The elephant in the zoom: will psychoanalysis survive the screen?

While screen-mediated analysis long predated the pandemic, it was largely seen as non-equivalent to in-person treatment by analysts and patients alike. When COVID forced us to move our entire practices to the screen, our concerns about its limitations were replaced by relief; we could continue doing analytic work during a terrifying and challenging time. Three years later, many have chosen to continue practicing remotely for reasons that are no longer driven by fears of exposure. We mostly minimize or deny our earlier concerns about the limitations of screen work. Have we chosen convenience, ease, and a personal sense of safety over togetherness, while ignoring the underbelly of remote work? This paper identifies the convergence of several forces underlying our decision to stay remote, including guilt and anxiety about privileging our own self-interest, unmourned losses and collective PTSD, fear of the future and existential anxiety about living in a techno-culture that threatens to replace us. Our denial of these powerful forces makes it easy to rationalize a decision to embrace remote work and disavow the threat it poses to our field.

Young Adult Women and Sexual Awareness in the Digital Age: Examining Pathways Linking Online Dating Debut and Mindfulness with Sexual and Mental Health.

Sexual awareness is an understudied phenomenon, despite its known effects on mental health. Little is known about the predictors of sexual awareness, including how early sexual debut and early engagement with online dating and hookup apps might impact the development of sexual mindfulness. Given the conceptual overlap between mindfulness and sexual awareness, this study tested a model that hypothesized that general mindfulness and early sexual and online dating debuts may be associated with mental health outcomes and sexual behavior through pathways involving sexual awareness (assertiveness, consciousness, appeal, and monitoring). A sample of 2,379 heterosexually active young adult women completed an online survey. Path models indicated that both early sexual debut (prior to age 15) and early online dating debut (prior to age 18) had significant, positive direct associations with anxiety and depression scores. Early online dating was also associated with condomless sex with casual male partners. However, both early sexual debut and early online dating debut were indirectly linked to greater sexual risk through greater appeal, and to lower sexual risk through sexual assertiveness. Additionally, greater monitoring contributed to more depression for those with an earlier sexual debut. These findings point to potential risks associated with early online dating. They also highlight benefits of studying sexual awareness as a multi-dimensional construct, especially as it helps to clarify divergent findings in the existing literature on the long-term consequences associated with early sexual debut. While some domains were associated with risk (monitoring and appeal), others were indicative of resilience (assertiveness).

The compounding effects of income loss and change in living arrangement on emerging adult women's mental health during COVID's onset.

Research suggests that young adult women were among those more susceptible to mental health declines in the initial months of COVID-19. Unfortunately, longitudinal data examining mental health before and after the pandemic's onset are extremely limited. In a sample of 240 women ages 18-29 who were surveyed online first in November-December 2019 and then again between May and July 2020, this study aimed to examine how major life changes associated with the pandemic (i.e. loss of income, loss of employment, change in relationship status, and change in living arrangement) impacted mental health (i.e. depression, anxiety, stress). Multivariate regression analyses were conducted on three models predicting stress, anxiety, and depression from the four life changes, controlling for the effects of mental health before the COVID-19 pandemic. Results showed that a change in living arrangement was uniformly associated with increased mental health problems among women who also experienced a decrease in income. Likewise, loss of income was uniformly related to increased mental health problems among women who also experienced a change in living arrangement. In contrast, job loss was associated with a decrease in stress, and changes in relationship status were not associated with mental health outcomes. These findings highlight the potential for COVID-19 to produce co-occurring and synergistic stressors. Meanwhile, the impact of job loss on mental health may have been attenuated by enhanced unemployment benefits. Mental health interventions that aim to support young women as the pandemic abates should be tailored to address the impact of multiple psychosocial stressors.

Drunk Texting: When the Phone Becomes a Vehicle for Emotional Dysregulation and Problematic Alcohol Use.

Background: Drunk texting is an understudied phenomenon, despite its ubiquity and evidence suggesting it may be implicated in heavy drinking. Research on texting motivations and use of the phone as a tool for self-regulation also represent newly emerging areas of study. Objective/Method: The goal of the current study was to examine how drunk texting relates to drinking based on difficulties in emotional regulation and texting motivations in a sample of 2,559 women. Results: Drunk texting predicted heavy drinking. Emotional regulation difficulties (specifically, lack of access to strategies and lack of emotional clarity) predicted reliance on texting to escape as well as to facilitate self-expression. Further, indirect associations found that texting to escape strengthened the association between emotional regulation difficulties and drunk texting, while texting as a form of self-expression buffered against this association. Conclusions: These results highlight the extent to which problematic drinking and drunk texting have overlapping associations with emotional regulation, which can result from the presence of certain motivations for text messaging. Implications are discussed for interventions targeting the use of both phones and alcohol to escape, and increasing awareness of emotional states that might trigger such behavior.

