Investigating the outcome of the initial assessment at a national transgender health service: Time to review the process?

Background: Globally, there is a lack of a standardized assessment process prior to the initiation of gender affirming medical interventions and consequently there is a discrepancy in this process among different transgender health services.

Aim: The main objective of this study is to investigate the outcome of the initial assessment process at a national transgender health service.

Method: The outcome of people over the age of 17 years, assessed at a large national transgender health service in the United Kingdom during a 2-year period was categorized into: (1) recommendation for cross-sex hormone treatment, or (2) no recommendation for cross-sex hormone treatment. In addition, 200 case notes were reviewed in order to investigate the level of agreement between the two clinicians involved in the assessment process.

Results: During the study period, a total number of 617 people completed their assessment at the service. Following assessment 380 (61.6%) patients were recommended for cross-sex hormone treatment, leaving 237 (38.4%) patients who required a longer assessment period or were discharged. The factors associated with being recommended for cross-sex hormone treatment were having socially transitioned, not smoking, having initiated cross-sex hormones prior to assessment, being older, and assigned male at birth. Out of the 200 case notes reviewed, agreement between assessor 1 and 2 (3 months apart) was found in 88% (n = 176) of the cases.

Discussion: Although the results of the study may not be generalizable to other international centers, questioning the assessment process and the role of the assessors is important to ensure treatment is offered in a timely and efficient manner. The findings from this study suggest that the routine inclusion of two assessors needs to be reviewed.     

Resolution of an impasse at a network meeting: Dialogical sequence analysis of the use of a shared formulation

The study describes the resolution of an impasse at a network meeting during clinical child neurological assessment procedure, analysed by dialogical sequence analysis (DSA) a micro-analytic method for analysing utterances. The two earlier studies of the project describe how a DSA-based case conceptualisation can be used to assess change in the dyadic interaction between neuropsychologist and parent. This study applies the same formulation to analyse group level interaction at the network meeting. The case of a four-year-old girl was selected from a database of videotaped and transcribed child neurological team assessment processes. A repetitive problematic pattern was clearly manifested between parents and the child. At an early stage of the assessment, the neuropsychologist formulated and shared with the parents a clinical formulation of the pattern, summarised as the controlling/coercive parents to the rebellious child. In the earlier studies, microanalysis using DSA confirmed the accuracy of the neuropsychologist’s initial formulation, which she had used in the encounters with the parents. This study traces how she made use of it to address a re-enactment of the problematic pattern, now between the parents and professionals at the network meeting. The analysis of the phases of the conflict resolution by using DSA suggests that the impasse represented a re-enactment of the role positions of coercion and rebelliousness. The use of the original formulation at the meeting helped the conflicting parties to reach an observing stance to the pattern and a more empathic attitude to each other. The micro-analytic methodology by DSA used in this study allows to show the therapeutic potential of the network meeting and also how the development of an empathic stance is manifested in the discourse content.     

A REVIEW OF ACADEMIC PERMANENT-PRODUCT DATA COLLECTION AND RELIABILITY PROCEDURES IN APPLIED BEHAVIOR ANALYSIS RESEARCH1

Three publication sources were reviewed to determine the recent conventions for collecting, and assessing the reliability of, academic permanent-product data (handwriting, examination papers, etc in applied behavior analysis. The primary source was the Journal of Applied Behavior Analysis (1968–1974). Secondary sources included conference proceedings titled, A new direction in education: behavior analysis (E. Ramp and B. L. Hopkins, Eds., Lawrence, Kansas: Support and Development Center for Follow Through, Department of Human Development, University of Kansas, 1971), and Behavior Analysis and Education (G. Semb, Ed., Lawrence, Kansas: Support and Development Center for Follow Through, Department of Human Development, University of Kansas, 1972). Finally, as a test of the generality of the findings in the two applied behavior analysis sources, the current issue of each of 14 psychological and/or educational journals was reviewed. Thirty JABA studies reported academic permanent-product data, but only 14 reported reliability. Increasingly more product data through 1973 have been reported along with a greater proportion of authors reporting reliability. The review of the two conference proceeding publications revealed the same trend. In 1971, only three studies reported academic product data, none with reliability, while in 1972, 15 reported academic data, nine including reliability assessment. The review of 14 current education/psychology journal issues revealed four studies reporting academic data, none with reliability. Across all sources, about one-half of the studies reported reliability. Most of the studies reporting reliability described the frequency of reliability assessment, with approximately equal numbers of JABA studies reporting reliability for each paper or reliability for each session. The use of uninformed observers was reported in only three JABA studies and one conference study. Marks made on subjects' papers by either the teacher or the primary observer were reported masked for reliability purposes by only two JABA and two conference studies. Reliability was calculated on a session total basis in two JABA studies. Point-by-point agreement was given in nine JABA and three conference studies. Perfect reliability (mean agreement of 100%) was reported in only six JABA and three conference studies. Scores between 90 and 100% were reported in nine JABA and four conference studies. Scores below 80% were reported in three JABA studies. No other percentage agreement scores were reported, although one JABA study reported correlational reliability (Pearson r). In summary, recently more studies have dealt with academic data and, until 1974, a greater proportion of these studies reported reliability assessment, and relatively few studies reported either replicable methods, 100% agreement, or controls for maintaining rater independence.     

