Centering culture in the treatment of opioid use disorder with American Indian and Alaska Native Communities: Contributions from a National Collaborative Board

American Indian/Alaska Native (AI/AN) communities are disproportionally impacted by the opioid overdose epidemic. There remains a dearth of research evaluating methods for effectively implementing treatments for opioid use disorder (OUD) within these communities. We describe proceedings from a 2-day Collaborative Board (CB) meeting tasked with developing an implementation intervention for AI/AN clinical programs to improve the delivery of medications to treat OUD (MOUD). The CB was comprised of Elders, cultural leaders, providers, individuals with lived experience with OUD, and researchers from over 25 communities, organizations, and academic institutions. Conversations were audio-recorded, transcribed, and coded by two academic researchers with interpretation oversight provided by the CB. These proceedings provided a foundation for ongoing CB work and a frame for developing the program-level implementation intervention using a strength-based and holistic model of OUD recovery and wellbeing. Topics of discussion posed to the CB included engagement and recovery strategies, integration of extended family traditions, and addressing stigma and building trust with providers and clients. Integration of traditional healing practices, ceremonies, and other cultural practices was recommended. The importance of centering AI/AN culture and involving family were highlighted as priorities for the intervention.     

Advance planning of discourse in potential exchange situations

Advance planning discourse strategies are examined in an experiment where subjects expect to be in a communicative situation (discussion vs appraisal) with another speaker (expert vs peer) whose opinions on a given topic differ diametrically from theirs. Findings indicate that two complementary processes are implemented: one on the level of the components of the universe of reference (via predication operations) and the other on the level of relationships between actors (through hedges).     

Talking about the silent fear: adolescents' experiences of violence in an urban high-rise community

The self-reported violent experiences of adolescents living in a public-subsidized urban high-rise building were examined. This effort was part of an interdisciplinary, community-university collaboration program called the HOME (High-rise On-site Multifamily Environments) Family Support Project. A survey of violent experiences and a one-on-one structured interview were conducted with 20 adolescent residents. Results of the quantitative and qualitative analyses revealed high degrees of exposure to violence among these adolescents, concerns for their personal safety, as well as insights into what they believe adults could and should be doing to address increasing levels of community violence. The implications of these results for conducting ecologically valid research on sensitive issues with adolescents and for family support program planning are discussed.     

A categorical and dimensional perspective on depression within a nonclinical sample of couples

The present study investigated the role of psychosocial variables that are indicators for depressive symptomatology within a couple. The variables chosen for this study were conflict communication, marital adjustment, attachment, attribution style, and personality traits--all potentially specific indicators. A global factor analysis on all our measures revealed that our individual and relational measures were stable findings. We wanted to compare a dimensional and categorical view of depression. First, we focused on the total nonclinical sample, considering depression on a continuum, and studying the selected characteristics along with the varying degree of depressive complaints. The results highlighted the importance of individual characteristics (neuroticism and life satisfaction) covarying with the level of depressive symptomatology in the nonclinical sample (n = 186 couples). Second, in addition to this correlational design, we compared the group of most depressed subjects and their partners with a control sample (n = 34). Both approaches pointed to the same conclusion: individual characteristics covaried with mild depression, whereas couple characteristics only came into the picture with a higher level of depressive complaints. The lowest levels of depressive complaints were associated with individual co-morbidity only, whereas increasing complaints went along with additional relational complaints. Implications for assessment and future research are discussed.     

As I See It: A Study of African American Pastors’ Views on Health and Health Education in the Black Church

The Black Church is the only institution that has consistently served the interest of African Americans, and there is no other institution in the African American community that rivals its influence (Camara, 2004). The spiritual well-fare, social support, health, and well-being of its people have been one of its main goals. With health disparities of African Americans still at an alarming rate, the Black Church has used informal education as a means to impart knowledge on health, as well as other non-religious and religious topics. One of the avenues least researched within the Black Church is the pastor’s perception of its educational role in health and wellness and its efforts to reduce health discrimination and health disparities between African American and European Americans in the U.S. Since social justice appears as a theme and concern in the traditions of many churches, it is only appropriate that, among other things, the Black Church should address the issue of health education and interventions. The purpose of this study was to explore African American pastors’ perceptions of the role of the Black Church in providing health care, health education, and wellness opportunities to African Americans. Many pastors reported their church provided some form of health education and/or health screenings. Their perceptions about the important issues facing their congregants versus African Americans in general were quite similar.     

