Confidentiality in psychological practice: a decrepit concept?

Although the principle of confidentiality in the relationship between psychologists and client has been vaunted, and is emphasised in the Australian Psychological Society's Code of Professional Conduct (the APS code; 1994), the confidentiality of this relationship is circumscribed by the absence of legal protections, the ethical beliefs of psychologists, institutional practices, and the provisions of the APS code itself. Lack of privilege in judicial proceedings, and statutory obligations to report certain types of behaviour, mandate breaches of confidentiality in some circumstances. Ethical beliefs of psychologists may support disclosure, especially where it is believed that there is danger of serious physical harm to the client or others. Multidisciplinary teams and institutional settings require the exchange of information for optimal delivery of services. Recent amendments to the APS code may require disclosure without the client's consent when a client is believed to be suicidal. Such developments, when considered at all, are typically regarded as exceptions to a general obligation of confidentiality. However, discussion of exceptions presupposes agreement on fundamental principle: the significance of, and rationale for, confidentiality in the psychologist-client relationship. It is argued in this paper that the obligation of confidentiality has been assumed rather than vigorously analysed and empirically explored. A critical examination of this obligation is the most appropriate starting point for the rehabilitation of contemporary principles of confidentiality in the psychologist-client relationship.     

Expectations and preferences regarding confidentiality in the psychologist-client relationship

Two hundred and fifty-six members of the Australian public were surveyed regarding situations in which a psychologist might breach confidentiality and third parties to whom information might be disclosed. There was strong agreement between respondents' expectations about the way in which psychologists would act, and their preferences regarding how psychologists should act. While respondents supported confidentiality within the psychotherapeutic relationship, they clearly distinguished situations in which, and third parties to whom, disclosure could appropriately occur. Disclosure was expected and preferred when a client revealed a murder (planned or confessed), suicide plans, child abuse, or treason, and where the recipients of the information were colleagues of the psychologist or parents of a client younger than 13 years. Compared to nonparents, parents more strongly supported disclosure regarding illegal drug use and child abuse, and believed that parents should have access to a child's records. In general, respondents' view of the way in which psychologists should treat confidentiality issues were consistent with the guidelines prescribed by the Australian Psychological Society in the Code of Professional Conduct (1986).     

Analysis of clustered data in community psychology: With an example from a worksite smoking cessation project

Although it is common in community psychology research to have data at both the community, or cluster, and individual level, the analysis of such clustered data often presents difficulties for many researchers. Since the individuals within the cluster cannot be assumed to be independent, the use of many traditional statistical techniques that assumes independence of observations is problematic. Further, there is often interest in assessing the degree of dependence in the data resulting from the clustering of individuals within communities. In this paper, a random-effects regression model is described for analysis of clustered data. Unlike ordinary regression analysis of clustered data, random-effects regression models do not assume that each observation is independent, but do assume data within clusters are dependent to some degree. The degree of this dependency is estimated along with estimates of the usual model parameters, thus adjusting these effects for the dependency resulting from the clustering of the data. Models are described for both continuous and dichotomous outcome variables, and available statistical software for these models is discussed. An analysis of a data set where individuals are clustered within firms is used to illustrate fetatures of random-effects regression analysis, relative to both individual-level analysis which ignores the clustering of the data, and cluster-level analysis which aggregates the individual data. Preparation of this article was supported by National Heart, Lung, and Blood Institute Grant R18 HL42987-01A1, National Institutes of Mental Health Grant MH44826-01A2, and University of Illinois at Chicago Prevention Research Center Developmental Project CDC Grant R48/CCR505025.     

A systematic review of physical guidance procedures as an open‐mouth prompt to increase acceptance for children with pediatric feeding disorders

This article reviews behavioral treatments of pediatric feeding disorders using physical guidance procedures as an open‐mouth prompt (i.e., jaw prompt, finger prompt, Nuk prompt, side deposit) to increase food acceptance. We identified 9 articles containing 35 systematic evaluations. We coded participant and study characteristics and assessed the experimental rigor, quality, and outcomes of each evaluation. Of the high‐quality research present, the finger prompt variation and side deposit reliably increased acceptance. We found mixed results on the efficacy of the jaw prompt, although it was the most widely researched procedure. Further, authors reported interobserver agreement for 100% of the participants, procedural integrity for 60%, social validity for 80%, fading for 5%, and follow‐up for 55%. Based on the invasive nature of physical guidance, we provide recommendations for researchers and clinicians to increase the quality of their treatment evaluations. We discuss limitations, implications for practice, and future research.     

