Posts

On This Day … 15 June

Published on by Andrew MarshallLeave a comment

People (Births)

  • 1902 – Erik Erikson, German-American psychologist and psychoanalyst (d. 1994).
  • 1924 – Hédi Fried, Swedish author and psychologist.

Erik Erikson

Erik Homburger Erikson (born Erik Salomonsen; 15 June 1902 to 12 May 1994) was a German-American developmental psychologist and psychoanalyst known for his theory on psychological development of human beings. He may be most famous for coining the phrase identity crisis. His son, Kai T. Erikson, is a noted American sociologist.

Despite lacking a bachelor’s degree, Erikson served as a professor at prominent institutions, including Harvard, University of California, Berkeley, and Yale. A Review of General Psychology survey, published in 2002, ranked Erikson as the 12th most cited psychologist of the 20th century.

Hedi Fried

Hédi Fried (born 15 June 1924) is a Swedish-Romanian author and psychologist. A Holocaust survivor, she passed through Auschwitz as well as Bergen-Belsen, coming to Sweden in July 1945 with the boat M/S Rönnskär.

What is Salutogenesis?

Published on by Andrew MarshallLeave a comment

Introduction

Salutogenesis is the origins of health and focuses on factors that support human health and well-being, rather than on factors that cause disease (pathogenesis).

More specifically, the “salutogenic model” was originally concerned with the relationship between health, stress, and coping through a study of holocaust survivors. Despite going through the dramatic tragedy of the holocaust, some survivors were able to thrive later in life. The discovery that there must be powerful health causing factors led to the development of salutogenesis. The term was coined by Aaron Antonovsky, a professor of medical sociology. The salutogenic question posed by Aaron Antonovsky is, “How can this person be helped to move toward greater health?”

Antonovsky’s theories reject the “traditional medical-model dichotomy separating health and illness”. He described the relationship as a continuous variable, what he called the “health-ease versus dis-ease continuum”. Salutogenesis now encompasses more than the origins of health and has evolved to be about multidimensional causes of higher levels of health. Models associated with salutogenesis generally include wholistic approaches related to at least the physical, social, emotional, spiritual, intellectual, vocational, and environmental dimensions. A comparison of the salutogenic model with the traditional pathogenic model is provided in the below video.

Derivation

The word “salutogenesis” comes from the Latin salus = health and the Greek genesis = origin. Antonovsky developed the term from his studies of “how people manage stress and stay well” (unlike pathogenesis which studies the causes of diseases). He observed that stress is ubiquitous, but not all individuals have negative health outcomes in response to stress. Instead, some people achieve health despite their exposure to potentially disabling stress factors.

In his 1979 book, Health, Stress and Coping, Antonovsky described a variety of influences that led him to the question of how people survive, adapt, and overcome in the face of even the most punishing life-stress experiences. In his 1987 book, Unraveling the Mysteries of Health, he focused more specifically on a study of women and aging; he found that 29% of women who had survived Nazi concentration camps had positive emotional health, compared to 51% of a control group. His insight was that 29% of the survivors were not emotionally impaired by the stress. Antonovsky wrote: “this for me was the dramatic experience that consciously set me on the road to formulating what I came to call the ‘salutogenic model’.”

In salutogenic theory, people continually battle with the effects of hardship. These ubiquitous forces are called generalised resource deficits (GRDs). On the other hand, there are generalised resistance resources (GRRs), which are all of the resources that help a person cope and are effective in avoiding or combating a range of psychosocial stressors. Examples are resources such as money, ego-strength, and social support.

Generalised resource deficits will cause the coping mechanisms to fail whenever the sense of coherence is not robust to weather the current situation. This causes illness and possibly even death. However, if the sense of coherence is high, a stressor will not necessarily be harmful. But it is the balance between generalised resource deficits and resources that determines whether a factor will be pathogenic, neutral, or salutary.

Antonovsky’s formulation was that the generalised resistance resources enabled individuals to make sense of and manage events. He argued that over time, in response to positive experiences provided by successful use of different resources, an individual would develop an attitude that was “in itself the essential tool for coping”.

Sense of Coherence

The “sense of coherence” is a theoretical formulation that provides a central explanation for the role of stress in human functioning. “Beyond the specific stress factors that one might encounter in life, and beyond your perception and response to those events, what determines whether stress will cause you harm is whether or not the stress violates your sense of coherence.” Antonovsky defined Sense of Coherence as:

“a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that (1) the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable and explicable; (2) the resources are available to one to meet the demands posed by these stimuli; and (3) these demands are challenges, worthy of investment and engagement.”

In his formulation, the sense of coherence has three components:

  • Comprehensibility: a belief that things happen in an orderly and predictable fashion and a sense that you can understand events in your life and reasonably predict what will happen in the future.
  • Manageability: a belief that you have the skills or ability, the support, the help, or the resources necessary to take care of things, and that things are manageable and within your control.
  • Meaningfulness: a belief that things in life are interesting and a source of satisfaction, that things are really worthwhile and that there is good reason or purpose to care about what happens.

According to Antonovsky, the third element is the most important. If a person believes there is no reason to persist and survive and confront challenges, if they have no sense of meaning, then they will have no motivation to comprehend and manage events. His essential argument is that “salutogenesis” depends on experiencing a strong “sense of coherence”. His research demonstrated that the sense of coherence predicts positive health outcomes.

Fields of Application

Health and Medicine

Antonovsky viewed his work as primarily addressed to the fields of health psychology, behavioural medicine, and the sociology of health. It has been adopted as a term to describe contemporary approaches to nursing, psychiatry, integrative medicine, and healthcare architecture. The salutogenic framework has also been adapted as a method for decision making on the fly; the method has been applied for emergency care and for healthcare architecture.

Workplace

The sense of coherence with its three components meaningfulness, manageability and understandability has also been applied to the workplace.

Meaningfulness is considered to be related to the feeling of participation and motivation and to a perceived meaning of the work. The meaningfulness component has also been linked with Job control and with task significance. Job control implies that employees have more authority to make decisions concerning their work and the working process. Task significance involves “the experience of congruence between personal values and work activities, which is accompanied by strong feelings of identification with the attitudes, values or goals of the working tasks and feelings of motivation and involvement”.

The manageability component is considered to be linked to job control as well as to access to resources. It has also been considered to be linked with social skills and trust. Social relations relate also to the meaningfulness component.

The comprehensibility component may be influenced by consistent feedback at work, for example concerning the performance appraisal.

Salutogenics perspectives are also considered in the design of offices.

What is Transference Focused Psychotherapy?

Published on by Andrew MarshallLeave a comment

Introduction

Transference focused psychotherapy (TFP) is a highly structured, twice-weekly modified psychodynamic treatment based on Otto F. Kernberg’s object relations model of borderline personality disorder.

It views the individual with borderline personality organisation (BPO) as holding unreconciled and contradictory internalised representations of self and significant others that are affectively charged. The defence against these contradictory internalised object relations leads to disturbed relationships with others and with self. The distorted perceptions of self, others, and associated affects are the focus of treatment as they emerge in the relationship with the therapist (transference). The treatment focuses on the integration of split off parts of self and object representations, and the consistent interpretation of these distorted perceptions is considered the mechanism of change.

TFP has been validated as an efficacious treatment for borderline personality disorder (BPD), though too few studies have been conducted to allow firm conclusions about its value. TFP is one of a number of treatments that may be useful in the treatment of BPD; however, in a study which compared TFP, dialectical behaviour therapy, and modified psychodynamic supportive psychotherapy, only TFP was shown to change how patients think about themselves in relationships.

Borderline Personality Disorder

TFP is a treatment for borderline personality disorder (BPD). Patients with BPD are often characterised by intense affects, stormy relationships, and impulsive behaviours. Due to their high reactivity to environmental stimuli, patients with BPD often experience dramatic and short-lived shifts in their mood, alternating between experiences of euphoria, depression, anxiety, and nervousness. Patients with BPD often experience intolerable feelings of emptiness that they attempt to fill with impulsive and self-damaging behaviours, such as substance abuse, risky sexual behaviour, uncontrolled spending, or binge eating. Further, patients with BPD often exhibit recurrent suicidal behaviours, gestures, or threats. Under intense stress patients with BPD may exhibit transient dissociative or paranoid symptoms.

Theoretical Model of Borderline Personality

According to an object relations model, in normal psychological development mental templates of oneself in relation to others, or object representations, become increasingly more differentiated and integrated. The infant’s experience, initially organised around moments of pain (“I am uncomfortable and in need of someone to care for me”) and pleasure (“I am now being soothed by someone and feel loved”), become increasingly integrated and differentiated mental templates of oneself in relation to others. These increasingly mature representations allow for the realistic blending of good and bad, such that positive and negative qualities can be integrated into a complex, multifaceted representation of an individual (“Although she is not caring for me at this moment, I know she loves me and will do so in the future”). Such integrated representations allow for the tolerance of ambivalence, difference, and contradiction in oneself and others.

For Kernberg the degree of differentiation and integration of these representations of self and other, along with their affective valence, constitutes personality organisation. In a normal personality organisation the individual has an integrated model of self and others, allowing for stability and consistency within one’s identity and in the perception of others, as well as a capacity for becoming intimate with others while maintaining one’s sense of self. For example, such an individual would be able to tolerate hateful feelings in the context of a loving relationship without internal conflict or a sense of discontinuity in the perception of the other. In contrast, in Borderline Personality Organisation (BPO), the lack of integration in representations of self and other leads to the use of primitive defence mechanisms (e.g. splitting, projective identification, dissociation), identity diffusion (inconsistent view of self and others), and unstable reality testing (inconsistent differentiation between internal and external experience). Under conditions of high stress, borderline patients may fail to appreciate the “whole” of the situation and interpret events in catastrophic and intensely personal ways. They fail to discriminate the intentions and motivations of the other and thus, perceive only threat or rejection. Thus thoughts and feelings about self and others are split into dichotomous experiences of good or bad, black or white, all or nothing.

Goals

The major goals of TFP are to reduce suicidality and self-injurious behaviours, and to facilitate better behavioural control, increased affect regulation, more gratifying relationships, and the ability to pursue life goals. This is believed to be accomplished through the development of integrated representations of self and others, the modification of primitive defensive operations, and the resolution of identity diffusion that perpetuate the fragmentation of the patient’s internal representational world.

Treatment Procedure

Contract

The treatment begins with the development of the treatment contract, which consists of general guidelines that apply for all clients and of specific items developed from problem areas of the individual client that could interfere with the therapy progress. The contract also contains therapist responsibilities. The client and the therapist must agree to the content of the treatment contract before the therapy can proceed.

Therapeutic Process

TFP consists of the following three steps:

  • Diagnostic description of a particular internalised object relation in the transference.
  • Diagnostic elaboration of the corresponding self and object representation in the transference, and of their enactment in the transference/countertransference.
  • Integration of the split-off self representations, leading to an integrated sense of self and others which resolves identity diffusion.

During the first year of treatment, TFP focuses on a hierarchy of issues:

  • Containment of suicidal and self-destructive behaviours.
  • Various ways of destroying the treatments.
  • Identification and recapitulation of dominant object relational patterns (from unintegrated and undifferentiated affects and representations of self and others to a more coherent whole).

In this treatment, the analysis of the transference is the primary vehicle for the transformation of primitive (e.g. split, polarised) to advanced (e.g. complex, differentiated and integrated) object relations. Thus, in contrast to therapies that focus on the short-term treatment of symptoms, TFP has the ambitious goal of not just changing symptoms, but changing the personality organisation, which is the context of the symptoms. To do this, the client’s affectively charged internal representations of previous relationships are consistently interpreted as the therapist becomes aware of them in the therapeutic relationship, that is, the transference. Techniques of clarification, confrontation, and interpretation are used within the evolving transference relationship between the patient and the therapist.

In the psychotherapeutic relationship, self and object representations are activated in the transference. In the course of the therapy, projection and identification are operating, i.e. devalued self-representations are projected onto the therapist whilst the client identifies with a critical object representation. These processes are usually connected to affective experiences such as anger or fear.

The information that emerges within the transference provides direct access to the individual’s internal world for two reasons. First, it is observable by both therapist and patient simultaneously so that inconsistent perceptions of the shared reality can be discussed immediately. Second, the perceptions of shared reality are accompanied by affect whereas the discussion of historical material can have an intellectualised quality and be thus less informative.

TFP emphasizes the role of interpretation within psychotherapy sessions. As the split-off representations of self and other get played out in the course of the treatment, the therapist helps the patient to understand the reasons (the fears or the anxieties) that support the continued separation of these fragmented senses of self and other. This understanding is accompanied by the experience of strong affects within the therapeutic relationship. The integration of the split and polarized concepts of self and others leads to a more complex, differentiated, and realistic sense of self and others that allows for better modulation of affects and in turn clearer thinking. Therefore, as split-off representations become integrated, patients tend to experience an increased coherence of identity, relationships that are balanced and constant over time and therefore not at risk of being overwhelmed by aggressive affect, a greater capacity for intimacy, a reduction in self-destructive behaviours, and general improvement in functioning.

Mechanisms of Change

In TFP, hypothesised mechanisms of change derive from Kernberg’s developmentally based theory of Borderline Personality Organisation, conceptualised in terms of unintegrated and undifferentiated affects and representations of self and other. Partial representations of self and other are paired and linked by an affect in mental units called object relation dyads. These dyads are elements of psychological structure. In borderline pathology, the lack of integration of the internal object relations dyads corresponds to a ‘split’ psychological structure in which totally negative representations are split off/segregated from idealised positive representations of self and other (seeing people as all good or all bad). The putative global mechanism of change in patients treated with TFP is the integration of these polarised affect states and representations of self and other into a more coherent whole.

Empirical Support

Preliminary Research

In early research studying the efficacy of a year-long TFP, suicide attempts were significantly reduced during treatment. Additionally, the physical condition of the patients was significantly improved. When the researchers compared the treatment year to the year prior, it was found that there was a significant reduction in psychiatric hospitalisations and days spent as inpatients in psychiatric hospitals. The dropout rate for the 1-year study was 19.1%, which the authors state as comparable to dropout rates in previous studies assessing the treatment of borderline individuals, including DBT research.

TFP vs. Treatment-As-Usual (TAU)

Results indicated that the TFP group experienced significant decreases in ER visits and hospitalisations during treatment year, as well as significant increases in global functioning when compared to TAU.

TFP vs. Treatment by Community Experts

A randomised clinical trial compared the outcomes of TFP or treatment by community experts for 104 borderline patients. The dropout rate was significantly higher in the community psychotherapy condition; however, the dropout rate for TFP was 38.5%, which the authors acknowledge as somewhat higher than dropout rates associated with dialectical behaviour therapy (DBT) and schema-focused therapy (SFT). The TFP group experienced significant improvement in personality organisation, psychosocial functioning, and number of suicide attempts. In this study neither group was associated with a significant change in self-harming behaviours.

TFP vs. DBT vs. Supportive Treatment

Prior to treatment and at four-month intervals during treatment, patients were assessed in the following domains: suicidal behaviour, aggression, impulsivity, anxiety, depression, and social adjustment. Results indicate that patients in all three conditions showed improvement in multiple domains at the one-year mark. Only DBT and TFP were significantly associated with improvement in suicidal behaviours; however, TFP outperformed DBT in anger and impulsivity improvement. Overall, participation in TFP predicted significant improvement in 10 of the 12 variables across the 6 domains, DBT in 5 of 12, and ST in 6 of the 12 variables.

