Psychoeducation and managed care: Clinical issues for the 1990s

Managed care has challenged mental health professionals to develop more efficient ways of addressing patient care needs. Psychoeducational programs, for patients and their families, have emerged as a medium by which relevant education and mutual support can be provided to participants. A review of the literature, a comprehensive model of psychoeducation, and the advantages of such models within the managed care program are offered. Also addressed are issues and import, treatment and research considerations.     

Prevention education and substance abuse treatment

Relapse prevention is influenced by a number of variables including stress and negative mood states, motivation and commitment to abstinence, social support, physiological factors, withdrawal symptoms, and a repertoire of cognitive and behavioral strategies utilized in responding to the relapse process. Diverse theoretical approaches have emphasized conditioning models as well as information processing, cognitive and affective components of treatment, cognitive and behavioral coping responses, and a variety of other procedures. Outcome studies related to treatment have failed to consistently support the effectiveness of several of these components. To overcomes this, the authors advocate a single subject design in the study of these approaches. This article emphasizes the role of relapse prevention, and training and education in facilitating long-term abstinence, particularly with those intervention methods that are based on social learning theory and cognitive-behavioral models.     

Clinton and the Empty Self

I detest the man who is the object of your study: as far as a single individual can be responsible for the misery of this part of the world, he surely is [Freud on Woodrow Wilson, 1920].     

The Grisso Tests for Assessing Understanding and Appreciation of Miranda Warnings with a Forensic Sample

The Instruments for Assessing Understanding and Appreciation of Miranda Rights, hereafter referred to as the Grisso tests, are widely used and recommended psychological tests designed to help assess ability to understand and appreciate Miranda warnings. This article describes the results of these tests administered to 439 individuals who participated in an evaluation to assess knowing and intelligent waiver of Miranda warnings during police questioning. This study is the first of its kind using a large sample of defendants who were referred for an assessment of capacity to waive Miranda rights. This forensic sample includes both juveniles (176) and adults (263), and the results are quite similar to the original Grisso norms. There are strong correlations between performance on these tests and IQ as well as between performance and age. This sample provides a broader foundation for users of the Grisso tests and answers some of the initial criticism of the instruments. Copyright © 2012 John Wiley & Sons, Ltd.     

A United States Forensic Sample for the Gudjonsson Suggestibility Scales

The Gudjonsson Suggestibility Scales (GSS) is a valuable test to use as part of a comprehensive assessment of psychological and interrogative factors relevant to a defendant's vulnerability to giving a false or involuntary confession. One limitation of the test is that the manual only provides information for samples from Iceland and Great Britain. This report describes the results of 334 individuals in the United States, who were administered the tests as part of an evaluation to assess confession‐related issues in a forensic context (i.e., capacity to waive Miranda rights or vulnerability in providing a false or involuntary confession). This forensic sample includes both juveniles and adults. Results are consistent with Gudjonsson's British and Icelandic samples, in which the Yield 1 score is more affected by intellectual and cognitive variables, but Shift and, to a lesser extent, Yield 2 scores are more related to emotional and personality characteristics. Copyright © 2012 John Wiley & Sons, Ltd.     

Rumors And Gossip As Forms Of Bullying: Sticks And Stones?

When most people hear the word bullying, they often envision a physical form of aggression—often between schoolchildren. And yet, much of the bullying and other forms of relational aggression occur not only in the schoolyard, but among those schoolchildren's parents, as well as in boardrooms, in faculty lounges, and in other places where adults congregate. The transmission of rumor and gossip is an enduring feature of power dynamics in any small or large group, as both a way of trying to make sense of ambiguous situations and as a form of social control. This article examines the construction, maintenance, proliferation, and management of rumors, gossip, and hearsay from a psychoanalytic perspective.     

Coercion in Groups: Finding One's Voice; Knowing One's Mind

Groups develop standards to facilitate their function and yet the standards that evolve are not always in line with the explicit task of the group. Group pressures and anxieties can move towards relief of strain in ways that may actually oppose the group's intended goals. The larger the group, the more difficult it may be to catch hold of relatively invisible coercive forces that guide behaviour. As Bion (1977 Bion, W. R. 1977. Seven Servants, New York: Jason Aronson.  [Google Scholar]) notes, group pressures tend to move towards cohesion and tradition, and away from the new idea that ultimately might be productive but would also be disregulating. Although clinicians learn about tensions between the individual and the group from a theoretical perspective, engaging with these tensions actively and reflectively can enhance both our understanding and our practice, as we discover ways in which we are buffeted by and at times succumb to these same processes. As a way of considering some of the more subtle ways in which we may find ourselves behaving out of line with our own integrity in relation to encounters with implicit group demands, I will use some of my own experiences in a group setting to highlight and illustrate some of these coercive forces that may work against the integration of new ideas in group settings.     

Sexually Violent Predators: Toward Reasonable Estimates of Recidivism Base Rates

The sexual recidivism rate of sex offenders is a controversial issue. Perhaps as controversial is the sexual recidivism rate of the select group of sex offenders who are examined pursuant to sexually violent predator (SVP) statutes. At present, reliable estimates of SVP recidivism are unavailable. We propose that reasonable estimates of SVP recidivism can be reached by considering three available pieces of data: (i) a likely recidivism rate of the general population of sex offenders; (ii) procedures typically followed by jurisdictions that civilly commit sex offenders; and (iii) classification accuracy of procedures. Although sexual recidivism rates vary across jurisdictions, the results of our analyses suggest sex offenders referred for examination pursuant to SVP statutes recidivate at substantially higher rates than typical sex offenders. Our results further suggest that sex offenders recommended for commitment as SVPs recidivate at even greater rates than SVP respondents who are not recommended for commitment. We discuss practice and policy implications of these findings. Copyright © 2013 John Wiley & Sons, Ltd.     

A Review of: “Hollander,M. (2008). Helping Teens Who Cut: Understanding and Ending Self Injury.”

Based upon informal observation of adverse effects arising during behaviorally oriented parent-training programs, 119 parents attending such programs answered a structured questionnaire regarding six specific adverse effects. Each of the “side effects” were reported by a substantial portion of the participants. In most cases, the severity of effects was not extreme. The mean number of side effects reported by each parent was 1.70. Based upon these findings, clinicians conducting such parent-training programs are encouraged to provide content material to prevent or ameliorate these adverse effects.