Creativity in Teaching Case Conceptualization Skills: Role-play to Show the Interconnectedness of Domains

Case conceptualization is an important skill for counselors to master in order to meet treatment needs of clients. Some students struggle while learning this skill, as it requires advanced cognitive complexity, reflection skills, and affective awareness. Further, it is difficult for developing counselors to understand the interconnectedness of clients’ presenting problems, history, and strengths to form a holistic case conceptualization. The authors of this article describe a role-play for teaching the complexity of case conceptualization, in which students role-play various perspectives of psychosocial information and process the experience to create a holistic conceptualization. Activity steps are outlined with examples, and process questions to facilitate classroom discussion are included. Suggestions for implementation are also provided.     

Social inequality,scientific inequality,and the future of mental illness

Background

Despite five decades of increasingly elegant studies aimed at advancing the pathophysiology and treatment of mental illness, the results have not met expectations. Diagnoses are still based on observation, the clinical history, and an outmoded diagnostic system that stresses the historic goal of disease specificity. Psychotropic drugs are still based on molecular targets developed decades ago, with no increase in efficacy. Numerous biomarkers have been proposed, but none have the requisite degree of sensitivity and specificity, and therefore have no usefulness in the clinic. The obvious lack of progress in psychiatry needs exploration.

Methods

The historical goals of psychiatry are reviewed, including parity with medicine, a focus on diagnostic reliability rather than validity, and an emphasis on reductionism at the expense of socioeconomic issues. Data are used from Thomas Picketty and others to argue that our failure to advance clinical care may rest in part on the rise in social and economic inequality that began in the 1970s, and in part on our inability to move beyond the medical model of specificity of disease and treatment.

Results

It is demonstrated herein that the historical goal of specificity of disease and treatment has not only impeded the advance of diagnosis and treatment of mental illness, but, in combination with a rapid increase in socioeconomic inequality, has led to poorer outcomes and rising mortality rates in a number of disorders, including schizophrenia, anxiety, and depression.

Conclusions

It is proposed that Psychiatry should recognize the fact of socioeconomic inequality and its effects on mental disorders. The medical model, with its emphasis on diagnostic and treatment specificity, may not be appropriate for investigation of the brain, given its complexity. The rise of scientific inequality, with billions allocated to connectomics and genetics, may shift attention away from the need for improvements in clinical care. Unfortunately, the future prospects of those suffering from mental illness appear dim.

     

Information Mismatch: Cancer Risk Counseling with Diverse Underserved Patients

As genetics and genomics become part of mainstream Medicine, these advances have the potential to reduce or exacerbate health disparities. Gaps in effective communication (where all parties share the same meaning) are widely recognized as a major contributor to health disparities. The purpose of this study was to examine GC-patient communication in real time, to assess its effectiveness from the patient perspective, and then to pilot intervention strategies to improve the communication. We observed 64 English-, 35 Spanish- and 25 Chinese-speaking (n = 124) public hospital patients and 10 GCs in 170 GC appointments, and interviewed 49 patients who were offered testing using the audio recordings to stimulate recall and probe specific aspects of the communication. Data analyses were conducted using grounded theory methods and revealed a fundamental mismatch between the information provided by GCs and the information desired and meaningful to patients. Several components of the communication that contributed to this mismatch and often resulted in ineffective communication included: (1) too much information; (2) complex terminology and conceptually difficult presentation of information; (3) information perceived as not relevant by the patient; (4) unintentional inhibition of patient engagement and question-asking; (5) vague discussions of screening and prevention recommendations. Our findings indicate a need to transform the standard model of genetic counseling communication using evidence-based principles and strategies from other fields of Medicine. The high rates of limited health literacy in the US, increasing access of diverse populations to genetic services, and growing complexity of genetic information have created a perfect storm. If not directly addressed, this convergence is likely to exacerbate health disparities in the genomic age.     

Subtyping obsessive-compulsive disorder: A taxometric analysis

Obsessive-compulsive disorder (OCD) is a heterogeneous condition comprising multiple symptoms. Researchers have identified OCD subtypes using a range of symptom-based research methods, including factor and cluster analyses and examination of differential treatment response. These methods can be challenged on the grounds that they fail to demonstrate the existence of discrete taxonomic entities. Furthermore, no study has examined subtyping on the basis of cognitive characteristics. In the present study, the categorical vs. dimensional status of 6 possible subtypes of OCD was examined using taxometric methods. Three potential cognitive subtypes (based on high levels of responsibility/threat estimation, perfectionism/certainty, and importance/control of thoughts) and 3 potential symptomatic subtypes (based on elevated levels of contamination obsessions and cleaning compulsions, checking, and obsessionality) were examined using the MAXEIG and MAMBAC procedures in a sample of 404 diagnosed cases of OCD. Findings favored dimensional models of the potential responsibility, perfectionism, checking, and contamination subtypes, but offered qualified support for taxonic models of the importance/control of thoughts and obsessional subtypes. Implications for the subclassification of OCD are discussed.     

Counting your blessings: Positive memories among grateful persons

We conducted two studies investigating the relationship of gratitude to autobiographical memory of positive and negative life events. Gratitude was assessed with an attitudinal measure and college students were asked to recall both positive and negative events from their past. In both studies, a significant positive relationship was found between trait gratitude and a positive memory bias. In Study 2 it was found that gratitude still reliably predicted positive memory bias after controlling for depression. Further, it was found that a positive intrusive memory bias was associated with gratitude in both studies. Thus, an important component of gratitude may be an enhanced tendency to recall positive events from one's life.     

Lessons Learned from the Parents Matter! Program

We present a discussion of some of the lessons the investigators learned during the development and implementation phases of the Parents Matter! Program (PMP). Lessons were learned that are relevant to various groups involved in large scale, multi-site, community-based intervention studies: investigators, community leaders, community members, project staff, and participants. Specific lessons learned include: (1) forge collaboration early: (2) maintain communication; (3) clearly delineate policies and procedures; and (4) develop proactive strategies. We also include a list of important questions to consider when contemplating similar projects.     

There is nothing paranormal about near-death experiences: how neuroscience can explain seeing bright lights, meeting the dead, or being convinced you are one of them

Approximately 3% of Americans declare to have had a near-death experience. These experiences classically involve the feeling that one's soul has left the body, approaches a bright light and goes to another reality, where love and bliss are all encompassing. Contrary to popular belief, research suggests that there is nothing paranormal about these experiences. Instead, near-death experiences are the manifestation of normal brain function gone awry, during a traumatic, and sometimes harmless, event.