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PubMed2005

[Self-assertion communication in the family].

The present research was aimed at studying the familiar triads (adolescent child-father-mother). The familiar dynamics was approached by empathic skills at intrapersonal level and by communication patterns among the family members at interpersonal level. Empathic skills were evaluated by the Davis Interpersonal Reactivity Index and by the Mehrabian and Epstein Empathy Questionnaire, while communication patterns were evaluated by the Consensus Rorschach test. Modeling a familiar problem-solving situation with the Consensus Rorschach test, we focused on the self-assertion capabilities of the family members in the communication process. This self-assertion was not qualified as positive or negative phenomenon, rather its intrapersonal and interpersonal relationships with empathy and communication styles were evaluated. The present results show a positive correlation of self-assertion with cooperative communication and a negative correlation with blocking communication. It is also shown that at interpersonal level, the self-assertion tendencies of the child are negatively correlated to the emphatic skills of family members.

Adolescent↗

PubMed1999

Findings of a pilot study of motivational interviewing with pregnant drinkers.

OBJECTIVE: Cost-effective interventions are needed for counseling pregnant drinkers, in order to reduce risk of fetal alcohol effects. METHOD: 42 pregnant women who reported alcohol consumption participated in this pilot study of motivational interviewing. Following a comprehensive alcohol use assessment, the participants were randomly assigned to receive either written information about the risks related to drinking during pregnancy or a one-hour motivational interview. The motivational interview was an empathic, client-centered, but directive session focusing on the health of the participants' unborn babies. RESULTS: At the end of a 2-month follow-up period, the 34 women (81%) who remained in the study showed a significant reduction in alcohol consumption and peak intoxication levels. Women who had reported the highest blood alcohol concentration (BAC) levels during early pregnancy showed a significantly greater reduction in their estimated BACs at follow-up (during later pregnancy) if assigned to the treatment rather than the control condition. CONCLUSIONS: Motivational interviewing shows promise as a specific intervention for initiating a reduction in drinking among pregnant women who are at greatest risk. Simpler assessment and advice may suffice for women with lower initial consumption levels.

Adult↗

PubMed2000

[A review of socio-behavioural studies on adherence to antiretroviral treatments: beyond biomedical models?].

This paper, based on a review of the literature of socio-behavioural research in this field, shows how the AIDS epidemic has renewed traditional approaches to patients behaviour toward medical treatment by substituting the notion of adherence for the traditional one of compliance. It shows how this issue of patients adherence has come to the forefront of HIV care with the recent diffusion of highly active antiretroviral therapeutics (HAART), because inadequate adherence has profound implications for the individual and public heath effectiveness of these therapeutic advances. The paper argues that two alternatives, and indeed conflicting, approaches to adherence to treatment in HIV infection however persist. The aim of the first approach remains to predict and correct non-adherent behaviour in certain patients and sometimes suggests that such predictions may provide justification for denying individuals treatment. This 'predictive' approach focuses on identification of individual barriers to 'good' adherence and calls on social science research to help improve the 'acceptability' of prescribed regimens for patients. An alternative 'empathic' approach focuses more on encouraging and supporting all HIV-infected patients medically eligible for HAART to devise appropriate individualised plans that can facilitate management of their treatment in their daily life. This latter approach more willingly learns from social science research which recognises the patient's subjective experience of illness as a central concern. In the future, the respective contributions of these two alternative approaches will have to be judged on the basis of their capacity to analyse both the factors which influence HIV-infected patients' initial adherence to antiretroviral treatment and those, potentially quite different, which interfere with adherence on the long term. They will also be judged for their capacity to inspire effective psychological and socio-behavioural interventions aimed at facilitating patients adherence.

Anti-HIV Agents↗

PubMed2005

Empathic accuracy in adults with a pervasive developmental disorder during an unstructured conversation with a typically developing stranger.

The present paper consists of two parts. In the first part, eleven high-functioning adults with pervasive developmental disorder (PDD) participated and were videotaped with a concealed camera while having an initial conversation with a typically developing stranger. Analyses revealed some significant differences with regard to the dyad members' overt behaviours. Contrary to our main hypothesis, analyses of the covert behaviour revealed that the participants with PDD did not differ from the typically developing participants in the ability to infer the thoughts and feelings of their interaction partner. The second part indicated that the inference ability of both groups was independent of the dyad members' behavioural characteristics and the content of the dyad members' thoughts and feelings. Issues addressed in this paper include the relation of scriptal knowledge to social functioning, and the advantage participants with PDD take from more structured interactions compared with less structured interactions.