TFP vs. Schema Focused Therapy

Significant improvements were found in both treatment groups on DSM-IV BPD criteria and on all four of the study’s outcome measures (borderline psychopathology, general psychopathology, quality of life, and TFP/SFT personality concepts) after 1-, 2-, and 3-years. Schema focused therapy (SFT, or schema therapy as it is now commonly known) was associated with a significantly higher retention rate. After three years of treatment, schema therapy patients showed greater increases in quality of life, and significantly more schema therapy patients recovered or showed clinical improvement on the BPD Severity Index, fourth version. However, the TFP cell contained more suicidal patients and showed less adherence casting doubt on a direct comparison between treatments. The schema therapy group improved significantly more than the TFP group with respect to relationships, impulsivity, and parasuicidal/suicidal behaviour although many of the alliance ratings were made after dropout. It was concluded that schema therapy was significantly more effective than TFP on all outcome measures assessed during the study. A follow-up of this study concluded that both clients and therapists rated therapeutic alliance higher in schema therapy than in TFP.

What is School Psychology?

Published on by Andrew Marshall1 Comment

Introduction

School psychology is a field that applies principles from educational psychology, developmental psychology, clinical psychology, community psychology, and behaviour analysis to meet the learning and behavioural health needs of children and adolescents.

It is an area of applied psychology practiced by a school psychologist. They often collaborate with educators, families, school leaders, community members, and other professionals to create safe and supportive school environments.

School psychologists primarily work with students who have learning disabilities, behavioural difficulties, mental disorders, and other health issues. They carry out psychological testing, psychoeducational assessment, intervention, prevention, counselling, and consultation in the ethical, legal, and administrative codes of their profession.

Background

School psychology dates back to the beginning of American psychology in the late 19th and early 20th centuries. The field is tied to both functional and clinical psychology. School psychology actually came out of functional psychology. School psychologists were interested in childhood behaviours, learning processes, and dysfunction with life or in the brain itself. They wanted to understand the causes of the behaviours and their effects on learning. In addition to its origins in functional psychology, school psychology is also the earliest example of clinical psychology, beginning around 1890. While both clinical and school psychologists wanted to help improve the lives of children, they approached it in different ways. School psychologists were concerned with school learning and childhood behavioural problems, which largely contrasts the mental health focus of clinical psychologists.

Another significant event in the foundation of school psychology as it is today was the Thayer Conference. The Thayer Conference was first held in August 1954 in West Point, New York in Hotel Thayer. The 9 day-long conference was conducted by the American Psychological Association (APA). The purpose of the conference was to develop a position on the roles, functions, and necessary training and credentialing of a school psychologist. At the conference, forty-eight participants that represented practitioners and trainers of school psychologists discussed the roles and functions of a school psychologist and the most appropriate way to train them.

At the time of the Thayer Conference, school psychology was still a very young profession with only about 1,000 school psychology practitioners. One of the goals of the Thayer Conference was to define school psychologists. The agreed upon definition stated that school psychologists were psychologists who specialise in education and have specific knowledge of assessment and learning of all children. School psychologists use this knowledge to assist school personnel in enriching the lives of all children. This knowledge is also used to help identify and work with children with exceptional needs. It was discussed that a school psychologist must be able to assess and develop plans for children considered to be at risk. A school psychologist is also expected to better the lives of all children in the school; therefore, it was determined that school psychologists should be advisors in the planning and implementation of school curriculum. Participants at the conference felt that since school psychology is a specialty, individuals in the field should have a completed a two-year graduate training program or a four-year doctoral programme. Participants felt that states should be encouraged to establish certification standards to ensure proper training. It was also decided that a practicum experience be required to help facilitate experiential knowledge within the field.

The Thayer Conference is one of the most significant events in the history of school psychology because it was there that the field was initially shaped into what it is today. Before the Thayer Conference defined school psychology, practitioners used seventy-five different professional titles. By providing one title and a definition, the conference helped to get school psychologists recognised nationally. Since a consensus was reached regarding the standards of training and major functions of a school psychologist, the public can now be assured that all school psychologists are receiving adequate information and training to become a practitioner. It is essential that school psychologists meet the same qualifications and receive appropriate training nationwide. These essential standards were first addressed at the Thayer Conference. At the Thayer Conference some participants felt that in order to hold the title of a school psychologist an individual must have earned a doctoral degree.

The issues of titles, labels, and degree levels are still debated among psychologists today. However, APA and NASP reached a resolution on this issue in 2010.

Social Reform in the Early 1900s

The late 19th century marked the era of social reforms directed at children. It was due to these social reforms that the need for school psychologists emerged. These social reforms included compulsory schooling, juvenile courts, child labour laws as well as a growth of institutions serving children. Society was starting to “change the ‘meaning of children’ from an economic source of labour to a psychological source of love and affection”. Historian Thomas Fagan argues that the preeminent force behind the need for school psychology was compulsory schooling laws. Prior to the compulsory schooling law, only 20% of school aged children completed elementary school and only 8% completed high school. Due to the compulsory schooling laws, there was an influx of students with mental and physical defects who were required by law to be in school. There needed to be an alternative method of teaching for these different children. Between 1910 and 1914, schools in both rural and urban areas created small special education classrooms for these children. From the emergence of special education classrooms came the need for “experts” to help assist in the process of child selection for special education. Thus, school psychology was founded.

Important Contributors to the Founding

Lightner Witmer

Lightner Witmer has been acknowledged as the founder of school psychology. Witmer was a student of both Wilhelm Wundt and James Mckeen Cattell. While Wundt believed that psychology should deal with the average or typical performance, Cattell’s teachings emphasized individual differences. Witmer followed Cattell’s teachings and focused on learning about each individual child’s needs. Witmer opened the first psychological and child guidance clinic in 1896 at the University of Pennsylvania. Witmer’s goal was to prepare psychologists to help educators solve children’s learning problems, specifically those with individual differences. Witmer became an advocate for these special children. He was not focused on their deficits per se, but rather helping them overcome them, by looking at the individual’s positive progress rather than all they still could not achieve. Witmer stated that his clinic helped “to discover mental and moral defects and to treat the child in such a way that these defects may be overcome or rendered harmless through the development of other mental and moral traits”. He strongly believed that active clinical interventions could help to improve the lives of the individual children.

Since Witmer saw much success through his clinic, he saw the need for more experts to help these individuals. Witmer argued for special training for the experts working with exceptional children in special educational classrooms. He called for a “new profession which will be exercised more particularly in connection with educational problems, but for which the training of the psychologist will be a prerequisite”.

As Witmer believed in the appropriate training of these school psychologists, he also stressed the importance of appropriate and accurate testing of these special children. The IQ testing movement was sweeping through the world of education after its creation in 1905. However, the IQ test negatively influenced special education. The IQ test creators, Lewis Terman and Henry Goddard, held a nativist view of intelligence, believing that intelligence was inherited and difficult if not impossible to modify in any meaningful way through education.] These notions were often used as a basis for excluding children with disabilities from the public schools. Witmer argued against the standard pencil and paper IQ and Binet type tests in order to help select children for special education. Witmer’s child selection process included observations and having children perform certain mental tasks.

Granville Stanley Hall

Another important figure to the origin of school psychology was Granville Stanley Hall. Rather than looking at the individual child as Witmer did, Hall focused more on the administrators, teachers and parents of exceptional children He felt that psychology could make a contribution to the administrator system level of the application of school psychology. Hall created the child study movement, which helped to invent the concept of the “normal” child. Through Hall’s child study, he helped to work out the mappings of child development and focused on the nature and nurture debate of an individual’s deficit. Hall’s main focus of the movement was still the exceptional child despite the fact that he worked with atypical children.

Arnold Gesell

Bridging the gap between the child study movement, clinical psychology and special education, Arnold Gesell, was the first person in the United States to officially hold the title of school psychologist, Arnold Gesell. He successfully combined psychology and education by evaluating children and making recommendations for special teaching. Arnold Gesell paved the way for future school psychologists.

Gertrude Hildreth

Gertrude Hildreth was a psychologist with the Lincoln School at Teacher’s College, Columbia then at Brooklyn College in New York. She authored many books including the first book pertaining to school psychology titled, “Psychological Service for School Problems” written in 1930. The book discussed applying the science of psychology to address the perceived problems in schools. The main focus of the book was on applied educational psychology to improve learning outcomes. Hildreth listed 11 problems that can be solved by applying psychological techniques, including: instructional problems in the classroom, assessment of achievement, interpretation of test results, instructional groupings of students for optimal outcomes, vocational guidance, curriculum development, and investigations of exceptional pupils. Hildreth emphasized the importance of collaboration with parents and teachers. She is also known for her development of the Metropolitan Readiness Tests and for her contribution to the Metropolitan Achievement test. In 1933 and 1939 Hildreth published a bibliography of Mental Tests and Rating Scales encompassing a 50-year time period and over 4,000 titles. She wrote approximately 200 articles and bulletins and had an international reputation for her work in education.

Issues Related to School Psychology

Intervention

One of the primary roles and responsibilities of school psychologists working in schools is to ensure the interventions they utilise effectively address students’ behaviour problems. Issues arise when school psychologists do not select interventions with sufficient research-based evidence in being effective for the individual with whom they are working. School psychologists, as researchers and practitioners, can make important contributions to the development and implementation of scientifically based intervention and prevention programmes to address learning and behavioural needs of students (National Association of School Psychologists (NASP).

There is a concern with implementing academic and behavioural interventions prior to the determination for special education services, and it has also been proposed that MTSS (Multi-Tiered Systems of Support) may address these concerns. The National Association of School Psychologists (NASP) recognises the need for evidence-based prevention and intervention practices to address student learning, social emotional development, behavioural performance, instructional methodology, school practices, classroom management, and other areas salient to school-based services and improving student outcomes (National Association of School Psychologists (NASP). Intervention and prevention research needs to address a range of questions related not only to efficacy and effectiveness, but also to:

  • Feasibility given resources (e.g. time, money, staffing);
  • Acceptability (e.g. teacher, student, and community attitudes toward intervention strategies);
  • Social validity (the relevance of targeted outcomes to everyday life of students);
  • Integrity or fidelity (the extent to which individuals responsible for implementing an intervention can do so as intended by its designers); and
  • Sustainability (extent to which school staff can maintain the intervention over time, without support from external agents).

A specific example of an intervention that has recently become popular among school psychologists is the School-wide Positive Behavioural Interventions and Supports (PBIS). Authorised under IDEA, the PBIS offers a “preventative, positive, and systemic framework or approach to affect educational and behavioural change” and can be used in the support of Tiers 1-3 in the education system. Research from single-case design studies and group studies demonstrates that the intervention can result in a reduction of major disciplinary infractions and aggressive behaviour, improvement in academic achievement, an increase in prosocial behaviour, a reduction in bullying behaviour reported by teachers, and much more. Through consistent and strong implementation fidelity, PBIS can provide school psychologists opportunities to assist the administration, teaching staff, and students in broad and specific ways.

Prevention

A way in which school psychologists can help students is by creating primary prevention programmes. Information about prevention should also be connected to current events in the community.

Issues with Assessment Process

Empirical evidence has not confirmed biases in referral, assessment, or identification; however, inferences have been made that the special education process may be oversimplified. The National Research Council has called attention to the questionable reliability of educational decision making in special education as there can be vast numbers of false positives and/or false negatives. Misidentified students in special education is problematic and can contribute to long term negative outcomes.

During the identification process, school psychologists must consider ecological factors and environmental context such as socioeconomic status. Socioeconomic status may limit funding and materials, impact curriculum quality, increase teacher-to-student ratios, and perpetuate a negative school climate.

Technological Issues

With the ever growing use of technology, school psychologists are faced with several issues, both ethical and within the populations they try to serve. As it is so easy to share and communicate over technology, concerns are raised as to just how easy it is for outsiders to get access to the private information that school psychologists deal with everyday. Thus exchanging and storing information digitally may come under scrutiny if precautions such as password protecting documents and specifically limiting access within school systems to personal files.

Then there is the issue of how students communicate using this technology. There are both concerns on how to address these virtual communications and on how appropriate it is to access them. Concerns on where the line can be drawn on where intervention methods end and invasion of privacy begin are raised by students, parents, administrators, and faculty. Addressing these behaviours becomes even more complicated when considering the current methods of treatment for problematic behaviours, and implementation of these strategies can become complex, if not impossible, within the use of technology.

To incorporate topics in a school, utilise lesson plans for students and staff because the teachers need to ensure the content is connected to other meaningful topics covered in the class/school.

Racial Disproportionality in Special Education

Disproportionality refers to a group’s under or overrepresentation in comparison to other groups within a certain context. In the field of school psychology, disproportionality of minority students in special education is a concern. Special Education Disproportionality has been defined as the relationship between one’s membership to a specific group and the probability of being placed in a specific disability category. Systemic prejudice is believed by some to be one of the root causes of the mischaracterisation of minority children as being disabled or problematic.

“Research on disproportionality in the U.S. context has posited two overlapping types of rationales: those who believed disproportionate representation is linked to poverty and health outcomes versus those who believed in the systemwide racist practices that contributed to over-representation of minority students.”

The United States Congress recently received an annual report on the implementation of IDEA which stated that proportionally Native Americans (14.09%) and African Americans (12.61%) were the two most highly represented racial groups within the realm of special education. In particular, African American males have been overidentified as having emotional disturbances and intellectual disabilities. They account for 21% of the special education population with emotional disturbances and 12% with learning disabilities. American Indian and Alaska Native students are also overrepresented in special education. They are shown to be 1.53 times more likely to receive services for various learning disabilities and 2.89 more likely to obtain services targeting developmental delays than all other Non-Native American student groups combined.] Overall, Hispanic students are often overidentified for special education in general; however, it is common for them to be under-identified for Autism Spectrum Disorder and speech and language impairments in comparison to White students.

Minority populations often have an increased susceptibility to economic, social and cultural disadvantages that can affect academic achievement. According to the US Department of Education, “Black children were three times as likely to live in poor families as white children in 2015. 12 percent of white and Asian children lived in poor families, compared with 36 percent of black children, 30 percent of Hispanic children, 33 percent of American Indian children, and 19 percent of others.” There may be other alternative explanations for behaviour and academic performance as well. For example, Black children are twice as likely as Whites to experience heightened levels of lead in the blood due to prolonged lead exposure. Lead poisoning can be known to affect a child’s behaviour by increasing their levels of irritability, hyperactivity, and inattentiveness even in less severe cases.

Cultural Biases

Some school psychologists realise the need to understand and accept their own cultural beliefs and values in order to understand the impact it may have when delivering services to clients and families. For example, these school psychologists ensure that students who are minorities, including African Americans, Hispanics, Asians, and Native Americans are being equally represented at the system level, in the classroom, and receiving a fair education.

For staff, it is important to look at one’s own culture while seeing the value in diversity. It is also vital to learn how to adapt to diversity and integrate a comprehensive way to understand cultural knowledge. Staff members should keep the terms race, privilege, implicit bias, micro aggression, and cultural relevance in mind when thinking about social justice.

Services

Behaviour Interventions

School psychologists are involved in the implementation of academic, behavioural, and social/emotional interventions within a school across a continuum of supports. These systems and policies should convey clear behaviour expectations and promote consistency among educators. Continuous reinforcement of positive behaviours can yield extremely positive results. Schoolwide positive behaviour supports A systematic approach that proactively promotes constructive behaviours in a school can yield positive outcomes. These programs are designed to improve and support students’ social, behavioural, and learning outcomes by promoting a positive school climate and providing targeted training to students and educators within a school. Data should be collected consistently to assess implementation effectiveness, screen and monitor student behaviour, and develop or modify action plans.