Abstracts

Abstract

This special issue of the American Journal of Family Therapy focuses on recent developments in Behavioral Marital Therapy (BMT). At first glance, one might expect an issue with such a title to be devoted exclusively to clinical practice. Yet only three of the six papers bear directly on clinical issues, although all of them have clinical implications. Two of the nonclinical papers are validational studies of assessment instruments associated with BMT. The sixth paper explores an important theoretical question regarding the relationship between childbirth and marital distress.     

Tomorrow Is Another Day: How Motives of Entrepreneurship Relate to the Pursuit of Business Growth

Past research has suggested that small business growth plays an important role in economic growth. This paper presents three studies that examined the psychological process underlying the relationship between motives of entrepreneurship and business growth pursuit by focusing on the role of time perspective. The results from three studies (Study 1, N = 142, and Study 2, N = 181, mostly Western small-business owners; Study 3,N = 254, Indonesian small-business owners) demonstrated that opportunity-based entrepreneurship was positively associated with business growth pursuit through increased future time perspective (Studies 1 to 3), whereas necessity-based entrepreneurship was negatively associated with business growth pursuit through increased present time perspective and decreased future time perspective (Study 3). These findings help explain why some business owners avoid business growth by highlighting the vital role of time perspective in explaining why and how motives of entrepreneurship relate to the pursuit of business growth across social and cultural contexts.     

Internal Cue Theory: Calibration and Resolution of Confidence in General Knowledge

A theory is proposed in which beliefs in the form of internal cue validities mediate the processing of ecological cue validities in the assessment of confidence. The conditions necessary for perfect calibration are specified: (a) correspondence between ecological and internal validity, (b) perfect translation of internal validity into a confidence assessment, and (c) consistent utilization of cues. Process errors are then added to these conditions to investigate how calibration is affected by error variance of confidence assessments. To accomplish this, the calibration score (C) is decomposed into three additive parts: D² = bias, i.e., the squared difference between mean confidence and proportion correct; R² = resolution, i.e., the squared difference between the standard deviations of confidence and proportion correct; L = linearity, i.e., how closely the calibration curve follows a linear function. In the equation C = D² + R² + L, R² (resolution) reflects the subject′s ability to discriminate cue validities. Selection of items is a critical factor in studies of confidence. Informal selection with a tendency to avoid easy items results in overconfidence. Internal cue theory predicts both that overconfidence should disappear (in accordance with previous research) and that resolution should improve when item selection is made representative of the natural environment. Both predictions are confirmed by data from published studies on confidence in general knowledge. It is noteworthy that resolution is still poor and accounts for the major portion of miscalibration under representative item selection.     

Applicant Reactions in Selection: Comprehensive meta‐analysis into reaction generalization versus situational specificity

This paper reports a comprehensive quantitative summary into applicant reactions to popular methods of employee selection. A detailed search of published and unpublished studies resulted in a final sample (k) of 38 independent samples covering 10 popular candidate assessment methods. Applicant reactions primary studies included samples from 17 countries internationally. Counter to previous suggestions for the situational specificity of applicant reactions, findings showed considerable similarity supporting the reaction generalizability hypothesis. Reaction favorability was structurally similar across countries and revealed a three‐tier clustering of overall favorability perceptions –most preferred (work samples, interviews), favorably evaluated (resumes, cognitive tests, references, biodata, personality inventories), and least preferred (honesty tests, personal contacts, graphology). Some differences in applicant reactions to dimension‐specific perceptions were found, however. Further analyses revealed strong positive correlations between favorability ratings and their validity and international usage. Implications for future research and ramifications for practice are considered in conclusion.     

