The use of consultation in psychological practice: ethical, legal, and clinical considerations

The importance of consulting with other professionals to maintain acceptable standards of care is well documented in many health care professions. However, evidence indicates that many psychologists fail to utilize consultation when needed, and that consultation use varies along dimensions such as the education and training of the consultee, the type of setting, number of years in practice, and proximity to available consultants. In this article, we review the research on the use of consultation by psychologists as well as other health care professionals. We discuss the clinical, ethical, and legal implications of seeking consultation as a professional psychologist. Finally, a detailed and practical model for the regular use of consultation is given to improve the routine use of consultation in clinical practice.     

Language task effects A comparison of stuttering and nonstuttering children

This study examined the effects of language-elicitation tasks and syntactic complexity on disfluencies of stuttering and nonstuttering children. The total disfluencies occurring on the production of imitated and modeled sentences of varying syntactic complexity was compared for the two groups. Results indicated a significant task effect, but nonsignificant complexity and group effects. Results are discussed within the framework of the “Demands and Capacities” model.     

Edge-Assignment and Figure–Ground Segmentation in Short-Term Visual Matching

Eight experiments examined the role of edge-assignment in a contour matching task. Subjects judged whether the jagged vertical edge of a probe shape matched the jagged edge that divided two adjoining shapes in an immediately preceding figure–ground display. Segmentation factors biased assignment of this dividing edge toward a figural shape on just one of its sides. Subjects were faster and more accurate at matching when the probe edge had a corresponding assignment. The rapid emergence of this effect provides an on-line analog of the long-term memory advantage for figures over grounds which Rubin (1915/1958) reported. The present on-line advantage was found when figures were defined by relative contrast and size, or by symmetry, and could not be explained solely by the automatic drawing of attention toward the location of the figural region. However, deliberate attention to one region of an otherwise ambiguous figure–ground display did produce the advantage. We propose that one-sided assignment of dividing edges may be obligatory in vision.     

Measuring How We Preach What We Practice: Psychoeducational Change in Depressed Inpatients

This study investigated the relationship between acquisition of psychoeducational principles and symptomatic improvement in depressed in-patients. One hundred and twenty-three inpatients hospitalized on a Cognitive Therapy Unit were administered the Test of Cognitive Behavioral Principles (TCBP) and the Beck Depression Inventory at admission and discharge. It was predicted that the TCBP scores would be higher at discharge than at pre-testing at admission. Further, it was hypothesized that the higher TCBP scores at post-test would be significantly correlated with lower Beck Depression Inventory scores at post-test. The results revealed that inpatients' TCBP scores improved over the course of treatment supporting the first hypothesis. However, the data did not support the second hypothesis as there was not a significant relationship between the TCBP scores and the BDI scores at discharge. The results are discussed in terms of clinical, theoretical, and methodological implications.     

Racial Categorization and Stereotype-Based Judgments About Homeless People1

The present study uses a social-cognitive paradigm to examine the association between racial categorization and stereotype-based judgments about homeless people. The study uses data from a national White subsample (N= 1,221) surveyed about attitudes toward homeless/homeless mentally ill people. It was hypothesized that individual differences in perceptions of the representativeness of Blacks in the homeless population, as measured by subjective estimates of the percentage of Blacks, would be associated with the enhancement of racially relevant negative stereotypes about homeless people. A secondary hypothesis was that perceptions of the representativeness of Blacks would be more strongly associated with the stereotype of homeless people as dangerous than with the view of them as lazy. The results support these hypotheses.     

Interpersonal conflict in group therapy: An object relations perspective

The aim of this paper is to demonstrate how object relations theory can be used to understand and regulate interpersonal conflict in group psychotherapy. Such concepts as projective identification, intersubjectivity and the analytic third are used to describe how conflict emerges in group psychotherapy and how it can be worked through. Case material is also provided to illustrate concepts and techniques in promoting a group's transition from a paranoid/schizoid to a depressive position. Positive aspects of the concept of projective identification are discussed including its use as a form of communication, a method of reducing anxiety and reintegrating previously dangerous and threatening aspects of the self.The paper was funded by Evan F. Lilly Memorial Trust Grant PV 13,067.     

Physician-assisted suicide: the role of mental health professionals

A review of the literature was conducted to better understand the (potential) role of mental health professionals in physician-assisted suicide. Numerous studies indicate that depression is one of the most commonly encountered psychiatric illnesses in primary care settings. Yet, depression consistently goes undetected and undiagnosed by nonpsychiatrically trained primary care physicians. Noting the well-studied link between depression and suicide, it is necessary to question giving sole responsibility of assisting patients in making end-of-life treatment decisions to these physicians. Unfortunately, the use of mental health consultation by these physicians is not a common occurrence. Greater involvement of mental health professionals in this emerging and debated area is advocated. Beyond describing mental health professionals' role in the assessment of patient competency or decision making capacity, other areas of potential involvement are described. A discussion of ethical principles relevant to this area follows, along with comments on the training necessary to adequately serve patient needs.