A model for theological interpretation in pastoral care

The wide-spread use of the clinical method in the preparation of ministers and the subsequent exposure of theprofession to other helpers raises questions about the uniqueness of ministry. Two responses are the efforts to locate uniqueness in terms of role and ritual and/or in terms of the moral dimensions of the clergy's work. The author argues that a more fundamental effort is needed, i.e., the recovery of theological interpretation in pastoral care. He presents a model including five elements which is designed to aid ministers to understand how they perceive experience theologically and how their pastoral responses are shaped by these perceptions. He then describes three settings in which the model has been used and discusses the results.     

Programmatic staff care in an outpatient setting

Traditionally, chaplains have provided care for staff through consultation, informal conversation, grief work, and more formal counsel and ritual. This article discusses four programmatic approaches to staff care created in response to particular assessed needs: "Finding Soul" addresses staff care needs to find meaning and joy in their work and to contribute to the "soul" of the institution. "Existential Expedition" helps staff both deal with their accumulated grief and provide better direct care around existential issues being faced by their patients. "After Book" provides a way for staff to have closure with parents/families and to provide holistic care to families after discharge from the system. "The Labyrinth Program" provides staff with an opportunity to de-stress and to attend to their emotional and spiritual well-being. Focused upon staff care, these programs also secondarily benefit both patients/families and the vision and mission of the institution.     

Fitness for automobile driving of patients at an epilepsy outpatient care unit

Patients who were free from seizures and not in possession of a driving license were examined for reasons for their being considered unfit to drive at an outpatient care centre for epileptics catering for 477 patients. The composition of the group was analyzed in respect of age, sex, intake of pharmaceuticals, risk factors and appropriateness of behaviour in traffic. Corresponding conclusions are drawn.     

A model of short-term counselling in primary care

Counselling in prima y care settings has received much interest throughout Britain. Many surgeries employ counsellors or psychologists as part of the primay health care team. This paper describes a model of primary care counselling using an example of a case encountered in general practice. It emphasizes the advantages of offering on-site counselling services, such as better possibilities of liaison with the referring doctor and coordination of patient care. Progress was made in seven sessions of short-term cognitive-behavioural treatment and a more stigmatizing referral (for example, to psychiatric services) was avoided. The case can be seen as an appropriate referral in the context of primay care counselling and illustrates the benefit of this approach to the treatment of psychological and social problems in general practice. Names and details have been changed to preserve confidentiality.     

A resocialization group for the socially impaired psychiatric outpatient

The advantages as well as the practical problems encountered in a supportive psychotherapy group for nonpsychotic patients with moderate social ineptness are described. The most effective group methods for this population included: high levels of therapist activity, constant support, mild confrontation, and other versatile techniques. The group was found to be successful in producing change. Members became more socially adept, self-initiating and productive, as well as less dependent and self-destructive. The therapeutic ingredients of such a group are speculated about, and further writings and studies on similar groups are suggested.     

Three preparatory studies for promoting implementation of outpatient schema therapy for borderline personality disorder in general mental health care

ObjectiveThree studies were conducted to prepare for the implementation of Schema Therapy (ST) for Borderline Personality Disorder (BPD) in general mental healthcare settings. Two were surveys to detect promoting and hindering factors, one was a preliminary test of a training program in ST.MethodsIn 2004, a diagnostic analysis of factors promoting and hindering implementation of a new treatment for BPD was conducted among both managers (n = 23) and therapists (n = 49) of 29 Dutch mental healthcare institutes through a written survey (Study 1). Next, a training program, including a set of DVDs displaying the major therapeutic techniques, was developed and tested among eight therapists. The training program was evaluated by the participants. After the training, three independent raters evaluated therapists' adherence and competence, viewing videos of the therapists completing structured role-plays (Study 2). In 2008, a second written survey was conducted in 22 mental health institutes to study factors for future nationwide implementation of ST (Study 3).ResultsBoth surveys indicated that the situation in most institutes was favorable for implementing a new effective treatment, as participants were not satisfied with the existing treatments, had suitable professional backgrounds, worked in settings with (B)PD-oriented care programs, and expressed a need for change. The surveys yielded clear results for promoting or hindering successful implementation of ST. Promoting factors included scientific evidence for the effectiveness of the treatment, structural changes in the patient's personality, rapidly noticeable effects for the patient, low drop-out rates and a favorable cost-effectiveness. Possible barriers included implementation mandated unilaterally by management, choosing ST based on financial or organizational needs, extending implementation over a lengthy period of time and providing telephone support by therapists beyond office hours. The eight-day training program received very positive ratings. After the training, therapists were rated as sufficiently adherent and competent applying ST to treat BPD patients, with peer supervision and supervision recommended as a supplement to the training.ConclusionThis study showed that the situation in 2005 was advantageous to start implementation of ST. Evaluation of the training and the achieved competence scores of trainees concluded that the training program was a good basis for training therapists in ST. Outcome of the survey in 2008 demonstrated that there was a clear interest for implementation of ST for BPD patients in the future.     

Validation of a component model of social skill with outpatient adults

Little social skills research has been generated from applied outpatient settings. The present study examined the relationship of behavioral social skill components to independent judges' social skill judgments. A secondary question was whether nonverbal components would demonstrate a curvilinear relationship to social skill ratings. Forty-two outpatient adults at a community mental health center were videotaped role-playing eight scenes (four commendatory and four refusal). Videotapes were viewed in random order by community members who rated the subject's social skill in the situation. Trained raters scored the videotapes on standard behavioral components. While both nonverbal and verbal components accounted for significant portions of unique variance, the percentage of eye contact was an overwhelmingly large contributor to skill judgments. No curvilinear trend was evidenced for the nonverbal components. The study extended prior findings with psychiatric inpatients into applied outpatient settings and indicated that a component social skills model is equally applicable with outpatient adults. The findings replicated with a second sample of outpatient adults.     

