Cotherapy treatment of phobias: A case study

A case study is presented of the treatment of a woman who had suffered from claustrophobia for over 13 years, by cotherapists using a combination of desensitization and flooding techniques. By assuming specific roles, the therapists expedited the therapeutic process to a successful conclusion in a brief period of time.     

A course in hypnosis for chaplains

Understanding the mental processes involved in suffering has always been the best basis for communication between patients and caretakers. In this paper we are concerned first with acknowledgment of the existence, generally unknown, and the effects, generally unrecognized, of the hypnotic processes that occur in many forms of suffering, and second with developing our thesis that the understanding and use of hypnotic principles can greatly enrich the chaplain's capacity to alleviate suffering. In this brief presentation we will confine our discussion to the teaching of hypnosis as a virtual necessity in modern clinical training for chaplains. Comments and considerations will precede and follow an outline of the course presently offered at Lenox Hill Hospital [but we cannot here attempt to discuss or explain the fundamentals of hypnotic process or any other aspects of the course content itself]. A basic bibliography is appended for those who wish to know more about hypnosis itself.     

THE THEOLOGICAL ANTHROPOLOGY OF RALPH WENDELL BURHOE

Abstract. A central aim of Ralph Wendell Burhoe's scientific theology is to define and interpret the meaning of human existence in relation to “ultimate reality.” As such, it can be understood as an exercise in theological anthropology. For Burhoe, this ultimate reality is “nature,” understood as the total reality system which is studied by the sciences and which the sciences are showing to be the sole determiner of the way things are. This article discusses various aspects of Burhoe's theological anthropology, as well as its value and credibility, and raises questions concerning his understanding of the value of the individual and the problems of evil and human sinfulness.     

A hybrid decision framework for evaluating psychometric evidence

The United States Supreme Court in Daubert v. Merrell Dow Pharmaceuticals (1993) directed federal trial judges to preliminarily evaluate the scientific bases of proffered expert evidence. This article presents a decision flowchart for evaluating psychometric data, and attempts to operationalize existing evidentiary standards in hybrid (part science/part law) terms. The resulting framework should better assist courts and forensic experts to understand, evaluate, and apply scientific reasoning in determining the admissibility and probative value of psychometric evidence.     

Assessing mental capacity and susceptibility to undue influence

Clinicians are commonly asked to participate in the determination of an individual's mental capacity and susceptibility to undue influence. Vague statutory definitions and lack of operational criteria for both determinations have contributed to inconsistency in the quality and usefulness of expert input to these determinations. Questionnaire responses of 119 probate judges from the U.S. indicate that this input is quite influential despite the problems mentioned above. This paper presents and discusses the judges' views on selected procedural and conceptual aspects of expert evaluation and testimony.     

Decision-making incapacity among nursing home residents: results from the 1987 NMES survey. National Medical Expenditure Survey

Recent legislative and regulatory developments have focused attention on older adults' capacity for involvement in health care decision-making. The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) focused attention on the rights of nursing home residents to be involved in health care decision-making to the fullest extent possible. This article uses data from the 1987 National Medical Expenditure Survey (NMES) to examine rates of incapacity for health care decision-making among nursing home residents. Elements of the Oklahoma statute were used to operationalize decision-making incapacity: disability or disorder, difficulty in decision-making or communicating decisions, and functional disability. Fifty-three percent of nursing home residents had a combination of either physical or mental impairment and an impairment in either self-care or money management. The discussion focuses on the policy and practice implications of significant rates of incapacity among nursing home residents.     

Maximizing internal and external validity in MMPI malingering research: a study of a military population

The authors investigated the effectiveness of various commonly used Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1943) indices of exaggeration and malingering in detecting suspected malingering in a military sample of 121 enlisted men. To maximize external validity, only men undergoing psychological evaluation were used as participants. Forty-one participants were identified as suspected malingerers through multiple criteria and were contrasted with schizophrenic-spectrum and clinic outpatient groups. To improve internal validity, the 41 suspected malingering participants were asked to retake the test without exaggerating. Results revealed that there were many false positives and fewer, but nonetheless many, false negatives with standard malingering indices. It appeared that the Gough Dissimulation scale (Gough, 1947) might hold the most promise as a measure of malingering, but other scales are also useful. Individual comparisons between different samples and implications for MMPI-2 (Butcher et al., 1989) are presented.     

Physicians' values and physician-value neutrality

For years articles have decried the lack of empathy in physicians' relationships with patients. In addition to being empathetic, physicians are called upon to assume the posture of value neutrality, i.e., not imposing one's values when dealing with patients. Empathy is clearly an expression of deeply held values; even the language used to define it is value-laden. Physicians are consistently called upon to exhibit traits which are expressions of their underlying values. However, if proponents of value-neutrality are to be taken literally one must not impose any of one's values on one's patients. But then one wonders how empathy could ever be expressed; further, it is hard to imagine what a truly value neutral physician would be like. It is time we recognize that any relationship between two persons requires the expression of values from both parties. These values help shape that relationship and define its further history. Physicians are not excluded from this process just because they consider themselves professionals. Divulging personal values to patients is both more honest and more in keeping with the concepts of justice, beneficence, non maleficence, and autonomy than to feign value-neutrality. A presentation of some type statement of values is timely and would give patients an idea of where a physician stands on a myriad of issues. Rather than being value-neutral, value non-neutrality seems a more right and reasonable posture for physicians to assume.     

Food-deprivation effects on punished schedule-induced drinking in rats.

Food-deprived rats (at 80% of their free-feeding weights) were exposed to a fixed-time 60-s schedule of food-pellet presentation and developed schedule-induced drinking. Lick-dependent signaled delays (10 s) to food presentation led to decreased drinking, which recovered when the signaled delays were discontinued. A major effect of this punishment contingency was to increase the proportion of interpellet intervals without any licks. The drinking of yoked control rats, which received food at the same times as those exposed to the signaled delay contingency (masters), was not consistently reduced. When food-deprivation level was changed to 90%, all master and yoked control rats showed decreases in punished or unpunished schedule-induced drinking. When the body weights were reduced to 70%, most master rats increased punished behavior to levels similar to those of unpunished drinking. This effect was not observed for yoked controls. Therefore, body-weight loss increased the resistance of schedule-induced drinking to reductions by punishment. Food-deprivation effects on punished schedule-induced drinking are similar to their effects on food-maintained lever pressing. This dependency of punishment on food-deprivation level supports the view that schedule-induced drinking can be modified by the same variables that affect operant behavior in general.