The stresses of psychotherapeutic work: a replication and extension.

The present study represents a replication and extension of a recent investigation of the patterns of stresses in psychotherapeutic work. A sample of 227 licensed psychologists who were practicing in Northern California were administered two Likert-type rating scales, which were expanded versions of questionnaires originally developed by Farber and Heifitz (1981). Factor analysis of the data revealed that the stressful aspects of therapeutic work include maintaining the therapeutic relationship, scheduling difficulties, professional doubt, work overinvolvement, and feeling personally depleted. In addition, stressful patient behaviors were found to cluster into five distinct categories: Expressions of negative affect, resistances, psychopathological symptoms, suicidal threats, and passive-aggressive behaviors. Demonstration of the empirical generalizability of the factor structure and of the relative importance of stressful therapeutic events argues for the usefulness of the extended versions of The Therapeutic Stresses and Stressful Patient Behaviors rating scales.

Relation of family factor to treatment outcome for bulimic patients.

The psychotherapy of 25 normal weight bulimic adolescent and late adolescent women (age 15-32 years, mean = 21 years), was reviewed to evaluate developmental and diagnostic precursors and the outcome of psychoanalytically oriented long-term therapy (mean = 33 sessions). Psychotherapy outcome was scored in these categories: bingeing and purging; food obsession; school/work satisfaction; equilibration with family of origin, and achievement of heterosexual closeness. On factor analysis, all factors loaded highly and a global outcome score was derived which was used as the dependent variable in a step-wise regression analysis with 18 family factors as independent variables. To identify family patterns that predicted degree of improvement, a multiple regression analysis was performed. Results indicated that family variables associated with maternal warmth explained an appreciable proportion of the variance in outcome. Such a finding is consistent with the formulation that patients with benign archaic maternal representations were better able than their counterparts with less benign maternal images to form a positive transference and better working alliance with the (female) therapist.

Organizational size and perceptions in a residential treatment program.

Centralization of a residential mental health treatment program from three small houses to one large facility provided a naturally occurring opportunity to study the effect of organizational size on the perceptions held by clients and staff. Quantitative data were repeatedly collected on their perceptions of themselves, the organization as a whole, and subgroups within the organization during their involvement in both the small and large social contexts. Results of repeated measures analyses of variance provided considerable support for the theoretically derived hypotheses of heightened anxiety, self-impoverishment, more negative views of the psychosocial environment, and greater psychological distance in the large organizational context.

Biofeedback, self-control and tension headache.

This research tested the belief that muscle contractions are a primary source of tension headache. EMG level was found to be associated with both headache-specific and more global symptoms following biofeedback training. However, the level of pretreatment relationship between EMG level and headache symptoms was weak, and the amount of reduction in EMG activity over the course of biofeedback did not explain improvement. In addition, although the voluntary control over muscle spasming evidence by lowered EMG readings appeared to enhance patients' post-treatment level of self-control, this cognitive process variable also could not account for outcome variance. The results offer limited support for the muscle-origins conception of tension headache and suggest the need for further research to clarify the contribution of physiological, cognitive and social factors to pain reduction.

The mid-life male sex-change applicant: a multiclinic survey.

Directors of coordinators of a cross-section of North American Gender Identity Clinics provided descriptive information on 1,637 sex-change applicants and psychosocial, psychosexual, and psychiatric data on 21 middle-aged male candidates. To determine the age relatedness of the findings, the mid-life male candidates were then compared on selected characteristics with a random sample of younger biological males seeking sexual reassignment at the Vanderbilt Gender Identity Clinic. The results are consistent with previous findings highlighting the factors at mid-life that intensify the male transsexual's desire for sexual transformation. Viewing the aging gender dysphoria patient's surgical request from a developmental perspective promotes appreciation of his predicament and informed consideration of his treatment options.

Borderline personality disorder and the MMPI.

Fourteen patients diagnosed as borderline on the basis of the Diagnostic Interview for Borderlines obtained a mean group profile of 8-2-7 similar in configuration, but more elevated than that obtained by a group of 7 diagnostically heterogeneous controls. The borderline patients manifested significantly greater hypochondriasis, depression and hysteria, slightly more schizotypal features, a more deviant self-presentation, and lesser defensiveness. However, considerable heterogeneity in symptomatology was found within the borderline subsample. Further, clinical scales comprised of a higher proportion of relatively subtle and presumably less structured items did not discriminate borderline from control patients more effectively than did those scales made up of a lower proportion of such items. The results offer partial support for the construct validity of the borderline syndrome and for the usefulness of the MMPI in differentiating it from other psychiatric disorders.

