Reflections on a do-it-yourself training program in clinical psychology

This paper is a somewhat modified version of the inaugural Rapaport—Klein Memorial Lecture at Austen Riggs Center presented June 21, 1974. The author describes the experiences, the series of “apprenticeships” and clinical exposures, which coalesced into his education, from teenage days in the New York Madison House settlement, through Harvard undergraduate and graduate work, to Worcester State Hospital as head of psychological services and research. In conclusion, the author discusses the effects of the kinds of training experiences he has described on the issues that arose in the formulation of formal standards of training in clinical psychology.     

Epilogue: Overarching themes and enduring contributions of the Lanzetta research program

In this Epilogue we step back from the four research lines that have been the focus of this two-part Special Issue and discuss four important themes that run through the Lanzetta research program: (1) the importance of the face as a fundamental channel of social communication, (2) the physiological nature of the information conveyed by facial expression, (3) the realization that response to facial expressions involve multiple levels of cognitive processing, and (4) the value in using multiple convergent measures and creative experimental paradigms to study complicated phenomena like emotional facial expressions. The ways in which these themes carry through the individual research lines are described, and important implications of the themes are highlighted.     

Exercise motivation in university community members: a behavioural intervention

The purpose of this study was to examine how exercise level, exercise motives, and barriers changed from the baseline phase to the follow-up phase after a behavioural and cognitive intervention aimed at increasing exercise. Seventy-five members of our university community (43 subjects in the control group and 32 in the experimental group), all of whom received cognitive feedback, agreed to complete the baseline phase. Only the experimental group received behavioural feedback and a free-access gym ticket with personal training in order to facilitate their adherence to exercise. The results suggest that a combination of behavioural and psychological techniques is an efficient strategy for increasing exercise level. In addition, the results showed that extrinsic motivation predominates the early stages of change-of-exercise behaviour, and that intrinsic motivation is important for progression towards maintenance. Subjects who decreased their exercise level increased their extrinsic exercise motivation and subjects who increased their exercise level decreased the barriers related to intrinsic motivation. These findings indicate that, in order to facilitate exercise adherence, feedback about motives for undertaking exercise is needed, combined with advice about how to improve physical condition. This combination could help eliminate certain barriers that hinder engaging in an active and healthy life-style.     

Adult urinary incontinence: Assessment,intervention, and the role of clinical health psychology in program development

Urinary incontinence (UI) is a disorder receiving little attention from clinical health psychologists. This paper establishes the importance of addressing the issue of UI within the clinical and research practices of clinical health psychologists. Over 10 million Americans suffer from loss of bladder control. Incontinence affects over half of older individuals in long-term care institutions, about one-third of hospitalized elderly, and up to 30% of Americans over the age of 60 living at home. Because of social stigma and misconceptions attached to urinary incontinence, it is estimated that less than half of those affected see a physician about their condition. Since UI is generally associated with medical, social, psychological, and economic consequences, a multidisciplinary perspective is important because these factors are integral in the selection of appropriate treatment. Definitions of UI, its incidence and costs, and brief reviews of treatment and management techniques are presented. Psychological sequelae and treatments are presented as a foundation for developing further treatment and research approaches. Guidelines for collaboration and consultation by clinical health psychologists with medical professionals in the area of UI are also discussed.     

Reporting a program evaluation: Needs,program plan,intervention, and decisions

The approach to intervention programs varies depending on the methodological perspective adopted. This means that health professionals lack clear guidelines regarding how best to proceed, and it hinders the accumulation of knowledge. The aim of this paper is to set out the essential and common aspects that should be included in any program evaluation report, thereby providing a useful guide for the professional regardless of the procedural approach used. Furthermore, the paper seeks to integrate the different methodologies and illustrate their complementarity, this being a key aspect in terms of real intervention contexts, which are constantly changing. The aspects to be included are presented in relation to the main stages of the evaluation process: needs, objectives and design (prior to the intervention), implementation (during the intervention), and outcomes (after the intervention). For each of these stages the paper describes the elements on which decisions should be based, highlighting the role of empirical evidence gathered through the application of instruments to defined samples and according to a given procedure.     

An evaluation of a community outreach program

A contact and counseling service for youth was examined with regard to the awareness of the program and its nature, the utilization of it, and the evaluation of it by the population of youth at risk. The program was evaluated both by a novel, unobtrusive approach to data-collection for use in a milieu where conventional methods were inoperable, and by an analysis of records from the agency. In addiction, process and activity observations of staff and clients were found to be useful for the evaluation of the agency's activities. The results indicated high levels of consumer awareness, mixed levels of utilization, positive evaluation, and an appropriate perception of goals and activities by the potential and actual users.     

