Women's Treatment Center

The prevalence of HIV-associated neurocognitive impairment persists despite highly effective antiretroviral therapy (ART). In this study we explore the role of internalized stigma, acceptance of negative societal characterizations, and perceptions about people living with HIV (PLWH) on neurocognitive functioning (executive function, learning, memory, attention/working memory, psychomotor speed, fluency, motor skills) in a national cohort of women living with HIV (WLWH) in the United States. We utilized observational data from a multicenter study of WLWH who are mostly African American living in low-resource settings. Neurocognitive function was measured using an eight-test battery. A multiple linear regression model was constructed to investigate the relationship between internalized stigma and overall neurocognitive functioning (mean of all neurocognitive domain standardized T-scores), adjusting for age, education, race, previous neuropsychological battery scores, illicit drug use, viral load, and years on ART. Our analysis revealed that internalized HIV-related stigma is significantly associated with worse performance on individual domain tests and overall neurocognitive performance (B = 0.27, t = 2.50, p = 0.01). This suggests HIV-related internalized stigma may be negatively associated with neurocognitive functioning for WLWH. This finding highlights a specific psychosocial factor associated with poor neurocognitive function that may be targeted to better promote the health of PLWH. Future research on the longitudinal relationship between these variables and the effects of other stigma dimensions on poor neurocognitive function would provide further insights into the pathways explaining the relationship between internalized stigma and neurocognition.

This paper examines a state of fear aroused in the analyst during a session. I suggest that the fear arose from the attempt to enter the patient's mental state—a state that was unfamiliar to the analyst. In entering what was essentially psychically foreign territory, I terrified myself with a version of the patient's experience.

Attempting to define the therapy relationship with women who are commonly diagnosed as Borderline is an especially challenging task. The purpose of this article is to provide a feminist-based theoretical framework within which the therapy relationship can be defined. This includes a formulation of the origins of relationship difficulties, with an understanding of the centrality of relationships for women's development. This also includes a definition of the therapist's role as a perspective keeper who empathically communicates the reality of the patient's relational experience as it manifests within the therapy relationship. The therapist holds perspective on the impact of the client's childhood, the need for safety, the need to tolerate ambivalence, and the need to pace the process of healing.