Quantifying Intrinsic and Extrinsic Contributions to Human Longevity: Application of a Two-Process Vitality Model to the Human Mortality Database

The rise in human life expectancy has involved declines in intrinsic and extrinsic mortality processes associated, respectively, with senescence and environmental challenges. To better understand the factors driving this rise, we apply a two-process vitality model to data from the Human Mortality Database. Model parameters yield intrinsic and extrinsic cumulative survival curves from which we derive intrinsic and extrinsic expected life spans (ELS). Intrinsic ELS, a measure of longevity acted on by intrinsic, physiological factors, changed slowly over two centuries and then entered a second phase of increasing longevity ostensibly brought on by improvements in old-age death reduction technologies and cumulative health behaviors throughout life. The model partitions the majority of the increase in life expectancy before 1950 to increasing extrinsic ELS driven by reductions in environmental, event-based health challenges in both childhood and adulthood. In the post-1950 era, the extrinsic ELS of females appears to be converging to the intrinsic ELS, whereas the extrinsic ELS of males is approximately 20 years lower than the intrinsic ELS.     

A Commentary on “Gender Perspectives in Cross-Cultural Couples”

This commentary expands on Kellner’s article by discussing clinical practice with Asian and Euro-American couples. Differences in Western and traditional Asian cultural expectations around intimacy and styles of emotional expression can often lead to misunderstanding among couples. Therapy can also be a challenge for couples when they do not share the same first language. A therapist who only speaks English can inadvertently create an alliance with the partner whose first language is English. On the other hand, bilingual therapists who use both English and an Asian language in the session can face challenges differentiating their roles as a therapist versus a translator. Case illustrations are presented to illustrate these challenges.

Becoming Each Other: A Single Case Exploration of Relational Consciousness in Couple Therapy

The concept of “relational consciousness” has gained increasing attention in the last decades in the fields of philosophy, sociology, and psychotherapy. Yet human consciousness with its concomitant awareness of self and other as distinct is linguistically and culturally situated in the individual mind. This article explores the lived experience of shared consciousness in the practice of “becoming the other” with a focus on therapy with one couple. The historical development of our understanding of consciousness as a relational phenomenon is addressed with particular attention to the observations, insights, and practices of Lev Vygotsky, George Herbert Mead, and Gregory Bateson, who have each contributed substantially to our understanding of mind as relationally experienced and constructed. The article explores implications for practice and future directions this methodology might take.

Sustained Empathic Focus and its Application in the Treatment of Couples

Although all psychoanalytically informed approaches to couples therapy recognize the importance of underlying dynamics, there are important differences in the focus of the treatment. This paper suggests a focus that is based on a self-psychological/intersubjective viewpoint. Two concepts that exemplify this model, a sustained empathic focus and an appreciation of the experience of vulnerability, are discussed and applied to a couples session. What is emphasized in this material is a process of focusing on underlying vulnerability, affect and subjective experience.

Culture and Masculinity: When Therapist and Patient are Latino Men

Treating clients from diverse cultural backgrounds, and supervising clinicians who are treating clients of the same ethnicity and gender, are now common experiences in our mental health system. As the growth of minorities in the US greatly outpaces the training of minority clinicians, more attention to these situations is needed. Operating from the premise that interpersonal sensitivity is a fundamental aspect of cross-cultural and cross-ethnic sensitivity, we describe the treatment of a Latino male by a Latino male clinician, in this case both of Puerto Rican descent. We outline the contours of the therapy with a man whose life history included numerous incidents of humiliation and thwarted efforts at efficacy, mastery, agency, and competence, resulting in an adult character structure based on shame and self-doubt. We also discuss the challenges to the clinician posed by working with a man whose traditional upbringing mirrored his own, with all the positives and negatives that must be considered in the countertransference. We describe clinical and cultural reasons for various interventions, and their resulting outcome. The framework of a dynamic interpersonal therapy and the challenges of transference, countertransference, therapist disclosure, and working-through are covered.     

Wrapping and Unwrapping Emotions: Clinical Practice with East Asian Immigrant Elders

Using the cultural norm of the way gifts are wrapped, unwrapped, and exchanged as a metaphor for interpersonal connections, this paper presents the way therapists can establish therapeutic relationships with East Asian clients who do not express emotions openly. We first discuss the ways in which emotions are conceptualized, experienced, and expressed in East Asian cultures. We then present vignettes of our work with older Chinese and Japanese immigrant women to illustrate the importance of therapist authenticity and co-construction of the therapeutic relationship. Using the framework of relational/cultural theory, which posits that healing takes place in the context of mutually empathic growth-fostering relationships, we illustrate the importance of establishing mutuality between therapist and client as a form of cultural empathy.     

Clinical Social Work and Psychoanalysis: Introduction to the Special Issue

As clinical social work developed in America it was highly influenced by the concepts and techniques of psychoanalysis and many of its practitioners became interested in seeking psychoanalytic training. More and more psychoanalysts are now coming from a background in clinical social work due to the development of a network of interdisciplinary training institutes and the opening of the Institutes of the American Psychoanalytic Association to non-medical candidates. This special issue considers how psychoanalysis may be affected as more of its practitioners and contributors come from a background in clinical social work. This introduction reviews the history of the development of clinical social work and outlines the issues related to “lay analysis” in this country.