The impact of stress on mothers' memory of a natural disaster

The effects of stress on mothers' recall for a major hurricane were studied. Stress was objectively defined as low, moderate, or high according to the severity of home damage. This study of 96 mothers was conducted concurrently with L. E. Bahrick, J. F. Parker, R. Fivush, and M. Levitt (1998), allowing the authors to compare child and adult recall as a function of the same stressor. There was a quadratic relationship between storm severity and total recall for adults, similar to their children. Mothers' recall increased from low to moderate severity, but recall at moderate severity did not differ from high severity. These findings help clarify the effects of stress on the amount and type of information adults recall in retrospective accounts of naturalistic, temporally extended events.     

The Analytic Moment Doesn't Fit Analytic “Technique”: Commentary on Tony Bass's “When the Frame Doesn't Fit the Picture”

Tony Bass in his groundbreaking contribution to the analytic literature argues cogently that the frame remains an essential reference point throughout any psychoanalysis, a statement about which he and I are in agreement. He also argues that for a frame to be therapeutically useful it must be flexible enough to allow negotiation of enactments and their working through in an intersubjective field, another point about which we are in complete accord. He and I each hold a self-state perspective that informs and enriches our clinical work. Where we diverge slightly is in how this perspective shapes the way we think about the nature of the “frame” as it applies to the dissociated self-states of patient and analyst that emerge and engage each other subsymbolically as an ongoing aspect of the work, often in quite bewildering and sometimes confounding ways. This paper speaks to a number of issues that I hope will bring into relief some of the points of contrast that do exist, while underlining the core commonality in our thinking and clinical sensibility that unites us.     

One Need Not Be a House to Be Haunted: On Enactment,Dissociation, and the Dread of “Not-Me”—A Case Study

This paper examines psychic trauma as experience so shockingly strange that it exceeds the threshold for cognitive processing and begins to flood the mind with unintegratable affect that threatens to disorganize the internal template on which one's experience of self-coherence, self-cohesiveness, and self-continuity depends. A detailed clinical vignette illustrates how the unprocessed “not-me” experience held by a dissociated self-state as an affective memory without an autobiographical memory of its traumatic origin “haunts” the self. It remains a ghostly horror even in an otherwise successful psychoanalysis unless a new perceptual reality is created between patient and analyst that alters the narrative structure maintaining the dissociation as though the past were still a present danger. The analyst's making optimal use of dissociative processes in an intersubjective and interpersonal context enables the patient more readily to self-regulate affect in those areas of implicit memory where trauma has left its mark; the dissociated ghosts of “not-me” are thus persuaded, little-by-little, to cease their haunting and participate more and more actively and openly as self-reflective, self-expressive parts of “me.”     

Commentary on Carola M. Kaplan's “Navigating Trauma in Joseph Conrad's Victory: A Voyage From Sigmund Freud to Philip M. Bromberg”

This commentary adds a few additional sparks to Carola M. Kaplan's incandescent essay at the boundary of literary fiction and psychoanalysis, and attempts to place her already generous treatment of my work into a perspective that enriches her synthesis. Conceptually, I try to further develop our shared understanding of why the legacy of developmental trauma too relationally barren to allow cognitive symbolization and self-reflection, leads to an adult life shaped by a dissociated mental structure that channels the “best of intentions” toward tragically predestined defeat. But beyond our conceptually explicit link, and perhaps even more central, is that the history of my own attempt to “navigate trauma” at the interface of psychoanalysis and literature has become part of a deeper connection between Kaplan and me. I discuss this implicit link between us as representing the fuller meaning of intersubjectivity and the wonders of selfhood, otherness, and human relatedness. My overarching emphasis is that Professor Kaplan, meticulously respecting the boundary of what defines fiction in literature, has simultaneously demonstrated the permeability of the boundary between fiction and nonfiction in human relationships —showing that what is most human in human beings is in one way always nonfiction if it is experientially authentic.     

The Gill/Bromberg Correspondence

This correspondence between Merton Gill, M.D., and Philip M. Bromberg, Ph.D., includes five letters written between December 7, 1979, and January 8, 1984. The first letter, from Gill to Bromberg, shared reflections on Bromberg's paper “Interpersonal Psychoanalysis and Regression,” published in the October 1979 issue of Contemporary Psychoanalysis. The exchange of letters that follows takes up a number of issues relevant to the evolution of analytic theory and technique, of historical as well as contemporary interest. Their discussion moves from a consideration of the nature and role of regression in psychoanalytic work to a consideration of mental structure and mental states, to free association and the analysis of transference, and finally to their reflections on the analytic frame and analytic technique itself.