Medicine as business and profession

This paper analyzes one dimension of the frequently alleged contradiction between treating medicine as a business and as a profession, namely the incompatibility between viewing the physician patient relationship in economic and moral terms. The paper explores the utilitarian foundations of economics and the deontological foundations of professional medical ethics as one source for the business/medicine conflict that influences beliefs about the proper understanding of the therapeutic relationship. It, then, focuses on the contrast and distinction between medicine as business and profession by critically analyzing the classic economic view of the moral status of medicine articulated by Kenneth Arrow. The paper concludes with a discussion of some advantages associated with regarding medicine as a business.     

Family coping strategies and the rural Appalachian working poor

Naturalistic research methods were used in this study to collect the voices, ideas, and opinions of rural, working poor, Appalachian families from Southeast Ohio about the stress of poverty in family life and family coping in the face of poverty. This data should be of interest to the professional family therapist who practices with the working poor.     

An evaluation of the reliability of probability judgments across response modes and over time

Despite the importance of probability assessment methods in behavioral decision theory and decision analysis, little attention has been directed at evaluating their reliability and validity. In fact, no comprehensive study of reliability has been undertaken. Since reliability is a necessary condition for validity, this oversight is significant. The present study was motivated by that oversight. We investigated the reliability of probability measures derived from three response modes: numerical probabilities, pie diagrams, and odds. Unlike previous studies, the experiment was designed to distinguish systematic deviations in probability judgments, such as those due to experience or practice, from random deviations. It was found that subjects assessed probabilities reliably for all three assessment methods regardless of the reliability measures employed. However, a small but statistically significant decrease over time in the magnitudes of assessed probabilities was observed. This effect was linked to a decrease in subjects overconfidence during the course of the experiment.     

A comparison of Guided Imaginal Coping and imaginal exposure in the treatment of panic disorder

The present study evaluated the efficacy of a new intervention, Guided Imaginal Coping (GIC), compared to imaginal exposure (IEX), and a waiting-list control (WLC) condition among 24 clinic outpatients meeting DSM-III-R criteria for panic disorder (PD) or PD with agoraphobia. GIC was the more consistently effective intervention, with individuals demonstrating significant improvement in frequency and severity of panic attacks (Pas) as well as significant reductions in physiological and subjective arousal to provocative imagery. Individuals in the IEX intervention demonstrated less consistent improvement on the dependent measures, while individuals in the WLC condition essentially remained unchanged. Both GIC and IEX were effective according to a composite measure of clinically significant improvement. However, only GIC was superior to the WLC condition when clinical improvement was defined as zero PAs at follow-up. These findings, while preliminary, suggest that GIC can be added to the armamentarium of effective approaches to treating PD.     

Live supervision in the postmodern era of family therapy: Issues,reflections, and questions

This article asserts that the family therapy field is approaching an epistemological shift from structuralism and positivism to postmodernism and relativism. The confluence of these movements: feminism, constructivism/constructionism, and cultural relativism is cited as a major impetus for the shift. Live supervision is examined within the context of this transformation, with a discussion of implications for the future.     

Supervising the person of the therapist: Issues,challenges and dilemmas

A major critical issue in marriage and family therapy today is the professionalization of the discipline. Thus the focus on training individuals for a career in marriage and family therapy necessitates the revisitation of the debate over personal growth versus skill development. The trend toward training the person of the therapist, however, would suggest that the field is moving toward the integration of self awareness and skill in the therapeutic system. With the popularization of training the person of the therapist comes other issues, challenges, and dilemmas for the field, including the crucial issue of training gender and culturally sensitive therapists. The potential for creating dual relationships when training the person of the therapist is both a dilemma and a challenge.     

Utility maximization and melioration: Internalities in individual choice

How do people go about choosing between alternatives in relatively simple settings? This study explores some of the variables that past work suggests may be relevant. Volunteer subjects worked for money in six procedures in which the probability of a payment from either of two alternatives was 1.0, but the rate of pay (i.e. the speed with which a payment was delivered or the size of the payment) interacted with the subjects recent allocation of choices, which we define as the ‘internalities’. Because of the internalities, choosing the currently more profitable alternative did not maximize total earnings. Subjects were more likely to fail to maximize when the interaction between present pay and past choices was spread over longer sequences of choices, or when the reward variable was the speed, rather than the value, of each payment. Subjects often disregarded the internalities and were instead guided by the current yields of the two alternatives, which is a frequently observed tendency, called ‘melioration’, in experiments on choices by animals. The tendency toward melioration was only partially counteracted by explicit instructions on how to maximize earnings. We discuss a theoretical framework for melioration that postulates both motivational and cognitive sources.     

Limits of focused attention in three-dimensional space

The present experiment examined the shape of the attentional gradient in three-dimensional space. Subjects performed a response-compatibility task in which they were instructed to respond to a centrally located target and ignore flanking distractors. The irrelevant distractors were presented at combinations of seven different depths, three different horizontal separations, and three different vertical separations relative to the target. Depth was varied in a stereoscopic display viewed through polarized glasses. Overall, the size of the response-compatibility effect decreased with increased separation in all three dimensions. Interestingly, the response-compatibility effect was larger for horizontal separations than for vertical separations and was larger for crossed disparities than for uncrossed disparities. The results suggest an elliptical focus of attention, with steeper gradients in the vertical dimensions than in the horizontal dimensions. In addition, the results suggest, along the vertical dimension, a steeper gradient for objects located beyond the focus of attention relative to that for objects located between the observer and the focus of attention.