Adult↗

PubMed1998

Awkward moments in patient-physician communication about HIV risk.

BACKGROUND: Physicians frequently encounter patients who are at risk for HIV infection, but they often evaluate risk behaviors ineffectively. OBJECTIVE: To describe the barriers to and facilitators of comprehensive HIV risk evaluation in primary care office visits. DESIGN: Qualitative thematic and sequential analysis of videotaped patient-physician discussions about HIV risk. Tapes were reviewed independently by physician and patient and were coded by the research team. SETTING: Physicians' offices. PARTICIPANTS: Convenience sample of 17 family physicians and general internists. Twenty-six consenting patients 18 to 45 years of age who indicated concern about or risks for HIV infection on a 10-item questionnaire administered before the physician visit were included. MEASUREMENTS: A thematic coding scheme and a five-level description of the depth of HIV-related discussion. RESULTS: In 73% of the encounters, physicians did not elicit enough information to characterize patients' HIV risk status. The outcome of HIV-related discussions was substantially influenced by the manner in which the physician introduced the topic, handled awkward moments, and dealt with problematic language and the extent to which the physician sought the patient's perspective. Feelings of ineffectiveness and strong emotions interfered with some physicians' ability to assess HIV risk. Physicians easily recognized problematic communication during reviews of their own videotapes. CONCLUSIONS: Comprehensive HIV risk discussions included providing a rationale for discussion, effectively negotiating awkward moments, repairing problematic language, persevering with the topic, eliciting the patient's perspective, responding to fears and expectations, and being empathic. Educational programs should use videotape review and should concentrate on physicians' personal reactions to discussing emotionally charged topics.

Adolescent↗

PubMed1990

Educational requirements of human sexuality in the counseling for and prevention of sexually transmitted diseases.

Sexually transmitted diseases (STDs) are usually stigmatizing, displaying not only medical but also social, psychological, and/or sexual consequences. Thus, it is of importance to provide STD patients with qualified counseling including three goals (1) providing comprehensive medical care; (2) providing information aimed at preventing spread of disease or reinfection; and (3) reducing social, psychological, and/or sexual sequelae. To accomplish these goals, health professionals need to be comfortable with their own sexuality, sensitive to patients' sexual concerns or problems, familiar with basic sexological knowledge, aware of their professional limitations, and warm, supportive, genuine, and empathic in the professional patient relationship. It is of further importance to not imply that sexual partners are necessarily of the opposite sex. Professionals often feel incapable of giving help as to sexual issues partly because a lack of basic knowledge and skills and partly because professionals are affected, like their patients, by taboos and constraints that make it difficult to talk about sexuality. Therefore, there is a need for including sexuality issues in professional training courses, focusing on preparing health personnel to provide patients with permission to talk about individual sexual concerns, as well as with information and specific suggestions related to a given sexual topic. Through increased awareness of one's own sexual affective attitudinal orientation combined with sexological knowledge and clinical skills, health professionals will become better counselors in human sexuality and hence in primary prevention of STDs.

Attitude of Health Personnel↗

PubMed2003

Neural mechanisms of empathy in humans: a relay from neural systems for imitation to limbic areas.

How do we empathize with others? A mechanism according to which action representation modulates emotional activity may provide an essential functional architecture for empathy. The superior temporal and inferior frontal cortices are critical areas for action representation and are connected to the limbic system via the insula. Thus, the insula may be a critical relay from action representation to emotion. We used functional MRI while subjects were either imitating or simply observing emotional facial expressions. Imitation and observation of emotions activated a largely similar network of brain areas. Within this network, there was greater activity during imitation, compared with observation of emotions, in premotor areas including the inferior frontal cortex, as well as in the superior temporal cortex, insula, and amygdala. We understand what others feel by a mechanism of action representation that allows empathy and modulates our emotional content. The insula plays a fundamental role in this mechanism.

Adult↗

PubMed2004

Impairment in cognitive and affective empathy in patients with brain lesions: anatomical and cognitive correlates.

