Observed behaviors during clinical interviews predict improvement in depression

A considerable percentage of depressed patients do not respond to antidepressive treatment. Early indicators of prognosis are needed. The aims of this study are to examine (a) whether the interpersonal behavior of patients and psychiatrist, as assessed by means of direct observation of behavior during a baseline clinical interview, might have predictive value with respect to therapeutic outcome and (b) which predictive potency measures of psychomotor activation, as assessed by less refined methods, such as global clinical judgment, might have. In the analysis used, speech-pause behavior was taken as the basic structure of the interaction. The relations of other behaviors such as looking and hand and head movement with this structure were determined. Evidence is presented that in a group of 31 depressives, improvement after a period of 10 weeks was related to observed behaviors during a baseline interview. The behaviors of the patients are interpreted as relational or nonrelational. The relational behaviors (i.e., looking yesnodding, gesturing) occur less in patients who will improve, whereas the nonrelational behaviors (i.e., intensive body touching, head movements) occur more in these patients. The nonrelational behaviors are presumed to be indicative of the state of arousal. The predictive potency of these variables could not be explained by their relationship with the baseline severity of depression, which in itself also predicted improvement. Moreover, global clinical assessment of psychomotor activation (i.e., retardation and agitation) could not be related to outcome.     

Do you really want to maintain that a flat tire can upset your stomach? Using the findings of the psychophysiology of stress to bolster the argument that people are not directly disturbed by events

The purpose of this paper is to help clients and others more fully appreciate the complex chain of events intervening between an external happening and an emotional response to that happening. It deals first with the sensory processing of physical stimulation and then presents the current state of knowledge regarding stress psychophysiology. A decision by the cortex which defines something as dangerous or threatening activates two major stress reaction pathways, the endocrine system and the autonomic nervous system, with a large number of physical consequences such as: acceleration of heart rate, increased blood pressure, reduced effectiveness of the immunological system, slowing of gastro-intestinal processes, pupil dilation, bronchial dilation and inhibition of salivation. The complexity and variety of such consequences is illustrated with a series of flow-chart diagrams, and it is suggested that these can be an additional and persuasive argument for the RET position which follows the claim of Epictetus: People are disturbed not by things, but by the views they take of them. Finally it is argued that while rapid emotional responses oftenseem to occur automatically it is because the intervening cortical processes are at times not verbalized. This is shown in the context of a diagrammatic outline of the Rational-Emotive Therapy process.Paul J. Woods, Ph.D., co-editor of this journal, is an associate fellow and an RET training supervisor of the Institute for Rational-Emotive Therapy.     

Albert Ellis' personal responses to the Survey of Rational-Emotive Therapists

This article presents Albert Ellis' personal responses to the Survey of Rational-Emotive Therapists and his answers to a number of questions that the first and second authors asked Ellis regarding some of his responses. Ellis also commented on how adequately he thought the results of the survey appeared to represent the current philosophies and practices of RET.     

Fallacies in pragma-dialectical perspective

In the pragma-dialectical approach, fallacies are considered incorrect moves in a discussion for which the goal is successful resolution of a dispute. Ten rules are given for effective conduct at the various stages of such a critical discussion (confrontation, opening, argumentation, concluding). Fallacies are discussed as violations of these rules, taking into account all speech acts which are traditionally recognized as fallacies. Special attention is paid to the role played by implicitness in fallacies in everyday language use. It is stressed that identifying and acknowledging fallacies in ordinary discussions always has a conditional character. Differences between the pragma-dialectical perspective, the Standard Treatment, and the formal logic approach to fallacy analysis are discussed.     

Conflict of interest between therapist-patient confidentiality and the duty to report sexual abuse of children

All 51 jurisdictions in the United States require physicians to report suspected child abuse. In most jurisdictions, reporting requirements override both confidentiality and privilege associated with the physician-patient relationship. The authors review the literature relevant to the conflict between privacy and reporting abuse and report the results of a national survey of therapists at sex offender treatment units. They discuss ethical problems experienced under these statutes by therapists who attempt to provide treatment for sex offenders, and by therapists who are required to report past instances of child abuse even when there is no evidence of ongoing abuse.     

Crime and amnesia: A review

The present article reviews amnesia for criminal offenses. It discusses the organic disorders most likely to be implicated, and the nature and differentiation of psychogenic amnesia. With the exception of alcohol and drug intoxication, organic dysfunction is a rare (though important) cause of amnesia for crime. Likewise, fugue states may occasionally be triggered by an offence, but are a very rare cause of the amnesia claimed by offenders. Amnesia is most commonly seen in homicide cases, in which it is claimed by 25% to 45% of offenders, but it occurs also in other types of violent crime, and occasionally in nonviolent crime. It arises in states of extreme emotional arousal, in alcoholic intoxication, and in states of florid psychosis; and it is also associated with depressed mood. Various methods have been advocated for the differentiation of genuine amnesia from deliberate simulation: this distinction can be difficult, but it is noticeable that many amnesic subjects either have reported the crime themselves or have made no attempt to conceal it. The nature of the deficit in this type of amnesia, and its implications for assessment, are also discussed.     

Reasons for employee sabotage in the workplace

Unionized workers at a factory were asked to rate a variety of reasons which would justify the use of sabotage in an organization, as well as the justifiability of four general methods of sabotage (slowdowns, destructiveness, dishonesty, and causing chaos). Results showed that as compared to those who didn't accept a wide variety of reasons for sabotage, those who accepted a variety of reasons would more readily justify all forms of sabotage except dishonesty. The data is discussed in terms of the reasons for the lack of justification that dishonesty receives, as well as future directions for the study of sabotage.     

Unanswered questions in assessment center research

This study compared the predictive validity of two types of overall assessment center ratings (clinical and mechanical) and two types of performance ratings (supervisor and subordinate). Data were gathered on approximately 50 law enforcement agency managers over a four-year time span. Results indicated that clinical predictions were not significantly better than mechanical ones and that prior performance ratings were better predictors of future performance ratings than were assessment centers. Further, dimension ratings within the assessment center were found to be unrelated to ratings of the same dimensions on the job four years later, supporting the notion of subtle criterion contamination (Klimoski & Strickland, 1977) and raising questions about the central assumptions underlying the assessment center approach.