The practice of empathy as a prerequisite for informed consent

The patient-physician relationship, as formulated in the traditional biomedical model of medicine, is inherently flawed. In entering this relationship, most patients seek simply to be delivered from illness back to normal psychosocial functioning. The physician, however, almost invariably responds with a purely biologic approach to diagnosis and treatment that often does not effectively address the patient's needs. This precludes the opportunity for a consensus between them, and may in fact lead to the physician manipulating the patient's decisions about the course of therapy. The relationship should be reshaped within a new scientific model of patient care that combines the biomedical analysis of disease with an empathic understanding of the patient's illness experience. Truly informed consent is viewed as a natural outcome of the application of this more comprehensive framework.     

A STAFF MANAGEMENT SYSTEM FOR MAINTAINING IMPROVEMENTS IN CONTINENCE WITH ELDERLY NURSING HOME RESIDENTS

We developed a staff management system for maintaining treatment gains achieved on a specialized continence unit located in a geriatric nursing home. Geriatric assistants learned to use a prompted voiding procedure to maintain improved dryness for 4 elderly residents. The staff management system included self-monitoring and recording of prompted voiding activities and supervisory monitoring and feedback based on group performance of these activities. Results show that the system was effective in maintaining prompted voiding activities with corresponding maintenance of improved patient continence. However, a gradual decline in staff performance was noted 4 to 5 months after the initiation of the system. During a subsequent phase of the study, provision of individual feedback restored staff performance to previous levels. Results are discussed in relation to the practicality of prompted voiding interventions in nursing home environments and the applicability of staff management systems in this setting.     

The effects of unstable clients in adolescent treatment: contagion versus continuity

This study examined the effects of integrating an unstable group of seriously disturbed adolescents into an existing day treatment program. Behavioral data were collected for an established group of subjects who were in treatment one year prior to and one year after the arrival of a new group of severely disturbed adolescents. It was found that the disruptive behavior displayed by the new admission subjects was not imitated by the subjects of the established group. Rather, there was a significant decrease in aggression and in the overall number of psychiatric events for the established group. The treatment milieu was seen to be resistant to the effects of the new admissions largely due to the structured form of treatment.     

The children's depression adjective check lists (C-DACL) with emotionally disturbed adolescent boys

In this study of the reliability and validity of the Children's Depression Adjective Check Lists (C-DACL; Brewer & Lubin, 1987) with emotionally disturbed adolescent boys (N=50),data were collected on two occasions. Internal consistency (alpha) was .89 and .94 for form H and .89 and .95 for form I. Alternate form reliabilities were .86 and .95. Split-half reliabilities were .80 and .89 for form H and .68 and .86 for form I. Concurrent validity was determined by correlations between C-DACL and the Self-Rating Scale of Depressed Mood. Correlations were .65 and .80 for H and .54 and .80 for I. Data from the present study were tested against data from emotionally disturbed adolescent girls (Sokoloff & Lubin, 1983), with boys scoring significantly lower on both forms (H and I) of the C-DACL.     

Psychometric evaluation of the dating anxiety survey: A self-report questionnaire for the assessment of dating anxiety in males and females

The Dating Anxiety Survey (DAS) was constructed to assess dating anxiety in males and females. Factor analysis of the survey revealed three factors: passive contact, active intentions for dating, and dating interactions. The reliabilities of the three subscales, as determined by coefficient alpha, were .87, .91, and .93 for males and .90, .90, and .92 for females, respectively. Correlations with dating history and a measure of social anxiety were generally of a low but significant magnitude, providing some support for concurrent validity. The results of the factor analysis lend support to the construct validity of the DAS. These findings suggest that the DAS is a potentially useful instrument in the self-report of dating anxiety.Portions of this paper were presented at the meeting of the Southeastern Psychological Association, Atlanta, GA, March 1983.     

The role of the magazine-response contingency on signal-directed responding in pigeons

Three experiments used a procedure for directly delivering water into the thirsty pigeon's mouth to explore the role that the instrumental magazine contingency plays in autoshaped responding. Magazine training was accomplished by requiring birds to contact a “magazine” key when it was illuminated, in order to obtain intraoral injections of water. Other subjects received water injections independent of a magazine-response contingency. Subsequently, magazine-trained subjects showed a transient enhancement in responding to the illumination of another “signal” key, whether that stimulus was presented alone or paired with water delivery. The overall level of maintained autoshaped responding was little influenced by the instrumental magazine contingency, although the within-trial time course of signal-directed responding was affected. When illumination of the signal key preceded access to water only when the signal was not contacted, pigeons directed many responses toward the signal key. However, there was no evidence that the instrumental magazine contingency enhanced responding on this omission schedule of reinforcement. These results thus confirm a small, but measurable contribution of the magazine-response contingency to signal-directed responding; they fail to support the conclusion that the instrumental magazine contingency greatly affects the outcomes of autoshaping studies.