Paranoia and narcissism in psychoanalytic theory. Contributions of self psychology to the theory and therapy of the paranoid disorders

Many factors go into a choice of a therapeutic focus: the patient's psychopathology; the therapist's training, countertransference reactions, and ideological beliefs; and, importantly, a decision about what seems most amenable to treatment and change. As a theory, self psychology describes one aspect of the paranoid process; as such, it is an incomplete theory that complements rather than invalidates more classical theories. As a technique, however, it suggests a style and focus conducive to working with paranoid patients, one that is markedly supportive, nonconfrontational, yet also interpretive. In this context, it must be remembered how difficult it is to treat paranoid patients psychotherapeutically, much less to keep them in treatment. The strategies discussed above do not wholly replace other dynamic approaches (e.g., counterprojective techniques), nor are they universally applicable. Some patients may be more amenable than others. However, the techniques provide a very supportive framework that may help the therapist to be more available to and in contact with the paranoid patient. More broadly, this paper's application of self psychology to the theory and therapy of the paranoid disorders further illustrates the practical utility of this approach. Attention to the narcissistic developmental line, interpersonal selfobject relationships, intrapsychic conflicts and deficits, and empathic immersion in the patients's world are important adjuncts to the psychotherapy of paranoid patients. Rather than an either/or dichotomy, the principle of overdetermination suggests a both/and relationship between self psychology and traditional theory, such that the self psychological approach complements rather than contradicts the classical psychoanalytic theory. The vicissitudes of the self simply add another perspective or vantage point from which to understand and respond to the patient, one which has perhaps more applicability for preoedipally disordered patients.     

Group intervention with children of parents with aids

This paper describes a format for group intervention with children of parents with AIDS. Therapeutic factors specific to group work with these children and special issues regarding AIDS are discussed. The stages of development of such groups are outlined, with particular attention paid to themes of grief and loss. Suggestions for future work in this area are given.     

Studies in dialogue and discourse. III. Utterance structure and utterance function in interrogative sequences

Natural conversations in first-grade classrooms are analyzed. Exchanges that are initiated and extended by questioning are the focus of attention, and analyses are directed principally to a comparison of adult-initiated and child-initiated interrogative series. Differences in structural features are found for each component utterance of an interrogative unit of discourse, namely, question, response, and confirmation. Adults ask more constraining questions than children, and children respond in more complex although less appropriate ways to children's questions than to adults' questions. The type of discourse within which an utterance is located influences the features of children's responses to children's but not to adults' questions. These differences are interpreted as reflecting differences in the relative power of adults and children in these settings.This work has been supported by a grant from the National Science Foundation for research on Social Effects on Language and Communication, Grant No. GS-3001.     

Interpersonal Reactions to Depression and Physical Disablllty In Dyadic Interactions1

Examined the interpersonal responses of persons engaged in dyadic interactions with confederates who enacted either depressed or socially appropriate roles and appeared either with or without a physical disability. Subject negative evaluations of confederates were indirectly obtained from a thought-listing measure. The overt behaviors of subjects were surreptitiously recorded on videotape and measures of verbal and nonverbal behavior were acquired. Subjects spoke less to the depressed targets and had significantly higher rates of negative evaluations of these persons. In addition, subjects gazed less at the depressed confederates. These effects were not moderated by target physical appearance. Findings are discussed as they relate to social models of depression and the stigmatizing effects of disability.     

Decision-makers use social information to update their preferences but choose for others as they do for themselves

People's risky decisions are susceptible to the social context in which they take place. Across three experiments using different paradigms, we investigated the influence of three social factors upon participants' decisions: the recipient of the decision-making outcome (self, other, or joint), the nature of the relationship with the other agent (friend, stranger, or teammate), and the type of information that participants received about others' preferences: none at all, general information about how previous participants had decided, or information about a specific partner's preference. We found that participants' decisions about risk did not differ according to whether the outcome at stake was their own, another agent's, or a joint outcome, nor according to the type of information available. Participants did, however, adjust their preferences for risky options in light of social information.     

A study of parents of violent children

This study based on in-depth interviews of 25 parents of violent children and a control group of 25 parents of nonviolent children concerned the parents' personalities. Parents were between 22 and 48 years of age and were from middle and lower middle socioeconomic backgrounds. Differences in classification by the nonblinded interviewers of parents into the two groups on six behavior characteristics were significant on chi2 tests. Some recommendations are made for further research.