The present study was designed to examine the degree of impairment in cognitive and affective empathy among patients with focal brain lesions, and the contribution of specific cognitive abilities (such as cognitive flexibility and processing of emotional information), to empathy. The cognitive and affective empathic response of patients with localized prefrontal lesions (n=36) was compared to responses of patients with parietal lesions (n=15) and healthy control subjects (n=19). Results indicate that patients with prefrontal lesions (especially those with lesions involving the orbitoprefrontal and medial regions) were significantly impaired in both cognitive and affective empathy as compared to parietal patients and healthy controls. When the damage was restricted to the prefrontal cortex, either left- or right-hemisphere lesions resulted in impaired empathy. However, when the lesion involved the right hemisphere, patients with parietal lesions were also impaired. The pattern of relationships between cognitive performance and empathy suggested dissociation between the cognitive correlates of affective and cognitive empathy.

Adult↗

PubMed1991

Psychological reaction to hospitalization and illness in the emergency department.

Each personality type presents with different methods of coping. Physicians should be aware of the impact on a patient's psychological functioning and ability to cope with illness and hospitalization, to understand and more effectively manage the patient. The physician must try to assess the patient's baseline personality from their past and present behavior. Establishing a good physician-patient relationship is important as a source of information about behavior of patients and how they will respond to their illness. Depending on the specific personality type, each patient will respond differently to the stress of illness. The effort of the emergency physician to identify personality types will aid in medical management of the patient and enable the physician to help each patient cope effectively with the illness and the hospitalization. The specific issues that seem to be threatening to traumatized patients include the following: helplessness, humiliation, blurring of body image, and gaps in memory filled with distortions. The traumatized patient experiences an altered state of consciousness which is either due to a physiologic cause or an emotional cause. Emotional causes are usually based on defensive dissociation. People who have been in an auto accident characteristically report loss of memory of the intense pain that the accident produces initially. Oftentimes, the core experience for the traumatic patient is not somatic, it is unconscious. The interesting feature is that so many patients do not remember the accident. The mind seems to be filled with all kinds of distortions and irrelevant and perhaps totally inconsistent fantasies, such as imprisonment, confinement, or deathlike experiences. Some report that they are being incarcerated, others recall being in a featureless cubicle with no contact with the normal world in which there are no windows, no pictures, no flowers. Others remember only being surrounded by masked, hatted, uniformed wardens who are standing over them with nasogastric tubes, intravenous lines, Foley catheters, arterial blood gases, subclavians, and dermal cut-downs. This is an overwhelming nightmare that can be relieved only by the empathic and caring physician and emergency department staff. The stress of medical illness and/or hospitalization can be overwhelming for some patients and is usually followed by some form of psychological response. Current understanding of the psychological impact of illness is based upon psychological defenses, coping mechanisms, and individual personality. It is the ability of the emergency physician to identify defenses, coping skills and personality types that will aid him or her in the medical management of the patients in their time of illness and hospitalization.

Disease↗

PubMed1985

Psychoanalytic constructions of female development and women's conflicts about achievement--Part II.

Central to the dynamics that underlie women's conflicts about their own autonomous achievements are the reappraised psychoanalytic concepts of penis envy and masochism. These ideas need not be abandoned because of the phallocentric bias that is responsible for their initial formulation. When they are conceptualized as serving defensive ego-maintaining functions for the woman, their richness in expressing aspects of women's psychological experiences becomes evident. Both culturally ascribed meanings to physiological differences and the physical differences themselves have an impact on an individual's developing psychological sense of self, and of self in relation to others. Girls and boys have different anatomies, which give rise to different bodily sensations, different definitions of what is acceptable and what is taboo, and arouse different feelings and reactions in caretakers on whom the child is dependent. The girl's developmental task of separation and individuation is complicated in two major ways that are relevant to adult women's achievement-related conflicts. First, as a female child, she is both more closely identified with her mother and more closely identified with by her mother. Her sensitivity to relationship and loss--particularly in her bond to her mother--grows in part from the intensities of these reciprocal identifications and from the capacities for empathic, affective relating that cultural and maternal expectations impart to daughters. Because mothers are so identified with their same-sex children, and because, as women, they themselves have learned to sacrifice aspects of their autonomy for either nurturant or dependent functions, mothers communicate ambivalent wishes and expectations to their daughters. On the one hand, a daughter receives the injunction that she carry on for her mother by fulfilling her thwarted longings and by compensating, with her own achievements, for her mother's disappointments. On the other hand, the daughter receives the simultaneous message that her accomplishments arouse her mother's envy and potential retaliation, but, most destructively, threaten to leave her empty, without a dependent appendage through whom she can live and bolster her self-worth. The second, complicated, aspect of the girl's task of separation and individuation, which relates to her adult conflicts around achievement, lies in the relationship between the cultural devaluation of whatever women have to do, and the kinds of fantasies and experiences to which the more hidden, internal and mysterious female genitals lend themselves.

