Methodological and theoretical issues in neuropsychological assessment

While there are philosophical and theoretical differences between neuropsychologists and behavior therapists, it is suggested that a significant reconciliation can be achieved in regard to assessment and treatment of the brain-damaged patient. While brain damage is often viewed as an irreversible disorder, there is evidence that substantial recovery of function can occur, particularly when adequate retraining is provided. There are practical and empirical considerations that suggest that neuropsychological tests are currently the best tools available for behavioral assessment of brain-damaged patients. However, the results of these tests can be used not only diagnostically but also to identify target behavioral deficits that may be rehabilitated through systematic retraining efforts. Such rehabilitation efforts can be optimally planned, implemented, and evaluated through an alliance between the neuropsychologist, who identifies the ability and deficit pattern, and the behavior therapist, who devises and evaluates the retraining program. It is possible that the successes of behavior therapy in numerous clinical and educational applications can be repeated in the cases of brain-damaged patients. However, such success would appear to be contingent on appreciation of the high degree of specificity often seen in neurological deficit patterns and the great complexities involved in the relationships between brain function and behavior.     

Rational emotive behavior therapy in a forensic setting: Practical issues

Incarceration results after a person cannot or will not adapt to societal rules. Inmates often hold irrational beliefs and practice self-defeating behaviors, which then lead to incarceration. By using REBT as a treatment modality, a forensic therapist can easily identify irrational thinking and teach the inmates to challenge these thoughts on both a cognitive and behavioral level.     

Conditioned reinforcement: Experimental and theoretical issues

The concept of conditioned reinforcement has received decreased attention in learning textbooks over the past decade, in part because of criticisms of its validity by major behavior theorists and in part because its explanatory function in a variety of different conditioning procedures has become uncertain. Critical data from the major procedures that have been used to investigate the concept (second-order schedules, chain schedules, concurrent chains, observing responses, delay-of-reinforcement procedures) are reviewed, along with the major issues of interpretation. Although the role played by conditioned reinforcement in some procedures remains unresolved, the results taken together leave little doubt that the underlying idea of conditioned value is a critical component of behavior theory that is necessary to explain many different types of data. Other processes (marking, bridging) may also operate to produce effects similar to those of conditioned reinforcement, but these clearly cannot explain the full domain of experimental effects ascribed to conditioned reinforcement and should be regarded as complements to the concept rather than theoretical competitors. Examples of practical and theoretical applications of the concept of conditioned reinforcement are also considered.     

Pharmacological interventions in autism: theoretical and practical issues

Focused on issues of drug treatment in relation to autism. Pharmacological treatment studies in autism are complicated by various factors including a tremendous range of syndrome expression, a lack of robust animal models of the disorder, and various methodological problems. Theories have tended to follow treatments, and various neurochemical systems have been the focus of study. Neurochemical systems potentially implicated include those involving dopamine, norepinephrine, serotonin, and neuropeptides. The dopaminergic system has been the most extensively studied. Treatments developed are effective relative to certain disabling symptoms but "core" problems (e.g., in social relatedness and communication) appear less responsive to medications. The development of new approaches to assessment, including integration of behavioral and pharmacological approaches, is an important research priority.     

A solution-focused approach to rational-emotive behavior therapy: toward a theoretical integration

A theoretical integration of rational emotive behavior therapy (REBT) and solution-focused therapy is described. It is suggested that the integrative conceptualization underscores these models’ complementary aspects by addressing the limitations of each and enhancing their respective strengths. The clinical theory and process of the integrative model is explicated along with a case example. Directions for future theory building, research, and practice are considered. Address correspondence to Jeffrey T. Guterman, Barry University, 11300 NE 2 Avenue, Adrian Dominican School of Education, Counseling Program, Powers Building, Miami Shores, FL 33161–6695, USA; e-mail: jguterman@mail.barry.edu     

Conceptual issues in network therapy

This paper presents three concepts developed within the context of a project to study and conduct network therapy. The concepts discussed are: (1) the need for balance in participant composition, specifically in terms of support systems for core members, and the participant levels of affective involvement; (2) the therapeutic use of polarization of the network members against the therapist; and (3) the shared leadership role within the team of therapists. Case illustrations are included to demonstrate the concepts presented; and other areas for future study are suggested.     

Psychopathic behavior and issues of treatment

The psychopathic personality is traditionally looked on as an antisocial disorder, although both the core symptoms—centering around egocentrism—and philosophical argument for the psychopath's “practical rationality”, suggest behaviors so diagnosed are not all that discrepant with mainstream western societal values. The relation of despised psychopathy to prized Machiavellianism is explored and a treatment strategy is introduced that is in keeping with the Machiavellian-psychopath distinction. In the face of repeated failure of treatment programs, this plan incorporates western society's concrete, historical values rather than the idealized values on the basis of which the diagnosis is presently made.     

Ethical and legal issues in e-mail therapy

Psychologists and psychiatrists recently started using electronic mail (e-mail) to conduct therapy. This article explores relevant ethical and legal issues including, among others, the nature of the professional relationship, boundaries of competence, informed consent, treating minors, confidentiality, and the duty to warn and protect. To illustrate these complex issues, two services currently operating are discussed. To address potential hazards to clients and the profession, a new ethical standard for e-mail therapists is offered.