Joel Weinberger

When clinical description becomes statistical prediction.

This article reconsiders the issue of clinical versus statistical prediction. The term clinical is widely used to denote 1 pole of 2 independent axes: the observer whose data are being aggregated (clinician/expert vs. lay) and the method of aggregating those data (impressionistic vs. statistical). Fifty years of research suggests that when formulas are available, statistical aggregation outperforms informal, subjective aggregation much of the time. However, these data have little bearing on the question of whether, or under what conditions, clinicians can make reliable and valid observations and inferences at a level of generality relevant to practice or useful as data to be aggregated statistically. An emerging body of research suggests that clinical observations, just like lay observations, can be quantified using standard psychometric procedures, so that clinical description becomes statistical prediction.

The family origins of empathic concern: a 26-year longitudinal study.

This study examined whether adult empathic concern was associated with parent behavior in early childhood. Subjects were drawn from a longitudinal sample first investigated by Sears, Maccoby, and Levin (1957). At age 31, 75 subjects completed the Adjective Checklist (Gough & Heilbrun, 1965, 1983), from which an index of empathic concern was derived. Scores on this index were regressed on 11 parenting dimensions derived from maternal interviews when the subjects were 5 years old. The results revealed a significant multiple R indicating that, taken together, the parenting dimensions predicted the level of empathic concern at age 31. Adult levels of empathic concern were most strongly related to the following parenting dimensions: paternal involvement in child care, maternal tolerance of dependent behavior, maternal inhibition of childs aggression, and maternal satisfaction with the role of mother.

Therapist Affect Focus and Patient Outcomes in Psychodynamic Psychotherapy: A Meta-Analysis

OBJECTIVE The authors systematically examined the relationship between therapist facilitation of patient emotional experience/expression and outcome in psychodynamic psychotherapy. METHOD Computer and manual searches were conducted for relevant publications, and 10 independent samples of short-term dynamic psychotherapy were included in a meta-analysis. Data analysis included calculation of an overall effect size of the relationship between therapist affect focus and outcome, statistical significance, and test for homogeneity. In addition, moderator analyses were conducted to examine the potential impact of type of outcome construct used and the methodological quality of individual studies. RESULTS The overall average weighted effect size across all outcome types was statistically significant (r=0.30), and the homogeneity statistic was nonsignificant. Moderator analyses indicated a statistically significant relationship between therapist facilitation of patient emotional experience/expression and outcome when more than one outcome construct was included but not when either a single or an unclear outcome construct was used. There were no significant relationships between methodological quality and the size of the effects, although use of audio- or videotaping for supervision demonstrated a moderate effect. CONCLUSIONS These data indicate that therapist facilitation of patient affective experience/expression is associated with patient improvement over the course of psychodynamic psychotherapy. Although the size of this relationship was not significantly related to methodological quality, results suggest the importance of close supervision of actual techniques through the use of audio- or videotapes. Additionally, results highlight the importance of defining outcome in a multidimensional way to properly assess theoretically relevant effects.

Common Factors in Psychotherapy

The term common factors refers to effective aspects of treatment shared by diverse forms of psychotherapy. Theorists and researchers interested in them argue that they may be more important than are factors unique to specific treatments and hailed by advocates of these treatments to be the important change agents (see e.g., Frank, 1973). This argument is bolstered by the fact that whereas psychotherapy has been shown to lead to beneficial effects, rarely has any specific type of treatment been shown to be superior to any other (Lambert, Shapiro, & Bergin, 1986; Luborsky, Singer, & Luborsky, 1975; Smith, Glass, & Miller, 1980; Stiles, Shapiro, & Elliot, 1986). If the multitude of different systems examined in these reviews can legitimately claim equal success, and it seems that they can, then maybe their diversity is illusory and they share core features which, in fact, are the curative elements responsible for therapeutic success (cf. Lambert, 1986).

Separating science from myth in subliminal psychodynamic activation

This paper reviews subliminal psychodynamic activation (SPA). Eight common criticisms are described and evaluated: (a) SPA data analysis is too liberal; (b) there are enough nonsignificant unpublished SPA studies to offset those showing effects; (c) SPA studies are difficult to replicate; (d) the claims of SPA proponents rely on unpublished studies; (e) SPA stimuli are not really subliminal; (f) experimenter expectancy effects and/or demand characteristics can account for SPA effects; (g) the mediating events said to underlay SPA effects have never been evinced; and (h) alternative explanations for SPA effects are superior to the psychoanalytic ones typically offered. Theoretical and statistical analyses revealed that only the argument concerning mediating events has serious merit. The SPA stimulus for which the most support was found was Mommy and I Are One. Oedipal sanction stimuli were also found to yield reliable effects whereas Oedipal prohibition stimuli did not. Suggestions for future research are offered. Resistance to SPA findings are considered in Kunhian terms.