How Language Enables Abstraction: A Study in Computational Cultural Psychology

The idea that language mediates our thoughts and enables abstract cognition has been a key idea in socio-cultural psychology. However, it is not clear what mechanisms support this process of abstraction. Peirce argued that one mechanism by which language enables abstract thought is hypostatic abstraction, the process through which a predicate (e.g., dark) turns into an object (e.g., darkness). By using novel computational tools we tested Peirce’s idea. Analysis of the data provides empirical support for Peirce’s mechanism and evidence of the way the use of signs enables abstraction. These conclusions are supported by the in-depth analysis of two case studies concerning the abstraction of sweet and dark. The paper concludes by discussing the findings from a broad and integrative theoretical perspective and by pointing to computational cultural psychology as a promising perspective for addressing long-lasting questions of the field.     

Anxiety Disorders in Childhood: Casting a Nomological Net

Empirical research highlights the need for improving the childhood anxiety disorder diagnostic classification system. In particular, inconsistencies in the stability estimates of childhood anxiety disorders and high rates of comorbidity call into the question the utility of the current DSM criteria. This paper makes a case for utilizing a nomological net⁴ model for advancing the understanding of childhood anxiety disorders. In this article, we discuss measurement and assessment issues related to improving the childhood anxiety disorder diagnostic system and show how these issues can be addressed by employing the nomological net of childhood anxiety. Because employing the nomological net involves drawing from etiological process theories to facilitate classification and assessment, an integrative model of childhood anxiety disorders is presented as a tentative heuristic. Then evidence for the existing symptom sets is discussed in the context of how process theory mechanisms may be utilized to improve classification and assessment. Testable hypotheses are presented. Measurement, disorder definition, treatment, and policy implications are also discussed.A nomological net can be briefly defined as the theoretical structure of a construct.     

Distraction by irrelevant sound during foreperiods selectively impairs temporal preparation

The issue of unidimensionality is dealt with in various research areas in the field of Psychology (e.g. conceptual spaces, semantic modeling, psychometrics) and always involves spatial modeling. An investigation of the dimensionality of opposite spatial scales (even basic) has however not yet been carried out. In this paper we look at whether opposite judgments of height, size, width and length (high/low, large/small, wide/narrow, and long/short) imply underlying unidimensional continua. In three experiments, independent ratings for the 8 above mentioned properties were elicited with participants looking at photographic representations of various objects (Study 1), real life objects (Study 2) and spatial extensions in object-independent conditions (Study 3). Explorative and confirmative factor analysis and Andrich Extended Rating Scale Models were applied in order to determine whether the ratings referred to opposite scales on the same linear continuum. Results from the three studies consistently revealed that this is not the case. A joint analysis of the data showed interesting interactions between the spatial properties analyzed suggesting a possible explanation for the lack of unidimensionality.     

A VIEW FROM ALBEMARLE1

This paper was originally delivered in July of 1975, within a few weeks of the Supreme Court's decision in the case of Albemarle Paper Company v. Moody. The law, of course, does not stand still. Less than a year after the Albemarle decision, the Supreme Court's decision in Washington v. Davis appeared to turn sharply away from the proposition that the EEOC guidelines are to be applied mechanically as the only legal touchstone of the job relatedness of a test. The Washington decision contains many obscurities and ambiguities, and at the time of writing (October 1976) it appears that at least one more Supreme Court case will be necessary in order to clarify this question. Though the present paper is outdated in some respects because of the Washington decision, it is hoped that it will continue to be of interest for the light it may shed on the interrelationship between the practice of industrial psychology and the judicial process in operation.     

Assessment and Good Teaching

Abstract. This article has three purposes. First, it makes the case for assessment as an educational practice that flows from the core concerns of a school, in this piece particularly seminaries and theological schools. Second, it describes practices that enable assessment to be a resource for achieving the quality everyone wants from an educational and formational program. Finally, it concludes with comments about building a “culture for assessment” so that it becomes a normative practice in how a school goes about the work of education and formation. This article will appear as a chapter in the forthcoming book Educating Leaders for Ministry, which is a collection of essays from the work of the 1996–2000 Keystone Conferences of Roman Catholic seminaries, funded by Lilly Endowment Inc.     

Electing to Take Control: Political Identification and Personal Control

Engaging in the political process is one way that individuals can exert control over society in general. Yet, emerging research suggests that engaging with political groups also helps people feel more in control of the course of their own lives. The present research examined whether this is always the case, using the natural experiment afforded by political events to probe the psychological mechanisms underpinning the relationship between group identification and personal control. Two cross-sectional studies conducted immediately after the 2016 Presidential election (total N = 752) and one longitudinal study conducted immediately before and after the 2020 Presidential election (N = 743) investigated the relationship between political group identification and personal control. Together, the studies tested whether this relationship is weakened under conditions of low agency (i.e., in a group that lost the election) and low predictability (i.e., immediately following a surprise election outcome). The results suggest that the relationship between political identification and personal control is robust except in the case of low agency and low predictability. The studies contribute to understanding the processes that link group-level political factors with individual-level psychological outcomes.     