Academic Interventions

Academic interventions can be conceptualised as a set of procedures and strategies designed to improve student performance with the intent of closing the gap between how a student is currently performing and the expectations of how they should be performing. Short term and long term interventions used within a problem-solving model must be evidence-based. This means the intervention strategies must have been evaluated by research that utilised rigorous data analysis and peer review procedures to determine the effectiveness. Implementing evidence-based interventions for behaviour and academic concerns requires significant training, skill development, and supervised practice. Linking assessment and intervention is critical for determining that the correct intervention has been chosen. School psychologists have been specifically trained to ensure that interventions are implemented with integrity to maximise positive outcomes for children in a school setting.

Systems-Level Services

Leaders in the field of school psychology recognise the practical challenges that school psychologists face when striving for systems-level change and have highlighted a more manageable domain within a systems-level approach – the classroom. Overall, it makes sense for school psychologists to devote considerable effort to monitoring and improving school and classroom-based performance for all children and youth because it has been shown to be an effective preventive approach.

Universal Screening

School psychologists play an important role in supporting youth mental wellness, but identifying youth who are in distress can be challenging. Some schools have implemented universal mental health screening programs to help school psychologists find and help struggling youth. For instance, schools in King County, Washington are using the Check Yourself digital screening tool designed by Seattle Children’s Hospital to measure, understand, and nurture individual students’ well-being. Check Yourself collects information about lifestyle, behaviour, and social determinants of health to identify at-risk youth so that school psychologists can intervene and direct youth to the services they need. Mental health screening provides school psychologists with valuable insights so that interventions are better fitted to student needs.

Crisis Intervention

Crisis intervention is an integral part of school psychology. School administrators view school psychologists as the school’s crisis intervention “experts”. Crisis events can significantly affect a student’s ability to learn and function effectively. Many school crisis response models suggest that a quick return to normal rituals and routines can be helpful in coping with crises. The primary goal of crisis interventions is to help crisis-exposed students return to their basic abilities of problem-solving so the student can return to their pre-crisis level of functioning.

Consultation

Consultation is done through a problem solving method that will help the consultee function more independently without the intensive support of a school psychologist.

Social Justice

The three major elements that comprise social justice include equity, fairness, and respect. The concept of social justice includes all individuals having equal access to opportunities and resources. A major component behind social justice is the idea of being culturally aware and sensitive. American Psychological Association (APA) and the National Association of School Psychologists (NASP) both have ethical principles and codes of conduct that present aspirational elements of social justice that school psychologists may abide by. Although ethical principles exist, there is federal legislation that acts accordingly to social justice. For example, the Elementary and Secondary Education Act of 1965 (ESEA) and the Individuals with Disabilities Education Improvement Act of 2004 (IDEA) address issues such as poverty and disability to promote the concept of social justice in schools.

Schools are becoming increasingly diverse with growing awareness of these differences. Cultural diversity factors that can be addressed through social justice practice include race/ethnicity, gender, socioeconomic status (SES), religion, and sexual orientation. With the various elements that can impact a student’s education and become a source of discrimination, there is a greater call for the practice of social justice in schools. School psychologists that consider the framework of social justice know that injustices that low SES students face can sometimes be different when compared to high SES students.

Advocacy

A major role of school psychologists involves advocating and speaking up for individuals as needed. Advocacy can be done at district, regional, state, or national level. School psychologists advocate for students, parents, and caregivers.

Consultation and collaboration are key components of school psychology and advocacy. There may be times when school personnel may not agree with the school psychologist. Differing opinions can be problematic because a school psychologist advocates for what is in the best interest of the student. School psychologists and staff members can help facilitate awareness through courageous conversations.

Multicultural Competence

School psychologists offer many types of services in order to be multiculturally competent. Multicultural competence extends to race, ethnicity, social class, gender, religion, sexual orientation, disability, age, and geographic region. Because the field of school psychology serves such a diverse range of students, maintaining representation for minority groups continues to be a priority. Despite such importance, history has seen an underrepresentation of culturally and linguistically diverse (CLD) school psychologists. which may appear alarming given that the diversity of our youth continues to increase exponentially. Thus, current professionals in the field have prioritised the acquisition of CLD school psychologists. School psychologists are trained to use their skills, knowledge, and professional practices in promoting diversity and advocating for services for all students, families, teachers, and schools. School psychologists may also work with teachers and educators to provide an integrated multicultural education classroom and curriculum that allows more students to be represented in learning. Efforts to increase multicultural perspectives among school psychologists have been on the rise to account for the increased diversity within schools. Such efforts include establishing opportunities for individuals representative of minority groups to become school psychologists and implementing a diverse array of CLD training programmes within the field.

Education

In order to become a school psychologist, one must first learn about school psychology by successfully completing a graduate-level training programme. A B.A. or B.S. is not sufficient.

United States

School psychology training programs are housed in university schools of education or departments of psychology. School psychology programmes require courses, practica, and internships.

Degree Requirements

Specific degree requirements vary across training programmes. School psychology training programs offer masters-level (M.A., M.S., M.Ed.), specialist-level degrees (Ed.S., Psy.S., SSP, CAGS), and doctoral-level degrees (Ph.D., Psy.D. or Ed.D.) degrees. Regardless of degree title, a supervised internship is the defining feature of graduate-level training that leads to certification to practice as a school psychologist.

Specialist-level training typically requires 3-4 years of graduate training including a 9-month (1200 hour) internship in a school setting.

Doctoral-level training programs typically require 5-7 years of graduate training. Requirements typically include more coursework in core psychology and professional psychology, more advanced statistics coursework, involvement in research endeavours, a doctoral dissertation, and a one-year (1500+ hour) internship (which may be in a school or other settings such as clinics or hospitals).

In the past, a master’s degree was considered the standard for practice in schools. As of 2017, the specialist-level degree is considered the entry-level degree in school psychology. Masters-level degrees in school psychology may lead to obtaining related credentials (such as Educational Diagnostician, School Psychological Examiner, School Psychometrist) in one or two states.

International

In the UK, the similar practice and study of School Psychology is more often termed Educational Psychology and requires a doctorate (in Educational Psychology) which then enables individuals to register and subsequently practice as a licensed educational psychologist.

Employment in the United States

In the United States, job prospects in school psychology are excellent. Across all disciplines of psychology, the abundance of opportunities is considered among the best for both specialist and doctoral level practitioners. They mostly work in schools. Other settings include clinics, hospitals, correctional facilities, universities, and independent practice.

Demographic Information

According to the NASP Research Committee, 74% of school psychologists are female with an average age of 46. In 2004-2005, average earnings for school practitioners ranged from $56,262 for those with a 180-day annual contract to $68,764 for school psychologists with a 220-day contract. In 2009-2010, average earnings for school practitioners ranged from $64,168 for those with a 180-day annual contract to $71,320 for school psychologists with a 200-day contract. For university faculty in school psychology, the salary estimate is $77,801.

Based on surveys performed by NASP in 2009-2010, it is shown that 90.7% of school psychologists are white, while minority races make up the remaining 9.3%. Of this remaining percentage, the next largest populations represented in school psychology, are African-Americans and Hispanics, at 3% and 3.4% respectively.

Shortages in the Field

There is a lack of trained school psychologists within the field. While jobs are available across the country, there are just not enough people to fill them.

Due to the low supply and high demand of school psychologists, being a school psychologist is very demanding. School psychologists may feel under pressure to supply adequate mental health and intervention services to the students in their care. Burnout is a risk of being a school psychologist.

Bilingual School Psychologists

Approximately 21% of school-age children ages 5-7 speak a language other than English. For this reason, there is an enormous demand for bilingual school psychologists in the United States. The National Association of School Psychologists (NASP) does not currently offer bilingual certification in the field. However, there are a number of professional training opportunities that bilingual LSSPs/School Psychologists can attend in order to prepare to adequately administer assessments. In addition, there are 7 NASP-Approved school psychology programs that offer a bilingual specialisation:

  • Brooklyn College-City University of New York- Specialist Level.
  • Gallaudet University- Specialist Level.
  • Queens College-City University of New York- Specialist Level.
  • San Diego State University- Specialist Level.
  • Texas State University- Specialist Level.
  • University of Colorado Denver- Doctoral Level.
  • Fordham University- Lincoln Centre – Doctoral Level.

New York and Illinois are the only two states that offer a bilingual credential for school psychologists.

International School Psychology

The role of a school psychologist in the United States and Canada may differ considerably from the role of a school psychologist elsewhere. Especially in the United States, the role of school psychologist has been closely linked to public law for education of students with disabilities. In most other nations, this is not the case. Despite this difference, many of the basic functions of a school psychologist, such as consultation, intervention, and assessment are shared by most school psychologists worldwide.

It is difficult to estimate the number of school psychologists worldwide. Recent surveys indicate there may be around 76,000 to 87,000 school psychologists practicing in 48 countries, including 32,300 in the United States and 3,500 in Canada. Following the United States, Turkey has the next largest estimated number of school psychologists (11,327), followed by Spain (3,600), and then both Canada and Japan (3,500 each).

Credentialing

In order to work as a school psychologist, one must first meet the state requirements. In most states (excluding Texas and Hawaii), a state education agency credentials school psychologists for practice in the schools.

The Nationally Certified School Psychologist (NCSP) credential offered by the National Association of School Psychologists (NASP). The NCSP credential is an example of a non-practice credential as holding the NCSP does not make one eligible to provide services without first meeting the state requirements to work as a school psychologist.

State psychology boards (which may go by different names in each state) also offer credentials for school psychologists in some states. For example, Texas offers the LSSP credential which permits licensees to deliver school psychological services within public and private schools.

Subspecialisations

  • Paediatric School Psychology.
  • Systems Level Consultation.
  • School Based Mental Health.
  • Behavioural School Psychology.

Professional Organisations in the United States

  • National Association of School Psychologists.
  • American Psychological Association.

Journals

  • Psychology in the Schools.
  • School Psychology Quarterly.
  • School Psychology Review.
  • School Psychology Forum: Research in Practice.
  • School Psychology International.
  • Canadian Journal of School Psychology.
  • International Journal of School & Educational Psychology.
  • Journal of Psychoeducational Assessment.

On This Day … 14 June

Published on by Andrew MarshallLeave a comment

People (Births)

  • 1864 – Alois Alzheimer, German psychiatrist and neuropathologist (d. 1915).

Alois Alzheimer

Alois Alzheimer (14 June 1864 to 19 December 1915) was a German psychiatrist and neuropathologist and a colleague of Emil Kraepelin. Alzheimer is credited with identifying the first published case of “presenile dementia”, which Kraepelin would later identify as Alzheimer’s disease.

After graduating from Wurzburg as a Doctor of Medicine in 1887, he spent five months assisting mentally ill women before he took an office in the city mental asylum in Frankfurt, the Städtische Anstalt für Irre und Epileptische (Asylum for Lunatics and Epileptics). Emil Sioli, a noted psychiatrist, was the dean of the asylum. Another neurologist, Franz Nissl, began to work in the same asylum with Alzheimer. Together, they conducted research on the pathology of the nervous system, specifically the normal and pathological anatomy of the cerebral cortex. Alzheimer was the co-founder and co-publisher of the journal Zeitschrift für die gesamte Neurologie und Psychiatrie, though he never wrote a book that he could call his own.

While at the Frankfurt asylum, Alzheimer also met Emil Kraepelin, one of the best-known German psychiatrists of the time. Kraepelin became a mentor to Alzheimer, and the two worked very closely for the next several years. When Kraepelin moved to Munich to work at the Royal Psychiatric Hospital in 1903, he invited Alzheimer to join him.

At the time, Kraepelin was doing clinical research on psychosis in senile patients; Alzheimer, on the other hand, was more interested in the lab work of senile illnesses. The two men would face many challenges involving the politics of the psychiatric community. For example, both formal and informal arrangements would be made among psychiatrists at asylums and universities to receive cadavers.

In 1904, Alzheimer completed his Habilitation at Ludwig Maximilian University of Munich, where he was appointed as a professor in 1908. Afterwards, he left Munich for the Silesian Friedrich Wilhelm University in Breslau in 1912, where he accepted a post as professor of psychiatry and director of the Neurologic and Psychiatric Institute. His health deteriorated shortly after his arrival so that he was hospitalised. Alzheimer died three years later.

Auguste Deter

In 1901, Alzheimer observed a patient at the Frankfurt asylum named Auguste Deter. The 51-year-old patient had strange behavioral symptoms, including a loss of short-term memory; she became his obsession over the coming years. Auguste Deter was a victim of the politics of the time in the psychiatric community; the Frankfurt asylum was too expensive for her husband. Herr Deter made several requests to have his wife moved to a less expensive facility, but Alzheimer intervened in these requests. Frau Deter, as she was known, remained at the Frankfurt asylum, where Alzheimer had made a deal to receive her records and brain upon her death.

On 8 April 1906, Frau Deter died, and Alzheimer had her medical records and brain brought to Munich where he was working in Kraepelin’s laboratory. With two Italian physicians, he used the staining techniques of Bielschowsky to identify amyloid plaques and neurofibrillary tangles. These brain anomalies would become identifiers of what later became known as Alzheimer’s disease.

Another hypothesis offered by Claire O’Brien was that Auguste Deter actually had a vascular dementing disease.

Findings

Alzheimer discussed his findings on the brain pathology and symptoms of presenile dementia publicly on 03 November 1906, at the Tübingen meeting of the Southwest German Psychiatrists. The attendees at this lecture seemed uninterested in what he had to say. The lecturer that followed Alzheimer was to speak on the topic of “compulsive masturbation”, which the audience was so eagerly awaiting that they sent Alzheimer away without any questions or comments on his discovery of the pathology of a type of senile dementia.

Following the lecture, Alzheimer published a short paper summarizing his lecture; in 1907 he wrote a larger paper detailing the disease and his findings. The disease would not become known as Alzheimer’s disease until 1910, when Kraepelin named it so in the chapter on “Presenile and Senile Dementia” in the 8th edition of his Handbook of Psychiatry. By 1911, his description of the disease was being used by European physicians to diagnose patients in the US.

Contemporaries

American Solomon Carter Fuller gave a report similar to that of Alzheimer at a lecture five months before Alzheimer. Oskar Fischer was a fellow German psychiatrist, 12 years Alzheimer’s junior, who reported 12 cases of senile dementia in 1907 around the time that Alzheimer published his short paper summarizing his lecture.

Alzheimer and Fischer had different interpretations of the disease, but due to Alzheimer’s short life, they never had the opportunity to meet and discuss their ideas.

Among the doctors trained by Alois Alzheimer and Emil Kraepelin at München in the beginning of the XXth century were the Spanish neuropathologists Nicolás Achúcarro and Gonzalo Rodríguez Lafora, two distinguished disciples of Santiago Ramón y Cajal and members of the Spanish Neurological School. Alzheimer recommended the young and brilliant Nicolás Achúcarro to organise the neuropathological service at the Government Hospital for the Insane, at Washington D.C. (current, NIH), and after two years of work, he was substituted by Gonzalo Rodríguez Lafora.

Other Interests

Alzheimer was known for having a variety of medical interests including vascular diseases of the brain, early dementia, brain tumours, forensic psychiatry and epilepsy. Alzheimer was a leading specialist in histopathology in Europe. His colleagues knew him to be a dedicated professor and cigar smoker.