Childhood Conduct Problems Trajectories are Associated with Distinct Antisocial Process Screening Device Dimensions

Journal of Psychopathology and Behavioral Assessment - There is ongoing debate regarding whether psychopathy dimensions (i.e., narcissism, callous-unemotional [CU] traits, and impulsivity) can be...     

Teaching oddity and insertion to Head Start children: An economical cognitive intervention

Two interventions were offered to Head Start preschoolers. Half of the children played numerous learning set games designed to teach the children (1) the oddity principle and (2) how to insert objects into a series. Mastery of these concepts is theoretically an important aspect of school readiness. The other half of the children engaged in the I Can Problem Solve (ICPS) exercises, a program designed to increase the children's competency in recognizing and responding to other people's feelings. The children who played the learning set games became superior at oddity and insertions with manipulable objects, and generalized these games to workbook-like formats resembling those encountered in kindergarten. They also scored higher on the numeracy and memory scales of the McCarthy Scales of Children's Abilities, indicating that mastery of oddity and insertions may have served as foundations for further cognitive growth. The children who participated in the ICPS exercises became superior at creating solutions to interpersonal problems, as measured by the Preschoolers Interpersonal Problem Solving Scale. The differences in the outcomes indicate that both interventions were successful in their own domains. The advantage the cognitive intervention produced on the McCarthy Scales suggests that oddity and insertion abilities may be a foundation in fact as well as in theory for general cognitive growth at this age.     

Practicing REBT in Italy: Cultural Aspects

This paper attempts to explore the cultural background for the adoption and practice of REBT by cognitive therapists in Italy since the 1980s. It is not an attempt to capture the history of Italian culture and philosophy from antiquity. Italian therapists tend to prefer the assessment phase of the ABC framework and not fully adopt REBT disputing interventions. They also attempt to link the ABC not only to the here and now but also to clients’ personal development. In our experience, they have combined REBT with constructivism and metacognition. These current features parallel the historical lack of confidence shown by many Italian philosophical thinkers—from Machiavelli to Gianni Vattimo—in the possibility of reducing reality to verification as well as the reproducible rules of logical rationality. The foregoing highlights the interest in exploring the emotional roots of politics, history, and concrete reality in the time frame following the 1980s. Some typical features of Italian social life, such as individualism, hierarchy, remote social distance, and competition can also be thought of as corresponding with the historical features of the way REBT has been adopted and functions in Italy.     

Hope for the Future and Avoidance of the Present: Associations with Well-being in Older Adults

Positive psychology and third wave cognitive behavioral therapy approaches have seldom been applied to older adults. This study therefore examined whether two concepts drawn from these areas, hope for the future and avoidance in the present, were associated with well-being in a sample of 259 older adults (65–94 years). Hope was measured as a stable trait. Experiential avoidance was measured as avoidance of present internal and external events. Respondents also completed two well-being measures: hedonic (positive and negative affect) and eudeimonic (meaning in life). Path analyses showed that high hope was significantly associated with high positive affect, and high meaning in life; and high experiential avoidance was associated with high negative affect and low meaning in life. This was also true when both (hope and avoidance) were taken into account, along with sociodemographic variables and perceived health. Many of the pathways between hope and well-being, and between experiential avoidance and well-being appear to be bidirectional. However the path from hope to positive affect was stronger than that from positive affect to hope. Further research is needed to clarify each of these points. Both hope for the future and lack of avoidance in the present are important for well-being in older adulthood and interventions targeting these processes may enhance positive aging and contribute to a sense of having a meaningful life.     

Physical aggression toward teachers: Antecedents,behaviors, and consequences

School violence is a significant public health concern that occurs in many forms. Physical aggression can cause serious bodily injury and long-term negative effects, and both teachers and students experience significant rates of physical aggression. There are few studies examining teachers’ experiences of physical aggression. Studies that go beyond prevalence are limited, and we know little about the triggers and consequences that surround these incidents. This qualitative investigation used an antecedent-behavior-consequence (A-B-C) framework to understand how incidents of physical aggression directed toward teachers unfold. The sample included 193 elementary and secondary teachers who completed an anonymous, online survey and described events leading up to and following their experiences with physical aggression. Using conventional content analysis, we identified common antecedents, such as breaking up fights, discipline, and directives, and common consequences, such as student removal, school staff involvement, positive outcomes, and inaction. Further analyses revealed seven common A-B-C patterns among physical aggression incidents that are highlighted and discussed. Utility of the A-B-C framework for teacher-directed violence is described, along with implications for research, practice, and policy. Exploring the context surrounding incidents of physical aggression directed against teachers provides useful information for violence prevention and interventions.