A primer on meta-analysis of correlation coefficients: The relationship between patient-reported therapeutic alliance and adult attachment style as an illustration

Abstract The aim of this article is twofold: to offer an introduction to meta-analysis using correlation coefficients to facilitate greater understanding of meta-analytic findings and to guide those interested in conducting meta-analyses. The authors review calculations for a weighted average effect size, the statistical significance of this effect, a test of homogeneity, confidence intervals, and file drawer analysis. They provide a running example of the relationship between patient-reported therapeutic alliance and adult attachment style. Results (k = 12, N = 581.17, weighted average r = .17, p < .0001, 95% confidence interval=.13–.21) indicated a positive, statistically significant relationship, suggesting that greater attachment security is associated with stronger therapeutic alliances, whereas greater attachment insecurity is associated with weaker therapeutic alliances. File drawer results suggested that some caution is warranted in terms of the size of the effect.

Identifying dissociative identity disorder: a self-report and projective study.

This study compared 21 female adult psychiatric patients diagnosed with dissociative identity disorder (DID) with 21 female adult nondissociative psychiatric patients to determine whether DID patients exhibit a distinguishing set of clinical features, and perceptual, attentional, and cognitive processes. Participants were assessed with the Dissociative Disorders Interview Schedule to assess diagnostic status. Group scores on the Dissociative Experiences Scale, Tellegen Absorption Scale, Childhood Trauma Questionnaire, Brief Symptom Inventory, and the Rorschach test were compared. DID participants reported earlier and more severe childhood trauma, more dissociative symptoms, and a greater propensity for altered states of consciousness. The DID participants also exhibited increased projective and imaginative activity, a diminished ability to integrate mental contents, a complex and driven cognitive style, and a highly unconventional view of reality.

The effects of subliminal symbiotic stimulation on free-response and self-report mood

Research has shown that subliminal presentation of MOMMY AND I ARE ONE (MIO) can help improve adaptive functioning. Two experiments tried to determine whether changes in mood, especially free-response mood, could help explain these findings. In one experiment, 20 men were randomly assigned to receive either a subliminal MIO or control stimulus. Results showed predicted effects on a free-response and no effects on a self-report mood measure. In the other experiment, 54 male subjects randomly received one of three subliminal stimuli. They evidenced the same pattern of mood results. Sentential semantics were shown to be relevant to the obtained results. Ascending threshold and 150 forced-choice discrimination trials demonstrated that subjects could not report stimulus content. It was concluded that MIO effects were attributable to unconscious processing of the entire message and that free-response mood may partly mediate these effects. Suggestions for future research were offered.

Very brief exposure: The effects of unreportable stimuli on fearful behavior

A series of experiments tested the hypothesis that very brief exposure to feared stimuli can have positive effects on avoidance of the corresponding feared object. Participants identified themselves as fearful of spiders through a widely used questionnaire. A preliminary experiment showed that they were unable to identify the stimuli used in the main experiments. Experiment 2 (N=65) compared the effects of exposure to masked feared stimuli at short and long stimulus onset asynchronies (SOA). Participants were individually administered one of three continuous series of backwards masked or non-masked stimuli: unreportable images of spiders (25-ms SOA), clearly visible images of spiders (500-ms SOA), or unreportable images of trees (25-ms SOA). Immediately thereafter, they engaged in a Behavioral Avoidance Test (BAT) with a live, caged tarantula. Exposure to unreportable images of spiders resulted in greater approach towards the tarantula than unreportable neutral images. A post-hoc comparison with clearly visible exposure to these same images approached significance. These effects were maintained at a 1-week follow-up (N=57). In Experiment 3 (N=26), participants engaged in the BAT 1 week prior to the exposure manipulation in order to provide a baseline measurement of their avoidant behavior, and again immediately after the exposure manipulation. Exposure to unreportable images of spiders reduced avoidance of the tarantula. Similar exposure to trees did not. Implications for the non-conscious basis of fear are discussed.

What you cannot see can help you: the effect of exposure to unreportable stimuli on approach behavior.

We examined effects of exposure to unreportable images of spiders on approach towards a tarantula. Pretests revealed awareness of the stimuli was at chance. Participants high or low (top and bottom 15%) on fear of spiders were randomly assigned to receive computer-generated exposure to unreportable pictures of spiders or outdoor scenes. They then engaged in a Behavioral Approach Task (BAT) with a live tarantula. Non-fearful participants completed more BAT items than spider-fearful individuals. Additionally, as predicted, a significant interaction (F(1,48)=5.12, p<.03) between fear of spiders and stimulus demonstrated that spider-fearful participants exposed to spiders completed more BAT items than spider-fearful participants exposed to control stimuli (but not as many as non-fearful participants). The findings support the hypothesis that exposure to unreportable feared stimuli promotes approach towards the feared object. Future research and clinical implications were discussed.