Confidentiality and mandatory reporting

Confidentiality is a cornerstone in the identity of the clergy. Confidentiality makes it safe to disclose sins, but the information received may sometimes cause dilemmas for the clergy. Through pastoral care with people in different circumstances, members of the clergy are on the front line for detecting and reporting child abuse and domestic violence. In this article, I explore how clerics judge dilemmas and determine the right course of action when facing cases of possible child abuse or domestic violence. How do members of the clergy reason through their choices? What grounds do they give for their actions? Data are provided from a mixed methods study with 53 Norwegian parish priests. The clergy’s decision-making will be the primary focus. Confidentiality is frequently associated with trust. The clergy maintain that confidentiality contributes to securing trust in themselves, as well as in the church as an institution. My analysis suggests that the clergy’s reflections on confidentiality conflict with Norwegian mandatory reporting laws and that the clergy may benefit from a reframing of pastoral confidentiality.     

Incest and professional boundaries: Confidentiality versus mandatory reporting

The mandatory reporting of an incest case by a mental health professional, sets in motion a chain of events which raise conflict for all involved. Typically, attorneys, the courts, health service providers, as well as primary treatment team become involved. This article discusses some of the relevant dilemmas that are raised by the personal and professional mandatory report of incest.     

Issues presented by mandatory reporting requirements to researchers of child abuse and neglect

Mandatory reporting laws, which vary slightly from state to state, require reporting by helping professionals when there is reasonable cause to suspect child abuse. Institutional Review Boards (IRBs) require researchers to warn subjects of this duty to report, which may have a chilling effect on subject rapport and candor. Certificates of confidentiality, in conjunction with other precautions, may reduce some barriers to valid research. Attempts to resolve problems created by reporting laws must produce the most valid research, while minimizing harm and distress to research participants, their families, and the researcher and meeting local and federal legal requirements.     

The placebo and the therapeutic uses of faith

The holistic movement in modern medicine has raised questions concerning the very character of the religion-medicine dialogue. A truly mutual interaction between theology and medicine must require of the theologian a serious interest in and understanding of medicine if the notion of the body-mind unity is to be taken seriously from the point of view of pastoral care. This paper suggests that this discussion may be enriched by a theological analysis of the placebo, which has lately been the subject of controversy within medical circles. Finally, it is suggested that the value of the placebo reposes in its serving as a symbol of the dynamics of faith in medical care.     

Examination of supervisory satisfaction in traditional and nontraditional gender-based reporting relationships

Supervisory Satisfaction relates to satisfaction with supervision rather than other conditions or agents in the work place. The supervisor-subordinate relationship is becoming increasingly important given the shift from managing work to managing people. Six variables were theorized as influencing satisfaction. Developing a parsimonious model to predict the variance in supervisor satisfaction, this empirical study examined 202 traditional supervisory relationships (subordinate reporting to a male supervisor) and 48 nontraditional supervisory relationships (subordinates reporting to a female supervisor). The sample was predominantly whites. Four of the five variables theorized, predicted a high level of variance in supervisory satisfaction in both traditional and nontraditional relationships. However the predictors were not different for the two groups.     

Power imbalances in therapeutic and forensic relationships.

This article examines the ways that power imbalances affect relationships in the forensic mental disability system and between therapists and their clients. It considers the impact of the “dual loyalty” dilemma on forensic relationships, the manner in which courts deal with this dilemma, and suggests several points of commonality that arise around such power conflicts. It also examines recent litigation involving therapeutic relationships, and attempts to extract doctrinal threads from these cases. Finally, it recommends that, in order for the judicial system to attempt to correct any of the underlying imbalances, courts and jurors must openly come to grips with the psycho-dynamic issues that underlie these imbalances.     

Improving clinical outcomes in REBT/CBT: The therapeutic uses of tape-recording

This paper outlines the numerous ways in which clinical outcomes in REBT/CBT can be enhanced and therapeutic impasses overcome through the regular and creative use of audiotherapy as a treatment adjunct. In particular therapy dosage intensity can be enhanced significantly and homework compliance improved. Audiotherapy also has a key role to play with clients who are isolated or are unsupported in their living environments. Such clients can be encouraged to use audio-taping as therapist-assisted interventions, so increasing the likelihood of their initiating therapeutic tasks such as graded activity assignments and disputing cognitive distortions and dysfunctional beliefs in vivo. The paper finally recommends that audio-taping of therapy sessions has sufficient major benefits to suggest its routine incorporation into therapeutic practice.     

