IMPASSE AND CHANGE: A SYSTEMIC/STRATEGIC VIEW OF THE THERAPEUTIC SYSTEM*

This paper examines how clients and therapists, together, create impasses or change. First, the general concept of a “therapeutic system” (therapist-plus-client) is briefly reviewed. Second, a model is described that synthesizes systemic and strategic ideas about therapeutic systems. Third, a series of questions based on this model is proposed for analyzing and resolving impasses. Finally, application of this framework is illustrated with a case.     

Predictors of contraceptive use by adolescent mothers

This study examines the differences between adolescents who do versus those who do not use contraceptives after the birth of their first child. The sample consists of 89 low-income mothers in the state of Indiana. A discriminant function analysis is used to determine if the adolescents' home environment, financial resources, self-esteem, or future orientation discriminates between contracepting and noncontracepting adolescents. If the adolescent is not receiving financial support from a romantic partner, intends to have another child within the next year, and expects to be a single parent in one year, she is less likely to be using contraceptives.     

Reducing bias in ecological studies: an evaluation of different methodologies

Summary.  Statistical methods of ecological analysis that attempt to reduce ecological bias are empirically evaluated to determine in which circumstances each method might be practicable. The method that is most successful at reducing ecological bias is stratified ecological regression. It allows individual level covariate information to be incorporated into a stratified ecological analysis, as well as the combination of disease and risk factor information from two separate data sources, e.g. outcomes from a cancer registry and risk factor information from the census sample of anonymized records data set. The aggregated individual level model compares favourably with this model but has convergence problems. In addition, it is shown that the large areas that are covered by local authority districts seem to reduce between-area variability and may therefore not be as informative as conducting a ward level analysis. This has policy implications because access to ward level data is restricted.     

The Value of Hate in the Countertransference

The author looks at the experience of hate in the countertransference and develops the idea that hate can be of particular value to the treatment process. He begins with an exploration of the therapist’s needs and discusses how unmet self-regulatory needs sometimes lead to feelings of frustration and rage toward the patient. The author explores these ideas as they are connected to Winnicott’s (1949, 1971) work on aggression and Jessica Benjamin’s (1992) work on recognition and destruction. The author espouses a difference between rage and hate, where rage is seen as indicative of unmet needs, and hate is seen as a force that can emancipate the therapist from the encumbrance of unmet needs. Case examples are provided to show the utility of this perspective. Laurence Green, M.S.W., Psy.D. is on the faculty and a member of the Institute of Contemporary Psychoanalysis. He is Co-chair of the History Committee of the International Federation of Psychoanalytic Education. He is in private practice in Los Angeles, California working with children, adolescents and adults.     

Attitudes Toward Control in Uncontrollable Situations: The Multidimensional Impact of Health Locus of Control on the Well-Being of Mothers of Children with Disabilities

This study examines the additive and interactive impact of four dimensions of health locus of control (internality, desire for information, powerful others, and chance) on two measures of well-being (perceived social support and subjective caregiver burden) among 81 mothers of children with disabilities. Narrative accounts and interactive interviews with such mothers are used to interpret and contextualize the quantitative results. Findings clearly support the multidimensionality of health locus of control. Among these mothers, internality is uncorrelated with both of the dimensions of externality often treated as its polar opposite. It is also uncorrelated with desire for information—often used as its indicator. Complex individual, additive and interactive affects on the measures of well-being were found for dimensions of health locus of control. Desire for information is negatively correlated with subjective burden. Mothers who do not want information about health feel greater burden of care. Internality and chance interact in their relationships to both aspects of well-being. Mothers who believe that both their own actions and chance affect health outcomes report the highest levels of social support. Where internality is low, the belief in chance increases perceived social support. Conversely, where chance is low, internality increases support. For highly internal mothers, belief in chance serves to reduce perceived subjective burden. Mothers high in chance but low in internality, on the other hand, feel more burdened by their parenting task. Implications for research and policy are discussed.     

Boundary detection through dynamic polygons

A method for the Bayesian restoration of noisy binary images portraying an object with constant grey level on a background is presented. The restoration, performed by fitting a polygon with any number of sides to the object's outline, is driven by a new probabilistic model for the generation of polygons in a compact subset of R² , which is used as a prior distribution for the polygon. Some measurability issues raised by the correct specification of the model are addressed. The simulation from the prior and the calculation of the a posteriori mean of grey levels are carried out through reversible jump Markov chain Monte Carlo computation, whose implementation and convergence properties are also discussed. One example of restoration of a synthetic image is presented and compared with existing pixel-based methods.     

SOCIAL ISOLATION OF THE URBAN POOR:

We focus on the effects of race, class, and neighborhood on social isolation. Using data from households in Atlanta, Georgia, we compare poor and nonpoor African Americans to nonpoor whites on two types of social ties and the social resources inherent in those ties. We find that poverty has an important influence on the social resources available to African Americans in and outside of their household. Poor blacks are less likely than other blacks and nonpoor whites to live with another adult, to have even one person outside the household with whom they discuss important matters (a discussion partner), or to have a college-educated person in their discussion network. Higher neighborhood poverty reduces the size of the discussion network for whites and blacks and affects the probabilities of having any kind of social contacts. Important for the social isolation thesis is our finding that among African Americans, living in a very poor neighborhood increases social isolation and reduces access to social resources via one's network of close ties.