The uncertainty of it all

The amygdala is clearly implicated in the processing of biologically relevant stimuli, particularly those that can lead to a state of fear. A new study by Herry, Bach and colleagues using both mouse and human subjects seemingly throws a wrench in the spokes by demonstrating that the amygdala is sensitive to non-biologically relevant stimuli (i.e. tones) when they occur in an unpredictable fashion. The implications of this finding for understanding the role of the amygdala in vigilance, threat assessment and anxiety are considered here.     

Treatment of the chronically mentally ill: an opportunity for the group therapist

This article focuses on the therapist's task of engagement in the group treatment of the chronic mentally ill. The dynamics of individual and group processes are reviewed with an emphasis on the contributions of social, interpersonal, and intrapsychic factors. Drawing upon the observations of Friedman (1988), the presentation explores therapists' efforts to restore their inner balance by (1) acting like a therapist, that is, according to their theory; (2) satisfying their curiosity; and (3) eliciting "something desirable," which is formulated as the therapist's search for interactive responses. Examples illustrate these elements as they emerge in group psychotherapy.     

Pastoral care and counseling with the chronically ill

The increasing prevalence of chronic illness and chronic pain problems offers a challenge to pastors and churches. In this paper, notions of surplus suffering and disability are discussed, misconceived rules and expectations characterized, and strategies for helping chronic patients and their families described.     

Mental health needs of the chronically mentally ill elderly

The treatment histories and current social, financial, and clinical status of 111 chronically mentally ill (CMI) persons over the age of 60 were examined. Information was obtained from Ss, family, mental health records, and mental health professionals familiar with Ss. Psychiatric symptoms were observed in 74% of Ss. Many Ss experienced long periods without acute episodes of illness. Recurring episodes eventually appeared in most Ss, however, and ongoing deficits in daily functioning and social contacts were prototypical. Two thirds of the Ss were living in the community, relying heavily on family contacts; the rest lived primarily in nursing homes (23.4%) or psychiatric hospitals (7.2%). Social support was the best predictor of level of functioning. Findings suggest that failure of CMI elderly to use mental health services is not due to lack of need. Mental health services currently do not appear to be meeting the needs of this population.     

Private-sector care for chronically mentally ill individuals. The more things change, the more they stay the same

Two profit-making industries, nursing homes and board-and-care homes, care for about one million chronic mental patients. This care is primarily custodial and probably not very different from the care patients received in the public sector prior to deinstitutionalization. Moreover, certain characteristics of privately owned facilities encourage poor patient care so as to maximize profit. The problem could be ameliorated if chronic mental patients were strong and informed consumers or if the public sector strongly regulated proprietary care. However, neither of these two conditions now hold. Perhaps the apparent difficulties in significantly improving care for chronically mentally ill individuals despite seemingly major changes in policy reflect a fundamental problem in overall social policy--a reluctance to care for chronically indigent individuals of all kinds.     

Doing it all Bass-Ackwards: The development of hierarchical factor structures from the top down

A simple method is presented for examining the hierarchical structure of a set of variables, based on factor scores from rotated solutions involving one to many factors. The correlations among orthogonal factor scores from adjoining levels can be viewed as path coefficients in a hierarchical structure. The method is easily implemented using any of a wide variety of standard computer programs, and it has proved to be extremely useful in a number of diverse applications, some of which are here described.     

Bringing it all back home: Time for reparation in Northern Ireland

Abstract

Complaints and Grievances in Psychotherapy: A Handbook of Ethical Practice, Fiona Palmer-Barnes, London: Routledge, 1998, 195 pp., £45 hb, £14.99 pb.

The Psychoanalytic Mystic, Michael Eigen, London: Free Association Books, 1998, 220 pp., £16.95 pb.

The Elusive Human Subject: A Psychoanalytic Theory of Subject Relations, Roger Kennedy, London: Free Association Books, 1998, 226 pp., £35 hb., £15.95 pb.

Counselling by Telephone, Maxine Rosenfield, London: Sage, 1997, 145 pp., £35 hb., £11.99 pb.

Defense Mechanisms in the Counselling Process, Arthur J. Clark, London: Sage, 1998, 255 pp., £13.99 pb.

Boy Crazy: Remembering Adolescence, Therapies and Dreams, Janet Sayers, London: Routledge, 1998, 185 pp., £14.99pb.

Emotional Milestones from Birth to Adulthood: A Psychodynamic Approach, Ruth Schmidt Neven, London and Bristol: Jessica Kingsley, 1997, 260 pp., £13.95 pb.     

Applications of cognitive testing to group therapies with the chronically mentally ill

Appreciation of the various cognitive deficits displayed by many chronic patients offers an alternative way of understanding each patient's predicament and an alternative way of approaching group and milieu therapies with chronic patients. Case examples taken from a test protocol based on neuropsychological testing procedures illustrate the clinical information that can be obtained in this important, but relatively unexplored area.     

Disability labeling vs. rehabilitation rhetoric for the chronically ill: a case study in policy contradictions.