What is Applied Psychology?

Published on by Andrew Marshall1 Comment

Introduction

Applied psychology is the use of psychological methods and findings of scientific psychology to solve practical problems of human and animal behaviour and experience.

Mental health, organisational psychology, business management, education, health, product design, ergonomics, and law are just a few of the areas that have been influenced by the application of psychological principles and findings. Some of the areas of applied psychology include clinical psychology, counselling psychology, evolutionary psychology, industrial and organisational psychology, legal psychology, neuropsychology, occupational health psychology, human factors, forensic psychology, engineering psychology, school psychology, sports psychology, traffic psychology, community psychology, and medical psychology. In addition, a number of specialised areas in the general field of psychology have applied branches (e.g. applied social psychology, applied cognitive psychology).

However, the lines between sub-branch specialisations and major applied psychology categories are often blurred. For example, a human factors psychologist might use a cognitive psychology theory. This could be described as human factor psychology or as applied cognitive psychology.

Brief History

The founder of applied psychology was Hugo Münsterberg. He came to America (Harvard) from Germany (Berlin, Laboratory of Stern), invited by William James, and, like many aspiring psychologists during the late 19th century, originally studied philosophy. Münsterberg had many interests in the field of psychology such as purposive psychology, social psychology and forensic psychology. In 1907 he wrote several magazine articles concerning legal aspects of testimony, confessions and courtroom procedures, which eventually developed into his book, On the Witness Stand. The following year the Division of Applied Psychology was adjoined to the Harvard Psychological Laboratory. Within 9 years he had contributed eight books in English, applying psychology to education, industrial efficiency, business and teaching. Eventually Hugo Münsterberg and his contributions would define him as the creator of applied psychology. In 1920, the International Association of Applied Psychology (IAAP) was founded, as the first international scholarly society within the field of psychology.

Most professional psychologists in the US worked in an academic setting until World War II. But during the war, the armed forces and the Office of Strategic Services hired psychologists in droves to work on issues such as troop morale and propaganda design. After the war, psychologists found an expanding range of jobs outside of the academy. Since 1970, the number of college graduates with degrees in psychology has more than doubled, from 33,679 to 76,671 in 2002. The annual numbers of masters’ and PhD degrees have also increased dramatically over the same period. All the while, degrees in the related fields of economics, sociology, and political science have remained constant.

Professional organisations have organised special events and meetings to promote the idea of applied psychology. In 1990, the American Psychological Society held a Behavioural Science Summit and formed the “Human Capital Initiative”, spanning schools, workplace productivity, drugs, violence, and community health. The American Psychological Association declared 2000-2010 the Decade of Behaviour, with a similarly broad scope. Psychological methods are considered applicable to all aspects of human life and society.

Advertising

Business advertisers have long consulted psychologists in assessing what types of messages will most effectively induce a person to buy a particular product. Using the psychological research methods and the findings in human’s cognition, motivation, attitudes and decision making, those can help to design more persuasive advertisement. Their research includes the study of unconscious influences and brand loyalty. However, the effect of unconscious influences was controversial.

Clinical Psychology

Clinical psychology includes the study and application of psychology for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment and psychotherapy, although clinical psychologists may also engage in research, teaching, consultation, forensic testimony, and program development and administration. Some clinical psychologists may focus on the clinical management of patients with brain injury – this area is known as clinical neuropsychology. In many countries clinical psychology is a regulated mental health profession.

The work performed by clinical psychologists tends to be done inside various therapy models, all of which involve a formal relationship between professional and client – usually an individual, couple, family, or small group – that employs a set of procedures intended to form a therapeutic alliance, explore the nature of psychological problems, and encourage new ways of thinking, feeling, or behaving. The four major perspectives are:

  1. Psychodynamic;
  2. Cognitive behavioural;
  3. Existential-humanistic; and
  4. Systems or family therapy.

There has been a growing movement to integrate these various therapeutic approaches, especially with an increased understanding of issues regarding ethnicity, gender, spirituality, and sexual-orientation. With the advent of more robust research findings regarding psychotherapy, there is growing evidence that most of the major therapies are about of equal effectiveness, with the key common element being a strong therapeutic alliance. Because of this, more training programmes and psychologists are now adopting an eclectic therapeutic orientation.

Clinical psychologists do not usually prescribe medication, although there is a growing number of psychologists who do have prescribing privileges, in the field of medical psychology. In general, however, when medication is warranted many psychologists will work in cooperation with psychiatrists so that clients get therapeutic needs met. Clinical psychologists may also work as part of a team with other professionals, such as social workers and nutritionists.

Counselling Psychology

Counselling psychology is an applied specialisation within psychology, that involves both research and practice in a number of different areas or domains. According to Gelso and Fretz (2001), there are some central unifying themes among counselling psychologists. These include a focus on an individual’s strengths, relationships, their educational and career development, as well as a focus on normal personalities. Counselling psychologists help people improve their well-being, reduce and manage stress, and improve overall functioning in their lives. The interventions used by Counselling Psychologists may be either brief or long-term in duration. Often they are problem focused and goal-directed. There is a guiding philosophy which places a value on individual differences and an emphasis on “prevention, development, and adjustment across the life-span.”

Educational Psychology

Educational psychology is devoted to the study of how humans learn in educational settings, especially schools. Psychologists assess the effects of specific educational interventions: e.g. phonics versus whole language instruction in early reading attainment. They also study the question of why learning occurs differently in different situations.

Another domain of educational psychology is the psychology of teaching. In some colleges, educational psychology courses are called “the psychology of learning and teaching”. Educational psychology derives a great deal from basic-science disciplines within psychology including cognitive science and behaviourally-oriented research on learning.

Environmental Psychology

Environmental psychology is the psychological study of humans and their interactions with their environments. The types of environments studied are limitless, ranging from homes, offices, classrooms, factories, nature, and so on. However, across these different environments, there are several common themes of study that emerge within each one. Noise level and ambient temperature are clearly present in all environments and often subjects of discussion for environmental psychologists. Crowding and stressors are a few other aspects of environments studied by this sub-discipline of psychology. When examining a particular environment, environmental psychology looks at the goals and purposes of the people in the using the environment, and tries to determine how well the environment is suiting the needs of the people using it. For example, a quiet environment is necessary for a classroom of students taking a test, but would not be needed or expected on a farm full of animals. The concepts and trends learned through environmental psychology can be used when setting up or rearranging spaces so that the space will best perform its intended function. The top common, more well known areas of psychology that drive this applied field include: cognitive, perception, learning, and social psychology.

Forensic Psychology and Legal Psychology

Forensic psychology and legal psychology are the areas concerned with the application of psychological methods and principles to legal questions and issues. Most typically, forensic psychology involves a clinical analysis of a particular individual and an assessment of some specific psycho-legal question. The psycho-legal question does not have to be criminal in nature. In fact, the forensic psychologist rarely gets involved in the actual criminal investigations. Custody cases are a great example of non-criminal evaluations by forensic psychologists. The validity and upholding of eyewitness testimony is an area of forensic psychology that does veer closer to criminal investigations, though does not directly involve the psychologist in the investigation process. Psychologists are often called to testify as expert witnesses on issues such as the accuracy of memory, the reliability of police interrogation, and the appropriate course of action in child custody cases.

Legal psychology refers to any application of psychological principles, methods or understanding to legal questions or issues. In addition to the applied practices, legal psychology also includes academic or empirical research on topics involving the relationship of law to human mental processes and behaviour. However, inherent differences that arise when placing psychology in the legal context. Psychology rarely makes absolute statements. Instead, psychologists traffic in the terms like level of confidence, percentages, and significance. Legal matters, on the other hand, look for absolutes: guilty or not guilty. This makes for a sticky union between psychology and the legal system. Some universities operate dual JD/PhD programmes focusing on the intersection of these two areas.

The Committee on Legal Issues of the American Psychological Association is known to file amicus curae briefs (someone who is not a party to a case who assists a court by offering information, expertise, or insight that has a bearing on the issues in the case), as applications of psychological knowledge to high-profile court cases.

A related field, police psychology, involves consultation with police departments and participation in police training.

Health and Medicine

Health psychology concerns itself with understanding how biology, behaviour, and social context influence health and illness. Health psychologists generally work alongside other medical professionals in clinical settings, although many also teach and conduct research. Although its early beginnings can be traced to the kindred field of clinical psychology, four different approaches to health psychology have been defined: clinical, public health, community and critical health psychology.

Health psychologists aim to change health behaviours for the dual purpose of helping people stay healthy and helping patients adhere to disease treatment regimens. The focus of health psychologists tend to centre on the health crisis facing the western world particularly in the US. Cognitive behavioural therapy and behaviour modification are techniques often employed by health psychologists. Psychologists also study patients’ compliance with their doctors’ orders.

Health psychologists view a person’s mental condition as heavily related to their physical condition. An important concept in this field is stress, a mental phenomenon with well-known consequences for physical health.

Medical

Medical psychology involves the application of a range of psychological principles, theories and findings applied to the effective management of physical and mental disorders to improve the psychological and physical health of the patient. The American Psychological Association (APA) defines medical psychology as the branch of psychology that integrates somatic and psychotherapeutic modalities, into the management of mental illness, health rehabilitation and emotional, cognitive, behavioural and substance use disorders. According to Muse and Moore (2012), the medical psychologist’s contributions in the areas of psychopharmacology which sets it apart from other of psychotherapy and psychotherapists.

Occupational Health Psychology

Occupational health psychology (OHP) is a relatively new discipline that emerged from the confluence of health psychology, industrial and organisational psychology, and occupational health. OHP has its own journals and professional organisations. The field is concerned with identifying psychosocial characteristics of workplaces that give rise to health-related problems in people who work. These problems can involve physical health (e.g., cardiovascular disease) or mental health (e.g. depression). Examples of psychosocial characteristics of workplaces that OHP has investigated include amount of decision latitude a worker can exercise and the supportiveness of supervisors. OHP is also concerned with the development and implementation of interventions that can prevent or ameliorate work-related health problems. In addition, OHP research has important implications for the economic success of organisations. Other research areas of concern to OHP include workplace incivility and violence, work-home carryover, unemployment and downsizing, and workplace safety and accident prevention. Two important OHP journals are the Journal of Occupational Health Psychology and Work & Stress. Three important organisations closely associated with OHP are the International Commission on Occupational Health’s Scientific Committee on Work Organisation and Psychosocial Factors (ICOH-WOPS), the Society for Occupational Health Psychology, and the European Academy of Occupational Health Psychology.

Human Factors and Ergonomics

Human factors and ergonomics (HF&E) is the study of how cognitive and psychological processes affect our interaction with tools, machines, and objects in the environment. Many branches of psychology attempt to create models of and understand human behaviour. These models are usually based on data collected from experiments. Human Factor psychologists however, take the same data and use it to design or adapt processes and objects that will complement the human component of the equation. Rather than humans learning how to use and manipulate a piece of technology, human factors strives to design technology to be inline with the human behaviour models designed by general psychology. This could be accounting for physical limitations of humans, as in ergonomics, or designing systems, especially computer systems, that work intuitively with humans, as does engineering psychology.

Ergonomics is applied primarily through office work and the transportation industry. Psychologists here take into account the physical limitations of the human body and attempt to reduce fatigue and stress by designing products and systems that work within the natural limitations of the human body. From simple things like the size of buttons and design of office chairs to layout of airplane cockpits, human factor psychologists, specializing in ergonomics, attempt to de-stress our everyday lives and sometimes even save them.

Human factor psychologists specialising in engineering psychology tend to take on slightly different projects than their ergonomic centred counterparts. These psychologists look at how a human and a process interact. Often engineering psychology may be centred on computers. However at the base level, a process is simply a series of inputs and outputs between a human and a machine. The human must have a clear method to input data and be able to easily access the information in output. The inability of rapid and accurate corrections can sometimes lead to drastic consequences, as summed up by many stories in Set Phasers on Stun. The engineering psychologists wants to make the process of inputs and outputs as intuitive as possible for the user.

The goal of research in human factors is to understand the limitations and biases of human mental processes and behaviour, and design items and systems that will interact accordingly with the limitations. Some may see human factors as intuitive or a list of dos and don’ts, but in reality, human factor research strives to make sense of large piles of data to bring precise applications to product designs and systems to help people work more naturally, intuitively with the items of their surroundings.

Industrial and Organisational Psychology

Industrial and organisational psychology, or I-O psychology, focuses on the psychology of work. Relevant topics within I-O psychology include the psychology of recruitment, selecting employees from an applicant pool, training, performance appraisal, job satisfaction, work motivation. work behaviour, occupational stress, accident prevention, occupational safety and health, management, retirement planning and unemployment among many other issues related to the workplace and people’s work lives. In short, I-O psychology is the application of psychology to the workplace. One aspect of this field is job analysis, the detailed study of which behaviours a given job entails.

Though the name of the title “Industrial Organisational Psychology” implies 2 split disciplines being chained together, it is near impossible to have one half without the other. If asked to generally define the differences, Industrial psychology focuses more on the Human Resources aspects of the field, and organisational psychology focuses more on the personal interactions of the employees. When applying these principles however, they are not easily broken apart. For example, when developing requirements for a new job position, the recruiters are looking for an applicant with strong communication skills in multiple areas. The developing of the position requirements falls under the industrial psychology, human resource type work. and the requirement of communication skills is related to how the employee with interacts with co-workers. As seen here, it is hard to separate task of developing a qualifications list from the types of qualifications on the list. This is parallel to how the I and O are nearly inseparable in practice. Therefore, I-O psychologists are generally rounded in both industrial and organisational psychology though they will have some specialisation. Other topics of interest for I-O psychologists include performance evaluation, training, and much more.

Military psychology includes research into the classification, training, and performance of soldiers

School Psychology

School psychology is a field that applies principles of clinical psychology and educational psychology to the diagnosis and treatment of students’ behavioural and learning problems. School psychologists are educated in child and adolescent development, learning theories, psychological and psycho-educational assessment, personality theories, therapeutic interventions, special education, psychology, consultation, child and adolescent psychopathology, and the ethical, legal and administrative codes of their profession.

According to Division 16 (Division of School Psychology) of the American Psychological Association (APA), school psychologists operate according to a scientific framework. They work to promote effectiveness and efficiency in the field. School psychologists conduct psychological assessments, provide brief interventions, and develop or help develop prevention programmes. Additionally, they evaluate services with special focus on developmental processes of children within the school system, and other systems, such as families. School psychologists consult with teachers, parents, and school personnel about learning, behavioural, social, and emotional problems. They may teach lessons on parenting skills (like school counsellors), learning strategies, and other skills related to school mental health. In addition, they explain test results to parents and students. They provide individual, group, and in some cases family counselling. School psychologists are actively involved in district and school crisis intervention teams. They also supervise graduate students in school psychology. School psychologists in many districts provide professional development to teachers and other school personnel on topics such as positive behaviour intervention plans and achievement tests.

One salient application for school psychology in today’s world is responding to the unique challenges of increasingly multicultural classrooms. For example, psychologists can contribute insight about the differences between individualistic and collectivistic cultures.

School psychologists are influential within the school system and are frequently consulted to solve problems. Practitioners should be able to provide consultation and collaborate with other members of the educational community and confidently make decisions based on empirical research.