Achievement↗

PubMed2005

Quantifiable change in functional brain response to empathic and forgivability judgments with resolution of posttraumatic stress disorder.

Previous functional neuroimaging studies of posttraumatic stress disorder (PTSD) have mainly focused on symptom-provocation paradigms in combat-related PTSD. We sought to elucidate the effect of non-combat-related PTSD on the physiology of social cognition. Thirteen patients with PTSD underwent functional magnetic resonance imaging (fMRI) while they engaged in tasks that (i) involve speculation on another's intention, (ii) invoke empathy and (iii) involve making judgments of the forgivability of others' actions; each versus 'baseline' social reasoning judgments. A post-therapy fMRI scan followed a course of modified cognitive behavioural therapy. Post-therapy, we found increased activation in brain regions predicted on the basis of foregoing work in healthy subjects. These included significant left middle temporal gyrus activation in post-therapy response to empathy judgments and posterior cingulate gyrus activation in post-therapy response to forgivability judgments. The specific regions of the human brain activated by empathy and forgivability judgments changed with symptom resolution in PTSD. Time and therapy are likely contributory factors that lead to a degree of 'normalisation' of the neural response to these social cognition tasks.

Adult↗

PubMedDate not supplied

Paradox and metaphor: transitional phenomena in the operations of the work ego.

Transitional phenomenon, paradox, metaphor, and empathic process are examined with emphasis on discerning what impels the work ego, or autonomous analyzing functions of the analyst, to move alternatively between evenly hovering attention and verbal intervention. The study is based on the premise that there are interfaces, which it attempts to clarify and broaden, between aspects of the psychoanalytic and literary perceptions of human experience, as these latter have been traditionally epitomized and structured in paradox and metaphor. Paradox and metaphor are seen as forms adapted from literature and rhetoric which represent, indicate, and focus on dilemmas, predicaments, and conflicts of living. Provisionally, I conclude that they are adaptive and defensive processes, directed against primitive affects deriving from the separation-individuation period of child development, that they are closely linked with and expressive of adult forms of transitional phenomena and processes associated with the stresses and conflicts of the same period, and that they constitute an important segment of the data from which the work ego draws its stimuli and information. I offer clinical vignettes and literary instances illustrating these connections.

Child Development↗

PubMed1994

Prosocial development.

The foregoing review has been organised in terms of five developmental hypotheses--let us now summarise the evidence bearing on each hypothesis. The first hypothesis, that a general prosocial impulse arises in the first year of life, is well-supported by the data. Some dispute remains about the point at which children are capable of responding sympathetically to companions in distress, with some investigators claiming that this takes place around the time of the second birthday (Kochanska, 1993), others placing this achievement earlier in development (Hoffman, 1975). The second, more controversial hypothesis, that the frequency of prosocial behaviour declines thereafter, is supported by cross-sectional data and by the burgeoning literature on the ways in which prosocial responding comes to be regulated cognitively and emotionally during the preschool years. Actual evidence for a decline and tests of hypotheses that the decline is associated with the acquisition of particular "display rules" and the regulation of empathic responding and guilt requires appropriately designed longitudinal studies. In general, our understanding of the normal course of prosocial development is limited due to the paucity of longitudinal data and the tendency of particular investigators to concentrate on single constructs--empathy, sharing, moral judgement or whatever--and not examine the interrelations of different types of prosocial behaviours in the same sample, tested under the same conditions. It is also not completely clear whether findings about empathic responding in experimental procedures (e.g. Miller et al., 1989) can be used to explain age changes in the selective display of prosocial behaviour under natural conditions. However, it is clear that future studies of prosocial development must examine the contributions of empathy, guilt and children's awareness of moral and conventional standards to children's overt prosocial actions with friends and family members. The contribution of children's close personal relationships, particularly their attachment relationships and close friendships, to prosocial behaviours, deserves increased attention. The third hypothesis was a claim that, during the childhood years, prosocial behaviour becomes differentiated in terms of gender, with females and males showing their prosocial tendencies in qualitatively different ways. Evidence bearing on this point is beset with measurement problems; it seems clear that girls report more empathy and are reputed by others to be more prosocial than boys, but direct observations do not always support such conclusions. Much more information is needed about ways in which boys in particular are prosocial--for example, co-operating with teammates whilst competing against other teams, in athletic contests.(ABSTRACT TRUNCATED AT 400 WORDS)

Altruism↗