Reframing DSM-IV: Positive Strategies From Developmental Counseling and Therapy

Professional counselors in educational and mental health settings all must deal with so-called psychopathology. At issue is how can they work with “disorder” from a positive, developmental perspective? Developmental counseling and therapy (DCT) offers an approach to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (American Psychiatric Association, 1994) classification systems that enables the reframing of severe client distress as a logical response to developmental history. Included are specific suggestions for positive case management and practice. Special attention is given to the interface of multicultural issues, etiology, and treatment. The authors maintain that if professional counselors take a developmental approach to a so-called disorder, the positive theoretical and psychoeducational integrity of the American Counseling Association can be maintained while working with the most difficult issues.     

Advance directives and the personal identity problem

The value and authority of advance directives such as the living will and the durable power of attorney are discussed, as well as the dangers of loss of personal identity and psychological continuity that these directives present. Differing theories of the degree of psychological continuity necessary for the preservation of personal identity are examined, concluding with the author's "compromise position" that cases of permanent unconsciousness and neurological dementia destroy some of the preconditions for personhood and thereby negate the choice between respecting the wishes of the formerly competent person and the new, different person's life because such beings are not persons at all.     

The acquisition of spatial knowledge under conditions of temporospatial discontinuity

Summary Three experiments were conducted to examine the effect of temporospatial discontinuity on route learning. Discontinuity was created by showing subjects in a route-learning task a set of environmental scenes comprising a route in scrambled, rather than logically sequenced, order. Results from Experiments 1 and 2 indicated that discontinuity during learning affected the accuracy and the quantity of the route knowledge acquired, but suggested that the processes underlying acquisition were relatively robust. Results from Experiment 3 suggested that learning routes under conditions of discontinuity leads to a greater exaggeration of distance between route segments than is the case without discontinuity.     

Management of extended-wear contact lenses in infant rhesus monkeys

Infant rhesus monkeys were fitted with extended-wear contact lenses (EWCLs) to correct surgically induced aphakia. The protocol that produced the most favorable experimental outcome, including good lens-wear compliance, involved: (1) custom-made EWCLs with parameters adjusted for each animal, (2) selection for study of neonates who seemed to tolerate EWCLs most naturally, (3) individual housing of monkeys, (4) lens check at 2-h intervals around the clock by trained personnel, (5) a large inventory of EWCLs for each animal, (6) periodic ophthalmologic examinations, and (7) darkroom housing of monkeys during treatment of lens-wear-related incidents. The EWCL is a new tool for studies of the visual system and is a useful complement to existing experimental techniques.     

The effect of therapist interventions on the therapeutic alliance with borderline patients

The authors draw attention to the problems of establishing and maintaining a therapeutic alliance in the psychotherapy of the borderline patient. They elaborate an extensive methodology designed to study the manner in which shifts in collaboration occur in response to therapist interventions. This report demonstrates how one particular borderline patient increased his ability to collaborate with the therapist in response to a transference focus in the psychotherapy. Methodological problems are noted as are directions for future research. Only a series of patients studied with this or with similar methodology will allow for a sophisticated and empirical rationale for choosing a particular form of psychotherapy for a particular kind of borderline patient.     

Rhythmic-movement facilitation of learning in working-class Afro-American children

In this study, we examined whether the cognitive performance of working-class Afro-American children could be enhanced based upon a presumed knowledge of the Black cultural experience. Children (6 and 9 years old) learned to match each of 12 pairs of pictures via a rhythmic movement-coordinated procedure accompanied by a musical beat or through a rote recitation procedure. It was expected and found that subsequent retention of the picture matches was superior in the rhythmic movement condition. Moreover, for the younger children, the effect was stronger for those who came from homes providing high stimulation and who had high levels of movement expressiveness.     

Nurses' Evaluations of Patient Attributions for the Cause and Future of Their Illness1

It was hypothesized that evaluations of patients' attributions for the cause and future of their illnesses would be seen as more realistic when these attributions coincided with subjects' views on the cause and future of the patients' illness. It was also thought that of the two, i.e., cause and future attributions, future attributions would be more pertinent for the observer when evaluating the adjustment of the patient. One hundred and twenty-eight female nurses assessed the health interviews of four patients through the use of questionnaires. The first hypothesis was supported in the case of causal attributions, but it was found that patients who accepted responsibility, regardless of nurses' views, were seen as more realistic. The second hypothesis was fully supported with future attributions indicating level of coping and causal attributions indicating level of emotional support needed. These findings have implications for caretakers' perceptions of the adaptiveness, for patients of serious illness, of control attributions.     

Reinstating study context produces unconscious influences of memory

Having read a word does more to benefit its later perceptual identification when many, rather than few, of the words in the test list have been previously read. Some have suggested that this proportion overlap effect is produced by an intentional use of recognition memory or recall in the perceptual identification task. Contrary to this account, we found that words that are easily recognized (words generated from an anagram at study) do not gain more from increasing overlap than do words that are poorly recognized (words read at study). These findings are problematic for claims that word perception relies on a module, such as a logogen system, that is separate from the rest of memory.     

Evidence for a parallel input serial analysis model of word processing

A parallel input serial analysis (PISA) model of word processing was developed and tested. The goal was to expand on the "critical processing duration" hypothesis of Johnson, Allen, and Strand (1989) so that both single-word and multiple-word presentation, letter detection data could be explained. In Experiments 1-3 four different word frequency categories on a single-presentation, letter detection task were used. These three experiments indicated that there was a curvilinear relationship between word frequency and letter detection reaction time (RT). That is, letter detection RTs for medium-high-frequency words were significantly longer than letter detection RTs for very-high-, low-, and very-low-frequency words. These results support the PISA model rather than the Healy, Oliver, and McNamara (1987) version of the unitization model. In Experiments 4-5 multiple-presentation (i.e., two words), letter detection tasks were used. The PISA model could also account for the results from these two experiments, but the unitization model could not.     

DSM-IV Literature reviews: Rationale,process, and limitations

DSM-IV will benefit from the extensive research and interest in diagnosis generated in large part by DSM-III. The development of DSM-IV is proceeding through three stages of empirical documentation, including literature reviews, analysis of unpublished data sets, and field trials. This paper discusses the rationale, process, and limitations of the literature reviews. The purpose of the literature reviews is to provide and to document a comprehensive review of the clinical and empirical literature to facilitate objective and empirically based decisions. The review process is guided by the explicit and systematic methods developed within meta-analysis. Limitations of the reviews are also discussed.The opinions expressed in this paper are those of the authors and do not necessarily represent the position of the American Psychiatric Association and its Task Force on DSM-IV.