Social Change

Psychologists have been employed to promote “green” behaviour, i.e. sustainable development. In this case, their goal is behaviour modification, through strategies such as social marketing. Tactics include education, disseminating information, organising social movements, passing laws, and altering taxes to influence decisions.

Psychology has been applied on a world scale with the aim of population control. For example, one strategy towards television programming combines social models in a soap opera with informational messages during advertising time. This strategy successfully increased women’s enrolment at family planning clinics in Mexico. The programming – which has been deployed around the world by Population Communications International and the Population Media Centre – combines family planning messages with representations of female education and literacy.

Sport Psychology

Sport psychology is a specialisation within psychology that seeks to understand psychological/mental factors that affect performance in sports, physical activity and exercise and apply these to enhance individual and team performance. The sport psychology approach differs from the coaches and players perspective. Coaches tend to narrow their focus and energy towards the end-goal. They are concerned with the actions that lead to the win, as opposed to the sport psychologist who tries to focus the players thoughts on just achieving the win. Sport psychology trains players mentally to prepare them, whereas coaches tend to focus mostly on physical training. Sport psychology deals with increasing performance by managing emotions and minimising the psychological effects of injury and poor performance. Some of the most important skills taught are goal setting, relaxation, visualisation, self-talk awareness and control, concentration, using rituals, attribution training, and periodisation. The principles and theories may be applied to any human movement or performance tasks (e.g. playing a musical instrument, acting in a play, public speaking, motor skills). Usually, experts recommend that students be trained in both kinesiology (i.e. sport and exercise sciences, physical education) and counselling.

Traffic Psychology

Traffic psychology is an applied discipline within psychology that looks at the relationship between psychological processes and cognitions and the actual behaviour of road users. In general, traffic psychologists attempt to apply these principles and research findings, in order to provide solutions to problems such as traffic mobility and congestion, road accidents, speeding. Research psychologists also are involved with the education and the motivation of road users.

What is Applied Behaviour Analysis?

Published on by Andrew Marshall3 Comments

Introduction

Applied Behaviour Analysis (ABA), also called behavioural engineering, is a scientific technique concerned with applying empirical approaches based upon the principles of respondent and operant conditioning to change behaviour of social significance.

It is the applied form of behaviour analysis; the other two forms are:

  • Radical behaviourism (or the philosophy of the science); and the
  • Experimental analysis of behaviour (or basic experimental research).

The name “applied behaviour analysis” has replaced behaviour modification because the latter approach suggested attempting to change behaviour without clarifying the relevant behaviour-environment interactions. In contrast, ABA changes behaviour by first assessing the functional relationship between a targeted behaviour and the environment. Further, the approach often seeks to develop socially acceptable alternatives for aberrant behaviours.

ABA has been utilised in a range of areas, including applied animal behaviour, schoolwide positive behaviour support, classroom instruction, structured and naturalistic early behavioural interventions for autism, paediatric feeding therapy, rehabilitation of brain injury, dementia, fitness training, substance abuse, phobias, tics, and organisational behaviour management.

ABA is considered to be controversial by some within the autism rights movement due to a perception that it emphasizes indistinguishability instead of acceptance and a history of, in some embodiments of ABA and its predecessors, the use of aversives such as electric shocks.

Definition

ABA is an applied science devoted to developing procedures which will produce observable changes in behaviour. It is to be distinguished from the experimental analysis of behaviour, which focuses on basic experimental research, but it uses principles developed by such research, in particular operant conditioning and classical conditioning. Behaviour analysis adopts the viewpoint of radical behaviourism, treating thoughts, emotions, and other covert activity as behaviour that is subject to the same rules as overt responses. This represents a shift away from methodological behaviourism, which restricts behaviour-change procedures to behaviours that are overt, and was the conceptual underpinning of behaviour modification.

Behaviour analysts also emphasize that the science of behaviour must be a natural science as opposed to a social science. As such, behaviour analysts focus on the observable relationship of behaviour with the environment, including antecedents and consequences, without resort to “hypothetical constructs”.

Brief History

The beginnings of ABA can be traced back to Teodoro Ayllon and Jack Michael’s study “The psychiatric nurse as a behavioural engineer” (1959) that they published in the Journal of the Experimental Analysis of Behaviour (JEAB). Ayllon and Michael were training the staff and nurses at a psychiatric hospital how to use a token economy based on the principles of operant conditioning for patients with schizophrenia and intellectual disability, which led to researchers at the University of Kansas to start the Journal of Applied Behaviour Analysis (JABA) in 1968.

A group of faculty and researchers at the University of Washington, including Donald Baer, Sidney W. Bijou, Bill Hopkins, Jay Birnbrauer, Todd Risley, and Montrose Wolf, applied the principles of behavior analysis to instruct developmentally disabled children, manage the behaviour of children and adolescents in juvenile detention centres, and organise employees who required proper structure and management in businesses, among other situations. In 1968, Baer, Bijou, Risley, Birnbrauer, Wolf, and James Sherman joined the Department of Human Development and Family Life at the University of Kansas, where they founded the Journal of Applied Behaviour Analysis.

Notable graduate students from the University of Washington include Robert Wahler, James Sherman, and Ivar Lovaas. Lovaas established the UCLA Young Autism Project while teaching at the University of California, Los Angeles. In 1965, Lovaas published a series of articles that outlined his system for coding observed behaviours, described a pioneering investigation of the antecedents and consequences that maintained a problem behaviour, and relied upon the methods of errorless learning that was initially devised by Charles Ferster to teach nonverbal children to speak. Lovaas also described how to use social (secondary) reinforcers, teach children to imitate, and what interventions (including electric shocks) may be used to reduce aggression and life-threatening self-injury.

In 1987, Lovaas published the study, “Behavioural treatment and normal educational and intellectual functioning in young autistic children”. The experimental group in this study received up to 40 hours per week in a 1:1 teaching setting at a table using errorless discrete trial training (DTT). The treatment is done at home with parents involved in every aspect of treatment, and the curriculum is highly individualized with a heavy emphasis on teaching eye contact, fine and gross motor imitation, and language. ABA principles were used to motivate learning and reduce non-desired behaviours. The outcome of this study indicated 47% of the experimental group (9/19) went on to lose their autism diagnosis and were described as indistinguishable from their typical adolescent peers. This included passing regular education without assistance, making and maintaining friends, and becoming self-sufficient as adults. These gains were maintained as reported in the 1993 study, “Long-term outcome for children with autism who received early intensive behavioural treatment”. Lovaas’ work went on to be recognised by the US Surgeon General in 1999, and his research were replicated in university and private settings. The “Lovaas Method” went on to become known as early intensive behavioural intervention (EIBI), or 30 to 40 hours per week of DTT.

Over the years, “behaviour analysis” gradually superseded “behaviour modification”; that is, from simply trying to alter problematic behaviour, behaviour analysts sought to understand the function of that behaviour, what antecedents promote and maintain it, and how it can be replaced by successful behaviour. This analysis is based on careful initial assessment of a behaviour’s function and a testing of methods that produce changes in behaviour.

While ABA seems to be intrinsically linked to autism intervention, it is also used in a broad range of other situations. Recent notable areas of research in JABA include autism, classroom instruction with typically developing students, paediatric feeding therapy, and substance-use disorders. Other applications of ABA include applied animal behaviour, consumer behaviour analysis, behavioural medicine, behavioural neuroscience, clinical behaviour analysis, forensic behaviour analysis, increasing job safety and performance, schoolwide positive behaviour support, and contact desensitisation for phobias.

Characteristics

Baer, Wolf, and Risley’s 1968 article is still used as the standard description of ABA. It lists the following seven characteristics of ABA.

  • Applied:
    • ABA focuses on the social significance of the behaviour studied.
    • For example, a non-applied researcher may study eating behaviour because this research helps to clarify metabolic processes, whereas the applied researcher may study eating behaviour in individuals who eat too little or too much, trying to change such behaviour so that it is more acceptable to the persons involved.
  • Behavioural:
    • ABA is pragmatic; it asks how it is possible to get an individual to do something effectively.
    • To answer this question, the behaviour itself must be objectively measured.
    • Verbal descriptions are treated as behaviour in themselves, and not as substitutes for the behaviour described.
  • Analytic:
    • Behaviour analysis is successful when the analyst understands and can manipulate the events that control a target behaviour.
    • This may be relatively easy to do in the lab, where a researcher is able to arrange the relevant events, but it is not always easy, or ethical, in an applied situation.
    • Baer et al. outline two methods that may be used in applied settings to demonstrate control while maintaining ethical standards.
    • These are the reversal design and the multiple baseline design.
    • In the reversal design, the experimenter first measures the behaviour of choice, introduces an intervention, and then measures the behaviour again.
    • Then, the intervention is removed, or reduced, and the behaviour is measured yet again.
    • The intervention is effective to the extent that the behaviour changes and then changes back in response to these manipulations.
    • The multiple baseline method may be used for behaviours that seem irreversible.
    • Here, several behaviours are measured and then the intervention is applied to each in turn.
    • The effectiveness of the intervention is revealed by changes in just the behaviour to which the intervention is being applied.
  • Technological:
    • The description of analytic research must be clear and detailed, so that any competent researcher can repeat it accurately.
    • Cooper et al. describe a good way to check this: Have a person trained in applied behaviour analysis read the description and then act out the procedure in detail.
    • If the person makes any mistakes or has to ask any questions then the description needs improvement.
  • Conceptually Systematic:
    • Behaviour analysis should not simply produce a list of effective interventions.
    • Rather, to the extent possible, these methods should be grounded in behavioural principles.
    • This is aided by the use of theoretically meaningful terms, such as “secondary reinforcement” or “errorless discrimination” where appropriate.
  • Effective:
    • Though analytic methods should be theoretically grounded, they must be effective.
    • If an intervention does not produce a large enough effect for practical use, then the analysis has failed
  • Generality:
    • Behaviour analysts should aim for interventions that are generally applicable; the methods should work in different environments, apply to more than one specific behaviour, and have long-lasting effects.

Other Proposed Characteristics

In 2005, Heward et al. suggested that the following five characteristics should be added:

  • Accountable:
    • To be accountable means that ABA must be able to demonstrate that its methods are effective.
    • This requires the repeatedly measuring the success of interventions, and, if necessary, making changes that improve their effectiveness.
  • Public:
    • The methods, results, and theoretical analyses of ABA must be published and open to scrutiny.
    • There are no hidden treatments or mystical, metaphysical explanations.
  • Doable:
    • To be generally useful, interventions should be available to a variety of individuals, who might be teachers, parents, therapists, or even those who wish to modify their own behaviour.
    • With proper planning and training, many interventions can be applied by almost anyone willing to invest the effort.
  • Empowering:
    • ABA provides tools that give the practitioner feedback on the results of interventions.
    • These allow clinicians to assess their skill level and build confidence in their effectiveness.
  • Optimistic:
    • According to several leading authors, behaviour analysts have cause to be optimistic that their efforts are socially worthwhile, for the following reasons:
      • The behaviours impacted by behaviour analysis are largely determined by learning and controlled by manipulable aspects of the environment.
      • Practitioners can improve performance by direct and continuous measurements.
      • As a practitioner uses behavioural techniques with positive outcomes, they become more confident of future success.
      • The literature provides many examples of success in teaching individuals considered previously unteachable.

Concepts

Behaviour

Behaviour refers to the movement of some part of an organism that changes some aspect of the environment. Often, the term behaviour refers to a class of responses that share physical dimensions or functions, and in that case a response is a single instance of that behaviour. If a group of responses have the same function, this group may be called a response class. “Repertoire” refers to the various responses available to an individual; the term may refer to responses that are relevant to a particular situation, or it may refer to everything a person can do.

Operant Conditioning

Operant behaviour is the so-called “voluntary” behaviour that is sensitive to, or controlled by its consequences. Specifically, operant conditioning refers to the three-term contingency that uses stimulus control, in particular an antecedent contingency called the discriminative stimulus (SD) that influences the strengthening or weakening of behaviour through such consequences as reinforcement or punishment. The term is used quite generally, from reaching for a candy bar, to turning up the heat to escape an aversive chill, to studying for an exam to get good grades.

Respondent (Classical) Conditioning

Respondent (classical) conditioning is based on innate stimulus-response relationships called reflexes. In his famous experiments with dogs, Pavlov usually used the salivary reflex, namely salivation (unconditioned response) following the taste of food (unconditioned stimulus). Pairing a neutral stimulus, for example a bell (conditioned stimulus) with food caused the dog to elicit salivation (conditioned response). Thus, in classical conditioning, the conditioned stimulus becomes a signal for a biologically significant consequence. Note that in respondent conditioning, unlike operant conditioning, the response does not produce a reinforcer or punisher (e.g. the dog does not get food because it salivates).

Environment

The environment is the entire constellation of stimuli in which an organism exists. This includes events both inside and outside of an organism, but only real physical events are included. A stimulus is an “energy change that affects an organism through its receptor cells”.

A stimulus can be described:

  • Topographically by its physical features.
  • Temporally by when it occurs.
  • Functionally by its effect on behaviour.

Reinforcement

Reinforcement is the key element in operant conditioning and in most behaviour change programmes. It is the process by which behaviour is strengthened. If a behaviour is followed closely in time by a stimulus and this results in an increase in the future frequency of that behaviour, then the stimulus is a positive reinforcer. If the removal of an event serves as a reinforcer, this is termed negative reinforcement. There are multiple schedules of reinforcement that affect the future probability of behaviour.

The use of punishments, especially those that inflict sensory or physical pain, is an area of controversy.

Punishment

Punishment is a process by which a consequence immediately follows a behaviour which decreases the future frequency of that behaviour. As with reinforcement, a stimulus can be added (positive punishment) or removed (negative punishment). Broadly, there are three types of punishment: presentation of aversive stimuli (e.g. pain), response cost (removal of desirable stimuli as in monetary fines), and restriction of freedom (as in a ‘time out’). Punishment in practice can often result in unwanted side effects. Some other potential unwanted effects include resentment over being punished, attempts to escape the punishment, expression of pain and negative emotions associated with it, and recognition by the punished individual between the punishment and the person delivering it.

Extinction

Extinction is the technical term to describe the procedure of withholding/discontinuing reinforcement of a previously reinforced behaviour, resulting in the decrease of that behaviour. The behaviour is then set to be extinguished. Extinction procedures are often preferred over punishment procedures, as many punishment procedures are deemed unethical and in many states prohibited. Nonetheless, extinction procedures must be implemented with utmost care by professionals, as they are generally associated with extinction bursts. An extinction burst is the temporary increase in the frequency, intensity, and/or duration of the behaviour targeted for extinction. Other characteristics of an extinction burst include an:

  • Extinction-produced aggression: the occurrence of an emotional response to an extinction procedure often manifested as aggression; and
  • Extinction-induced response variability: the occurrence of novel behaviours that did not typically occur prior to the extinction procedure.

These novel behaviours are a core component of shaping procedures.

Discriminated Operant and Three-Term Contingency

In addition to a relation being made between behaviour and its consequences, operant conditioning also establishes relations between antecedent conditions and behaviours. This differs from the S-R formulations (If-A-then-B), and replaces it with an AB-because-of-C formulation. In other words, the relation between a behaviour (B) and its context (A) is because of consequences (C), more specifically, this relationship between AB because of C indicates that the relationship is established by prior consequences that have occurred in similar contexts. This antecedent-behaviour-consequence contingency is termed the three-term contingency. A behaviour which occurs more frequently in the presence of an antecedent condition than in its absence is called a discriminated operant. The antecedent stimulus is called a discriminative stimulus (SD). The fact that the discriminated operant occurs only in the presence of the discriminative stimulus is an illustration of stimulus control. More recently behaviour analysts have been focusing on conditions that occur prior to the circumstances for the current behaviour of concern that increased the likelihood of the behaviour occurring or not occurring. These conditions have been referred to variously as “Setting Event”, “Establishing Operations”, and “Motivating Operations” by various researchers in their publications.