Secret powers: Acts of Googling in the therapeutic relationship.

OBJECTIVE: The ease of online searching has diminished people's expectations of privacy and the ability to control access to information about oneself, which can alter basic assumptions about the therapy relationship. METHOD: This grounded theory study explored psychotherapists' experiences of searching online for patients and being searched for by patients, among 28 clinicians of primarily psychodynamic orientation. RESULTS: Many therapists search online for information about patients, but often minimize or rationalize this action and do not share it with their patients. Meanwhile, while they believe their patients search for them, they find it difficult to raise the topic directly in therapy. Thus, when it comes to online searching and discovery of information, an air of secrecy pervades the therapeutic relationship. CONCLUSIONS: Despite the serious implications that the pervasiveness of online searching has for the treatment relationship, therapists lack sufficient support for exploring their motivations, curiosities, and urges surrounding this action.

(What) do you believe?: Therapist spiritual/religious/non-religious self-disclosure.

OBJECTIVE: Spiritual/religious/non-religious (S/R/N) identity development is often neglected in psychotherapy training and represents an area where psychotherapists feel they lack competence. Such feelings can become even more pronounced when it comes to S/R/N self-disclosure. This study explores the decisions therapists make regarding self-disclosure, which impacts the psychotherapy process. METHOD: This grounded theory study explores psychotherapists' S/R/N self-disclosure based on qualitative interviews with 21 psychotherapists representing varied theoretical orientations and spiritual, religious, atheist, and agnostic backgrounds. RESULTS: Findings reveal that while some self-disclosure happens on an explicit level, more often psychotherapists find implicit ways to share S/R/N aspects of the self for purposes of enhancing the therapeutic alliance and to convey openness. Psychotherapists also attempt to avoid the topic altogether, either to protect the therapeutic relationship or because of unresolved S/R/N identity in the therapist. CONCLUSIONS: Developing skills related to S/R/N self-disclosure represents an important aspect of multicultural competence, which can impact clients' feelings of safety and comfort discussing their own S/R/N identity. This capacity is strongly influenced by the therapist's self-awareness regarding S/R/N identity. Suggestions for engaging S/R/N identity and disclosure in supervisory experiences and academic preparation are discussed.

Discrimination, Internalized Homonegativity, and Attitudes Toward Children of Same-Sex Parents: Can Secure Attachment Buffer Against Stigma Internalization?

With increasing numbers of same-sex couples raising children in the United States, discriminatory attitudes toward children of same-sex parents (ACSSP) are of increasing concern. As with other forms of stigma and discrimination, lesbian, gay, and bisexual (LGB) individuals are at risk for internalizing these societal attitudes, which can negatively affect parenting-related decisions and behaviors and the mental and physical health of their children. Secure attachment is characterized by positive views of the self as loveable and worthy of care that are understood to develop in early relationships with caregivers. Secure attachment has been associated with positive mental and physical health, including among LGB individuals and couples. This study aimed to test the potential buffering role of secure attachment against stigma internalization by examining associations among secure attachment, discrimination, internalized homonegativity (IH), and ACSSP in an online survey study of 209 U.S. adults in same-sex relationships. Bootstrap analyses supported our hypothesized moderated mediation model, with secure attachment being a buffer. Greater discrimination was indirectly associated with more negative ACSSP through greater IH for individuals with mean or lower levels, but not for individuals with higher than average levels of secure attachment, specifically because among those with higher levels of secure attachment, discrimination was not associated with IH. These findings build on and extend past research, with important implications for future research and clinical work with LGB individuals, same-sex couples, and their families, including potential implementation of interventions targeting attachment security.

Texting Under the Influence: Emotional Regulation as a Moderator of the Association Between Binge Drinking and Drunk Texting.

Texting and alcohol have each been noted to increase perceptions of control, decrease behavioral inhibition, and modulate unpleasant emotions. While drunk texting is a well-known cultural phenomenon, it has received almost no attention in research. In a sample of 211 young adult women, and using a new measure to operationalize drunk texting, difficulty accessing strategies during moments of distress moderated the relationship between binge drinking and drunk texting. Difficulties accessing emotion regulation strategies were associated with drunk texting among those who reported binge drinking. Among nonbinge drinkers, deficits in emotion regulation strategies were not associated with drunk texting. In addition, drunk texting was associated with sex in bivariate correlations. Given the lack of research on the antecedents and consequences of drunk texting, this study suggests that drunk texting may be used as a strategy for emotional regulation and may be predictive of sexual behavior. Results inform several avenues for further inquiry into the motivations and expectations underlying drunk texting and also imply potential routes for intervention.