Effects of Cognitive Complexity and Emotional Upset on Processing Supportive Messages: Two Tests of a Dual‐Process Theory of Supportive Communication Outcomes

We report tests of hypotheses derived from a theory of supportive communication outcomes that maintains the effects of supportive messages are moderated by factors influencing the motivation and ability to process these messages. Participants in two studies completed a measure of cognitive complexity, which provided an assessment of processing ability, and reported their degree of upset with a problem situation, which was hypothesized to impact both motivation and ability; they subsequently evaluated the helpfulness of comforting messages that varied in person centeredness. Consistent with predictions, an index of message processing depth—the degree to which participants discriminated between the helpfulness of better and worse supportive messages—was associated with the factors additively in both studies and interactively in one study.     

Computerized assessment of verbal skill

This paper describes a computerized diagnostic test for the assessment of basic literacy skills in Dutch. Central in this test is a skill labeledword image, referring to the subject's implicit knowledge of orthographic structure. Test norms were obtained in a group of reference subjects. The most notable trend found in the standardization study was that the development of word image performance showed a nonlinear, U-shaped trend. Two case studies are reported. A supplementary validation study, based on test data collected from standard reference groups of normal and poor readers, demonstrated that word image performance is significantly related to between-group differences.     

May the force be with you

This paper is a critical assessment of argumentum ad baculum, or appeal to force. Its principal contention is that, contrary to common opinion, there is no general fallacy of ad baculum. Most real-life ad baculums are, in fact, fairly strong. A basic logical form for reconstructed ad baculums is proposed, and a number of heterodoxical conclusions are also advanced and argued for. They include that ad baculum is not necessarily a prudential argument, that ad baculum need not involve force, violence, or threats, and that one can argue ad baculum to oneself. The starting point of the paper, however, is a critical evaluation of three ad baculums from the exercise sets of Irving Copi's well-known Introduction to Logic.     

Gender/ed identities: an overview of our current work as child psychotherapists in the Gender Identity Development Service

Abstract

This paper is adapted from a presentation first given at the 2017 Association of Child Psychotherapists (ACP) Conference. We hope to give a feel of our work as psychoanalytic child psychotherapists working in a Tier 4 national assessment service for gender variant children and connect with our colleagues working therapeutically with these families in Child and Adolescent Mental Health Services (CAMHS) and other settings. Gender variance does not have a single cause, or straightforward developmental pathway; rather it is a complex interplay of multiple factors, akin to sexuality in the diverse manifestations and ‘tributaries’ taken. This paper is given as a plea for complexity, to counter the current intense focus on gender identity and the consequent reductionism this can lead to. To this end, three case studies from the clinic, taken from Under Five, Latency and Adolescent phases of development, are explored. The complexity of the cases is then discussed, followed by parallel issues of development, divergence and difference. These three ‘average’ cases from the Gender Identity Development Services (GIDS) serve to demonstrate the need for child psychotherapy as part of multi-disciplinary thinking about gender variance and how attention must be maintained to each unique story and process of identity development; as well as our clinical task to establish and encourage depressive functioning and secondary processes where possible.     

Does participation in research lead to changes in attitudes among clinicians? Report on a survey of those involved in a French practice research network

Background/Objective: With increasing awareness of some of the limitations of randomised controlled trials as the ‘gold standard’ of psychotherapy evaluation, researchers at the start of the twenty‐first century have focused on a number of new priorities: developing studies in natural conditions; investigating the psychotherapeutic process to better understand the conditions, causes and mechanisms of change; and reducing the gap between clinicians and researchers. Can these three interrelated objectives be combined? Method: A French psychotherapy practice‐based research network (PRN) is used as a field of research for these issues. A survey was used to investigate the conditions that encouraged the clinicians to participate in the PRN study within the context of clinicians’ general opposition to research. Results: Several elements emerged as the key to clinicians’ positive involvement in research: the methodology implemented (intensive case studies during one year); the choice of measures; the constant attention to the practicalities and the potential contribution of studies to clinical practice; the organisation of work in peer groups; the training methods; the use of new information technologies and the sense of participation in a project that would support the profession. Implications: These elements are briefly discussed in relation to the question of how best to encourage clinicians to engage with research.