Verbal Behaviour

B.F. Skinner’s classification system of behaviour analysis has been applied to treatment of a host of communication disorders. Skinner’s system includes:

  • Tact: A verbal response evoked by a non-verbal antecedent and maintained by generalized conditioned reinforcement……
  • Mand: Behaviour under control of motivating operations maintained by a characteristic reinforcer.
  • Intraverbals: Verbal behaviour for which the relevant antecedent stimulus was other verbal behaviour, but which does not share the response topography of that prior verbal stimulus (e.g. responding to another speaker’s question).
  • Autoclitic: Secondary verbal behaviour which alters the effect of primary verbal behaviour on the listener. Examples involve quantification, grammar, and qualifying statements (e.g. the differential effects of “I think…” vs. “I know…”).

Measuring Behaviour

When measuring behaviour, there are both dimensions of behaviour and quantifiable measures of behaviour. In applied behaviour analysis, the quantifiable measures are a derivative of the dimensions. These dimensions are repeatability, temporal extent, and temporal locus.

  • Repeatability:
    • Response classes occur repeatedly throughout time – i.e. how many times the behaviour occurs.
    • Count is the number of occurrences in behaviour.
    • Rate/frequency is the number of instances of behaviour per unit of time.
    • Celeration is the measure of how the rate changes over time.
  • Temporal extent:
    • This dimension indicates that each instance of behaviour occupies some amount of time – i.e. how long the behaviour occurs.
    • Duration is the period of time over which the behavior occurs.
  • Temporal locus:
    • Each instance of behaviour occurs at a specific point in time – i.e. when the behaviour occurs.
    • Response latency is the measure of elapsed time between the onset of a stimulus and the initiation of the response.
    • Interresponse time is the amount of time that occurs between two consecutive instances of a response class.
  • Derivative measures:
    • Derivative measures are unrelated to specific dimensions.
    • Percentage is the ratio formed by combining the same dimensional quantities.
    • Trials-to-criterion are the number of response opportunities needed to achieve a predetermined level of performance.

Analysing Behaviour Change

Experimental Control

In applied behaviour analysis, all experiments should include the following:

  • At least one participant.
  • At least one behaviour (dependent variable).
  • At least one setting.
  • A system for measuring the behaviour and ongoing visual analysis of data.
  • At least one treatment or intervention condition.
  • Manipulations of the independent variable so that its effects on the dependent variable may be quantitatively or qualitatively analysed.
  • An intervention that will benefit the participant in some way.

Methodologies developed through ABA Research

Task Analysis

Task analysis is a process in which a task is analysed into its component parts so that those parts can be taught through the use of chaining: forward chaining, backward chaining and total task presentation. Task analysis has been used in organisational behaviour management, a behaviour analytic approach to changing the behaviours of members of an organisation (e.g. factories, offices, or hospitals). Behavioural scripts often emerge from a task analysis. Bergan conducted a task analysis of the behavioural consultation relationship and Thomas Kratochwill developed a training programme based on teaching Bergan’s skills. A similar approach was used for the development of microskills training for counsellors. Ivey would later call this “behaviourist” phase a very productive one[58] and the skills-based approach came to dominate counsellor training during 1970-1990. Task analysis was also used in determining the skills needed to access a career. In education, Englemann (1968) used task analysis as part of the methods to design the Direct Instruction curriculum.

Chaining

The skill to be learned is broken down into small units for easy learning. For example, a person learning to brush teeth independently may start with learning to unscrew the toothpaste cap. Once they have learned this, the next step may be squeezing the tube, etc.

For problem behaviour, chains can also be analysed and the chain can be disrupted to prevent the problem behaviour. Some behaviour therapies, such as dialectical behaviour therapy, make extensive use of behaviour chain analysis, but is not philosophically behaviour analytic.

Prompting

A prompt is a cue that is used to encourage a desired response from an individual. Prompts are often categorized into a prompt hierarchy from most intrusive to least intrusive, although there is some controversy about what is considered most intrusive, those that are physically intrusive or those that are hardest prompt to fade (e.g. verbal). In order to minimise errors and ensure a high level of success during learning, prompts are given in a most-to-least sequence and faded systematically. During this process, prompts are faded quickly as possible so that the learner does not come to depend on them and eventually behaves appropriately without prompting.

Types of prompts Prompters might use any or all of the following to suggest the desired response:

  • Vocal prompts: Words or other vocalisations.
  • Visual prompts: A visual cue or picture.
  • Gestural prompts: A physical gesture.
  • Positional prompt: For example, the target item is placed close to the individual.
  • Modelling: Modelling the desired response.
    • This type of prompt is best suited for individuals who learn through imitation and can attend to a model.
  • Physical prompts: Physically manipulating the individual to produce the desired response.
    • There are many degrees of physical prompts, from quite intrusive (e.g. the teacher places a hand on the learner’s hand) to minimally intrusive (e.g. a slight tap).

This is not an exhaustive list of prompts; the nature, number, and order of prompts are chosen to be the most effective for a particular individual.

Fading

The overall goal is for an individual to eventually not need prompts. As an individual gains mastery of a skill at a particular prompt level, the prompt is faded to a less intrusive prompt. This ensures that the individual does not become overly dependent on a particular prompt when learning a new behaviour or skill.

Thinning a Reinforcement Schedule

Thinning is often confused with fading. Fading refers to a prompt being removed, where thinning refers to an increase in the time or number of responses required between reinforcements. Periodic thinning that produces a 30% decrease in reinforcement has been suggested as an efficient way to thin. Schedule thinning is often an important and neglected issue in contingency management and token economy systems, especially when these are developed by unqualified practitioners (see professional practice of behaviour analysis).

Generalisation

Generalisation is the expansion of a student’s performance ability beyond the initial conditions set for acquisition of a skill. Generalisation can occur across people, places, and materials used for teaching. For example, once a skill is learned in one setting, with a particular instructor, and with specific materials, the skill is taught in more general settings with more variation from the initial acquisition phase. For example, if a student has successfully mastered learning colours at the table, the teacher may take the student around the house or school and generalise the skill in these more natural environments with other materials. Behaviour analysts have spent considerable amount of time studying factors that lead to generalisation.

Shaping

Shaping involves gradually modifying the existing behaviour into the desired behaviour. If the student engages with a dog by hitting it, then they could have their behaviour shaped by reinforcing interactions in which they touch the dog more gently. Over many interactions, successful shaping would replace the hitting behaviour with patting or other gentler behaviour. Shaping is based on a behaviour analyst’s thorough knowledge of operant conditioning principles and extinction. Recent efforts to teach shaping have used simulated computer tasks.

One teaching technique found to be effective with some students, particularly children, is the use of video modelling (the use of taped sequences as exemplars of behaviour). It can be used by therapists to assist in the acquisition of both verbal and motor responses, in some cases for long chains of behaviour.

Interventions Based on an FBA

Critical to behaviour analytic interventions is the concept of a systematic behavioural case formulation with a functional behavioural assessment or analysis at the core. This approach should apply a behaviour analytic theory of change. This formulation should include a thorough functional assessment, a skills assessment, a sequential analysis (behaviour chain analysis), an ecological assessment, a look at existing evidenced-based behavioural models for the problem behaviour (such as Fordyce’s model of chronic pain) and then a treatment plan based on how environmental factors influence behaviour. Some argue that behaviour analytic case formulation can be improved with an assessment of rules and rule-governed behaviour. Some of the interventions that result from this type of conceptualization involve training specific communication skills to replace the problem behaviours as well as specific setting, antecedent, behaviour, and consequence strategies.

Use in the Treatment of Autism Spectrum Disorders

ABA-based techniques are often used to teach adaptive behaviours or to diminish behaviours associated with autism, so much that ABA itself is often mistakenly considered to be synonymous with therapy for autism. According to a paper from 2007, it was considered to be an effective “intervention for challenging behaviors” by the American Academy of Paediatrics, though this has been refuted by more recent papers. ABA for autism may be limited by diagnostic severity and IQ.

Efficacy

Recent reviews of the efficacy of ABA-based techniques in autism include:

  • A 2007 clinical report of the American Academy of Paediatrics concluded that the benefit of ABA-based interventions in autism spectrum disorders (ASDs) “has been well documented” and that “children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior”.
  • Researchers from the MIND Institute published an evidence-based review of comprehensive treatment approaches in 2008. On the basis of “the strength of the findings from the four best-designed, controlled studies”, they were of the opinion that one ABA-based approach (the Lovaas technique created by Ole Ivar Løvaas) is “well-established” for improving intellectual performance of young children with ASD.
  • A 2009 review of psycho-educational interventions for children with autism whose mean age was six years or less at intake found that five high-quality (“Level 1” or “Level 2”) studies assessed ABA-based treatments. On the basis of these and other studies, the author concluded that ABA is “well-established” and is “demonstrated effective in enhancing global functioning in pre-school children with autism when treatment is intensive and carried out by trained therapists”. However, the review committee also concluded that “there is a great need for more knowledge about which interventions are most effective”.
  • A 2009 paper included a descriptive analysis, an effect size analysis, and a meta-analysis of 13 reports published from 1987 to 2007 of early intensive behavioural intervention (EIBI, a form of ABA-based treatment with origins in the Lovaas technique) for autism. It determined that EIBI’s effect sizes were “generally positive” for IQ, adaptive behaviour, expressive language, and receptive language. The paper did note limitations of its findings including the lack of published comparisons between EIBI and other “empirically validated treatment programs”.
  • In a 2009 systematic review of 11 studies published from 1987 to 2007, the researchers wrote “there is strong evidence that EIBI is effective for some, but not all, children with autism spectrum disorders, and there is wide variability in response to treatment”. Furthermore, any improvements are likely to be greatest in the first year of intervention.
  • A 2009 meta-analysis of nine studies published from 1987 to 2007 concluded that EIBI has a “large” effect on full-scale intelligence and a “moderate” effect on adaptive behaviour in autistic children.
  • A 2009 systematic review and meta-analysis by Spreckley and Boyd of four small-n 2000-2007 studies (involving a total of 76 children) came to different conclusions than the aforementioned reviews. Spreckley and Boyd reported that applied behaviour intervention (ABI), another name for EIBI, did not significantly improve outcomes compared with standard care of preschool children with ASD in the areas of cognitive outcome, expressive language, receptive language, and adaptive behaviour. In a letter to the editor, however, authors of the four studies meta-analysed claimed that Spreckley and Boyd had misinterpreted one study comparing two forms of ABI with each other as a comparison of ABI with standard care, which erroneously decreased the observed efficacy of ABI. Furthermore, the four studies’ authors raised the possibility that Spreckley and Boyd had excluded some other studies unnecessarily, and that including such studies could have led to a more favourable evaluation of ABI. Spreckley, Boyd, and the four studies’ authors did agree that large multi-site randomised trials are needed to improve the understanding of ABA’s efficacy in autism.
  • In 2011, investigators from Vanderbilt University under contract with the Agency for Healthcare Research and Quality performed a comprehensive review of the scientific literature on ABA-based and other therapies for autism spectrum disorders; the ABA-based therapies included the UCLA/Lovaas method and the Early Start Denver Model (the latter developed by Sally Rogers and Geraldine Dawson). They concluded that “both approaches were associated with … improvements in cognitive performance, language skills, and adaptive behavior skills”. However, they also concluded that “the strength of evidence … is low”, “many children continue to display prominent areas of impairment”, “subgroups may account for a majority of the change”, there is “little evidence of practical effectiveness or feasibility beyond research studies”, and the published studies “used small samples, different treatment approaches and duration, and different outcome measurements”.
  • An October 2019 report by the United States Department of Defence found that “76 percent of TRICARE beneficiaries in the ACD had little to no change in symptom presentation over the course of 12 months of applied behavior analysis (ABA) services, with an additional 9 percent demonstrating worsening symptoms.”
  • Controversy regarding ABA persists in the autism community. A 2017 study found that 46% of people with autism spectrum undergoing ABA appeared to meet the criteria for post-traumatic stress disorder (PTSD), a rate 86% higher than the rate of those who had not undergone ABA (28%). According to the researcher, the rate of apparent PTSD increased after exposure to ABA regardless of the age of the patient. However, the quality of this study has been disputed by other researchers.
  • A 2019 review article concluded ABA proponents have utilised predominantly non-verbal and neurologically different, children who are not recognised under this paradigm to have their own thought processes, basic needs, preferences, style of learning, and psychological and emotional needs, for their experiment. This also indicates a missing voice of children and nonverbal people who cannot express their view on ABA.

Use of Aversives

Some embodiments of applied behaviour analysis as devised by Ole Ivar Lovaas used aversives such as electric shocks to modify undesirable behaviour in their initial use in the 1970s, as well as slapping and shouting in the landmark 1987 study. Over time the use of aversives lessened and in 2012 their use was described as being inconsistent with contemporary practice. However, aversives have continued to be used in some ABA programs. In comments made in 2014 to the FDA, a clinician who previously worked at the Judge Rotenberg Educational Centre claimed that “all textbooks used for thorough training of applied behavior analysts include an overview of the principles of punishment, including the use of electrical stimulation.” In 2020, the FDA banned the use of electrical stimulation devices used for self-injurious or aggressive behaviour and asserted that “Evidence indicates a number of significant psychological and physical risks are associated with the use of these devices, including worsening of underlying symptoms, depression, anxiety, posttraumatic stress disorder, pain, burns and tissue damage.”

Controversy

The value of eliminating autistic behaviours is disputed by proponents of neurodiversity, who claim that it forces autistics to mask their true personalities on behalf of a narrow conception of normality. Autism advocates contend that it is cruel to try to make autistic people “normal” without consideration for how this may affect their well-being. Instead, these critics advocate for increased social acceptance of harmless autistic traits and therapies focused on improving quality of life. Julia Bascom of the Autistic Self Advocacy Network (ASAN) has said, “ASAN’s objection is fundamentally an ethical one. The stated end goal of ABA is an autistic child who is ‘indistinguishable from their peers’ – an autistic child who can pass as neurotypical. We don’t think that’s an acceptable goal. The end goal of all services, supports, interventions, and therapies an autistic child receives should be to support them in growing up into an autistic adult who is happy, healthy, and living a self-determined life.”

It has been suspected that there might be a publication bias against those research articles share a controversial account of ABA. Publication bias could lead to exaggerated estimates of intervention effects.

What is Antisocial Personality Disorder?

Published on by Andrew Marshall4 Comments

Introduction

Antisocial personality disorder (ASPD or infrequently APD) is a personality disorder characterised by a long-term pattern of disregard for, or violation of, the rights of others. A weak or non-existent conscience is often apparent, as well as a history of legal problems or impulsive and aggressive behaviour.

Antisocial personality disorder is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), while the equivalent concept of dissocial personality disorder (DPD) is defined in the International Statistical Classification of Diseases and Related Health Problems (ICD); the primary theoretical distinction between the two is that antisocial personality disorder focuses on observable behaviours, while dissocial personality disorder focuses on affective deficits. Otherwise, both manuals provide similar criteria for diagnosing the disorder. Both have also stated that their diagnoses have been referred to, or include what is referred to, as psychopathy or sociopathy. However, some researchers have drawn distinctions between the concepts of antisocial personality disorder and psychopathy, with many researchers arguing that psychopathy is a disorder that overlaps with but is distinguishable from ASPD.