Internal-external control and headache response to biofeedback and psychotherapy.

This study was undertaken to determine the comparative validity of two competing hypotheses derived from different conceptualizations of internal versus external control. On the basis of the premise that this dimension is merely a belief on the periphery of personality, it was predicted that headache patients who felt that they could exert some influence over their own health would become more involved in and hence derive more benefit from both psychotherapy and biofeedback than their counterparts who did not believe that their own efforts could affect their health status. Following the assumption that locus of control is a manifestation of an underlying need, however, it was predicted that externally oriented headache patients would respond more favorable to the structure provided by biofeedback than would their internally oriented counterparts, whereas internals would fare better than externals in the relatively less directive arena of psychotherapy. Although the results were mixed, they tend on balance to offer differential support for the interaction hypothesis and hence for the formulation of locus of control as a reflection of an underlying need rather than as a superficial belief.

Locus of control, persistence, and use of contingency information in physically abused children.

Abused children are believed to develop in a harsh environment with minimal contingency of parental responses to their behavior. Seligman proposed that noncontingent caregiving produces helplessness. In this study, helplessness was assessed by measures of persistence and locus of control and by an experimental manipulation which varied contingency feedback. Compared to matched nonabused peers, abused children showed no less persistence in working for rewards, made equivalent use of contingency information to maintain persistence, and assumed equivalent responsibility for success. However, they took less responsibility for failure. Family learning history may render abused children helpless primarily in avoidance of aversive outcomes.

Psychiatric diagnosis of chronic pain patients.

Using DSM-III, the authors reviewed the psychiatric diagnoses of 43 patients evaluated over a 1-year period by a university medical center pain board and found that 98% of the patients had an axis I disorder and 37% had an axis II disorder. The findings are discussed in relationship to earlier findings and treatment implications.

Inpatient community meeting as an aid to psychiatric diagnosis.

There is a growing evidence that the clinical distinction of schizophrenia from mania should be based on a multidimensional approach rather than on the presence of characteristic symptoms. In-patient community group meetings are rarely appreciated as one source of such differential diagnostic data. Some patients are observed to manifest group behaviour which belies the schizophrenic diagnoses with which they re-enter the hospital. Three illustrative cases are presented in which patients so identified were successfully treated with lithium carbonate alone. The clinical and theoretical implications of this phenomenon are discussed.

Self-mutilation and the borderline personality.

As part of a larger study of pathological self-injury, 14 self-mutilators and 14 psychiatric controls matched for age, sex, and inpatient/outpatient status were administered the Diagnostic Interview for Borderlines. Consistent with Gunderson's theory of borderline personality disorder, the self-mutilators scored significantly higher on impulse-action patterns, affects, psychoticism, and interpersonal relations as well as on the total borderline index. A review of clinical records likewise revealed that self-mutilators were more likely than controls to have been diagnosed as borderline and to have received a greater number of different diagnoses during their treatment career. The results have implications for developmental theory, diagnosis, and treatment and provide support for the construct validity and clinical utility of the borderline syndrome and the Diagnostic Interview for Borderlines.

Keeping the faith: Psychosocial correlates of activism persistence into middle adulthood.

This study was conducted to determine certain ideological, personological, lifestyle, and familial correlates of activism persistence into middle adulthood. Almost 15 years following their arrest for participation in the Free Speech Movement, 30 former Berkeley activists responded to a political activity scale and measures selected to tap variables in each of the contextual domains. Although persisters did not differ from nonpersisters with respect to most lifestyle dimensions, they were distinguished by more radical beliefs, stronger repudiation of Protestant ethic values, and a stronger family legacy of social concern. The results provide more support for theories of activists' adult development based on notions of generational continuity, rather than generational rebellion.

Racial attribution effects on clinical judgment: a failure to replicate among white clinicians.

The case profile of a young male community outpatient that had elicited racial expectancies from black clinicians was shown to a demographically similar sample of white clinicians. Manipulation of his racial attribution failed to influence impressions of psychobehavioral adjustment or therapeutic recommendations. In addition, the overall ratings given by the white assessors were more lenient than those given by the black assessors. The notion that white clinicians' evaluations of black patients are poorly insulated from the racial prejudices of the larger society continues to run counter to mounting experimental evidence. Its persistence in the absence of such confirmation is discussed in terms of the low credibility of analogue methodology in relation to personal conviction.