Among persons with chronic renal disease, limited encouragement to use self-care treatment options and easy access to disability income benefits tend to reinforce the concept of disability rather than foster rehabilitation goals. More than 80% of all chronic renal disease patients on dialysis therapy receive treatment in facilities at which they become highly dependent on medical staff, and estimates of unemployment among persons aged 21-59 years suffering from this disease range from 60% to 75%. The authors' data indicate that patients who receive dialysis treatment within facilities experience negative effects on their perceived health status and health locus of control as compared to patients who practice self-care dialysis at home. Although many factors contribute to unemployment among dialysis patients, the availability of disability income benefits seems to act as the most important deterrent to employment. Increasing the emphasis on the rehabilitation of this chronically ill population will require a movement away from disability labeling by providers of care and the patients themselves, as well as adjustment in the dialysis reimbursement system and in the eligibility requirements for disability compensation.     

John Exner and the book that started it all: a review of The Rorschach Systems

This article is a review and a reassessment of Exner's (1969) The Rorschach Systems. The book reviews the history of the development of the Rorschach, primarily in the United States, including a detailed analysis of the progressive development of systems devised by Klopfer, Beck, Piotrowski, Hertz, Rapaport, and Schafer. The final versions of each system are compared with each other, and with Rorschach's own system. The development of the book is linked to Exner' s personal relationship with Klopfer, Beck, and Hertz. The book is described as the basic forerunner of Exner's Comprehensive System.     

The factor analytic structure of the Roberts Apperception Test for Children: a comparison of the standardization sample with a sample of chronically ill children

A confirmatory principal component factor analysis of the Roberts Apperception Test for Children was conducted using the standardization sample and a sample of chronically ill children. An interpretation of three- and four-factor solutions identified the three-factor solution as superior to the four-factor solution as measured by chi-square goodness of fit and coefficients of convergence. A cluster analysis using Ward's minimum variance method was calculated to determine the typical profiles that best describe the chronically ill sample. Results of this analysis reveal two distinct profiles that differ primarily on the level of adaptive psychological functioning.     

Selective responsiveness of chronically ill children to assessments of depression.

Many investigators have noted that depression is a common symptom among pediatric cancer patients. However, prevalence rates vary widely across studies. This variation in prevalence rates may be due, in part, to selective reporting of patients based on measures used and environmental cues. In this study, we evaluated 50 chronically ill pediatric patients (19 cancer and 31 diabetic patients) for their use of selective reporting of depression. Factors in the 2 x 2 design were Intervention (disclosure videotape and cartoon videotape) and Examiner (familiar examiner and unfamiliar examiner). In the Intervention manipulation, subjects were shown either a videotape prompting the child that self-disclosure was appropriate or a tape of a cartoon (control condition). In the Examiner manipulation, subjects were administered the experimental measures by either a familiar (parent) or unfamiliar (research assistant) examiner. Dependent variables were the Children's Depression Inventory (CDI; Kovacs, 1981), the Depression scale of the Roberts Apperception Test for Children (RATC; McArthur & Roberts, 1982), and a depression measure taken from the Child Behavior Checklist (CBCL; Achenbach & Edelbrock, 1983). As hypothesized, the Examiner x Intervention interaction revealed that children who did not view the disclosure videotape and who were tested by an unfamiliar examiner gave significantly lower self-reports of depression on the CDI than children in the other conditions. However, parent and child projective reports of depression did not vary as a function of experimental condition. The results are interpreted as selective responding on the part of pediatric patients. Limitations of assessing internal psychological states in children are discussed.     

Experts see it all: configural effects in action observation

Biological motion perception is influenced by observers’ familiarity with the observed action. Here, we used classical dance as a means to investigate how visual and motor experience modulates perceptual mechanism for configural processing of actions. Although some ballet moves are performed by only one gender, male and female dancers train together and acquire visual knowledge of all ballet moves. Twenty-four expert ballet dancers (12 female) and matched non-expert participants viewed pairs of upright and inverted point light female and common dance movements. Visual discrimination between different exemplars of the same movement presented upright was significantly better in experts than controls, whilst no differences were found when the same stimuli were presented upside down. These results suggest expertise influences configural action processing. Within the expert group, effects were stronger for female participants than for males, whilst no differences were found between movement types. This observer gender effect could suggest an additional role for motor familiarity in action perception, over and above the visual experience. Our results are consistent with a specific motor contribution to configural processing of action.     

Locus of control among psychosomatically and chronically ill children and adolescents

In a matched group design, two groups of children suffering from a psychosomatic disease (bronchial asthma and ulcerative colitis) were compared with two groups of children suffering from other chronic illnesses affecting the same organ (cystic fibrosis and Crohn's disease) and with healthy subjects with regard to locus of control. With the exception of bronchial asthma, all clinical groups were characterized by greater internal locus of control. There were no significant relationships between the IE-dimension and further clinical parameters specific to each disease. Furthermore, there was an indication that psychiatric disturbance in general is related to external locus of control. The IE dimension did not contribute to a differentiation between the types of psychosomatic and chronic illness.