Brief History

The first version of the DSM in 1952 listed sociopathic personality disturbance. This category was for individuals who were considered “…ill primarily in terms of society and of conformity with the prevailing milieu, and not only in terms of personal discomfort and relations with other individuals”. There were four subtypes, referred to as “reactions”: antisocial, dyssocial, sexual, and addiction. The antisocial reaction was said to include people who were “always in trouble” and not learning from it, maintaining “no loyalties”, frequently callous and lacking responsibility, with an ability to “rationalise” their behaviour. The category was described as more specific and limited than the existing concepts of “constitutional psychopathic state” or “psychopathic personality” which had had a very broad meaning; the narrower definition was in line with criteria advanced by Hervey M. Cleckley from 1941, while the term sociopathic had been advanced by George Partridge in 1928 when studying the early environmental influence on psychopaths. Partridge discovered the correlation between antisocial psychopathic disorder and parental rejection experienced in early childhood.

The DSM-II in 1968 rearranged the categories and “antisocial personality” was now listed as one of ten personality disorders but still described similarly, to be applied to individuals who are: “basically unsocialised”, in repeated conflicts with society, incapable of significant loyalty, selfish, irresponsible, unable to feel guilt or learn from prior experiences, and who tend to blame others and rationalise. The manual preface contains “special instructions” including “Antisocial personality should always be specified as mild, moderate, or severe.” The DSM-II warned that a history of legal or social offenses was not by itself enough to justify the diagnosis, and that a “group delinquent reaction” of childhood or adolescence or “social maladjustment without manifest psychiatric disorder” should be ruled out first. The dyssocial personality type was relegated in the DSM-II to “dyssocial behaviour” for individuals who are predatory and follow more or less criminal pursuits, such as racketeers, dishonest gamblers, prostitutes, and dope peddlers. (DSM-I classified this condition as sociopathic personality disorder, dyssocial type). It would later resurface as the name of a diagnosis in the ICD manual produced by the WHO, later spelled dissocial personality disorder and considered approximately equivalent to the ASPD diagnosis.

The DSM-III in 1980 included the full term antisocial personality disorder and, as with other disorders, there was now a full checklist of symptoms focused on observable behaviours to enhance consistency in diagnosis between different psychiatrists (‘inter-rater reliability’). The ASPD symptom list was based on the Research Diagnostic Criteria developed from the so-called Feighner Criteria from 1972, and in turn largely credited to influential research by sociologist Lee Robins published in 1966 as “Deviant Children Grown Up”. However, Robins has previously clarified that while the new criteria of prior childhood conduct problems came from her work, she and co-researcher psychiatrist Patricia O’Neal got the diagnostic criteria they used from Lee’s husband the psychiatrist Eli Robins, one of the authors of the Feighner criteria who had been using them as part of diagnostic interviews.

The DSM-IV maintained the trend for behavioural antisocial symptoms while noting “This pattern has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder” and re-including in the ‘Associated Features’ text summary some of the underlying personality traits from the older diagnoses. The DSM-5 has the same diagnosis of antisocial personality disorder. The Pocket Guide to the DSM-5 Diagnostic Exam suggests that a person with ASPD may present “with psychopathic features” if he or she exhibits “a lack of anxiety or fear and a bold, efficacious interpersonal style”.

Epidemiology

As seen in two North American studies and two European studies, ASPD is more commonly seen in men than in women, with men three to five times more likely to be diagnosed with ASPD than women. The prevalence of ASPD is even higher in selected populations, like prisons, where there is a preponderance of violent offenders. It has been found that the prevalence of ASPD among prisoners is just under 50%. Similarly, the prevalence of ASPD is higher among patients in alcohol or other drug (AOD) use treatment programmes than in the general population, suggesting a link between ASPD and AOD use and dependence. As part of the Epidemiological Catchment Area (ECA) study, men with ASPD were found to be three to five times more likely to excessively use alcohol and illicit substances than those men without ASPD. While ASPD occurs more often in men than women, there was found to be increased severity of this substance use in women with ASPD. In a study conducted with both men and women with ASPD, women were more likely to misuse substances compared to their male counterparts.

Individuals with ASPD are at an elevated risk for suicide. Some studies suggest this increase in suicidality is in part due to the association between suicide and symptoms or trends within ASPD, such as criminality and substance use. Offspring of ASPD victims are also at risk. Some research suggests that negative or traumatic experiences in childhood, perhaps as a result of the choices a parent with ASPD might make, can be a predictor of delinquency later on in the child’s life. Additionally, with variability between situations, children of a parent with ASPD may suffer consequences of delinquency if they’re raised in an environment in which crime and violence is common. Suicide is a leading cause of death among youth who display antisocial behaviour, especially when mixed with delinquency. Incarceration, which could come as a consequence of actions from a victim of ASPD, is a predictor for suicide ideation in youth.

Signs and Symptoms

Antisocial personality disorder is defined by a pervasive and persistent disregard for morals, social norms, and the rights and feelings of others. Individuals with this personality disorder will typically have no compunction in exploiting others in harmful ways for their own gain or pleasure and frequently manipulate and deceive other people. While some do so through a façade of superficial charm, others do so through intimidation and violence. They may display arrogance, think lowly and negatively of others, and lack remorse for their harmful actions and have a callous attitude to those they have harmed. Irresponsibility is a core characteristic of this disorder; most have significant difficulties in maintaining stable employment as well as fulfilling their social and financial obligations, and people with this disorder often lead exploitative, unlawful, or parasitic lifestyles.

Those with antisocial personality disorder are often impulsive and reckless, failing to consider or disregarding the consequences of their actions. They may repeatedly disregard and jeopardise their own safety and the safety of others, which can place both themselves and other people in danger. They are often aggressive and hostile, with poorly regulated tempers, and can lash out violently with provocation or frustration. Individuals are prone to substance use disorders and addiction, and the non-medical use of various psychoactive substances is common in this population. These behaviours lead such individuals into frequent conflict with the law, and many people with ASPD have extensive histories of antisocial behaviour and criminal infractions stemming back to adolescence or childhood.

Serious problems with interpersonal relationships are often seen in those with the disorder. People with antisocial personality disorder usually form poor attachments and emotional bonds, and interpersonal relationships often revolve around the exploitation and abuse of others. They may have difficulties in sustaining and maintaining relationships, and some have difficulty entering them.

Conduct Disorder

While antisocial personality disorder is a mental disorder diagnosed in adulthood, it has its precedent in childhood. The DSM-5’s criteria for ASPD require that the individual have conduct problems evident by the age of 15. Persistent antisocial behaviour, as well as a lack of regard for others in childhood and adolescence, is known as conduct disorder and is the precursor of ASPD. About 25-40% of youths with conduct disorder will be diagnosed with ASPD in adulthood.

Conduct disorder (CD) is a disorder diagnosed in childhood that parallels the characteristics found in ASPD and is characterised by a repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate norms are violated. Children with the disorder often display impulsive and aggressive behaviour, may be callous and deceitful, and may repeatedly engage in petty crime such as stealing or vandalism or get into fights with other children and adults. This behaviour is typically persistent and may be difficult to deter with threat or punishment. Attention deficit hyperactivity disorder (ADHD) is common in this population, and children with the disorder may also engage in substance use. CD is differentiated from oppositional defiant disorder (ODD) in that children with ODD do not commit aggressive or antisocial acts against other people, animals, and property, though many children diagnosed with ODD are subsequently re-diagnosed with CD.

Two developmental courses for CD have been identified based on the age at which the symptoms become present. The first is known as the “childhood-onset type” and occurs when conduct disorder symptoms are present before the age of 10 years. This course is often linked to a more persistent life course and more pervasive behaviours, and children in this group express greater levels of ADHD symptoms, neuropsychological deficits, more academic problems, increased family dysfunction, and higher likelihood of aggression and violence. The second is known as the “adolescent-onset type” and occurs when conduct disorder develops after the age of 10 years. Compared to the childhood-onset type, less impairment in various cognitive and emotional functions are present, and the adolescent-onset variety may remit by adulthood. In addition to this differentiation, the DSM-5 provides a specifier for a callous and unemotional interpersonal style, which reflects characteristics seen in psychopathy and are believed to be a childhood precursor to this disorder. Compared to the adolescent-onset subtype, the childhood-onset subtype, especially if callous and unemotional traits are present, tends to have a worse treatment outcome.

Comorbidity

ASPD commonly coexists with the following conditions:

  • Anxiety disorders.
  • Depressive disorder.
  • Impulse control disorders.
  • Substance-related disorders.
  • Somatization disorder.
  • Attention deficit hyperactivity disorder.
  • Bipolar disorder.
  • Borderline personality disorder.
  • Histrionic personality disorder.
  • Narcissistic personality disorder.
  • Sadistic personality disorder.

When combined with alcoholism, people may show frontal function deficits on neuropsychological tests greater than those associated with each condition. Alcohol Use Disorder is likely caused by lack of impulse and behavioural control exhibited by Antisocial Personality Disorder patients. The rates of ASPD tends to be around 40-50% in male alcohol and opiate addicts. However, it is important to remember this is not a causal relationship, but rather a plausible consequence of cognitive deficits as a result of ASPD.

Causes

Personality disorders are seen to be caused by a combination and interaction of genetic and environmental influences. Genetically, it is the intrinsic temperamental tendencies as determined by their genetically influenced physiology, and environmentally, it is the social and cultural experiences of a person in childhood and adolescence encompassing their family dynamics, peer influences, and social values. People with an antisocial or alcoholic parent are considered to be at higher risk. Fire-setting and cruelty to animals during childhood are also linked to the development of antisocial personality. The condition is more common in males than in females, and among people who are in prison.

Genetic

Research into genetic associations in antisocial personality disorder suggests that ASPD has some or even a strong genetic basis. Prevalence of ASPD is higher in people related to someone afflicted by the disorder. Twin studies, which are designed to discern between genetic and environmental effects, have reported significant genetic influences on antisocial behaviour and conduct disorder.

In the specific genes that may be involved, one gene that has seen particular interest in its correlation with antisocial behaviour is the gene that encodes for Monoamine oxidase A (MAO-A), an enzyme that breaks down monoamine neurotransmitters such as serotonin and norephinephrine. Various studies examining the genes’ relationship to behaviour have suggested that variants of the gene that results in less MAO-A being produced, such as the 2R and 3R alleles of the promoter region, have associations with aggressive behaviour in men. The association is also influenced by negative experience in early life, with children possessing a low-activity variant (MAOA-L) who experience such maltreatment being more likely to develop antisocial behaviour than those with the high-activity variant (MAOA-H). Even when environmental interactions (e.g. emotional abuse) are controlled for, a small association between MAOA-L and aggressive and antisocial behaviour remains.

The gene that encodes for the serotonin transporter (SCL6A4), a gene that is heavily researched for its associations with other mental disorders, is another gene of interest in antisocial behaviour and personality traits. Genetic associations studies have suggested that the short “S” allele is associated with impulsive antisocial behaviour and ASPD in the inmate population. However, research into psychopathy find that the long “L” allele is associated with the Factor 1 traits of psychopathy, which describes its core affective (e.g. lack of empathy, fearlessness) and interpersonal (e.g. grandiosity, manipulativeness) personality disturbances. This is suggestive of two different forms, one associated more with impulsive behaviour and emotional dysregulation, and the other with predatory aggression and affective disturbance, of the disorder.

Various other gene candidates for ASPD have been identified by a genome-wide association study published in 2016. Several of these gene candidates are shared with attention-deficit hyperactivity disorder, with which ASPD is comorbid. Furthermore, the study found that those who carry 4 mutations on chromosome 6 are 1.5 times more likely to develop antisocial personality disorder than those who do not.

Physiological

Hormones and Neurotransmitters

Traumatic events can lead to a disruption of the standard development of the central nervous system, which can generate a release of hormones that can change normal patterns of development. Aggressiveness and impulsivity are among the possible symptoms of ASPD. Testosterone is a hormone that plays an important role in aggressiveness in the brain. For instance, criminals who have committed violent crimes tend to have higher levels of testosterone than the average person. The effect of testosterone is counteracted by cortisol which facilitates the cognitive control of impulsive tendencies.

One of the neurotransmitters that has been discussed in individuals with ASPD is serotonin, also known as 5HT.[41] A meta-analysis of 20 studies found significantly lower 5-HIAA levels (indicating lower serotonin levels), especially in those who are younger than 30 years of age.

While it has been shown that lower levels of serotonin may be associated with ASPD, there has also been evidence that decreased serotonin function is highly correlated with impulsiveness and aggression across a number of different experimental paradigms. Impulsivity is not only linked with irregularities in 5HT metabolism, but may be the most essential psychopathological aspect linked with such dysfunction. Correspondingly, the DSM classifies “impulsivity or failure to plan ahead” and “irritability and aggressiveness” as two of seven sub-criteria in category A of the diagnostic criteria of ASPD.

Some studies have found a relationship between monoamine oxidase A and antisocial behaviour, including conduct disorder and symptoms of adult ASPD, in maltreated children.

Neurological

Antisocial behaviour may be related to head trauma. Antisocial behaviour is associated with decreased grey matter in the right lentiform nucleus, left insula, and frontopolar cortex. Increased volumes have been observed in the right fusiform gyrus, inferior parietal cortex, right cingulate gyrus, and post central cortex.

Intellectual and cognitive ability is consistently found to be impaired or reduced in the ASPD population. Contrary to stereotypes in popular culture of the “psychopathic genius”, antisocial personality disorder is associated with both reduced overall intelligence and specific reductions in individual aspects of cognitive ability. These deficits also occur in general-population samples of people with antisocial traits and in children with the precursors to antisocial personality disorder.

People that exhibit antisocial behaviour demonstrate decreased activity in the prefrontal cortex. The association is more apparent in functional neuroimaging as opposed to structural neuroimaging. The prefrontal cortex is involved in many executive functions, including behaviour inhibitions, planning ahead, determining consequences of action, and differentiating between right and wrong. However, some investigators have questioned whether the reduced volume in prefrontal regions is associated with antisocial personality disorder, or whether they result from co-morbid disorders, such as substance use disorder or childhood maltreatment. Moreover, it remains an open question whether the relationship is causal, i.e. whether the anatomical abnormality causes the psychological and behavioural abnormality, or vice versa.

Cavum septi pellucidi (CSP) is a marker for limbic neural maldevelopment, and its presence has been loosely associated with certain mental disorders, such as schizophrenia and post-traumatic stress disorder. One study found that those with CSP had significantly higher levels of antisocial personality, psychopathy, arrests and convictions compared with controls.

Environmental

Family Environment

Some studies suggest that the social and home environment has contributed to the development of antisocial behaviour. The parents of these children have been shown to display antisocial behaviour, which could be adopted by their children. A lack of parental stimulation and affection during early development leads to sensitization of the child’s stress response systems, which is thought to lead to underdevelopment of the child’s brain that deals with emotion, empathy and ability to connect to other humans on an emotional level. According to Dr. Bruce Perry in his book The Boy Who Was Raised as a Dog, “the [infant’s developing] brain needs patterned, repetitive stimuli to develop properly. Spastic, unpredictable relief from fear, loneliness, discomfort, and hunger keeps a baby’s stress system on high alert. An environment of intermittent care punctuated by total abandonment may be the worst of all worlds for a child.”