Sexual orientation and first-year college students' nonmedical use of prescription drugs.

OBJECTIVE: To examine differences between heterosexual and lesbian, gay, bisexual, and questioning students' nonmedical use of prescription drugs (NMUPD). PARTICIPANTS: First-year university students between October 2009 and October 2013 who self-identified as heterosexual, lesbian, gay, bisexual, or questioning. METHODS: Students completed questionnaires on demographic variables and NMUPD. Any NMUPD was examined, as were stimulants, anxiolytics, and painkillers. Hierarchical regression was used to examine differential NMUPD based on sexual orientation, gender, and race. RESULTS: For any NMUPD and painkillers, bisexual and questioning students reported higher rates of nonmedical use than heterosexual students and gay men. When compared with heterosexual females, lesbian, bisexual, and questioning females reported higher any NMUPD and nonmedical painkiller use. For stimulants and anxiolytics, bisexual students reported the highest nonmedical use, followed by gay and lesbian students. CONCLUSIONS: There may be particular risk for NMUPD associated with membership in marginalized groups in terms of both sexual orientation and gender.

Instagram #instasad?: exploring associations among instagram use, depressive symptoms, negative social comparison, and strangers followed.

As the use and influence of social networking continues to grow, researchers have begun to explore its consequences for psychological well-being. Some research suggests that Facebook use can have negative consequences for well-being. Instagram, a photo-sharing social network created in 2010, has particular characteristics that may make users susceptible to negative consequences. This study tested a theoretically grounded moderated meditation model of the association between Instagram use and depressive symptoms through the mechanism of negative social comparison, and moderation by amount of strangers one follows. One hundred and seventeen 18-29 year olds completed online questionnaires containing demographics, frequency of Instagram use, amount of strangers followed on Instagram, the Center for Epidemiological Resources Scale for Depression, and the Social Comparison Rating Scale. Instagram use was marginally positively associated with depressive symptoms, and positive social comparison was significantly negatively associated with depressive symptoms. Amount of strangers followed moderated the associations of Instagram use with social comparison (significantly) and depressive symptoms (marginally), and further significantly moderated the indirect association of Instagram use with depressive symptoms through social comparison. Findings generally suggest that more frequent Instagram use has negative associations for people who follow more strangers, but positive associations for people who follow fewer strangers, with social comparison and depressive symptoms. Implications of negative associations of social networking for people who follow strangers and the need for more research on Instagram use given its increasing popularity are explored.

Psychometric Properties of the Modified Posttraumatic Stress Disorder Symptom Scale among Women with Posttraumatic Stress Disorder and Substance Use Disorders Receiving Outpatient Group Treatments.

OBJECTIVE: The use of psychometrically sound measures to assess and monitor PTSD treatment response over time is critical for better understanding the relationship between PTSD symptoms and Substance Use Disorder (SUD) symptoms throughout treatment. We examined the psychometric properties of the Modified Posttraumatic Stress Disorder (PTSD) Symptom Scale, Self-Report (MPSS-SR). METHODS: Three hundred fifty three women diagnosed with co-occurring PTSD (full or sub-threshold) and SUD who participated in a multisite treatment trial completed the MPSS-SR at pre-treatment, weekly during treatment, and posttreatment. Reliability and validity analyses were applied to the data. RESULTS: Internal consistency was excellent throughout the course of the trial demonstrating the MPSS-SR's high reliability. Strong correlations between MPSS-SR scores and the Brief Symptom Inventory and the Clinician Administered PTSD Scale (CAPS) severity scores demonstrated the MPSS-SR's convergent and concurrent validity. We conducted a classification analysis at posttreatment and compared the MPSS-SR at various cutoff scores with the CAPS diagnosis. A cutoff score of 29 on the MPSS-SR yielded a sensitivity rate of 89%, a specificity rate of 77%, and an overall classification rate of 80%, indicating the measure's robust ability to accurately identify individuals with PTSD in our sample at posttreatment. CONCLUSIONS: Findings support the use of the MPSS-SR as a reliable and valid tool to assess and monitor changes in PTSD symptoms over the course of treatment and as an alternative to structured clinical interviews to assess PTSD symptoms among populations with SUDs.