A parallel-processing model for scanning

A parallel-processing model for scanning is proposed wherein all items in the display set are processed together but with different time constants. The time constant for each item depends upon its serial position and is an additive combination of primacy and recency effects. The primacy effect is linear, and the recency effect is logarithmic. Scanning can either be exhaustive or self-terminating, and “multiple looks” may occur with negative probes. It is shown that this model predicts a linear relationship between reaction time and set size, parallel or 2∶1 slope ratios depending upon the proportion of multiple looks, and serial position effects if the scanning is self-terminating.     

A model for describing spirituality

A model for describing the spiritual dimension of life is presented. The model consists of six factors or dimensions along which life can be experienced as a spiritual person. These factors are identified as those of the journey, transcendence, community, religion, “the mystery of creation”, and transformation. Evil is described as a lack of progress and/or regression in any of these six dimensions. Recent literature is cited to indicate some of the diversity of understanding of spirituality and in support of various parts of the author's model. Lawrence L. LaPierro, M. Div., is a United Methodist Church minister serving as Director of Chaplains at the Department of Veterans Affairs Medical Center in White River Junction, Vermont who has appeared before in this journal. The author gratefully acknowledges the encouragement and editorial suggestions of Gail M. Barton, M.D., Director of Outpatient Psychiatry at the Veterans Affairs Medical Center, White River Junction, Vermont.     

A model for science kinematics

A comprehensive model for describing various forms of developments in science is defined in precise, set-theoretic terms, and in the spirit of the structuralist approach in the philosophy of science. The model emends previous accounts in centering on single systems in a homogenous way, eliminating notions which essentially refer to sets of systems. This is achieved by eliminating the distinction between theoretical and non-theoretical terms as a primitive, and by introducing the notion of intended links. The force of the model is demonstrated by formally incorporating many of the important, precise meta-theoretic concepts occurring in the literature.This paper was written under DFG project Ba 678/3-2.     

A model for narcolepsy.

A model for narcolepsy is developed on the basis of data obtained from brains collected at post mortem from three patients with narcolepsy. The concentration of dopamine, noradrenaline, and serotonin and their metabolites was measured in many brain regions. The number and affinity of the 3-H-spiperone and 3-H-prazocin binding sites was also measured in many of these regions to characterize the D-2 dopamine and alpha-1-noradrenergic receptors, respectively. Evidence for significantly increased serotonin levels and serotonin turnover was found in many brain regions. Noradrenaline turnover was increased in the frontal cortex. DOPAC/DA was significantly reduced in the striatum. The number of D-2 dopamine receptors, however, was markedly increased in this region. The number of alpha-1-noradrenergic receptors was significantly decreased in the frontal cortex and amygdala. Our neurochemical data demonstrating increased NA and 5-HT turnover suggest that locus coeruleus noradrenergic neurones and raphe serotonergic neurones are overactive in narcolepsy. Current evidence posits that increased activity in these neurones depresses the activity of cholinergic pedunculopontine (PP) REM sleep effector neurones. PP neurones project to and stimulate the dopaminergic substantia nigra compacta neurones. Decreased PP activity in narcolepsy, thus, could lead to pontine cholinergic supersensitivity and could also reduce the firing rates of dopaminergic neurones, as the low striatal ratio of DOPAC/DA suggests. An increase in the number of D-2 dopamine receptors in the striatum may result. The reason for the increased activity of the noradrenergic and serotonergic neurones remains to be determined, but immune inactivation of alpha-1-noradrenergic receptors may be the initiating event. Low alpha-1-noradrenergic receptor numbers may account for the chronic drowsiness of narcolepsy. The repeated entry into sleep, and into REM sleep in particular, may represent a homeostatic response to increase these receptor numbers and, thus, to increase alertness. Some therapeutic implications of this model are presented in the discussion.     

A model for counselor-student-teacher involvement

School counselors need to adopt some new supplementary roles in order to get more involved in the classroom learning situation. The Inquiry Role Approach (IRA) offers such a program for counselor involvement. The IRA establishes teams of students who work with the counselor and the teacher in the regular classroom. Individual referrals to the counselor are accepted as part of the classroom routine. Preliminary evaluation of the program suggests that certain attitudes and social skills are enhanced, and the counselors benefit by dealing directly with more students in a classroom situation.     

A mathematical model for conditioning

It is postulated that occurrence of a conditioned response depends on recurrence of one of a finite number of specific vigilance reactions. Number of trial on which a conditioned response occurs is shown to be a sufficient statistic for estimating the number of such vigilance reactions. The hypothesis is tested by noting whether numbers of trials on which conditioned responses occur fall within confidence intervals determined on the basis of a selected sufficient statistic. Applications of the model to psychological research are suggested.From a doctoral dissertation at Cornell University. The author wishes to acknowledge the invaluable advice and help of Professor H. S. Liddell, under whose direction this research was conducted. A special debt of gratitude is due to Dr. Jack Kiefer of the Cornell department of mathematics, whose skill and interest aided materially in the development of the mathematical portions of this paper.     

A retrospective examination of outpatient commitment in New York

Outpatient commitment (OC) is a growing trend in mental health treatment. The impetus for this movement has been partly due to the public perception that some mentally ill outpatients are prone to violence as result of poor treatment compliance. Numerous studies have shown that poor treatment compliance is associated with increased hospitalization, substance abuse, homelessness, and contact with the criminal justice system. This study examined treatment effectiveness, demographic variables, hospital utilization, and violence among 100 OC participants in New York. Results indicate that OC can be an effective means of increasing treatment compliance and reducing hospitalization and encounters with the criminal justice system.