Offering predictive testing for Huntington disease in a medical genetics clinic: Practical applications

Predictive testing for Huntington disease is presently offered in a select few medical genetics centers in the United States. This is in part due to the labor intensive counseling and psychological testing suggested by the research protocols. We discuss some specific suggestions for establishing programs for Huntington disease predictive testing within pre-existing medical genetics clinics to encourage more centers to offer presymptomatic testing. This will allow more at risk individuals the opportunity to consider predictive testing and cut down the expenses of traveling to the few predictive testing centers that currently exist. The counseling principals will remain similar to those discussed here, even following the identification of the Huntington disease mutation.     

Sado-masochism as a defense against merging: Six case studies

This paper reports on several patients who use sado-masochism as a defense against an unconscious wish for and fear of merging. The sado-masochism can be expressed as a sexual perversion or in a difficult ungratifying interpersonal relationship. These relationships have some of the quality of addictions in that the patients have a compulsive need to continue them and find it extremely difficult to leave them. Therapy must focus on helping the patient become more separate, rather than on other problems which may also be present. Initially, the therapist needs to take an educational stance in regard to the process the patient must complete, rather than the more traditional analytic stance.     

Morale and Job Satisfaction Among Nurses: What Can Hospitals Do?

In an attempt to account for morale and job satisfaction among 314 nurses, this study investigated the influence of work-related and interpersonal variables. Morale on the unit was directly related to supervisor support, co-worker relationships, and work recognition. Personal morale was accounted for by recognition, physical environment, the job itself, and pay. Job satisfaction was predicted by personal morale, work commitment, job clarity, work pressure, and innovation. Suggestions for improving nurse morale and job satisfaction are made.     

Punished and Nonpunished Responding in A Multiple Schedule in Humans: A Brief Report

Four male subjects responded on a multiple schedule in which responding was maintained by a random interval 20-sec (RI20) schedule of point presentation. Responding was suppressed in alternating components by an added variable ratio 30 (VR30) schedule of point subtractions. Each component was accompanied by distinctive stimulus lights. Subjects were exposed to the multiple schedule from the initial session. Two subjects experienced four 50-min sessions daily (Experiment 1) and the other two subjects participated in one 50-min session daily (Experiment 2). Once responding in the punished components had stabilized, responding in the nonpunished components continued to increase across sessions. Nonpunished responding did not stabilize even after as many as 36 sessions. These results are discussed in the context of previous studies using animals which employed multiple schedules with punished and nonpunished response contingencies.

     

An MMPI-based empirical model of malingering and deception

The empirically-based model of malingering and deception described by Rogers (1984b) was operationalized using MMPI and clinical interview data. Subjects (N = 159) were patients committed to an inpatient forensic hospital as ‘Incompetent to Stand Trial’ or ‘Not Guilty by Reason of Insanity’. Inter-rater reliability was acceptable for the 11 criteria used to define response styles. Each subject was categorized into one of five response style groups: ‘Reliable’, ‘Malingering’, ‘Defensive’, ‘Irrelevant’, or ‘Unclassifiable’. Factor analysis of the rating criteria yielded four factors, three of which are comparable to the assigned groups, providing some validation for the constructs underlying these groups.     

Stories for therapy: The right story to the right person at the right time

In the postmodern information era with its increasing complexity and demands on my time, I find storytelling increasingly attractive. The right story told to the right person(s) at the right time in the right way can powerfully define and shape both individuals and the systems into which they organize themselves. As interventions go, I find stories to be relatively high impact, low-risk, parsimonious, and user-friendly. This paper contains some of my favorite teaching stories and describes why and how I use them as both a family therapist and teacher of family therapy.     

The self-narrative and acute psychosis

The aim of this study was to apply the narrative approach in analyzing family therapy meetings in cases of acute psychosis. The self-narrative is essential in acute psychosis since it is either collapsed or not coherent enough. The results indicate that it is important to create concrete practices that produce stories concerning the patient in relation to others. The self-narrative must be re-authored by the patient even though it is socially constructed. This is achieved by creating multiple perspectives of self-narratives in so-called therapy meetings with the patient, family members, and staff members representing different professionals.     

“Not with me you don't”: A story of narrative practice and dissociative disorder

This paper discusses issues relating to therapeutic practice based upon the narrative metaphor. A case of someone suffering the effects of Dissociative Identity disorder is used to illustrate the difficulties that clients can experience with the “expert” knowledge conception of therapy. The value of the “respectful” and “non-expert” emphasis of Narrative Practice emerges even when the therapist believes that he or she lacks expertise in the client's apparent “condition.” Three themes emanating from the case form the basis for the discussion: the client's experience of being recruited into accepting the diagnostic label of Dissociative Identity Disorder; the effects of being forced to accept a contract to eliminate self-abusive behaviour; and the therapist's dealing with a gun in the therapy room.     

The recovering female alcoholic: A family affair

Supported by a review of relevant literature and a case study, the author argues that family therapy intervention enhances the likelihood of a female alcoholic's positive prognosis. With a basis in systems theory, family therapy views the family as a system and, hence, perceives the alcoholism as a symptom of that family. A profile of the female alcoholic, how her drinking affects her family, and the role that family therapy plays in the recovery process are examined.