Cultural Influences

The sociocultural perspective of clinical psychology views disorders as influenced by cultural aspects; since cultural norms differ significantly, mental disorders such as ASPD are viewed differently. Robert D. Hare has suggested that the rise in ASPD that has been reported in the United States may be linked to changes in cultural mores, the latter serving to validate the behavioural tendencies of many individuals with ASPD. While the rise reported may be in part merely a byproduct of the widening use (and abuse) of diagnostic techniques, given Eric Berne’s division between individuals with active and latent ASPD – the latter keeping themselves in check by attachment to an external source of control like the law, traditional standards, or religion – it has been suggested that the erosion of collective standards may indeed serve to release the individual with latent ASPD from their previously prosocial behaviour.

There is also a continuous debate as to the extent to which the legal system should be involved in the identification and admittance of patients with preliminary symptoms of ASPD. Controversial clinical psychiatrist Pierre-Édouard Carbonneau suggested that the problem with legal forced admittance is the rate of failure when diagnosing ASPD. He states that the possibility of diagnosing and coercing a patient into prescribing medication to someone without ASPD, but is diagnosed with it could be potentially disastrous, but the possibility of not diagnosing it and seeing a patient go untreated because of a lack of sufficient evidence of cultural or environmental influences is something a psychiatrist must ignore, and in his words, “play it safe”.

ICD-10

The World Health Organisation’s (WHO’s) International Statistical Classification of Diseases and Related Health Problems, tenth edition (ICD-10), has a diagnosis called dissocial personality disorder (F60.2):

It is characterised by at least 3 of the following:

  • Callous unconcern for the feelings of others;
  • Gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations;
  • Incapacity to maintain enduring relationships, though having no difficulty in establishing them;
  • Very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
  • Incapacity to experience guilt or to profit from experience, particularly punishment; and/or
  • Marked readiness to blame others or to offer plausible rationalisations for the behaviour that has brought the person into conflict with society.

The ICD states that this diagnosis includes “amoral, antisocial, asocial, psychopathic, and sociopathic personality”. Although the disorder is not synonymous with conduct disorder, presence of conduct disorder during childhood or adolescence may further support the diagnosis of dissocial personality disorder. There may also be persistent irritability as an associated feature.

It is a requirement of the ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

Psychopathy

Psychopathy is commonly defined as a personality disorder characterised partly by antisocial behaviour, a diminished capacity for empathy and remorse, and poor behavioural controls. Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare’s Psychopathy Checklist, Revised (PCL-R). “Psychopathy” is not the official title of any diagnosis in the DSM or ICD; nor is it an official title used by other major psychiatric organisations. The DSM and ICD, however, state that their antisocial diagnoses are at times referred to (or include what is referred to) as psychopathy or sociopathy.

American psychiatrist Hervey Cleckley’s work on psychopathy formed the basis of the diagnostic criteria for ASPD, and the DSM states ASPD is often referred to as psychopathy. However, critics argue ASPD is not synonymous with psychopathy as the diagnostic criteria are not the same, since criteria relating to personality traits are emphasized relatively less in the former. These differences exist in part because it was believed such traits were difficult to measure reliably and it was “easier to agree on the behaviours that typify a disorder than on the reasons why they occur”.

Although the diagnosis of ASPD covers two to three times as many prisoners than the diagnosis of psychopathy, Robert Hare believes the PCL-R is better able to predict future criminality, violence, and recidivism than a diagnosis of ASPD. He suggests there are differences between PCL-R-diagnosed psychopaths and non-psychopaths on “processing and use of linguistic and emotional information”, while such differences are potentially smaller between those diagnosed with ASPD and without. Additionally, Hare argued confusion regarding how to diagnose ASPD, confusion regarding the difference between ASPD and psychopathy, as well as the differing future prognoses regarding recidivism and treatability, may have serious consequences in settings such as court cases where psychopathy is often seen as aggravating the crime.

Nonetheless, psychopathy has been proposed as a specifier under an alternative model for ASPD. In the DSM-5, under “Alternative DSM-5 Model for Personality Disorders”, ASPD with psychopathic features is described as characterised by “a lack of anxiety or fear and by a bold interpersonal style that may mask maladaptive behaviours (e.g. fraudulence).” Low levels of withdrawal and high levels of attention-seeking combined with low anxiety are associated with “social potency” and “stress immunity” in psychopathy. Under the specifier, affective and interpersonal characteristics are comparatively emphasized over behavioural components.

Treatment

ASPD is considered to be among the most difficult personality disorders to treat. Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community. Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts. They may only simulate remorse rather than truly commit to change: they can be seductively charming and dishonest, and may manipulate staff and fellow patients during treatment. Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated.

Most treatment done is for those in the criminal justice system to whom the treatment regimes are given as part of their imprisonment. Those with ASPD may stay in treatment only as required by an external source, such as parole conditions. Residential programmes that provide a carefully controlled environment of structure and supervision along with peer confrontation have been recommended. There has been some research on the treatment of ASPD that indicated positive results for therapeutic interventions. Psychotherapy also known as talk therapy is found to help treat patients with ASPD. Schema therapy is also being investigated as a treatment for ASPD. A review by Charles M. Borduin features the strong influence of Multisystemic therapy (MST) that could potentially improve this imperative issue. However, this treatment requires complete cooperation and participation of all family members. Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance use, although others have reported contradictory findings.

Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviours. Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behaviour and abstaining from antisocial behaviour. However, the impulsive and aggressive nature of those with this disorder may limit the effectiveness of even this form of therapy.

The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD. A 2020 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which 8 studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD. Nonetheless, psychiatric medications such as antipsychotics, antidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co-occur with ASPD for which medications are indicated.

Prognosis

According to Professor Emily Simonoff of the Institute of Psychiatry, Psychology and Neuroscience there are many variables that are consistently connected to ASPD, such as: childhood hyperactivity and conduct disorder, criminality in adulthood, lower IQ scores and reading problems. The strongest relationship between these variables and ASPD are childhood hyperactivity and conduct disorder. Additionally, children who grow up with a predisposition of ASPD and interact with other delinquent children are likely to later be diagnosed with ASPD. Like many disorders, genetics play a role in this disorder but the environment holds an undeniable role in its development.

Boys are twice as likely to meet all of the diagnostic criteria for ASPD than girls (40% versus 25%) and they will often start showing symptoms of the disorder much earlier in life. Children that do not show symptoms of the disease through age 15 will not develop ASPD later in life. If adults exhibit milder symptoms of ASPD, it is likely that they never met the criteria for the disorder in their childhood and were consequently never diagnosed. Overall, symptoms of ASPD tend to peak in late-teens and early twenties, but can often reduce or improve through age 40.

ASPD is ultimately a lifelong disorder that has chronic consequences, though some of these can be moderated over time. There may be a high variability of the long-term outlook of antisocial personality disorder. The treatment of this disorder can be successful, but it entails unique difficulties. It is unlikely to see rapid change especially when the condition is severe. In fact, past studies revealed that remission rates were small, with up to only 31% rates of improvement instead of remittance. As a result of the characteristics of ASPD (e.g. displaying charm in effort of personal gain, manipulation), patients seeking treatment (mandated or otherwise) may appear to be “cured” in order to get out of treatment. According to definitions found in the DSM-5, people with ASPD can be deceitful and intimidating in their relationships. When they are caught doing something wrong, they often appear to be unaffected and unemotional about the consequences. Over time, continual behaviour that lacks empathy and concern may lead to someone with ASPD taking advantage of the kindness of others, including his or her therapist.

Without proper treatment, individuals suffering with ASPD could lead a life that brings about harm to themselves or others. This can be detrimental to their families and careers. ASPD victims suffer from lack of interpersonal skills (e.g. lack of remorse, lack of empathy, lack of emotional-processing skills). As a result of the inability to create and maintain healthy relationships due to the lack of interpersonal skills, individuals with ASPD may find themselves in predicaments such as divorce, unemployment, homelessness and even premature death by suicide. They also see higher rates of committed crime, reaching peaks in their late teens and often committing higher-severity crimes in their younger ages of diagnoses. Comorbidity of other mental illnesses such as Depression or substance use disorder is prevalent among ASPD victims. People with ASPD are also more likely to commit homicides and other crimes. Those who are imprisoned longer often see higher rates of improvement with symptoms of ASPD than others who have been imprisoned for a shorter amount of time.

According to one study, aggressive tendencies show in about 72% of all male patients diagnosed with ASPD. About 29% of the men studied with ASPD also showed a prevalence of pre-meditated aggression. Based on the evidence in the study, the researchers concluded that aggression in patients with ASPD is mostly impulsive, though there are some long-term evidences of pre-meditated aggressions. It often occurs that those with higher psychopathic traits will exhibit the pre-meditated aggressions to those around them. Over the course of a patient’s life with ASPD, he or she can exhibit this aggressive behaviour and harm those close to him or her.

Additionally, many people (especially adults) who have been diagnosed with ASPD become burdens to their close relatives, peers, and caretakers. Harvard Medical School recommends that time and resources be spent treating victims who have been affected by someone with ASPD, because the patient with ASPD may not respond to the administered therapies. In fact, a patient with ASPD may only accept treatment when ordered by a court, which will make their course of treatment difficult and severe. Because of the challenges in treatment, the patient’s family and close friends must take an active role in decisions about therapies that are offered to the patient. Ultimately, there must be a group effort to aid the long-term effects of the disorder.

On This Day … 13 June

Published on by Andrew MarshallLeave a comment

People (Births)

  • 1809 – Heinrich Hoffmann, German psychiatrist and author (d. 1894).
  • 1894 – Leo Kanner, Ukrainian-American psychiatrist and physician (d. 1981).
  • 1931 – Irvin D. Yalom, American psychotherapist and academic.

Heinrich Hoffmann

Heinrich Hoffmann (13 June 1809 to 20 September 1894) was a German psychiatrist, who also wrote some short works including Der Struwwelpeter, an illustrated book portraying children misbehaving.

Hoffmann worked for a pauper’s clinic and had a private practice. He also taught anatomy at the Senckenberg Foundation. None of this paid very well, and when the Frankfurt lunatic asylum’s previous doctor (who was a friend of his) retired in 1851, he was eager to take the post even though he had no expertise in psychiatry. This changed quickly, as his later competent publications in the field show. Hoffmann portrays himself as a caring, humane psychiatrist, who strove to be the sunshine in the life of his miserable patients. His gregarious personality may well have been popular with many of them. His statistical compilations show that up to 40% of the people with acute cases of what would today be called schizophrenia were discharged after a few weeks or months and stayed in remission for years and perhaps permanently. Always a skeptic, Hoffmann voices doubts whether this was due to any therapy he may have given them. Much of his energy from 1851 onwards went into campaigning for a new, modern asylum building with gardens in the city’s green belt. He was successful and the new clinic was built at the site of today’s Frankfurt University’s Humanities campus (The original building was demolished in the 1920s).

Leo Kanner

Leo Kanner (13 June 1894 to 03 April 1981) was an Ukrainian American psychiatrist, physician, and social activist best known for his work related to autism. Before working at the Henry Phipps Psychiatric Clinic at the Johns Hopkins Hospital, Kanner practiced as a physician in Germany and in South Dakota. In 1943, Kanner published his landmark paper Autistic Disturbances of Affective Contact, describing 11 children who were highly intelligent but displayed “a powerful desire for aloneness” and “an obsessive insistence on persistent sameness.” He named their condition “early infantile autism,” which is now known as autism spectrum disorder. Kanner was in charge of developing the first child psychiatry clinic in the United States and later served as the Chief of Child Psychiatry at the Johns Hopkins Hospital. He is one of the co-founders of The Children’s Guild, a non-profit organisation serving children, families and child-serving organisations throughout Maryland and Washington, D.C., and dedicated to “Transforming how America Cares for and Educates its Children and Youth.” He is widely considered one of the most influential American psychiatrists of the 20th century.

Irvin D. Yalon

Irvin David Yalom (born 13 June 1931) is an American existential psychiatrist who is emeritus professor of psychiatry at Stanford University, as well as author of both fiction and nonfiction.

After graduating with a BA from George Washington University in 1952 and a Doctor of Medicine from Boston University School of Medicine in 1956 he went on to complete his internship at Mount Sinai Hospital in New York and his residency at the Phipps Clinic of Johns Hopkins Hospital in Baltimore and completed his training in 1960. After two years of Army service at Tripler General Hospital in Honolulu, Yalom began his academic career at Stanford University. He was appointed to the faculty in 1963 and promoted over the following years, being granted tenure in 1968. Soon after this period he made some of his most lasting contributions by teaching about group psychotherapy and developing his model of existential psychotherapy.

His writing on existential psychology centres on what he refers to as the four “givens” of the human condition: isolation, meaninglessness, mortality and freedom, and discusses ways in which the human person can respond to these concerns either in a functional or dysfunctional fashion.

In 1970, Yalom published The Theory and Practice of Group Psychotherapy, speaking about the research literature around group psychotherapy and the social psychology of small group behavior. This work explores how individuals function in a group context, and how members of group therapy gain from his participation group.

In addition to his scholarly, non-fiction writing, Yalom has produced a number of novels and also experimented with writing techniques. In Every Day Gets a Little Closer Yalom invited a patient to co-write about the experience of therapy. The book has two distinct voices which are looking at the same experience in alternating sections. Yalom’s works have been used as collegiate textbooks and standard reading for psychology students. His new and unique view of the patient/client relationship has been added to curriculum in psychology programs at such schools as John Jay College of Criminal Justice in New York City.

Yalom has continued to maintain a part-time private practice and has authored a number of video documentaries on therapeutic techniques. Yalom is also featured in the 2003 documentary Flight from Death, a film that investigates the relationship of human violence to fear of death, as related to subconscious influences. The Irvin D. Yalom Institute of Psychotherapy, which he co-directs with Professor Ruthellen Josselson, works to advance Yalom’s approach to psychotherapy. This unique combination of integrating more philosophy into the psychotherapy can be considered as psychosophy.

He was married to author and historian Marilyn Yalom, who died in November, 2019. Their four children are: Eve, a gynaecologist, Reid, a photographer, Victor, a psychologist and entrepreneur and Ben, a theatre director.

What is the National Psychological Association for Psychoanalysis?

Published on by Andrew Marshall1 Comment

Introduction

The National Psychological Association for Psychoanalysis (NPAP) is an institution established in New York City by Theodore Reik in 1948, in response to the controversy over lay analysis and the question of the training of psychoanalysts in the States.

Following the lead established by Sigmund Freud, the NPAP offered training to the three core disciplines of medicine, social work and psychology, as well as to graduates from the humanities.

Brief History

Over the following decades, inevitably dissensions emerged in the organisation, and other non-medical training institutions were set up in the United States.

Current Ideology

The organisation currently sees itself as a vibrant professional association of analysts representing a diversity of theories that comprise contemporary psychoanalytic inquiry. The NPAP’s diverse membership is active in research, publication, legislation, public education, and cultural affairs, thus ensuring a psychoanalytic contribution to the community at large. The NPAP also publishes the highly respected and internationally recognised journal The Psychoanalytic Review, the oldest continuously published psychoanalytic journal in the United States.

Mindful of a legacy reaching directly back to Freud, the Institute today offers comprehensive psychoanalytic training grounded in the classical tradition, expanded by contemporary insights, and designed to prepare candidates for the professional practice of psychoanalysis.