Treating criminal psychopaths in a therapeutic community program

A Therapeutic Community (TC) treatment program for adult male offenders is summarized and treatment outcome data are discussed. Psychopaths showed less clinical improvement, displayed lower levels of motivation and were discharged from the program earlier than non-psychopaths. There were significant positive treatment effects for the non-psychopaths and a mixed group. Psychopathy Checklist scores (Hare, 1985) consistently postdict and predict treatment outcome and attrition from the program.     

Treatment of families in conflict: Recurrent themes in literature and clinical practice

This article undertakes to demonstrate, through works of great literature throughout the ages, that our best writers have always understood the primacy and linkages between individual growth, character and destiny, and the context of the various living systems that impinge upon each individual, the primary context being the family of origin. Beginning with the immortal classic, theSophoclean Trilogy, which inspired Freud's use of the major character's name in these three dramas, Oedipus has been used to explain the psychological complex which Freud regarded as universal. The author in this article finds a rather different point of view borne out by these same dramas, as well as in the other literary works cited. It is the discovery that the identified patient is not Oedipus, but his natural and adoptive families.This often-quoted classic in family therapy literature is slightly revised and reprinted, with permission, fromNew Directions in Mental Health, NY: Grune & Stratton, 1968.     

Intensive family intervention in a community consultation framework

This article describes a form of mental health consultation to community workers who have reached a state of crisis in their work with unmotivated, multi-problem families. The central part of the consultation is a therapeutic intervention that draws on principles of time extension and network intervention. The consultant sees the family together with its community workers in a one-time, intensive meeting of up to six hours duration. This meeting is divided into three phases, aimed at achieving respectively (1) structural, (2) emotional, and (3) cognitive imbalancing of the family system. This creates a new situation, which hopefully will enable the community workers and the family to move out of the crisis in which they had become stuck.     

Implementation of a comprehensive schoolwide behavioral intervention: The ABC program

The Academic and Behavioral Competencies (ABC) Program, a schoolwide program to reduce classroom disruption and encourage rule following, academic task completion, and homework completion, is described. The program was initially developed and implemented in an elementary school with a high-risk population. Data from teachers, parents, and children indicate high levels of satisfaction with the program. In addition, unobtrusive measures of program impact, reported as reductions in referrals to the principal's office, suspensions, and increases in homework completion rates relative to the year prior to implementation of the program, suggest a preliminary positive impact of the program. A replication is reported for another school district, with teacher evaluations of satisfaction and effectiveness reported, supporting the flexibility and adaptability of the program. Although the present article does not constitute a systematic evaluation of the ABC Program, it presents preliminary data on the process of implementation and stakeholder satisfaction.     

Discussion: Reflections from the clinical trenches

This paper involves a series of personal reflections on the deleterious impact of excessive bureaucracy and other institutional forces on the psychosocial treatment of the chronically mentally ill. The writer appeals to three groups of mental-health practitioners—behavior analysts, practicing clinicians, and academic clinicians—to promote cultural change by advocating a restructuring of large-scale bureaucracies with the concurrent establishment of multiple community-based associations.     

The effect of a twelve-week dropout intervention program

The problem of the high school dropout has been of serious concern to educators, service agencies, and society for many years. The problem has reached epidemic proportions in large urban communities with high concentrations of minority youngsters from low-income families. Given the magnitude of this problem from both the economic and humanistic perspective, the purpose of the study was to determine the effect of a twelve-week intervention program on potential dropouts. It was initiated in the Spring of the 1981-82 school year with a follow-up on the retention and absence rates in the fall of the same year. The results of the intervention revealed that the experimental intervention did impact significantly upon both variables of primary concern in the study, the retention and absence rates; the four affective measures of student attitude were not significantly affected by the program. These results pose serious questions concerning the generalizations of the self-concept to academic achievement.     

Contemplation and compassion: the heart of a Franciscan spirituality of clinical pastoral supervision

After five years of supervising CPE modules in two different hospitals in South Africa, a chaplain supervisor reflects on how his Franciscan spirituality had impacted his supervisory ministry. He describes how he was able to narrow the impact to two defining Franciscan qualities: contemplation and compassion. This article explores the relationship between spirituality and clinical pastoral supervision. Then the Franciscan dimension of contemplation and compassion of Franciscan spirituality are considered. Finally some contours of a Franciscan spirituality of clinical pastoral supervision are described.     

Delinquents and drug use: a model program for community reintegration

Evidence indicates that serious and persistent delinquency and the frequent use of illicit drugs emerge from common etiological roots. This suggests that treatment efforts which target risk factors of adolescent drug use and crime may be effective in preventing subsequent antisocial behavior. This paper describes Project ADAPT, a treatment program for juvenile delinquents based on the Social Development Model, which integrates this knowledge of risk factors. Project ADAPT is a 3 1/2-year demonstration project which combines behavioral skill training, supportive network development, and involvement in prosocial activities to facilitate the community reentry of youths following placement in a Washington state correctional facility.