving for oral gratification), Fairbairn (who gave up the notion of regression), and Guntrip (who viewed regression as a schizoid phenomenon related to the ego weakness). According to Balint, the clinical appearance of a regression would depend also on the way the regression is recognized, is accepted, and is responded to by the analyst. In this respect, his position was close to Winnicott's reformulation of the therapeutic action. Yet, the work of Balint reflects the persuasion that the progressive fluidification of the solid structure could be enabled only by the analyst's capacity for becoming himself or herself [unsolid].     

How Does Change Occur Within the Psychoanalytic Encounter?

On November 6, 2002, Dr. James Fosshage delivered the following talk at a Clinical Training Conference held at the Blanton-Peale Institute. The Clinical Training Conference at Blanton-Peale provides experiential and conceptual resources to support the therapist-in-training in the context of his/her professional identity. The training conference is attended by candidates of all phases of the Psychoanalytic Program, the Pastoral Psychotherapy Program, and the Marriage and Family Program, as well as faculty members, administrators, staff, and interns of the institute. The residents were asked to review three articles written by Dr. Fosshage in preparation for his presentation: Toward Reconceptualising Transference: Theoretical and Clinical Considerations, International Journal of Psycho-Analysis (1994) 75 (2): 265–280; Countertransference as the Analyst's Experience of the Analysand: Influence of Listening Perspectives, Psychoanalytic Psychology (1995) 12 (3): 375–391; and Listening/Experiencing Perspectives and the Quest for a Facilitating Responsiveness, Conversations in Self Psychology: Progress in Self Psychology, (1997) 13: 33–55.     

Adrenocortical reactivity and social competence in seven year-olds

We examined temporal changes in salivary cortisol in response to a peer self-presentation task in a group of seven year-olds, some of whom scored high, average, and low on the Harter, 1983 Perceived Social Competence Scale. Salivary cortisol was measured pre-task, and 20 and 35 min post-task. We found a significant relation between individual differences in perceived social competence and salivary cortisol reactivity in response to the task. Children who perceived themselves as socially competent exhibited a significantly greater decrease in salivary cortisol from 20 to 35 min following the task compared with children who self-reported a relatively lower degree of social competence. We speculate on the meaning of salivary cortisol changes in childrens socio-emotional development.     

Professional and Provider Perspectives on Family Involvement in Therapeutic Foster Care

Therapeutic foster care (TFC) offers a promising community-based treatment option for children with serious emotional and behavioral disorders in the child welfare system. Family involvement is believed to contribute to achieving the goal of family reunification in TFC, but there has been little attention to family involvement in TFC. I present findings of a qualitative study of child welfare professionals' and TFC providers' perspectives on family involvement. Respondents' views of parent-child contact, parent-professional communication and information sharing, and family involvement in decision making were examined. Values and attitudes toward family involvement, practices related to family involvement, barriers to involvement, and strategies to promote involvement emerged as themes. Professionals in this study believed in the value of family involvement, but there were challenges at the organizational level and related to some TFC providers' lack of training to work with families.     

Making Decisions About Life-Sustaining Medical Treatment in Patients With Dementia

The problem of decision-making capacity in patients with dementia, such as those with early stage Alzheimer's, can be vexing, especially when these patients refuse life-sustaining medical treatments. However, these patients should not be presumed to lack decision-making capacity. Instead, an analysis of the patient's decision-making capacity should be made. Patients who have some degree of decision-making capacity may be able to make a choice about life-sustaining medical treatment and may, in many cases, choose to forgo treatment.