Therapeutic techniques vs therapeutic relationships in child behavior therapy

The parents of 56 children who had received behavior therapy rated a number of variables, including the degree to which they viewed the therapeutic relationship versus the specific techniques used in treatment as important, the extent to which the child improved in therapy, and the child's present functioning. Therapists also provided ratings of clinical improvement. Even though parents gave the highest ratings for the importance of the relationship in therapy, the correlation between technique and clinical outcome was statistically significant while the correlations between the relationship and outcome was not. These statistical associations also held when therapists rated improvement. Also, therapists saw greater improvement in children than did the parents. Over-all, the results support the view that the relationship and techniques are interwoven and are both perceived as important factors in treatment.     

Client experience of gender in therapeutic relationships: an interpretive ethnography.

The purpose of this study was to explore clients' experiences of gender in therapeutic relationships in order to inform therapists of critical issues from clients' perspectives. To capture clients' views, the researchers chose an interpretive ethnographic design that used unstructured, collaborative interviews with clients who had worked with both female and male therapists. The interviews were analyzed using procedures developed by Kvale (1996), who emphasizes the importance of including the client's voice in data gathering, analysis, and final presentation. The results were reviewed with the clients to insure accurate presentation of their views. The final results were organized into six themes: client-therapist connection, male therapists, female therapists, topics discussed, effectiveness, and confounding factors. Researchers discuss the implications of gender-stereotyped behavior in therapy, the relationship between therapist gender and therapeutic alliance, and recommendations for practicing gender-sensitive therapy.     

Attributional Biases in Sexually Coercive Males1

A social cognitive framework was applied to sexually coercive behavior. Sixty-two male undergraduates completed a self-report measure of sexually coercive behavior, as well as several questionnaires assessing trait aggression, the encoding of sexual behaviors, attributions of hostile intent, and traditional attitudes toward women. Results demonstrate a relationship between the encoding of sexual behaviors and committing sexually coercive behaviors. A tendency to encode ambiguous dating behaviors as admissions of sexual intent related strongly to initiating sexually coercive behavior, while none of the variables examined were strongly related to persisting in sexually coercive behavior. Similar effects were found when controlling for all of the other variables. Implications for intervention designs are discussed.     

The diagnostic and therapeutic uses of family conflicts in a Chinese context: the case of anorexia nervosa

There are two untested cultural beliefs commonly held among family therapists in Hong Kong: (1) Chinese families are reserved in disclosing their conflicts to an 'outsider'; and (2) it would be culturally inappropriate to elicit family conflicts in treatment. In this article, an attempt is made to examine these cultural beliefs based on the results of a qualitative study of thirty-five Chinese patients suffering from anorexia nervosa. These patients and their families have participated in a pre-treatment family interview prior to the commencement of family treatment. The results of the study have shown that the afflicted Chinese families are very willing to disclose their difficulties to the researcher. The onset of the disorder has led to different types of family conflicts including: (1) overt family conflicts related to food refusal; (2) covert family conflicts; (3) increased sibling rivalry; (4) increased parent–child conflict; and (5) marital tension and distress. The clinical implications of this study are discussed at the end of the article.     

Coercive and precocious sexuality as a fundamental aspect of psychopathy

Sexual behavior is closely associated with delinquency and crime. Although psychopaths, by definition, have many short-term sexual relationships, it has not been shown that sexuality is a core aspect of psychopathy. A Darwinian view of psychopathy led to the hypothesis that psychopaths have a unique sexuality involving early, frequent, and coercive sex. Our subjects were 512 sex offenders assessed on the Hare Psychopathy Checklist (PCL-R). Five variables reflecting early, frequent, and coercive sex loaded on the same principal component in exploratory factor analysis on a subset of the sample, whereas PCL-R items pertaining to adult sexual behavior did not. Confirmatory factor analysis of the remaining subjects yielded a measurement model containing three inter-correlated factors - the traditional two PCL-R factors, and coercive and precocious sexuality. Taxometric analyses gave evidence of a natural discontinuity underlying coercive and precocious sexuality. Coercive and precocious sexuality yielded statistically significant associations with other study variables predicted by the Darwinian hypothesis. The present findings are consistent with prior empirical findings and support the hypothesis that psychopathy has been a nonpathological, reproductively viable, alternate life history strategy.     

Deterrence and Coercive Diplomacy: The Contributions of Alexander George

Alexander George was a towering figure who made path breaking and enduring contributions to political psychology, international relations, and social science methodology. I focus on George's closely related research programs on deterrence and coercive diplomacy, with special attention to the importance of the asymmetry of motivation, strategies for "designing around" a deterrent threat, the controllability of risks, images of the adversary, signaling, the sequential failure of deterrence, the role of positive inducements along with coercive threats, and the need for actor-specific models of the adversary. In the process, I highlight other elements of George's theoretically and methodologically integrated research program: his conceptions of the proper role of theory; his emphasis on the infeasibility of a universal theory and the need for conditional generalizations that are historically grounded, sensitive to context, bounded by scope conditions, and useful for policy makers; and the indispensability of process tracing in theoretically driven case studies.