Religion,personality, and clinical assessment

Religion is an integral part of every person's life and occupies a central place in every personality. Viewing religion as referring to that which is of primary importance in one's life, one sees it as performing an integrative function, consolidating and ordering all of the inputs to personality, and giving consistency to one's behavior. Thus, an understanding of the individual and an assessment of his religion are necessary for a complete understanding of his problems.     

Behavioral correlates of selected MMPI-2 clinical, content, and restructured clinical scales

In this study, we evaluated the validity of the Restructured Clinical (RC; Tellegen et al., 2003) scales by identifying and comparing behavioral correlates of selected RC scales (RCd, RC2, RC4), their original Clinical scale counterparts (Scale 2, Scale 4), and conceptually related Content scales (DEP, ASP, CYN) in an outpatient clinical sample (N = 150). The results of this study indicate that RC4 is a stronger predictor of several antisocial behaviors than Clinical Scale 4 or the Content Scales ASP and CYN. In contrast, RC2 demonstrated significantly lower correlations with several behaviors conceptually related to depression than its Clinical scale counterpart or DEP. DEP was highly correlated with RCd (r = .91, p < .0001), suggesting that the 2 scales may be measuring similar constructs. Overall, the results of this study demonstrate relatively few differences among the scales selected in their ability to predict extratest behaviors.     

Religion,mental health,and clinical issues

This article reviews a number of studies investigating the relationship between religion and the variables of mental health and social behavior. Characteristics of religious health and pathology are examined, and a framework for clinical assessment and treatment of religious pathology is described. Tentative conclusions concerning the subject matter are drawn and limitations of the number and type of studies are outlined.     

Clinical judgment, clinical training, and professional experience

Reviews studies on training, experience, and clinical judgment. The results on the validity of judgments generally fail to support the value of on-the-job experience in mental health fields. The validity results do provide limited support for the value of training. Other results suggest that experienced clinicians are better than less experienced judges at knowing which of their judgments are likely to be correct and which are likely to be wrong. Reasons why clinicians have trouble learning from experience are given. Recommendations are made for improving training and clinical practice.     

Patient's surface, clinical surface, and workable surface

Surface is a term often used in clinical theory, which seems to have eluded a reliable definition. Freud used the term mostly to denote the analysand's consciousness. This patient's surface does not always coincide with the data the analyst can observe, i.e., the clinical surface. It is proposed that clinical surface be understood, in contrast to other psychoanalytic concepts, as the clinical evidence that does not need conjecture to be grasped cognitively. The concept of "average expectable apperception" is introduced. Workable surface is defined as those aspects of the clinical surface that lend themselves well to the exploration of unconscious dynamics or genesis. Ideas about which surfaces are optimally workable vary according to different schools of technique. The advantages of considering clinical surface the objective anchorage of psychoanalysis as a positive science and of differentiating it from patient's surface and workable surface are discussed.     

Consensus, clinical decision making, and unsettled cases

The model of clinical ethics consultation (CEC) defended in the ASBH Core Competencies report has gained significant traction among scholars and healthcare providers. On this model, the aim of CEC is to facilitate deliberative reflection and thereby resolve conflicts and clarify value uncertainty by invoking and pursuing a process of consensus building. It is central to the model that the facilitated consensus falls within a range of allowable options, defined by societal values: prevailing legal requirements, widely endorsed organizational policies, and professional standards of practice and codes of conduct. Moreover, the model stipulates that ethics consultants must refrain from giving substantive recommendations regarding how parties to a moral disagreement in the clinic should evaluate their options. We argue that this model of CEC is incomplete, because it wrongly assumes that what counts as the proper set of allowable options among which the parties are to deliberate will itself always be clearly discernible. We illustrate this problem with a recent case on which one of us consulted-a neonate born with trisomy 18 (T18). We try to show that law, policy, and standards of practice reveal no clear answer to the question posed by the case: namely, whether forgoing gastrostomy tube feedings for a baby with T18 is allowable. We suggest there may be other kinds of cases in which it may simply be unsettled whether a given choice falls within the set of allowable options within which consensus is to be facilitated. What should an ethicist do when confronting such unsettled cases? We agree with the facilitation model that an ethicist should remain neutral among the allowable options, when it is clear what the allowable options are. But, in unsettled cases, the role of a consultant should be expanded to include a process of moral inquiry into what the allowable options should be. We end by raising the issue of whether this means an ethicist should share his or her own conclusions or views about the allowability of a given clinical option.     

Conceptual,methodological, and clinical issues in cognitive-behavioral assessment

This article reviews cognitive-behavioral assessment principles and procedures. The functions of such assessments are noted, and issues and advances in cognitive assessment are discussed. The need for integrated cognitive, behavioral, and affective assessments is then explored. Finally, conceptual methodological, and clinical issues in the integration of assessments and study of reciprocal determinants are presented.Preparation of this paper was supported in part by a General Research Board Faculty Research Award from the University of Maryland. The author would like to thank Steve Graham, Donald Meichenbaum, Barbara Keogh, and Bernice Wong for their feedback during the preparation of this paper.     

Chronic pain,compensation and clinical knowledge

The nosological status of the putative clinical entity of compensation neurosis and the relationship of chronic pain complaints to compensation are explored. It is concluded that, using the traditional criteria of diagnostic validity, there is no support for the view that a specific type of psychiatric disorder related to compensation or litigation can be demonstrated. Although it has been generally considered that chronic pain complaints reflect an underlying disease state, recent evidence has shown that in the medico-legal setting the nature of the compensation system and the level of available benefits have a marked influence on both the rate of chronic pain complaints and the duration of pain related work incapacity.     

Pellegrino,MacIntyre, and the internal morality of clinical medicine

Theoretical Medicine and Bioethics - There has been significant debate about whether the moral norms of medical practice arise from some feature or set of features internal to the discipline of...     

The local clinical scientist, evidence-based practice, and personality assessment

The local clinical scientist model was devised for clinical practitioners including those engaged in personality assessment. It emphasizes the importance of local data, the consideration of each clinical encounter as a mini-research project, and the incorporation of existing research data where relevant. It is consistent with, but goes beyond, evidence-based practice. There is a need to guard against the operation of cognitive heuristics for the model to be applied effectively.