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.     

An introduction to organic brain syndromes

Organic brain syndromes are of forensic interest for several reasons. First, patients with organic brain syndromes may require judicial determination of competence in any of a number of areas, e.g., testamentary capacity, need for financial guardianship, or competence to make medical decisions. Second, any patient whose mental state is of legal interest will need evaluation for contributing organic factors; uncovering these factors may have considerable medical and legal consequence. Third, the discovery of organic factors may be decisive in the outcome of a judicial proceeding, where “hard” biological data are often accorded more weight, and are thus more persuasive, than “soft” psychological data. This article provides an introductory overview of the organic brain syndromes. For each syndrome, the clinical features are described and are illustrated with a case vignette, the more common etiologies are presented, and selected aspects to the evaluation are highlighted. In addition, since the detectian of malingered mental illness is a key component in many forensic contexts, characteristics are described which help to distinguish actual from malingered mental illness.     

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.     

The use of structured multi-domain job analysis for the construction of assessment center methods and procedures

This article addresses the defensibility of the assessment center based on a content oriented validation strategy. One reason for the confusion in this area is the fact that there are no agreed upon methods for constructing the assessment procedures. Therefore, the purpose of this article is to describe how structured multi-domain job analysis information can be used to develop an assessment center which is well grounded with regard to content validity.     

Adjustment to hemodialysis treatment through behavioral controls

The present study was conducted to examine the hypothesis that compliant chronically ill patients, typically described as adjusted, reinforce more positive social environments using behavioral controls than noncompliant patients, typically described as maladjusted. Specifically, it is hypothesized that diet-compliant chronic hemodialysis patients emit significnatly more active involvement-in-treatment behaviors and more social behaviors than diet-noncompliant chronic hemodialysis patients. Subjects, who ranged in age from 30 to 77 years, were outpatients at a kidney center. Behavioral observations were conducted to assess the occurrence or frequency of (1) four involvement-in-treatment behaviors that are routinely taught to all patients and (2) two social behaviors, which were patient verbalizations and smiles. The results showed that compliant patients emitted significantly more involvement-in-treatment behaviors and smiles than noncompliant patients. Results support the proposed control framework that compliant, in contrast to non-compliant, chronically ill patients have recourse through positive behavioral controls when adjusting to the stresses of illness. It was proposed that through these controls, compliant patients reinforce positive environments rather than simply respond to life circumstances as given.     

Millon Clinical Multiaxial Inventory (MCMI) computer-generated diagnoses: How do they compare to clinician judgment?

During the past several decades, computers have achieved increasing prominence in psychological assessment procedures. This is particularly true for computer-based test interpretation and diagnosis. This study reports on a study designed to compare the accuracy of computer-based diagnoses with clinician-generated diagnoses. The Millon Clinical Multiaxial Inventory (MCMI) was administered to 151 consecutively admitted inpatients at a large private psychiatric hospital. The computer-generated diagnoses were compared with those generated by admitting psychiatrists. The results indicated that the MCMI diagnostic impressions underestimated the severity of depressive disorders when compared with clinician diagnoses on Axis I. Specifically, clinicians diagnosed major depression much more frequently than did the MCMI. In addition, clinicians diagnosed anxiety disorders much less frequently than did the MCMI.     

Testing the limits of the phonetic mnemonic system

Three experiments tested the efficacy of the phonetic mnemonic system under varying conditions of application. The first study attempted unsuccessfully to replicate and extend the work of Morris and Greer (1984), who had shown training in the phonetic mnemonic method to facilitate memorization of a serial list of two-digit numbers. In the present study, subjects trained in the phonetic mnemonic method failed to learn lists of two-, four-, and six-digit numbers better than control subjects. The second experiment partially replicated the first, the differences being that training in the phonetic mnemonic method was strengthened, and time allotted for number recall was extended. Under these circumstances the phonetic mnemonic group recalled the two-, four-, and six-digit numbers significantly better than the control groups, a finding conforming with Morris and Greer's (1984) results. The third experiment partially replicated the second, everything being the same except that, in this case, subjects constructed their own key words representing each number, instead of these words being supplied by the experimenter. Under these conditions, subjects trained in the phonetic mnemonic method recalled significantly fewer numbers than control subjects.     

Perceptual organization of acoustic stimuli by budgerigars (Melopsittacus undulatus): II. Vocal signals

Operant conditioning and multidimensional scaling procedures were used to study auditory perception of complex sounds in the budgerigar. In a same-different discrimination task, budgerigars learned to discriminate among natural vocal signals. Multidimensional scaling procedures were used to arrange these complex acoustic stimuli in a two-dimensional space reflecting perceptual organization. Results show that budgerigars group vocal stimuli according to functional and acoustical categories. Studies with only contact calls show that birds also make within-category discriminations. The acoustic cues in contact calls most salient to budgerigars appear to be quite complex. There is a suggestion that the sex of the signaler may also be encoded in these calls. The results from budgerigars were compared with the results from humans tested on some of the same sets of complex sounds.