Client or patient? Contrasts between medical and counselling models of confidentiality

Conflicts can arise within counseling in primary care settings over issues of client confidentiality as perceived from a therapeutic as opposed to medical perspective. ‘Ideal types’ of counseling confidentiality and medical confidentiality are compared, according to a proposed structural model of confidentiality. In contrast with a therapeutic concept of confidentiality as an interpersonal contract between client and counsellor, a structural model of confidentiality appropriate to medical and primary care settings would include reference to crucial aspects such as risk assessment, and the sharing of client information within a multi-disciplinary team. The client-centred counselling model of confidentiality is then explored with reference to the Derbyshire Inquiry Report on the mental health care provided for a client with psychiatric problems. The limitations of adopting an exclusive client-centred counselling approach towards confidentiality in primary care settings are noted, given the requirements of the Care Programme Approach for effective risk assessment and inter-professional liaison in the care of client and patients with psychiatric problems. The potential resultant issues of counsellor and general practitioner liability are identified in relation to complaints systems and the key legal concept of vicarious liability.     

Boundary effects of vague risk information on taxpayer decisions

In compliance decisions, the decision maker usually has only vague or ambiguous knowledge of the probability of being caught and the outcome (amount of penalty). An experiment is reported which extends work on effects of probability ambiguity by manipulating outcome ambiguity as well. When outcomes were limited to a bounded range and probabilities ranged between their natural boundaries [0, 1] in experimental tax decisions, symmetrical boundary effects were found in which vague estimates for both the probability and outcome dimensions caused vagueness aversion (and higher compliance) when the vague estimate was near the more favorable lower boundary of either dimension and vagueness seeking (and lower compliance) when the vague estimate was near the less favorable upper boundary. Probability and outcome vagueness effects were found to be independent of the vagueness of the other dimension, and vagueness effects were not systematically related to the level of the other dimension.The results suggest that a common cognitive process mediates the impact of vagueness on both dimensions. This may be a vagueness-adjustment process in which vague estimates are adjusted toward the middle of the bounded range, or a vagueness-preference process in which vague outcomes, and vague probabilities as well, are evaluated based on utility considerations, as though probability were a tangible commodity. For increasing compliance, the results suggest that risk information should be disseminated only when risks of punishment are relatively high. When risks are low, random enforcement techniques that enhance vagueness become more effective.     

The use of publicly-posted performance feedback in an inpatient psychiatric treatment setting

This study examined the effects of publicly-posted performance feedback on the in-hospital behavior of patients residing on a self-management unit at a large, state operated, psychiatric treatment facility. When contrasted to a baseline phase in which staff received weekly information regarding patients' performance, scores in six of the eight assessment areas improved when this information was provided directly to patients. The authors' conclude that performance feedback may be a useful adjunct to inpatient treatment programs because it clarifies programmatic expectations, helps focus attention on developing strategies or interventions to meet those expectations, and encourages active treatment participation from patients and staff.     

An effect of linguistic experience: The discrimination of [r] and [l] by native speakers of Japanese and English

To test the effect of linguistic experience on the perception of a cue that is known to be effective in distinguishing between [r] and [l] in English, 21 Japanese and 39 American adults were tested on discrimination of a set of synthetic speech-like stimuli. The 13 “speech” stimuli in this set varied in the initial stationary frequency of the third formant (F3) and its subsequent transition into the vowel over a range sufficient to produce the perception of [r a] and [l a] for American subjects and to produce [r a] (which is not in phonemic contrast to [l a ]) for Japanese subjects. Discrimination tests of a comparable set of stimuli consisting of the isolated F3 components provided a “nonspeech” control. For Americans, the discrimination of the speech stimuli was nearly categorical, i.e., comparison pairs which were identified as different phonemes were discriminated with high accuracy, while pairs which were identified as the same phoneme were discriminated relatively poorly. In comparison, discrimination of speech stimuli by Japanese subjects was only slightly better than chance for all comparison pairs. Performance on nonspeech stimuli, however, was virtually identical for Japanese and American subjects; both groups showed highly accurate discrimination of all comparison pairs. These results suggest that the effect of linguistic experience is specific to perception in the “speech mode.”     

Memory for lateral orientation of slides in picture stories

Three picture stories were constructed by taking slides of people involved in three different activities. Two sequences of these slides were presented. Subjects were asked whether or not each slide in the second sequence was in the same lateral orientation as in the first sequence. Experiment 1 presented the slides in correct or random sequence and in correct or random lateral orientation (2 by 2 design). The two groups who received correct orientation excelled in recognition of orientation in the test series. Experiment 2 replicated the random orientation condition, found that pre-warning of the recognition task had no effect on performance, and suggested that these subjects did not make use of the events in determining laterality. Experiment 3 replicated the correct order and orientation condition and further revealed that new but appropriate slides in the test series were accurately judged as to lateral orientation which fit the context of the original stories.     

Intimate partner aggression reporting concordance and correlates of agreement among men with alcohol use disorders and their female partners

This study examined relationship aggression reporting concordance among 303 men with alcohol use disorders and their female partners enrolled in couples-based alcohol abuse treatment. Agreement for physical and psychological aggression was generally consistent with, or higher than, concordance rates reported among other populations. Men's antisocial personality disorder characteristics were the strongest predictor of higher concordance for male- and female-perpetrated aggression. Higher alcohol problem severity, poorer relationship adjustment, and higher psychopathic personality features were associated with better concordance in some analyses. Women reported experiencing more physical aggression than men reported perpetrating, and women reported perpetrating more psychological aggression than men reported experiencing. Findings highlight the importance of obtaining aggression reports from both partners and the need for research investigating methods for improving concordance.     

Predicting cognitive control from preschool to late adolescence and young adulthood

In this longitudinal study, the proportion of time preschoolers directed their attention away from rewarding stimuli during a delay-of-gratification task was positively associated with efficiency (greater speed without reduced accuracy) at responding to targets in a go/no-go task more than 10 years later. The overall findings suggest that preschoolers' ability to effectively direct their attention away from tempting aspects of the rewards in a delay-of-gratification task may be a developmental precursor for the ability to perform inhibitory tasks such as the go/no-go task years later. Because performance on the go/no-go task has previously been characterized as involving activation of fronto-striatal regions, the present findings also suggest that performance in the delay-of-gratification task may serve as an early marker of individual differences in the functional integrity of this circuitry.     

Capacity limits for face processing

We present three experiments in which subjects were asked to make speeded sex judgements (Experiment 1) or semantic judgements (Experiments 2 and 3) to face targets and nonface items, while ignoring a solitary flanking distractor face or a nonface stimulus. Distractors could be either congruent (same response category) or incongruent (different response category) with the target. Distractor congruency effects were consistently observed in all combinations of target-distractor stimulus pairs, except when a distractor face flanked a target face. The failure to find congruency effects in this condition was explored further in a fourth experiment, in which four task-irrelevant flankers were simultaneously presented. Once again, no face-face congruency effects were found, even though comparison distractors interfered with face and nonface targets alike. However, four simultaneously presented distractor faces did not interfere with nonface targets either. We suggest that these experiments demonstrate a capacity limit for visual processing in these conditions, such that no more than one face is processed at a time.